Evidence to Scottish Parliament Health and Sport Committee on Public Sector Reform (Scotland) Bill

The Clerk
The Health and Sport Committee
The Scottish Parliament
Holyrood
Edinburgh
EH99 1SP

17 August 2009

Dear Sir

Public Services Reform (Scotland) Bill

Thank you for the invitation to respond to this important Bill. Alzheimer Scotland is Scotland’s leading national charity which aims to: represent the interest of people with dementia and their carers; provide high quality services; and promote the provision of high quality services by others. We therefore welcome the intention of this Bill, which aims to ensure that regulatory bodies in place to safeguard and improve the quality of public services will work with increased effectiveness and efficiency.

Dementia is a complex illness which causes severe memory loss and gradual cognitive decline. It affects every aspect of the lives of those diagnosed (currently an estimated 69,000 people in Scotland). It gradually affects their ability to make some or all decisions about their health, welfare and finances. It affects their ability to communicate, reason and act in their own interests. It severely compromises their ability to stand up for their own rights and leaves them vulnerable to neglect and abuse. For this reason the Bill is welcomed because it aims to provide a more rigorous system of scrutiny to better regulate services which people with dementia receive both as citizens who use a range of public services, and as people with a need for high quality health and social care services from the point of diagnosis and throughout the illness. We therefore have a particular interest in the proposed establishment of Healthcare Improvement Scotland and Social Care and Social Work Improvement Scotland.

We have made a submission to the Finance Committee regarding concerns about Parts 2 and 6 of the Bill, and will be responding to the separate consultation by the Scottish Government on the future structure of the Mental Welfare Commission for Scotland (MWC). We welcomed Ministers’ decision that the MWC should remain an independent body, focusing on the rights of the individual under mental health legislation, which imposes statutory duties on both the NHS and local authorities. We appreciate the importance placed in the Bill on co-operation between scrutiny bodies. The following comments relate to Parts 4 and 5 of the Bill which we understand are being considered by the Health and Sport Committee.

First, with regard to Part 4 of the Bill, we agree with the Principles and with the Ministers’ authority to set standards for social services, and the comprehensive provisions for the inspection, investigation and regulation of services. However we note that the complaint function seems to exclude care services provided by local authorities and seek clarification on this point.

We have considerable concerns about arrangements for the regulation of Part 4 of the Adults with Incapacity (Scotland) Act 2000 (the 2000 Act). This is a provision for the management of funds of residents in care homes and NHS continuing care patients (within specified levels). We understand that the implementation of this part of the 2000 Act has been problematic from the start and that the Scottish Government commissioned research at the end of 2008 into. (Jan Rait to ring me to-day about findings). We have always been concerned about the operation of this part of the Act and believe that regulatory requirements have created severe barriers to the uptake of Part 4. As a consequence, many people with dementia have lacked access to any funds they may have over and above their state pension/benefits. It is unclear from the Bill as to what the proposed arrangements are for the management of funds of patients in NHS continuing care. We believe that Part 4 (if it is to continue) should be supervised by the Office of the Public Guardian. However we believe that there would be merit in considering the management of residents’ funds under Part 3 of the 2000 Act (Access to Funds scheme), but understand that such a change is out with the scope of this Bill.

Part 5 of the Bill provides HIS with a complaints and inspection function that applies only to independent health care services and not to the NHS. We request the Committee seeks clarification on what arrangements are to be put in place with regard to the inspection of services under the NHS. We believe the Bill should indicate how and in what circumstances HIS can recommend improvements to the NHS. We note this is specified for other health and social services. We consider that the ability for HIS to report to Ministers when required improvements have not been met would be helpful.

We believe that the key aim of the regulatory system for health and social care is the need to achieve consistency of agreed standards across all care settings and that this is a fundamental right of service users, whether their care and treatment is provided by private, voluntary or statutory services. For example, we see no reason why the Government’s national care standards should not apply across all health care as well as social care settings.

One final point, Alzheimer Scotland (through its 24 Hour Helpline and other services) is frequently contacted by carers who are dissatisfied with the way in which their complaints about NHS care have been handled, and we observe that arrangements often seem to be overly complicated. We have noted that complaints systems for both health and social care vary considerably across the country. We suggest that the Bill presents the opportunity to deal with discrepancies in dealing with complaints across the NHS and to simplify procedures.

We hope these comments are helpful. Please contact me if you have any queries.

Yours sincerely

Jan Killeen
Director of Policy