Official Report

  • Scottish Parliament Wednesday 7 May 2008
    • [The Presiding Officer opened the meeting at 14:30]

    • Time for Reflection
    • Free Personal Care
      • The Presiding Officer (Alex Fergusson): The next item of business is a statement by the Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon, on free personal care.

      • The Deputy First Minister and Cabinet Secretary for Health and Wellbeing (Nicola Sturgeon): I wish to outline the Scottish Government's response to the independent funding review of free personal care, which was published last week. I will also update members on the positive discussions that we and local government have had to address key aspects of the policy. Those discussions have been taken forward in the spirit of joint accountability, in line with the principles of our concordat. I take this opportunity to thank Lord Sutherland and the other members of his independent group for their substantial and considered report.

        We commissioned the review to provide greater clarity on long-standing concerns about the funding of the policy. We asked the review also to examine the United Kingdom Government's decision to withdraw attendance allowance from residents of care homes in Scotland.

        The report confirms that the free personal care policy has widespread support and is delivering real benefits to thousands of our most vulnerable older people. It commends local government and delivery agencies for their work in achieving those outcomes.

        However, the report confirms the concerns that we and local government have raised about the clarity and funding of the policy. It also provides us with a frank analysis of the longer-term challenges that we face from Scotland's changing demographics. In light of those findings, the report delivers a 12-point action plan, recommending key areas for action in the short, medium and long term. I have today written formally to Lord Sutherland, confirming that the Scottish Government accepts all 12 of his recommendations. They sit alongside the work that we and local government have been taking forward together.

        The Government has already uprated the fixed-rate allowances to older people in care homes, in line with inflation, from 1 April, which is the first increase since the policy was introduced. There will be further inflationary increases in the next two years.

        We have agreed the need to undertake specific action to improve information systems at national and local levels to ensure greater transparency in future costs associated with the policy. We will renew our efforts to improve public information and understanding of the policy. We will clarify the legislation and guidance on cross-boundary placements. With the Convention of Scottish Local Authorities, we are looking for a way to ensure an effective performance framework for long-term care services for older people within the single outcome agreement approach.

        We have agreed the need for a wider set of joint work streams to review demographic pressures and other practical issues that impact on the current and future demands and costs of care. That work needs to start now, ahead of the next five-year review, as recommended by Lord Sutherland.

        Lord Sutherland confirms that a significant element of the difficulties that have affected the policy in recent years arises from a shortfall in funding. Following dialogue with local government, I am delighted to confirm today that, in line with Lord Sutherland's recommendations, the Scottish Government will provide additional funding of £40 million to local authorities from 2009-10 to stabilise the policy. We and local government agree the need to ensure that the additional funding will deliver improved outcomes for vulnerable older people.

        We have been working with COSLA to consider those aspects of the policy that have lacked clarity and to address practical issues, in particular eligibility criteria, waiting times and food preparation. Lord Sutherland concludes that those issues have, to a degree, overshadowed the success of the policy and undermined its operation.

        We accept that the legislation is not clear on the matter of charging for food preparation. Initial Scottish Executive guidance was wrong, and revised guidance failed to clarify the issue. Since 2002, a number of councils have decided to remove charges. However, eight councils currently still charge. We and local government support the need to address the issue, and I confirm that the Government will introduce legislation to clarify the matter. The effect of that legislation will be that councils will not be entitled to charge for food preparation, which will mean that people who are assessed as requiring, for example, assistance with the preparation or reheating of meals or assistance with eating will not be charged. We would expect the policies of the eight councils that currently charge to change when that legislation takes effect.

        Lord Sutherland states that for those people who are assessed as needing free personal and nursing care, there should be a clear

        "entitlement … analogous with the NHS".

        He recognises that, as in the national health service, local authorities need to be able to manage the delivery of services to target those most in need, and practical issues of capacity and personal choice do not allow for waiting for services to be eradicated entirely.

