 Llywydd wings. Rwy'n credu chi o'r魚llwch i'r cystans ddaf, rwyf yn rwyf yn ddod yn gallu i ni i Gwanaeth Gwanaeth i Gwanaeth sgolau i Alun Ddod ondbreathydd a Oeddemnigol Fe Alun Ddod yn ddod yn ddod. Fy loedwch gyda hi i ddefnyddio ar gyfer y cyfathol o leolol funud o leolol o'r ingибodd y ddaf, oedd, o'r cystans, i nog i modd o leolol oleddadaf, oedd, yn fyw, yn gweithio i gweithio Shona Robison, to speak to her and move the motion. Fourteen minutes please. Presiding Officer, I'm very pleased to open this debate today on integration of health and social care very timely as we move towards the new world of integration from the first of April. I was Minister for Public Health in 2011 when we committed to bringing forward legislation to ensure our system of health and social care focuses on the people who need it most. I also have personal experience of working in health and social care before being elected as a home care organiser, so this subject is of particular importance to me. For people who have multiple complex needs young or old, health and social care support that is well joined up can be the key to living full lives, going to work, living in their own homes and participating in the lives of their communities. People are living longer in Scotland, testament to in large part to great improvements in our health and care services over many years, and that is a good thing. As people live longer, integration is about adding quality of life to people's years of life, particularly people with long-term conditions. We know that numbers are going up in 2013 more than 425,000 people over the age of 75 were living with a long-term condition. By 2037, we expect the number to rise by 83 per cent to 779,000 people. And integration is also about ensuring that we bring compassion, dignity to people and their families at the end of life. It is important that we plan ahead, ensuring that our systems are in good shape to make Scotland an excellent place to live whatever your age, whatever your circumstances and whatever your support needs. Those are objectives that I know that we all share for ourselves and for our loved ones, and I am grateful to this Parliament for its support across the floor for this programme of reform over the past few years. I am also grateful to colleagues in COSLA, whose leadership on this agenda I greatly value. This is a hugely ambitious national programme of reform. At its heart, though, are people. I was reminded of this when I visited Clifmaninshire Community Healthcare Centre, which provides a wide range of services to its local community. The centre is home to two inpatient wards, three GP practices, a day therapy unit and a local mental health resource centre. That is what integration is about, bringing together services and professionals to ensure an integrated person-centred experience. Nationally, we are now moving into implementation. In a couple of weeks' time, the first of our new integrated partnerships for health and social care will go live. In one sense, years of hard work by colleagues in the NHS, local government, the third and independent sectors, Government and Parliament is coming to fruition. In another sense, though, this is just one more albeit large stride along the path. That is why I am hosting a conference for leaders on integration later this month, to which I have invited some of the parliamentarians here today. I hope that you can attend. The idea of integrating is not new. Community health partnerships set the baseline for today's reforms. Under reshaping care for older people, we introduced the change fund with the principle of pulling a proportion of the money that we commit to health and social care. We are building on that by bringing together budgets, planning and provision along the whole pathway of care, primary healthcare, social care and aspects of hospital care that provide the best opportunities for redesign in favour of prevention. Progress is local too. All around Scotland, chief officers are being appointed to lead the work of the new partnerships, and consultation is under way on their integration schemes. Their partnership agreements must be submitted for approval by 1 April. A lot of work goes into writing the integration schemes in each area. Each one is unique to the circumstances of the partnership. Each one depends on strong joint working between the health board and council, and it is great to see those core documents arriving now for sign-off. Just a few weeks ago, it gave me tremendous pleasure to approve the integration schemes for the three Ayrshire partnerships and lay the order in Parliament that will enable them to be established in April. Of course, once the integration schemes are signed off, the local work to improve outcomes really begins as partnerships get to work on their strategic plans for integrated services. Already from around the country, we can see examples of local commitment to improvement through integrations such as Glasgow's ambitious programme to reduce delayed discharge and improve into immediate care. It is not just Glasgow across the country, partnerships are starting to behave as if they were already integrated. Local information tells us that delayed discharges are starting to come down. Two thirds of partnerships look well placed to deliver the two-week target at April. That kind of innovation will be crucial to success in terms of improving outcomes, and what happens in communities within partnerships in primary and social care settings will be as important as what happens in