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Mr. Bill Walker: It was the hon. Member for Perth and Kinross (Ms Cunningham) who said that.
Ms Squire: I apologise to the hon. Lady for that mistake.
Yesterday, I was pleased to learn of the announcement of United Kingdom licence approval for the drug Aricept, which is the first ever drug treatment for the symptoms of Alzheimer's disease. However, it is not a cure, and its effective use depends on early diagnosis by GPs. Given that GPs are already overworked, that will be extremely difficult.
I agree with the remarks about registration and inspection. I was shocked to discover that Tayside health board does not make nursing home inspection reports available even to local authorities, let alone to the families and individuals who are facing one of the most difficult decisions of their lives.
When does the Minister intend to ensure that inspection reports on residential homes and nursing homes are freely available and accessible to members of the community? Which of us would take a major decision--one that will affect our lives and our finances--without being able to
pick up detailed reports and information documents on the subject, take them home, look them over and discuss them with our families?
Mr. William McKelvey (Kilmarnock and Loudoun):
I shall be brief, because I know that my colleagues wish to speak. I join those who have congratulated my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) on securing this important debate. It has raised many issues, and we would have liked more time, but we are doing our best to make our point.
The Select Committee on Scottish Affairs is studying community care in Scotland, a great deal of which is devoted to the elderly. All our evidence is now in, and will be published. I hope that we have time to finish the report, but if not, I hope that the new Government will pick up the evidence and produce the report. It is important for our elderly and for the disabled.
I will cut my remarks because of a lack of time, but I want to put on record what has been said in "Kaleidoscope of Care", a publication from Her Majesty's Stationery Office. In just a few words, it gets to the heart of what is important about care for the elderly. It says:
I do not have time to go into detail or to mention all the figures, but I want to give hon. Members an understanding of the extent of the problem. It is a general problem, but I will give the figures for the whole of Ayrshire.
In Ayrshire, 6,332 people are receiving home help. Drastic cuts in the provision of home help are likely to occur at the next budget of all the councils in that area. That will leave many people without that essential help. As my hon. Friend the Member for Glasgow, Springburn (Mr. Martin) said, some people see nobody from week to week, or even year to year, and their only contact with the outside world is their home help. It is an essential part of their life.
Ayrshire has a larger share of people in nursing homes than other areas, because many people wish to come to our nursing homes. Many large buildings have been turned into nursing homes. There are 2,174 people in nursing homes, and 1,017 in residential homes. The total of those receiving community care services in Ayrshire is
about 24,000. I cannot give an exact figure, because some people are listed twice if they are receiving different types of care. That is a large part of our population. When one considers the extent of that care and the many people it helps, one can see that any cuts in expenditure would be sad.
I understand that I walk a tightrope between what I can discuss here and what has been heard in evidence to the Select Committee. Much of the evidence received by the Select Committee is private and cannot be mentioned now. However, the report will be worth reading by those interested in this matter.
On the day on which the Minister of State, Scottish Office, the right hon. and learned Member for Edinburgh, West (Lord James Douglas-Hamilton), was giving evidence to the Select Committee I was handed a letter from Maggie McLeod of Edinburgh Voluntary Sector Community Care Alliance. The letter said:
Mrs. Maria Fyfe (Glasgow, Maryhill):
I hope that my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) gets some answers from the Minister this morning. I shall be brief, so as to allow the Minister to respond.
On residential care, we have heard about the disgraceful incident at Glenglova. I believe that there should be national minimum standards for residential care to ensure healthy eating, suitable heating and opportunities for entertainment beyond a television parked in the corner of the lounge. I agree with the hon. Member for Perth and Kinross (Ms Cunningham) that decent pay for the employees is important in the standard of care.
I want to take an unusual step and congratulate the Prime Minister on helping to warm up a pensioner in Maryhill. She telephoned me to say that she woke up in her cold house and opened her morning mail, only to find a letter inviting her to contribute £20 to the Tory party election fund. She was so indignant that she warmed up immediately. She pointed out that £20 is equivalent to the Christmas bonus for two years. I agree with the pensioners charter that that whole issue should be looked at once again.