        Lord Sutherland notes that, in the vast majority of cases, people with significant assessed needs currently receive care services in line with those needs without undue complication or delay. However, current difficulties of interpretation and variability have emphasised the need for more clarity and consistency in what people can expect.

        Lord Sutherland suggests that access to care services should be supported with a standardised approach to assessment and delivery of services, with common processes and waiting times. Together with local government, we accept the need to provide a more open and transparent model that explains to service users how access to free personal and nursing care will be managed. People who need help should have their needs determined through a care needs assessment co-ordinated by professional social work staff. Decisions about the level of care that they receive and how quickly they receive it should be based on the outcome of that assessment.

        Following earlier discussions, and taking on board the conclusions in the Sutherland report, our shared aim is to seek the establishment of a common eligibility framework that categorises the needs of older people and is applied by all local authorities. In support of that approach, we will together accelerate the comprehensive implementation across all councils and their NHS partners of the single shared assessment model to assist consistent and co-ordinated needs assessments.

        Taking on board the practical considerations that are set out in the detail of the Sutherland report, we, together with local authorities, will look to establish a common commitment across all councils to deliver services within a standard maximum waiting time for those clients who are assessed as having immediate or urgent care needs. I should emphasise that the standard will be a maximum limit. For people with priority needs, local authorities will continue to arrange and deliver services and equipment as a matter of urgency, usually within days.

        As in the NHS, there should be active monitoring of the needs of people who are assessed as not having immediate needs and, where practical and appropriate, there should be preventive measures to reduce the risk of their needs becoming more critical.

        We will use the time over the coming months to further refine and clarify the detail of those arrangements to ensure that they deliver consistent and genuine improvements in the outcomes for older people.

        I would like to address directly the issue of attendance allowance. The report states clearly that the UK Government should not have withdrawn the attendance allowance resources that were previously paid to residents in care homes, which are currently valued at £30 million a year. Attendance allowance is a tax-free, social security benefit that is paid to UK citizens over the age of 65 who need help with personal care or who need a lot of looking after.

        Prior to the implementation of free personal and nursing care, people who funded their own care in a care home could apply for and receive attendance allowance. However, the UK Government determined that personal care payments were a contribution to the residents' accommodation costs and that attendance allowance payments should therefore be withdrawn. The value of the payments withdrawn from eligible residents in 2002 was £23 million and the current value is more than £30 million a year.

        The previous Scottish Executive reset the levels of personal care payments for care home residents to compensate for the loss of attendance allowance, to ensure that residents did not lose out. That added significantly to the overall costs of the policy. If the savings from the withdrawal of attendance allowance had been transferred to the Scottish budget, the increase in costs would have been offset. However, as we know, that did not happen and the savings were retained by the Treasury.

        The UK Government's decision—a reaction to a policy of which it did not approve—was deeply unjust and wrong. The current funding gap that Lord Sutherland has identified would be significantly less if those additional resources were available to invest in care services in Scotland. As well as being unjust, the decision is anomalous. People in Scotland who live in their own homes and receive public support for their personal care needs can still receive attendance allowance, as can older people in care homes in England who receive free nursing care.

        It is therefore no surprise that the Sutherland review concludes that there is a clear inequity, as entitlement to attendance allowance has been stopped for residents of Scotland while it continues for residents of other parts of the UK, and that the Scottish budget is bearing the costs. That is not a new opinion from Lord Sutherland. He raised similar concerns in his evidence to the Health Committee's care inquiry, which published its report in 2006.

        Henry McLeish, the First Minister when free personal and nursing care was introduced, supports Lord Sutherland's view and has said that the Westminster Government should take a "much more mature view". I am pleased that members of the Scottish Parliament and spokespersons from other parties have expressed similar views.

        The Scottish Government is determined that we should seek the reinstatement of the funding and correct the inequity that has been identified by Lord Sutherland. The Scottish Government has therefore asked for the issue to be discussed as a priority at the next meeting of the joint ministerial committee.

        I believe that our existing strong case will be further strengthened if we can demonstrate a co-ordinated and consistent response from this Parliament, so I will seek an early opportunity for the Parliament to express its view formally on this important matter.