hospitals. That is why we have legislated for localities within partnerships. Through localities, communities, clinicians and other professionals, we will directly influence how services are provided and resources are used. Localities' priorities must drive strategic planning and partnerships to enable a real shift towards supporting people in their own homes. Of course, improving care is not a task only for the statutory partners. The third and independent sectors and the views of users and carers are important, too. Our legislative framework assures their role in strategic planning and localities. As part of ensuring real improvement in the quality of services, we are also integrating and enhancing improvement support, bringing together healthcare improvement Scotland, the joint improvement team and the quality and efficiency support team, and providing an additional £2.5 million to support improvement in the new integrated health and social care landscape. I previously committed to refreshing our 2020 vision for health and social care. We will sharpen its focus even further on integration's foundation, the triple aim for raising performance, improve people's experience of care, improve the wellbeing of the population and improve the use of resources. Integration will bring together the very significant resources that we commit to health and social care. We have provided some flexibility for local systems to agree the integrated arrangements most appropriate to local circumstances. The legislation sets out the minimum that must be integrated, amounting to at least £7.7 billion of health and social care resource integrated across the country to maximise people's outcomes. Nevertheless, we recognise that some additional resource to support innovation is important. We are already providing £100 million in 2015-16 to support innovation and integrated practice in partnerships under the integrated care fund. Early today, I announced extension of the integrated care fund for a further two years. £100 million per year will be provided in 2016-17 and 2017-18. The £200 million is part of more than half a billion pounds of additional funding that we will be providing over the next three years to support integration. The cabinet secretary mentioned just a moment ago in her opening remarks outcomes, and I think that we would agree that they are particularly important. What is the Government's definition of outcomes with health and social care integration and how will those be measured? The outcomes have been published today and will be available to members. I am just about to come on to say something about that, but they will be measured through the information that is gathered and the data that is gathered through local partnerships. We are providing a lot of support to make sure that each partnership has a baseline. Each will have a baseline of information that they can then measure progress against so that they can show not just themselves but the wider population that they serve and us that the progress that they are making across those outcomes. I will come on to say a little bit more about that in a minute. The investment will support and drive innovation in local systems. The money will be used to build up preventative and anticipatory care, to drive down delayed discharge, to extend our use of telehealth and to support primary care and its key role in leading integration. How will we know whether integration is working, which is the question that has just been asked? Today, I have published indicators that you can find in SPICE that have been developed in partnership with the NHS, COSLA and the third and independent sectors. The new partnerships will publish annual performance reports using those indicators, which replace the previous indicators for reshaping care for older people by drawing together measures that are appropriate for the whole system under integration. They reflect two important aspects of care. First, people's experience of care such as a percentage of adults who are able to look after their own health well. Secondly, key measures of effectiveness of the system such as the rate of emergency admissions to hospital for adults and the percentage of people who are discharged from hospital within 72 hours of being ready. Those indicators will help us to understand progress across Scotland towards our co-priorities. The other ones will not be of a surprise to people who are exactly what we would expect to measure in terms of making progress. We are also investing in improving the data available to partnerships. Robust data, which can be aggregated at different levels of granularity for localities and partnerships, will be vital. Partnerships must use the data available to them to ensure that they focus their efforts on the people for whom there are the greatest opportunities for improvement. The new partnerships will manage the resources currently associated with 96 per cent of delayed discharges and 83 per cent of unplanned admissions for people aged over 75. For example, from our on-going work to improve the standard of the data that we collect, we also now understand that, nationally, 2 per cent of the population accounts for 50 per cent of hospital and prescribing resource use. That is a huge opportunity for the partnerships to get and identify their 2 per cent of the population and, importantly, to do something about better supporting them. We do not know yet whether the distribution is appropriate. We are gathering the community data that is necessary to understand the full