Transport for the elderly has not had an airing yet. Local authority provision for bus passes varies widely across the country. We should aim to achieve minimum
standards for the transport of the elderly at low prices. If people are to keep in touch with the community and enjoy life to the end of their days, transport is important.
Mr. Malcolm Chisholm (Edinburgh, Leith):
I congratulate my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) on securing this rare debate on Scottish health and community care on the Floor of the House. It is the first such debate during the eight months that I have been on the Front Bench and for many months before that.
Our thoughts this morning as we discuss this subject are with the elderly people in Leith who are ill with E. coli. I am sure that all hon. Members want to send them and their relatives their best wishes this morning.
The latest shocking outbreak highlights the urgent need for an all-out war against E. coli in Scotland. First, research must be supported and prioritised. Secondly, the recommendations of Professor Pennington must be implemented in full, including the recommendations on butchers' shops. Perhaps the Minister could assure us this morning that the full report will be completed soon, and that there will be a debate on it on the Floor of the House in March.
One of the lessons from Lanarkshire was that information must be made available at the earliest possible moment. I have been asking questions about that last night and this morning, and shall continue to seek more detailed information about possible delays on Monday and Tuesday in Leith.
The conflict between commercial considerations and the interests of consumers was evident in Lanarkshire and elsewhere, and makes even stronger the incontrovertible case for an independent food standards agency, as advocated by the Labour party.
My hon. Friend the Member for Greenock and Port Glasgow raised many important issues. He referred to payment for nursing home and residential care. We believe that that issue is so important that it will be referred to a royal commission when Labour comes into government. Nothing less will do.
My hon. Friend the Member for Greenock and Port Glasgow and the hon. Member for Perth and Kinross (Ms Cunningham) raised the possibility of bringing nursing and social care under one roof, regulated by one system. That is supported in the dementia manifesto. The suggestion must be given serious consideration, as it seems a helpful way forward.
My hon. Friend the Member for Greenock and Port Glasgow and the hon. Member for North Tayside (Mr. Walker) homed in on the Tayside report into the provision of residential care in the council and private
sectors. The Government are trying to make the running on the matter, and suggest that local authorities could save money if they spent more in the private sector.
I welcome the fact that the Accounts Commission is studying the matter. Judgment should be reserved until that report is available. At present we can consider two factors--first, that quality is the key aspect, and secondly, that staff wages and conditions must be taken into account, as they appear to be the most significant factor in the cost variation. We should remember that the Tayside report makes it clear that there could not be a quick transfer to the private sector, even if it was desirable. We must also bear in mind the fact that, if all provision was in the private sector, the private sector could hold a council to ransom. The rates charged might be much higher in that situation.
There has been significant growth in the private nursing home sector, and it has been unplanned and unregulated. There are no common standards across Scotland, and there is no common registration and inspection framework. The problem was recognised by the Scottish Office as far back as January 1994, in response to a sheriff's verdict in the Highland region. The sheriff stated that there was no common standard that he could apply when giving a verdict on a particular nursing home.
In January 1994, the Scottish Office set up a working group to consider criticisms of the Nursing Homes Registration (Scotland) Act 1938, and to consider how the problems might be overcome by the issue of a national standards document, accompanied by client-specific guidelines. It is hard to believe that, after more than three years, we have no conclusions from that working party. We still do not have a regulatory framework that is applied consistently throughout Scotland and seeks to provide quality and protect the vulnerable. Perhaps even more shockingly, as my hon. Friend the Member for Dunfermline, West (Ms Squire) pointed out, the reports that are compiled regularly on nursing homes are not available to the public or to local authorities.
The Government like to run on the health versus local government issue, and keep telling us that they are prioritising health rather than local government. The debate reminds us that the distinction is unrealistic, because local government is crucially involved in the delivery of health via community care. My hon. Friend the Member for Dunfermline, West alluded to housing, which is also crucial to the delivery of health. The distinction between local government and health is phoney and worthless.