        As the Sutherland report makes clear, the issue of attendance allowance is not just a matter of equity. Being able to consider all the funding streams available to support the long-term care needs of our most vulnerable older people—including local authority funding, health spending and UK benefits—is vital to how we prepare for the demographic challenges that we face. I whole-heartedly agree with Lord Sutherland's vision that we need to take a more holistic approach to meeting future demand for care.

        Lord Sutherland's report and recommendations set us all significant challenges, both to stabilise the current policy determined by the Parliament and to be ambitious and bold in how we prepare for the future needs of our ageing population. I reassure members and the people of Scotland of the Government's commitment to address those challenges and to secure the future of free personal and nursing care.

      • The Presiding Officer: The cabinet secretary will now take questions on the issues raised in her statement. We have around 30 minutes for questions, after which we will move to the next item of business.

      • Margaret Curran (Glasgow Baillieston) (Lab): I thank the cabinet secretary for the early circulation of her statement and I associate the Labour Party with the thanks to Lord Sutherland for his work.

        As the Sutherland report recognises, the introduction of free personal care by the previous Executive was groundbreaking and represented a key change to the long-term care of the elderly in Scotland. I hope that the cabinet secretary can recognise the points that Lord Sutherland makes in his report. He states:

        "The policy was implemented with expedition, and on the whole the process has gone well … A number of factors contributed to this … the resources of the relevant areas of government were marshalled very effectively."

        Lord Sutherland has produced a striking report that presents us all with a challenge. I refer in particular to his clarion call that we must recognise the profound issue of demographic change. Many issues will be raised in relation to that in the debate next week, which I look forward to.

        In the meantime, I ask the following specific questions. How will local authorities deal with financial pressures that they may face in the current financial year? Out of which budget will the £40 million be found? Is the establishment of a common commitment, which I take to mean a minimum standard of service that we can expect throughout Scotland, consistent with the concordat and with recent statements by ministers about the need for minimum standards of service more generally throughout Scotland? Finally, will the cabinet secretary guarantee that addressing the financial issues that are raised in the Sutherland report will not mean any reduction in service for the care of people living in their own homes, nor any price increases for that care?

      • Nicola Sturgeon: I can shoot down that particular piece of scaremongering straight away. It is absolutely not the case that what I have announced today will have the effect that Margaret Curran suggests.

        I have accepted all of Lord Sutherland's recommendations and I also accept all of his comments in the report. The introduction of free personal and nursing care did great credit to the Parliament and all parties in the Parliament. It is now incumbent on members to work together to ensure that we secure the policy for the long term, which is exactly what my statement seeks to make happen.

        Margaret Curran could have been a wee bit gracious and found it within herself to welcome the additional £40 million that we have committed to secure the future of the policy.

        Margaret Curran asked about this year. As I said in my statement, we have agreed with COSLA that the investment of the additional resource must deliver improved outcomes for older people. Indeed, that is something that Lord Sutherland made clear in his report. It is important that we take the time this year to work with COSLA, for example to clarify the legislation with regard to food preparation, and to develop the common assessment criteria and the common eligibility framework, which will ensure that that money delivers improved outcomes for older people.

        All that I have said today has been worked up in partnership with COSLA—such is the way in which the Government now works with its local authority friends and colleagues. My statement was entirely consistent with the spirit and letter of the concordat. I am delighted that Margaret Curran sets such store by the concordat—that is, perhaps, another of the many U-turns that we have heard from the Labour Party this week.

        It is important to acknowledge that Lord Sutherland has said that the policy of free personal care is delivering well for more than 50,000 older people in Scotland but that there are issues to do with inconsistency and variability. It is also important that we develop consistent standards that will apply across Scotland. I am confident that taking forward the work of Lord Sutherland will enable us to do so.

      • Mary Scanlon (Highlands and Islands) (Con): I thank the cabinet secretary for the advance copy of her statement. Scottish Conservatives welcome the on-going discussions on attendance allowance, the recognition of the need for further clarity on eligibility and the funding of the policy, and the commitment to address the funding shortfall of £40 million.