picture, and we will be helping partnerships with that. Locally, that kind of analysis will enable people through strategic planning to look closely at whether people are getting the right kinds of care to maximise their wellbeing. By putting a human face on data, the new partnerships will be well placed to focus on priorities for improvement, on the people who need and use care most to improve their wellbeing and on improving the sustainability of services. In future, that might mean providing more care in communities and less within the hospital environment when that is not in the best interests of the person who is receiving care. We still have some way to go on shifting that balance. Tackling delayed discharges and managing unscheduled care remain among my highest priorities. We allocated significant additional funding at the end of last year to reduce delayed discharge. The impact of our overall investments in delayed discharge will take some time to be felt, but I was pleased that the January census showed that 20 local authorities had delays over two weeks in single figures and are well placed to deliver the zero target to April against that two-week target. Our focus over winter was on easing pressure on the acute sector, so it was pleasing to see the most recent statistics indicating some improvement in delayed discharge across that period. We are not complacent, but we still have much to do. One patient delayed is one too many. I want to eradicate that problem. For those people who are delayed, we are providing the worst possible outcome at the highest possible cost. Clinical evidence shows us that any delay over 72 hours is detrimental to wellbeing. At the January census, 14 local authority areas recorded fewer than 10 delays of more than 72 hours, showing that it can be done. We will see that our indicators for integration include performance against a 72-hour discharge measure, which has been agreed and welcomed by COSLA. Two priorities are key to implementation of integration. The first of which I have spoken about at length is improving outcomes for people using services. The second, without which the first cannot succeed, is to support the workforce into and through implementation. The quality of health and social care in Scotland depends on its compassionate and motivated workforce, ensuring that the workforce is organised appropriately to provide the right care in the right place at the right time will be central to success. People who work in multidisciplinary multi-agency teams tell us that it is better for them and better for the people that they care for. Integrated working means that people are not working in silos. It avoids the situation in which the left-hand does not know what the right hand is doing. Most importantly, it is satisfying to know that you are working in a team where the person being cared for is supported to achieve the outcomes that matter most to them. Our ambitions for health and social care integration are clearly set out wherever you live and whatever your circumstances we are committed to ensuring that this country is the best place to live healthy, fulfilling and independent lives. I am very happy to accept the amendments, Deputy Presiding Officer. I think that they, in the spirit of consensus, add to our motion and I move the motion in my name. Excellent. Many thanks. I now call on Jenny Marra to speak to you and move amendment 12710.3, 10 minutes or thereby, please, Ms Marra. Thank you very much, Presiding Officer. I thank the cabinet secretary for this opportunity this afternoon to debate integration of health and social care services. She and I both agree that this is one of the biggest challenges in our health service at the moment but that it is a complex challenge and especially on a local level, a complex and difficult challenge to get these things right. The integration of health and social care is a reform that Scottish Labour has advocated for a long time now and is firmly a shared ambition of this Parliament. Against a backdrop of an increasingly ageing population and straightened budgets, getting an efficient and smooth patient flow through our health system is absolutely essential if we are to end the shortfalls in care, which I think that we have to be honest, which are in our communities today. It should form part of a shift to a more preventative focus to delivering healthcare, which deals with smaller problems and identifies problems before they manifest themselves or become too big to manage in the home or in the community and then end up in our hospitals in the acute system as bigger, more expensive problems both for public budgets but also for the impact on people's lives and their families to deal with. We recognise the hard work that is going into making this happen, the hard work by our local authorities and our health boards across the country and the willingness of people to create meaningful and effective working partnerships for the good of patients. We also acknowledge the difficulty in managing such a change and welcome progress that has been made by the Scottish Government and the local authorities across this country. The establishment of the joint integration boards is a critical step in making reality a reform that will hopefully allow us to protect and care for predominantly elderly people but for people right across our communities and those who are vulnerable in their homes in a way that we would want to care for our loved ones. I am struck by the many representations that I have had from stakeholders on