§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Streeter.]10.49 pm
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I am grateful for the opportunity to rehearse some of the fears and anxieties felt in my constituency and that of my right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) about the consequences of the budgetary constraints facing the new unitary authority in the provision of community care in the borders.
I do not wish to waste valuable time tonight in detailed castigations of central Government for causing that problem, although it would be easy to do so. Opposition Members often resort to blaming the Government for how we got here. I do not care to rehearse those problems tonight.
I start by placing on the record the difficulties facing the local authority as a result of the fact that the 1996–97 financial settlement required the social work committee of the new unitary Scottish Borders council to reduce its social work budget by 9 per cent. in the current financial year.
For the purposes of tonight's argument, it does not matter how we arrived at the situation or who is to blame. Recrimination will not help us to make the best progress we can. I am anxious to confront the future, consider the problems that confront the local authority, and discover what can be done, in partnership with central Government, to try to solve some of the problems.
I should be misleading the House if I did not say that I was deeply anxious and troubled by the position that is unfolding locally. I shall use the time available to me to ask the Government whether they will consider undertaking a fundamental and thorough review of the current system of finance for community care, not only in south-east Scotland and the Borders region but throughout Scotland and the rest of the United Kingdom.
The Scottish Borders council is now being forced to save about £240,000—nearly a quarter of a million pounds—from this year's general care budget of £3.7 million. It is being forced to make that saving in 12 months, and as a result must take decisions that mete out an extreme form of rough justice—especially, in the first instance, on the home care assistants, who are being made to bear the brunt of the cuts, which are being made in a rush.
Having spent some time studying the local authority's position, I support the principles behind the decisions that the council is taking, because they are obviously the least worst option. I have been persuaded by the social work department that any other attempt to make savings of that magnitude in the required time scale would have required a significant reduction in the hours of care available to clients, which is in no one's interests and must be avoided at all costs.
The measures are being forced on the council in an unduly short period, with indecent haste. People throughout the Borders feel great distress and concern. No one opposes sensible attempts to obtain value for money, but the scale of the savings that must be made in such a hopelessly short period has forced the council to reassess 202 all its existing clients and determine whether current levels of care were appropriate to their current needs, and whether they could survive with less care. That in itself is a difficult process.
Secondly, the council is considering a pilot project to externalise a significant proportion of the in-house services provided in home care. That will effectively create, for the first time, a two-tier system of pay for home care assistants—comprising care tasks, which involve personal duties such as bathing people; and domestic tasks, which involve lighting fires, cleaning and so on.
All this is being done at the same time as the council is expected to deal with changes in the system of social work, including the alteration in the capital disregard when calculating the means available to clients for residential long-term care. That change was announced in last year's Budget, and the money being offered in recompense does not begin to meet the loss of income that the council will suffer.
Moreover, there are increased costs associated with paying for a raft of new social work duties involved in the implementation of the Children Act 1989 and the Carers (Recognition and Services) Act 1995.
Taken together, all these elements produce extreme financial pressure on social work departments such as the one run by Borders council. This evening, I call on the Government to look carefully again at these financial pressures, and I ask the Minister to consider whether it is possible, even at this late stage, to continue the three-year transitional relief that the council until recently enjoyed. That would give the council more time to prepare for the changes and to ease their implementation.
I suggest that the pilot scheme implemented by Borders council runs with the grain of Government policy. It seeks to do much of what the Government want councils in general to achieve. The scheme could serve as a model for other areas if it were properly financed and implemented.
The real danger for the Government is that the problems facing the council are likely to worsen significantly because of the shortage of money and the lack of time to make the necessary changes. That combination will lead to difficulties which, in the long run, will not do anything to promote the idea and policy of community care—a policy to which the Government are rightly committed.
A series of problems face Borders council at present, and the Government should be alive to them and should seek to work with the council to remedy them. First, there are the severe cuts that could be made to the income available to home care assistants. These are vital workers who perform intimate services for the clients they help, often for far longer than the hours for which they are paid. Their morale has, not surprisingly, been severely hit. If the good will of this vital group of workers is lost, we shall, in effect, have cut off our nose to spite our face.