        The review is mainly about funding. Will the Government now ensure that councils pay the same amount to the independent and voluntary sector as they pay when someone is placed in a council-run home, given that the same quality standards apply?

        Secondly, with so much confusion over the policy, how does the Government intend to improve public information and understanding, as recommended by Lord Sutherland?

        Thirdly, in looking at the future provision, will the Government revisit the issue of integrated care homes? When the Community Care and Health (Scotland) Act 2002 was passed, the Health and Community Care Committee understood that the issue would be revisited, to ensure that elderly people did not have to move from residential to nursing care when their condition deteriorated.

        Finally, what is being done to increase the uptake of direct payments for care?

      • Nicola Sturgeon: I thank Mary Scanlon for her welcome for the significant announcements that we have made today, and thank her for what I assume was an expression of the Scottish Conservatives' support for the Government's attempts to get back the £30 million that was wrongly taken out of the Scottish budget in respect of attendance allowance.

        On the point about the independent and voluntary sector and the council sector, positive work is being done between COSLA and the independent care home sector to ensure that the issues that have been problematic for some time are resolved. The work on consistent quality standards across all care homes is extremely important and I welcome the progress that is being made in that respect.

        Mary Scanlon is right to ask about improving public information. One issue for which we are all perhaps to some degree to blame is that, in being—rightly—excited about the free personal care policy, which is in the vanguard and is leading edge, we did not take enough time to explain to the public the contract that Lord Sutherland's original report recommended between the state and the individual and the division between personal nursing costs and what he called hotel costs. That information now needs to be provided and we will look to work with COSLA to find the best ways of doing that.

        We are seeing progress on integrated care homes, which will be an important strand of work on the future provision of care. Lord Sutherland's report makes helpful points about the need for the integrated model of care.

        The Minister for Public Health is leading work on direct payments, which have a big and a potentially much bigger role to play in allowing people to have the dignity and independence in their later years that they all deserve and which most of them want.

      • Ross Finnie (West of Scotland) (LD): I, too, thank the cabinet secretary for an advance copy of her statement. On the Liberal Democrats' behalf, I welcome her immediate acceptance of all 12 of Sutherland's recommendations and her announcements on funding and other matters, which we must all applaud.

        There is no question but that the cabinet secretary has the Liberal Democrats' whole-hearted support on attendance allowance. The matter goes a little further. An interesting point of principle is that, when a policy and its funding were decided before the Parliament was established, and when the Parliament has subsequently decided by a majority that a better way of fulfilling that policy exists, there should be no presumption that the funding stream should not be adjusted to take account of the Parliament's will, given that the Westminster Parliament approved this Parliament's establishment. A matter of principle—I see that the cabinet secretary with responsibility for broader matters is sitting on the Cabinet Secretary for Health and Wellbeing's left—and not just the attendance allowance question needs to be decided.

        Asking questions is always difficult after my preceding colleagues have asked seven questions, but never mind. The cabinet secretary mentioned discussing with COSLA what the report refers to as managing expectations. I am not wholly persuaded that that matter is simply for COSLA and local government. Free personal care is seen as a public policy and a Government policy, so I say with respect that improving understanding of it rests more with the cabinet secretary's good self and the Government than with a conversation with local government, although that might help.

        Having an effective performance framework is important. We understand that the Government has introduced a new means of dealing with that, but we are a year on, and it is becoming important to understand better the timeframe in which standards will become available, so that Parliament can measure performance in accordance with the framework that will be established.

        I have no problem in being gracious about the additional £40 million, but I am still interested to know where it is coming from.

      • Nicola Sturgeon: I thank Ross Finnie for his graciousness in all his questions. Unsurprisingly, I agree whole-heartedly with his comments about attendance allowance. I know that this is probably not the day on which Labour members want to hear talk about Westminster contradicting Scotland but, nevertheless, needs must.