those issues because we know that they are complex and difficult challenges. There are procedural issues that have been raised with me such as ensuring that our various local partners are consulted and nervousness around budgets. Those two sides, as we speak here today, are coming together and thrashing out budgets on how much the health boards and local authorities put into this. I have had many representations from councillors as well as to how local authorities will meet the budget constraints that they are expected to come up with, but there is broad agreement on the principle of bringing together these two essential services and ensuring a joined up and consistent approach. With such good will going forward towards a difficult project, I am confident that everyone involved is doing their very best to make this a success. I am sure that we all agree that, though ensuring a more functional way of delivering health and social care is an important step, it can only be a starting point. I would like to quote from the briefing that the BMA has given us today, which says that structural reform is not an end in itself and it is vital that those proposed new models for health and social care focus more on outcomes than on the management structure. That is why I welcome the cabinet secretary's publication of the core suite of indicators that give us a starting point as to what those outcomes look like so that we can measure progress against that. The British Medical Association also cites investment in building capacity in community and social care services as one of the key issues that need to be addressed. That is the essential point. When you have one budget struggling to deliver a service and another budget under constraints 2, pulling them together does not automatically deliver the results that we would want. I am sure that the cabinet secretary has had representations on that, as I have had. Unless we properly resource our hardworking NHS staff and care workers with what they need, we will continue to see a logjam in the system and patient care will continue to be impacted. The board's integration on 1 April, as I said, is only a starting point to that, but I think that a bigger step in the right direction would be a proper resourcing of care workers so that we can move to a point where all care workers across the country are earning the living wage and there are more of them to deliver the care that we need. We also know—and Labour has argued this point in the chamber before—that we need more nurses in our NHS to deliver the care that is required both in hospitals, in the acute setting and in the community. It would be remiss of this debate this afternoon not to rehearse some of the challenges that people in our communities are facing, because this is a quite technical and complex matter that we are putting together these joint integration boards. However, the human face of this is never far, I think, from all of our surgeries as MSPs, but certainly in our communities. It is important to remember why those changes are necessary and why it is very important that we get this right. 15-minute care visits, leaving our elderly with insufficient care and more likely to end up in hospital as a result of that care that they are not getting. Unexceptible levels of delayed discharge—I take the cabinet secretary's point that she is making some progress, but I am sure that she would agree with me as we had this debate in the public forum a couple of weeks ago that the delayed discharge figures are still unacceptable, meaning that people are kept in hospital beds at an expense to their own health, but at a massive public cost. I thank the member for taking intervention. In some cases, local authorities are simply not working with health boards and vice versa, and that causes delayed discharge. Sandra White says that the whole point of this debate today is that local authorities and health boards are coming together to try and integrate this care to prevent delayed discharge. I am trying to go through the impact in our communities, but I think that that is indeed the whole point of this. When she says that some local authorities are not working, perhaps she touches on quite a good point. I think that from what I have heard that some of the integration models across the country—and the people I have been speaking to—it seems to be working more smoothly and the boards are coming together in a more holistic way in some parts of the country and perhaps not so in others. I did want to ask the cabinet secretary perhaps if she can address this when she is summing up later on. If there are going to be standards across the country, we are making sure that there are standards that are set by the Scottish Government so that we do not have a postcode lottery for want of a better phrase where standards of integration are working better in some parts of the country than there are in others. To go back to the human impact of this, we know that delayed discharge means that people are in hospital at a cost to themselves and their own health but also at a great cost to the public purse when they should be at home. We know that half a million bed days have been lost and more than 400 patients have sadly lost their lives while waiting to be discharged after having been medically and clinically fit to go home. We also know that the failure to meet accident and emergency targets across Scotland, time and again and especially this winter, are having an impact at the other end of the hospital, at the back door of the