Secondly, the break in continuity between clients and home care assistants is a worrying aspect of the changes. These relationships have often been built up over many years; they are invaluable to the physical, mental, social and psychological care of some clients, some of whom live in isolated parts of the rural, landward areas of the constituency. There is also the possibility that the contract requirements will be so restrictive and tightly drawn in terms of financial constraints that either they will not be tendered for by any organisation because it will be 203 impossible to keep their profit and loss accounts in the black, or they will be taken over by private companies that will make them work by cutting corners. As a consequence, standards will fall and the social work department will have to pick up the pieces.
I received a letter from the Royal College of Nursing which expands on some of those fears. It makes two points about the Scottish Borders council that the Government should take on board. First, it states:The RCN is particularly concerned that cutbacks in domiciliary care services will have knock-on effects on community health services,"—which come out of another budget but are still public expenditure—
placing yet more pressure on community nurses.That would be in no one's interests.
Secondly, the RCN is rightly concerned about some of the aspects of the proposals to externalise some of the domiciliary services whichraise questions of accountability and health and safety both for the carer and the client. There are also concerns about assessing the suitability of carers and whether police checks will be mandatory for services contracted out.Those are all important questions.
I wonder whether we are giving ourselves enough time to think matters through, given the way in which the pilot project is being forced on the local council in the Borders. My right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale is most concerned and had he not had engagements elsewhere, he would have told the Minister that the financial constraints have been so severe that the Scottish Borders council social work department has been unable to negotiate realistic fees with the owners of local private homes. The department is simply laying down levels of fees that it can afford and that bear no relation to the costs borne by private home owners. Therefore, the plural provision in the private sector in the Borders region could be severely prejudiced.
I hope that the Government will examine the problem as a matter of urgency. I perceive a willingness to change and run with the grain of the Government's policy. Externalising some of those domiciliary services could be done sensibly in a bona fide way particularly through voluntary organisations such as Crossroads. However, such organisations would face great difficulties in tendering for contracts as they do not have the administrative or financial capability to do so. That is a great shame. It is also possible that home care assistants could organise a service more cheaply and efficiently and provide better value for money, but not within the time scale or in the present circumstances in the Borders. The Government should take those problems very much to heart and sort them out in future.
In conclusion, I hope that I have laid down some markers to show that there is real concern in the Scottish Borders about some of the enforced decisions that are being taken by the social work department. I pay tribute to the work that is being carried out, but there could be real problems later this year. If the pilot scheme does not work because client needs exceed the available budget and nobody tenders for the contracts to externalise the services, the social work department will be left with no alternative way of making the savings required but to cut 204 the number of hours available to clients. That will put people at risk, so it is not acceptable. If things are bad this year, according to some of the references from Ministers that have been reported to me, they will be even worse next year.
Can the Minister reassure those who are struggling with the problems and trying their best to make the system work according to Government policy? They are shackled to taking difficult short-term decisions that are causing great distress to people who do not deserve to suffer in that way. We must sort out the mess and ensure that there is sensible provision of community care which meets the needs of clients in the Scottish Borders council area in the near future.
§ 11.5 pm
§ The Minister of State, Scottish Office (Lord James Douglas-Hamilton)
I congratulate the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on securing the debate, and on making many useful points tonight.
I have good news about Crossroads, which is currently funded by the Scottish Office. It recently received a one-off additional grant in recognition of its contribution. The hon. Gentleman raised a number of issues that are relevant not only to the Scottish borders but more widely regarding the arrangements for funding, service provision and support for the most vulnerable people in our society.
I shall address the specific points about community care services in the borders, but first I shall refer briefly to the funding of social work services in Scotland. The implementation of the community care policy has initiated a significant shift in the provision of health and social care services for vulnerable people towards care in their own homes and in residential accommodation in the community.
The substantial additional financial resources that have been allocated to authorities reflect the central role of social work departments in developing the pattern of social care provision in their areas. In the current year, local authorities have some £662 million available for their community care responsibilities, compared with £378 million at the beginning of the decade.
The hon. Gentleman referred to cuts in services and to concerns expressed by the Royal College of Nursing. By making more effective use of their resources, authorities should be in a strong position to ensure that appropriate levels of support are available for vulnerable people. The local authorities will continue to be responsible for undertaking care needs assessments. When services are contracted out, authorities will continue to promote standards through contract conditions. Users of contracted-out services will continue to have access to local authority complaints procedures. I accept the importance that the hon. Gentleman placed on monitoring.