        An important specific point is that, in effect, the attendance allowance decision robbed the Scottish budget of £30 million and has had consequences for the policy's implementation, but we must also resolve the bigger issue of principle, to ensure that the same thing does not happen with future policies. I am sure that we can all think of a few future policies that might fall into that category. It is unacceptable for Westminster to seek to undermine and frustrate the exercise of the Parliament's devolved powers on matters on which it wants to act. Westminster tried to do that with attendance allowance. We must rectify that situation and establish the principle that such an approach is unacceptable.

        On public expectations, I apologise if I gave the wrong impression. I did not in any way try to suggest that managing expectations is a matter for COSLA. I think that I said that the Government would have to work with COSLA to address that matter. I agree with Ross Finnie. I absolutely accept that there is a responsibility—in fact, I would go as far as to say the lead responsibility—on the Scottish Government's shoulders to ensure that the public policy on free personal care is properly understood and explained. We will certainly discharge our responsibility, but it is clear that COSLA also has an important role and interest in free personal care. It is therefore important that we work together in a spirit of partnership on all the aspects that I mentioned in my statement.

        Ross Finnie mentioned the performance framework. In my statement, I said that we require to develop an effective performance framework in line with the framework of single outcome agreements. Work on that is progressing extremely well. It is not only the Government that thinks that we now have a much better focus on outcomes rather than on inputs—that view is shared widely across local government. Such a focus has transformed the relationship between local and central Government for the better, and I hope that all members welcome that.

        I thank Ross Finnie for welcoming the £40 million that I mentioned. Obviously, that money must come from within the resources that are available to the Scottish Government—I see the Cabinet Secretary for Finance and Sustainable Growth listening carefully to everything that I am saying. Clearly, when we publish our budget for the next financial year, it will be open to full scrutiny by the Parliament. Today, what is important is that we are making a clear commitment to ensure that the resources that Lord Sutherland has said are required are provided to stabilise the policy.

      • The Presiding Officer: We come to questions from back benchers. You know the form: brevity is beautiful in both questions and answers.

      • Michael Matheson (Falkirk West) (SNP): I welcome the cabinet secretary's statement. In particular, I welcome the Government's commitment to ensuring that the policy is adequately funded through the provision of an additional £40 million.

        Given that there appears to be growing cross-party consensus that the Westminster Government has acted in an unjust and spiteful way in holding back £30 million of attendance allowance money that belongs to Scotland, will the cabinet secretary advise members on the procedure that will be employed as the issue is taken through the joint ministerial committee? Will she ensure that, where possible, the Parliament is kept informed of the progress that is made in taking Scotland's case to London?

      • Nicola Sturgeon: I think that widespread consensus now exists that the Westminster Government's decision was wrong and should now be put right. As I have said, we have formally intimated to the United Kingdom Government that we want the issue that Michael Matheson raises to be on the agenda for the next joint ministerial committee meeting. The fact that that committee will start to meet again after such a long gap is a positive step. It is important in the first instance that we have such discussions and that we make clear to the UK Government our determination that the money in question be returned to the Scottish budget. I also said in my statement that it is important to have the Parliament speaking with one voice, which is why there will be an early opportunity for the Parliament to do that and for members to debate the other issues that I have raised. I believe that if the Parliament is united and shows determination, we can and should prevail.

      • Dr Richard Simpson (Mid Scotland and Fife) (Lab): The Labour Party welcomes much of the statement. We were in favour of the policy, which was put through by the whole Parliament. It is clear that the funding that has been announced is welcome. However, my colleague Margaret Curran asked a question to which we still have not received an answer. What will we do in the very short term, over the course of the next year? If every time that Labour spokesmen ask questions the cabinet secretary attacks them personally, says that they are scaremongering and then does not answer their questions, we will not be able to get constructive relationships on matters that the cabinet secretary rightly said should be consensual. I would like an answer to my colleague's question.