hospital, and this is an integrated problem. We know every time we fail to get this care right that it is a sick or vulnerable or an elderly person put through a distress that should not happen in our modern health service. Despite the clear challenges that we face with our ageing population and both budgets of health boards and local authorities under serious pressure, we must do better and we must get this right. We welcome the progress that has been outlined today but we should also recognise that we are still a long way from realising our ambitions and I would reiterate again that I think that integration on 1 April is really the first step to getting this right. It is our intention, Presiding Officer, to support the Government's motion this afternoon and I thank the cabinet secretary for supporting our amendment today as well. In the spirit of that, I would be very interested if the Government could set out perhaps their plan of how exactly delayed discharge she said that she would pledge that it would be ended by the end of this year, is that the end of this calendar year and therefore is there a plan on top of the integrated boards as to how she will manage to do that. I share her determination and I look forward to the cabinet secretary meeting her pledge on delayed discharge. I think that today is a good opportunity to debate this important issue and I look forward to hearing the contributions. The cabinet secretary said that this debate is timely, given that all health boards are required by law to submit their integration schemes for ministerial approval by 1 April, and the new health and social care partnerships across Scotland must be up and running by the same date next year. Even before the legislative route was considered, there were a number of areas of good practice where progress was being made towards the integration of health and social care, notably from my point of view, the excellent collaborative work in West Lothian and in Highland, which I saw at first hand as a member of the Health and Sport Committee. Unfortunately, such good practice was not uniform across the country, hence the need for legislation. I am pleased to hear that the first integration joint board for Ayrshire has been approved this month and I look forward to the forthcoming establishment of health and social care partnerships throughout Scotland. From the unprecedented number of briefings that we have received ahead of this debate, it is clear that there is complete agreement across all sectors that integration is vital if the 2020 vision for health and social care, which has cross-party support in this Parliament, is to be achieved, and that that will require the on-going commitment of NHS boards and local authorities to work together in pursuit of the outcomes that Scotland's patients and service users need and want, with services at local level designed with and for the receptions of those services. Without integration, it is hard to imagine how the complex needs of an ageing and increasingly frail elderly population can be met and the aspiration achieved of people living good lives as healthy as possible in their local communities for as long as possible, reducing the need for unplanned hospital admissions and hence relieving the pressures on our emergency services and helping patients to flow through secondary care when that is needed so that delayed discharge ceases to be the serious issue that it is currently. However, it is clear, as others have said, that there is still a considerable way to go to achieve the necessary integration between all the health and social care services that are required to cater for the increasing demands of demographic change, and a number of organisations have expressed their current concerns to us this week. The BMA stresses that health boards and local authorities must engage meaningfully with clinicians from both primary and secondary care at both strategic and locality level, and there is a clear message that GPs must have a leadership role locally, with the authority and influence to deliver effective integration. GPs, in my opinion, are pivotal in directing care for their patients, and their activities account for around 50 per cent of total spending on the NHS in Scotland, so clearly their role in the planning of integrated services is crucial. I confess that I was a little bit dismayed at the health committee meeting this week when we were discussing seven-day working, that although around the table integration cropped up on several occasions, GPs were scarcely mentioned until I reminded witnesses of their key role, which, of course, they did agree with. The College of GPs, the RCGP, would like to see general practice recognised as the major hub in a network of community health provision, working, of course, with a team of health professionals, including health visitors, district nurses, advanced nurse practitioners, associated health professionals and social care and third sector providers, all of whom are key to the wellbeing of an ageing and increasingly dependent population. Historically, those various professionals did work in silos, parallel to rather than with each other, and it requires significant change in culture and trust for these people to set aside their professional differences and come together as a team, focused on the holistic needs of every person within their care. The GP is the obvious person to lead such a team and to be fully engaged in planning local services. Having seen it first-hand, the success of the former local healthcare