An additional £250,000 has been allowed within the grant-aided expenditure allocation to the Scottish Borders council for the provision of adult community care services. We would encourage all local authorities to accord appropriate priority to the provision of services on which vulnerable people rely.
Concern has been expressed that the criteria for receiving home help services will be reassessed as part of the tendering process. As a matter of good practice, all local authorities should regularly re-examine the services 205 they provide, to ensure that resources are targeted properly. That exercise will identify the types of home care service that people require. Eligibility criteria in the borders will not be changed.
As to the cost of new circulars—for example, guidance about the Carers (Recognition and Services) Act 1995— we have issued a number of guidance documents advising councils about their social work functions as part of the arrangements for local government reorganisation. They relate to existing responsibilities and do not require the provision of additional resources.
Transitional protection was provided to authorities where there was a traditionally high level of DSS expenditure on residential placements proportional to population needs. The arrangements ended last year, but monitoring of local authority expenditure on residential accommodation in the borders shows that the original DSS transfer allocation was generous.
I accept that many authorities are now reviewing their budgets. That is a matter of good practice, but it is particularly important when a legacy of reduced surpluses and unrealistically high underlying expenditure levels has been inherited from outgoing councils.
Reference was made to funding in the borders. I believe that the allocation was generous, as I said. Many of the residents in residential and nursing home care supported by DSS funding prior to 1993 had not been from the Borders. The borders region thus had no responsibility to fund its successors.
Despite that, the Convention of Scottish Local Authorities agreed that Borders should receive funding, in the form of transitional protection, to help in the first three years. During that period, the former local authority's expenditure on purchasing places in independent sector residential and nursing home accommodation was well below the levels estimated when the DSS transfer allocation to the authority was calculated.
None the less, the allocation for community care responsibilities has increased by more than £250,000 from last year's level, to over £14 million. It is for the local authority to determine its funding priorities.
Particularly important is the fact that we have encouraged authorities to plan the use of current and future financial resources as part of a strategic approach to the provision of community care services. Authorities are therefore required to set out those proposals in their community care plans, which are reviewed—rightly—on an annual basis. In addition, local community care arrangements can be monitored closely, first, through local consultation; secondly, by the Scottish Office through research; thirdly, through statistical returns; fourthly, through the social work services inspectorate; and fifthly, through the community care implementation unit.
I accept the point made by the hon. Member for Roxburgh and Berwickshire, that monitoring is very important. If people are to receive the services they need, authorities must aim to achieve value for money from all the services they purchase—both those purchased from independent providers and those from their in-house services.
Local authority residential care homes are generally substantially more expensive than independent sector homes, without necessarily providing better standards of 206 care. Research has not found a relationship between cost and quality. The typical unit cost to Borders council of care for people in its own residential care homes is about £6,000 per person higher than equivalent independent sector provision. If people currently in local authority homes in the borders were in independent sector homes, the saving would be more than £1 million.
Our aim is not to end the long tradition of local authority provision of social care services. That would be neither practical nor desirable. However, as purchasers of community care services, authorities must ensure that they are even-handed in buying care provision and obtaining value for money in the best interests of the patients and consumers.
The hon. Member for Roxburgh and Berwickshire has expressed concern about externalising home help services, which are currently provided in-house by Scottish Borders council. Total social work expenditure on home help services in Scotland is about £100 million each year. Almost all that is for services provided directly by authorities.
Compulsory competitive tendering has been introduced to the purchasing of many services provided by authorities, which includes many manual and white-collar jobs. That discipline has brought about substantial improvements in the cost and the quality of services and applies both to services purchased from independent sector providers and to the authorities' in-house teams, where they have been successful. We have not introduced compulsory competitive tendering to the provision of social work services, in the belief that authorities will seek to make the best use of their resources in helping vulnerable people,
Scottish Borders council's social work committee proposes to put out to tender part of the home help service for the elderly. The hon. Member for Roxburgh and Berwickshire is concerned about a loss of quality for the recipients of the services. Both he and I share an interest in maintaining a very high quality of care and securing value for money in the provision of services.