        My question is on a slightly different issue: the targets for assessments and action to address needs. In her statement, the cabinet secretary referred to people with urgent and priority needs, whereas local authorities usually refer to people with critical and substantial needs. Whichever words are used, we are talking about the top two categories of need. How does what the cabinet secretary said square with the Government's decision, which she continually states, that the six-week target on blocked beds will be met, if only those with substantial and critical needs or urgent and priority needs will have their needs met within the six weeks that Lord Sutherland suggested? To achieve uniformity, what will happen to those targets if the needs of other groups are not met within that time period?

      • Nicola Sturgeon: That is not quite what I said, and it is a point on which it is important that I make my position clear, so I will come back to it.

        I hope that we can have a constructive relationship on this issue, but if the Labour Party spokesperson greets what everybody agrees is good news by impugning some malign motive or hidden agenda in it, Richard Simpson should not be surprised if there is a bit of attack in return. Sometimes, the best thing to do is what he has just done—be gracious and accept that what we have announced today is good news for older people throughout Scotland.

        I remind Richard Simpson that council budgets have increased for this financial year by more than the rate of inflation. Therefore, the budgets that councils have available to them for free personal care have already increased this year. We have also, for the first time, increased the payments for free personal and nursing care in line with inflation. It is not at all fair to suggest that the Government is doing nothing this year.

        Importantly—the point was made strongly by Lord Sutherland—we have agreed with COSLA that substantial additional investment of the kind to which we have committed ourselves today must be tied to real improvements in outcomes for older people. We must take the time to work through the detail so that there is clarity on food preparation, and we must work through and get right the detail on the common assessment criteria, the common eligibility framework and the standard maximum waiting times. We are working closely with COSLA and we are making fantastic progress in a spirit of partnership. That is what makes me confident that, when we invest that money in the next financial year, it will deliver real improvements for older people.

        Lord Sutherland is very clear on the issue of entitlement, and members should recall that I have accepted all his recommendations. When someone is assessed as needing free personal care, they have an entitlement to that care. However, as in the NHS, the level of care to which they are entitled and the length of time that it might be acceptable for them to wait for it will be driven by the assessment of their need. Again, as in the NHS, it is important that councils are able to manage their resources to ensure that those who are in greatest need have their needs catered for as quickly as possible.

        At the moment, there is no maximum waiting time for those with urgent care needs. We are suggesting the establishment of a maximum waiting time for those people. Currently, if somebody is deemed to have low-level care needs, because of the way in which the eligibility criteria work in some councils, those people are effectively filtered out of the system altogether—they are not even recorded or monitored. We are saying that, even if somebody does not have immediate care needs, they must be monitored to ensure that their situation does not fall off the radar screen. I think that that is substantial progress, and I hope that everybody welcomes it.

      • Christine Grahame (South of Scotland) (SNP): I welcome the commitment to clarification on cross-border payments, which is an issue that is obviously of concern to people in the Scottish Borders.

        Scottish Borders Council is one of the eight local authorities that continues to charge for food preparation. Does the cabinet secretary agree that, while we await the legislation that will clarify the situation, those who are currently being charged may well have a legal remedy to recoup those payments? Does she also agree that, at the very least, until the new legislation is in place, Scottish Borders Council and the other seven councils that currently charge for food preparation should act according to the spirit, if not the letter, of the current law?

      • Nicola Sturgeon: As I have acknowledged openly and frankly today, I think that the legislation is unclear, which has led to local authorities taking their own legal advice on the matter. Some local authorities have decided to stop charging; others have made a different decision. It is not for me to advise individuals on what course of action they should take. My responsibility for the future is to ensure that that lack of clarity is rectified. Going back to a point that Ross Finnie made, I think that the responsibility for that lies with the Government. It is for us to ensure that, from here on in, the legislation is clear, and that is what we intend to do. We want to put it beyond any doubt that food preparation is something for which individuals should not be charged.

      • Malcolm Chisholm (Edinburgh North and Leith) (Lab): I welcome the cabinet secretary's statement, but does she agree that the main challenge facing the future of the policy is Scotland's changing demographics? Does she agree that the main reason why the original costings were an underestimate is that the 2006 census projected far more old old people—that is, people living over the age of 90—than the previous census, on which the care development group report was based?