co-operatives, I read with interest the BMA's proposal for GP cluster groups within a geographical locality working together and advising the health and social partnership on the provision and performance of services locally, which they suggest would give local control over service delivery, allowing early resolution of problems and the development of best practice for patients and service users and engaging the GPs within the locality. Of course, we lost that engagement with the much larger and less responsible CHPs as well. I was not aware of that, but I am glad to hear it, because I think that it is a fundamental point. The third sector also has a key role in the successful integration of health and social care and could make a very valuable contribution to service planning. Many good projects were developed using the change fund for reshaping care for older people such as the befriending service set up by voluntary action orcney and a transport collaborative project in my own home region working to improve and co-ordinate health and social care transport and remove a barrier for older people to get to medical appointments or to allow them to get to local activities aimed at reducing social isolation. There is concern in the sector that a loss of change funding could jeopardise the provision of excellent preventative measures such as those that have been shown to improve the wellbeing of many people and have cut down on the number of GP and nursing consultations. Marie Curie has stressed that health and social care services are crucial, and I agree to ensuring appropriate care for people with terminal illness, whatever it is and their concern that at the present time there is a lack of progress by some integration authorities in coming together and they are worried that if the transition towards integrated care is not carried out smoothly there could be an adverse impact on third sector services which involve partnership with statutory bodies and which need decisions and funding to be agreed for service level agreements. The RCN points out some issues which they feel need to be addressed in the year which remains before the deadline for integration if we are to be confident that integration plans will indeed improve care for the people that they represent, such as the need for quality and safety to be written into commissions for providing services whoever is delivering them. To ensure the robust governance of care, they have developed a checklist of issues which they think local integration teams should address. Of course, they also point out the need for integrated IT systems across health and social care. Nearly all the issues raised in the briefings we have had indicate a need for investment and some concern was expressed particularly by the BMA that the previously announced 100 million may not have been sufficient to build up the community and social care capacity needed to achieve genuinely integrated care, so I have no doubt that they will be encouraged by today's announcement of the further 200 million over the next two years. To conclude, there is widespread support for the integration of health and social care but, as our amendment suggests, there are still enormous challenges to be overcome in order to achieve it, so I move the amendment in my name and we will also support the other amendments at decision time. Thanks very much. I now call on Jim Hume to speak to you and move amendment 12710.1, an assembly generous amount of times available to you, Mr Hume. Thank you very much, Deputy Presiding Officer. I'll start by welcoming today's announcement of 200 million pounds into the integration fund and the mention of, of course, telehealth and mental health services capacity. This debate is timely. We've approaching the deadline for local authorities to produce their integration schemes. That said, like others, I note that Ayrshire has already had its scheme approved by the cabinet secretary. Clearly, the success of good integration will lie with detail from the very beginning. However, there are challenges that we must address early on to achieve the aims of the act and the Scottish Government. I'm sure that it won't be complacent at this stage. The health and social care integration comes at a moment when there's the chance to prevent a crisis from materialising. I want to bring to the debate, like others, the views of the British Medical Association. First, ensuring sufficient capacity building in community and social care services must be accompanied by recurring and sustainable action for long-term planning. Secondly, engagement must be among primary and secondary care clinicians on the relevant integration joint boards and monitoring committees to allow for, of course, a co-ordinated and effective integration. Thirdly, allowing medical leadership at a local level where GPs are actively and strategically involved in the planning of this integration. I think that those three points are the key to ensuring that patients and communities receive the necessary and appropriate capacity and support. We know that this change will not happen overnight. Transition must occur in a highly facilitated manner while addressing the main drivers for health and social care integration. We know that bedwalking is still a real threat to the maintenance of a high-quality healthcare provision in hospitals. I welcome any progress that we are having, but the Royal College of Emergency Medicine warns that the lack of hospital beds after emergency admissions is one of the main causes for higher