Potentially this is the first example of an authority purchasing such services from the independent sector on a significant scale. The contract will initially be for a 12-month period. The council has indicated that it will review the contract arrangements after nine months to ensure continuity of service provision. I can assure the hon. Member that we also will monitor the progress of this initiative.
Concern has also been expressed about the time scale for the tendering process. The council developed a specification for tendering for the home help service some time ago, which is applicable to its in-house service and to external providers. The specification articulates the principles of care, health and safety issues, procedures and routines, and reviews and staffing on which the service should be based.
The provision of home help services has increased markedly, even in the last five years. In 1990, more than 82,000 people in Scotland were assisted by home helps; by 1995 that had increased to over 93,000, a rise of 14 per cent. Over the same period, however, the increase in such services in the borders area was double the national figure—a rise of 28 per cent., to almost 2,000.
Despite that increase relative to population, the number of home helps in the borders was lower than in any other local authority in Scotland. It is against that background 207 that the authority is considering how it can best meet the needs of its local population. It is right that it should seek to purchase services as cost-effectively as possible. The terms of such purchases will be a matter for negotiation between the authority and individual providers.
It is inevitable that there will be a range of unit costs, just as there is a range of service demands. The home help service meets the needs of older persons in a wide range of practical ways, which vary among individuals, and range from help with household tasks such as shopping and cleaning to help with personal care tasks such as washing and dressing. Home helps often provide company as well as assistance for older people, but the local authority home help service largely excludes heavy lifting or working above floor level—for example, cleaning windows or replacing light bulbs—from its stated responsibilities.
Authorities must take account of differing needs when considering how services can best be delivered in the most cost-effective way. The views and interests of service users and their carers should also be considered. The Carers (Recognition and Services) Act 1995, which came into effect on 1 April, gives carers a statutory right to request an assessment of their own needs.
In the case of the home help service in the borders, the authority is, in the tendering process, differentiating between domestic and personal care, as the hon. Gentleman suggested. I understand that it is the former that is being put out to tender, while the more skilled personal care services will continue to be provided by staff who have a proven record in that area.
The hon. Gentleman also expressed concern about the conditions of home help staff when the management of services is transferred to independent sector providers. The vast majority of independent sector social care providers offer high-quality care and appropriate wage levels to their staff. As with other public sector areas, authorities have been encouraged to ensure that wage increases are funded from efficiency savings. If that advice has been followed, authorities should be able to tender for former local authority-managed services at realistic funding levels. Regardless of who provides the service, they must offer a high standard of care and be seen to do so.
The hon. Gentleman is rightly concerned about the quality of services. Contract specifications are very important. They must include criteria against which
208 quality can be measured and monitored, so that the welfare of the recipients of the services can be protected. Another means of ensuring that standards are maintained is registration of providers. We believe that the current arrangements for self-regulation have proved an effective means of maintaining standards in the independent domiciliary sector.
The private sector played an integral role in the work of the Joint Advisory Group of Domiciliary Care Associations in producing a standards guidance document. The United Kingdom Homecare Association has also produced a code of practice for providers and a recommended complaints procedure for clients.
The need for statutory control of domiciliary care provision was considered in the Department of Health document "Moving Forward", on the regulation and inspection of services in England and Wales. It was also considered by the Scottish Office working group on residential care home registration procedures, which is due to report to very shortly. We shall then decide what action, if any, to take in the light of the working group's deliberations. Authorities may, however, introduce their own measures. I understand that Borders council purchases services only from independent sector providers that are registered with it as approved suppliers of domiciliary care.
The provision of domiciliary services, including home helps, is central to allowing older people to retain maximum independence. Our aim is for services to be developed that can respond flexibly and sensitively to the needs of individuals, and concentrate on those with the greatest need.
This year, the social work services inspectorate published a report on an inspection of local authority home help services for older people. It examined provision in six areas of Scotland, including Kelso. The report found that, overall, the home help service was reliable, but that difficulties were experienced at times of staff holidays and sickness, during evenings and at weekends, with certain household tasks such as window cleaning and with the frequency and length of service.
The report also—
§ The motion having been made after Ten o'clock, and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned accordingly at nineteen minutes past Eleven o'clock.