        Although I agree with the cabinet secretary on the specific attendance allowance issue, does she agree that perhaps the most important recommendation in Lord Sutherland's report relates to the wider review of all the costs of long-term care? Would it not be sensible to set the attendance allowance issue within that wider context?

      • Nicola Sturgeon: I thank Malcolm Chisholm for his constructive comments. I agree that changing demographics are in large part responsible for the care estimates being off-beam. I deliberately did not imply that there was any fault on the part of the care development group or the previous Administration for that, or seek to blame them. The important thing is that we all now work together to put the matter right.

        Although the return of the attendance allowance moneys is very important in the context of Lord Sutherland's recommendation on how to "stabilise the policy" in the short term, I agree with Malcolm Chisholm that Lord Sutherland's most radical and important recommendations are those that deal with the longer term. Lord Sutherland rightly states that we must start planning now for our changing demographics. He also rightly points out that such planning must be about much more than just free personal and nursing care. The money that we spend on free personal and nursing care amounts to only 10 per cent of the total that we spend on services for older people. Regardless of the policy on free personal care, planning for future demographics is absolutely critical. As I said in my statement, we intend to get on with that straight away.

      • David McLetchie (Edinburgh Pentlands) (Con): The cabinet secretary noted that eight councils in Scotland are still charging for assistance with meal preparation. Is she aware that COSLA has been stalling on that issue for the past five years? COSLA has consistently refused to seek a legal opinion on behalf of all its member councils on the interpretation of the legislation, notwithstanding the fact that it was well aware that several councils have legal opinions to the effect that such charges are illegal. Is she aware that local authorities such as the City of Edinburgh Council, West Lothian Council and Western Isles Council have not only ended the practice of charging for meals preparation but, to their credit, refunded people who were wrongly charged for that element of personal care? Is it not quite wrong that older people living in eight areas of Scotland are still charged for such services when the charges have been pronounced illegal and have been stopped in the rest of the country? I echo Christine Grahame by asking that the minister insist that the practice cease forthwith and that she ensure that those who have been wrongly charged by councils since the introduction of the policy are refunded, as is only their due and their right.

      • Nicola Sturgeon: My statement sent out a message about what I think about charging for food preparation. However, I am not interested in playing the blame game; I want to fix the problems with the policy so that we secure it for the long term. As I said to Christine Grahame, the lack of clarity in the legislation and the guidance has led to different councils reaching different positions based on differing pieces of legal advice. In fairness, COSLA did not frame the legislation or write the guidance, which was the responsibility of the Government. I accept that the legislation and the guidance are unclear; we will clarify them. In future, we will not have a situation—which I accept is wrong—in which people in some parts of the country pay for food preparation while people in other parts of the country do not.

      • Jamie Stone (Caithness, Sutherland and Easter Ross) (LD): Further to Malcolm Chisholm's point about Scotland's changing demographics, it will come as no surprise to the cabinet secretary that my mind goes instantly to the Highland Council area, parts of which have a very rapidly aging population—arguably, the graph is steeper in the Highlands than in other parts of Scotland. Does the cabinet secretary recognise that problem? Will she outline what mechanisms the Scottish Government will adopt to deal with it? How will the Government fine-tune the settlement within the £40 million envelope, which we all welcome, or within whatever funding streams might come on tap? If the issue is not treated at that slightly smaller level, it could present a severe problem at the most local level.

      • Nicola Sturgeon: As Jamie Stone will know, part of the Sutherland review's remit was to look at not just the overall level of resources available to local government but their distribution among local authorities. In his report, Lord Sutherland recognises that the distribution of resources to local authorities is under review and argues that the resources for free personal care should be included in that overall picture.

        I accept the premise of the points that Jamie Stone makes. Not only must we deal with the changing demographics in the country as a whole, but we must be sensitive to the differing pictures within Scotland. There are particular issues in remote and rural Scotland, as in many other areas. I assure the member that we will be mindful of that as we take forward work on free personal care for the long term.