patient mortality, simply putting crowding duds kill. We have heard this call from other experts. Patients are not being released from hospitals on time, causing bottlenecks in the system, reducing the capacity of caring for new patients. The numbers show that almost three quarters of total delayed discharge bed days are occupied by patients aged 75 and over. That number is estimated to double in the next 10 years. We regret that the Government cut a third of geriatric beds since 2010, before integration was in place, as that has put additional pressure on the system. We know the choking figure of almost 170,000 bed days lost as a result. An ageing population is a taking time bomb and less addressed. More people are having to live with multiple complex and long-term conditions, so getting the right treatment at the right time in the right place for those we need is critical if we are to continue on track to make Scotland a leader in healthcare service provision. We also need to think about palliative care and how we can improve access to that. We know from an earlier Murray Curie, Edinburgh University and NHS Lothian research that only 20 per cent of non-cancer patients in Scotland are receiving palliative care before passing away. Most patients in the study were identified for palliative care too late to fully benefit on average only eight weeks before dying. The resources put in place for integration should include those who are at the end of their life who need support, empowerment and information to soften the transitions in their mental and physical health. That is also echoed by the British Heart Foundation. The British Heart Foundation is running a pilot programme of cardiac psychologists in NHS North Ayrshire and Arran for supports given to patients of heart disease after major incidents. Within two years of such incidents, 50 per cent of patients develop depression unless appropriate and personal care is given. However, that is beyond the capacity of clinicians at hospitals. People should be assured of support when they return home after long hospital stays. The only way to achieve that is through ensuring a successful integration from the very outset. That is why I want to point out the importance of the last two points of the BMA. Involving GPs who have an integral role to play through their expertise in public health must be highly encouraged and facilitated. The Royal College of General Practitioners is calling for GPs to have the network literacy to ensure that patients receive the care they deserve. However, I remain concerned, and the cabinet secretary will not be surprised that it raised the fact that funding for general medical services has been cut to a record low. I realise that the cabinet secretary will be at pains to talk about the £40 million of additional funding, but I am told that there is a lack of clarity from those in the profession about where exactly this money is going, indeed where it has been deployed and if it has actually been allocated yet. Perhaps the cabinet secretary may mention this in her summing up. Integrating health and social care is no small task, but for the welfare of patients and for the dedicated health and social work staff who will be empowered to provide better care for their communities, integration is, of course, very welcome. It is a long-standing ambition of man, politicians and health professionals alike. The challenges must be acknowledged by this Government for it to be successful, and we need the Government to give the professionals the support that they need to allow them to give their patients the best of care. With nearly 170,000 bed days lost to boarding, the sticking time bomb cannot be allowed to continue, and I look to the cabinet secretary for assurances that she will support the Liberal Democrat amendment, which reflects the views of health professionals across Scotland. We shall be supporting all amendments and the Government's motion today, and I move the amendment in my name. We now move to the open debate. We have a bit of time in hand today, so I can be generous with time, and I firstly call on Bob Doris to be followed by Malcolm Chisholm. Thank you very much, convener. This morning, I spent my morning meeting a gentleman called Tommy Taylor, 100-year-old today. He stays up in Parkhouse in North Glasgow. He is a wonderful man, still very sprightly. He stays independent living, and he stays in sheltered housing, but he has his own house. It was a privilege to meet him and pass on my kind regards to him. He was not part of a ticking time bomb. He was part of the celebration, which is people getting to live into old age to be happy and healthy and content. I am not deliberately having a go at Mr Hume. It is just that it does not sit easy with me that expression of ticking time bomb. If we have an issue in a problem of people growing older, we will get an issue with our value set. We should relish people growing older and value society. I know that that is not the expression that Mr Hume was meaning. The point of his suggestion is that it is forecast that we will have more people that are over 75. The majority of beds being blocked are from people of elder age. Therefore, there is a problem that we are going to get more and more pressure on beds. I was not trying to be unhelpful. I was just trying to make a general point about healthy active ageing, and we want more of it. That is all I was trying to do. That debate is an opportunity for the entire Parliament to come together and unite around the clear benefits