Social work is crucially involved in community care. This year £42 million was taken out of the grant-aided assessment figures for social work by the Scottish Office. Next year £55 million-worth of new burdens in community care must be met by councils across Scotland, at a time when their cash grant from the Government is being reduced. That has resulted in the current problems in community care. There is the dead person's shoes policy, whereby people cannot get places in nursing homes unless someone in the nursing home dies. There are further problems, such as the delays in community care assessment and the decline in home help.
Bed blocking has arisen because of the pressure on social work and community care budgets. That problem is exacerbated by the decline of almost 3,000 in the number of acute hospital beds in Scotland this decade,
the lack of step-down beds even partially to fill the vacuum, and the cut of almost 2,000 this decade in the number of long-stay beds available. Furthermore, there are no clear eligibility criteria for those beds. We shall address the problem as a matter of early priority.
We are not opposed to all bed closures. The theory of community care is that certain beds should be closed, with the transfer of resources into the community. That is welcome in respect of people with learning disabilities and of many psychiatric beds, although there are problems with the number of acute psychiatric beds. However, the transfer of resources should be made more transparent. There should be a standard method of recording resource transfers to make them transparent and traceable.
The scale of the bed closures, combined with the bed blocking problems, has led to the many health stories this winter about pressure on acute hospital beds. Ten days ago, we were told that all hospitals in Lanarkshire were having difficulties in coping with medical admissions. Throughout January, there was a red alert in Lothian, where only emergency cases were admitted to hospital, yet throughout that month it was openly stated in Lothian that 100 beds were blocked because it was impossible to find a place in nursing homes for those people. Bed blocking affects not only people who want to get into hospital and people who should be in another, more appropriate place; it also affects waiting lists, because surgical beds must be used to provide extra medical beds.
That is one reason why the most recent health statistics, which came out in December, show that waiting lists in Scotland were at record levels, at more than 82,000. The Government message on waiting lists is quite the contrary, but that is just one of the many phoney claims that they make about the health service. It is as empty as their claim to be cutting bureaucracy in the health service. I am glad that the Secretary of State and the Minister for Health have been a little more coy about making that claim since the health statistics were published in December.
The annual health statistics made it clear that bureaucracy in trusts soared last year by more than £13 million, or more than 5 per cent. Perhaps even the Government are now a little shy of claiming that they are cutting the costs of and the waste in NHS bureaucracy caused by their internal market.
We want a full debate on the health service to discuss bureaucracy and the Government's plans to increase privatisation and commercialisation in the health service in Scotland. We had a new angle on that at the Scottish Grand Committee last Monday, when the Health Minister admitted that the Government would not rule out plans to privatise clinical services under private finance initiative arrangements.
We press the Government for a debate on the Scottish health service before the general election. We do not seem to be able to secure such debates under the present system of government. This is the first debate on Scottish health on the Floor of the House that I can remember. If we had a Scottish Parliament, we would ensure that Scottish health received the attention that it deserves.
"Officially, what most would consider admirable policies are in place. The aim is to support carers, encourage independence, foster co-ordination, and emphasise comprehensive but responsive assessment. But if these aims were really being achieved, would it be so difficult to achieve home help? Would the supply of occupational therapists be at its current low level? Would the systems for discharging the elderly patients from hospital be as haphazard as they now appear to be? Would so many old people continue to have what, by the standards of most in our population, are very low incomes and poor housing? Much good work is done in the community care of old people, but it is patchy. Unless resources for community care are considerably increased, the patchiness will remain and reforms will merely benefit one group of old people at the expense of another. We have seen that effective community care for elderly people is possible. Is there the political will to provide it?"
That publication is well worth reading and considering.
"Edinburgh city social work department has stopped assessing people for care services"--
all people, not just the elderly--
"and has a waiting list of 1,372 people."
That list includes those who might need admission to residential homes. The letter said that, currently,
"admissions to residential homes have been frozen."
I wonder whether the Minister took that up in his constituency, or whether he has any further information. The fact that 1,372 people in Edinburgh are on a waiting list for an assessment, which may take between 12 and 16 weeks before they receive the care they need, is something that any civilised society should find unacceptable. Edinburgh city council would say that that has happened because of cuts in its budget. Perhaps the Minister will comment on that.
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