      • The Presiding Officer: Four members have indicated that they have questions to ask, but less than four minutes remain for them to do so.

      • Nigel Don (North East Scotland) (SNP): My question is about the assessment of people's needs. The cabinet secretary was right to say that people should have their needs determined professionally. I cannot expect her to know how fast that is done in every local authority in Scotland, but my experience is that sometimes it is not done very fast. Does she agree that the lead time for assessment is crucial to the process? Will she ensure that councils have enough staff to enable them to take that first step?

      • Nicola Sturgeon: I agree that it is vital that older people with care needs are assessed as quickly as is possible and practicable. That is one reason why is important to get consistency and common procedures in place in all councils. We are committed to accelerating the move towards a single shared assessment. In that process, we will focus on exactly the kind of issues that Nigel Don has raised.

      • Helen Eadie (Dunfermline East) (Lab): I apologise to the cabinet secretary for my late arrival two minutes into her statement. I, too, compliment her graciously on the statement.

        One major concern of all our constituents is that the service, by its nature, is demand led. That creates challenges for all local authorities within the Government's funding settlement. Could it lead to rationing? If so, how will the cabinet secretary ensure that the needs of those who require free personal care do not go unmet, given that local authority funding is finite and demand may outstrip finance? As Ross Finnie said, when the money runs out, where will additional money come from?

      • Nicola Sturgeon: I thank Helen Eadie for her apology; I understand totally the reasons for her late arrival. However, I suggest gently to her that it would have been good if she had used the few minutes before she arrived in the chamber to read the Sutherland report, because it is intended to address precisely the issue that she raises—how we manage demand for free personal care and ensure that, although the policy is based on an entitlement, people in greatest need have greatest call on resources. We are wrestling with that issue. I assure her that we will continue to progress it through the announcements that I have made today and the work that we are undertaking with COSLA.

        I point out to Helen Eadie and other members that Lord Sutherland says that the policy is clearly sustainable. That is an important point that should give us all cause for optimism about its future. I take great heart from Lord Sutherland's statement and know that old people throughout the country and their families will do so, too.

      • Jackson Carlaw (West of Scotland) (Con): I am not sure whether a statement on the elderly in need of care is an appropriate opportunity for me to welcome back to the chamber the First Minister, Ross Finnie and the Presiding Officer after their recent indispositions, but I do so on behalf of my colleagues.

        Future demographics are a cause for some alarm. Does the cabinet secretary agree that whatever is achieved after today must not be interpreted by the public as a general signal that anyone can safely abdicate their responsibility to plan prudently for their old age and, where possible, to have regard to their health as they live their lives? If care is to be fully funded, the boundaries of the state must be understood.

      • Nicola Sturgeon: The member makes an important point that relates to the issue of public information and education. One of the failures of all of us in explaining the policy was that many people got the impression that, following the introduction of free personal care, all the costs of old age would be met by the state. That was never Lord Sutherland's recommendation or the Parliament's intention. The Parliament intended that personal and nursing care should be funded by the state but that some people, depending on their personal circumstances, would still have to contribute to meeting their hotel or accommodation costs. It is our fault that that point has not been put across as well as it should have been. We all have a responsibility to explain it better and, in so doing, to make it clear that all of us have a responsibility to plan for our old age.

      • Irene Oldfather (Cunninghame South) (Lab): Will the cabinet secretary ensure that the particular needs of old people with Alzheimer's and dementia are taken into consideration when a common eligibility framework is established, so that they can be offered equity in the social and health care systems?

      • Nicola Sturgeon: I commend Irene Oldfather for her attention to dementia issues; she certainly pursues them with a great deal of attention and interest. I give her an absolute assurance that the needs of that particular group of older people will be very much at the top of our minds as we develop our work.

    • International Framework
    • Business Motion
    • Parliamentary Bureau Motion
    • Decision Time
    • Alternative and Augmentative Communication