that should flow from health and social care integration. With integration beginning in April 2015 and to be fully implemented by April 2016, it is important that local integration partnerships are supported and resourced. The Scottish Government has clearly invested and continues to invest much resource. I am going to list some of that investment, but for a very specific reason, I am going to run through some of that investment just now. For instance, the integrated care fund, which we have heard love will provide £100 million in 2015-16 for partnerships to improve outcomes and to support service redesign in favour of prevention. Such financial support will be built on from investing from the reshaping care for older people change fund, which we have already heard about £300 million over four years ending this year. If we feed in the mix of £73.5 million to pretend centrally for nationally supported initiatives and an additional £100 million specifically on delayed discharge, we will get a very self-evident picture of huge investment in this area. The point that I want to make is that cash invested does not necessarily make a measure of the quality of service provided to patients. That is the reason for listing the undoubted resource that has been put in. It is how the money is spent, how it is invested in a strategic and coordinated way. That is what makes the real difference. It is the lived outcomes of older people. That is what matters. Just a couple of things in relation to the change fund for older people. We now have this new £100 million fund. I am minding that Health and Social Care Alliance Scotland has drawn more attention to the fact that a lot of what they would see as successful pilots from the reshaping care for older people monies has not been mainstreamed in the real challenge for the new integration fund over the coming two years. I am delighted that extra £200 million investment is that some of that is mainstreamed and it is not recurring pilots. I think that that is a real challenge that we have. I just wanted to put some of that on the record as well. At health committee on Tuesday, my Labour colleague Dr Richard Simpson spoke of consulted vacancies in the NHS in concerns over nursing numbers that have been trained. In my comments, I noted that 1,200 additional consultants existed in the system and I noted 2,300 additional nurses under this current Government. I was trying to put into context the comments that Dr Simpson was making but I should also point out that I stressed that it was about having the right professional with the right skills at the right place at the right time to help out and that would always be a consultant and it would not always be a nurse. I just get a feeling that on all sides of the chamber, including on this side, we sometimes have been counting the headcount on things that get the headlines, be it consultants or be it nurses. However, some of the evidence that we are getting through the health committee is about a well-resourced, well-planned, multi-disciplinary team. Maybe it is not always 1,000 more nurses you need. Maybe it is five or six more nurses in a certain place with a physiotherapist and another OT and a social worker available at weekends. Maybe it is that kind of thing and when we take forward our integrated workforce planning, perhaps we have to be less simplistic. Yes, we need national workforce recruitment plans and training plans for nurses and for consultants but at the very localised area I think we have to get better fleshed out workforce planning and it is not that impressive for politicians to talk about can we just have four more nurses and one physiotherapist. It makes sense to say give us 1,000 of this and 500 of that and we grab the headlines but it is about real quality local planning and multi-disciplinary teams and surely to goodness that is what health and social care integration is about. I just wanted to put that on record here this afternoon. So many different things I wanted to say. I should mention Glasgow of course and an equal measure can I give Glasgow city council criticism and praise. Hopefully that still keeps the consensus on board today. I think there has been a bit of active gatekeeping for vulnerable, lively people in Glasgow seeking to get residential home placements. I've got constituency cases that I believe would flesh that out and I've got significant concern over it but in the same breath I have to say to you that David Williams, the head of social work in Glasgow is also the head of the shadow integration board and he along with the health board have fast-tracked 120 new intermediate beds. Hopefully to tackle that very problem that I'm saying. So criticism and praise in equal measure. Maybe we're starting to see some of the fruits of health and social care integration happening because actually it's about cultural shifts rather than structural change and that's a theme that I think all the briefing papers we've got here today wanted to say. I want to talk a little bit about carers because part of that health and social care multidisciplinary team does for me mean care staff in a residential home somewhere. We do maybe have to get a bit more clever at churning out, identifying where there's care worker churn because you need stable committed care home staff to provide a quality service in the care home. We need better at home care to have people living happier and healthier at home in the first place before they go to a care home. That's all part of active positive local planning in the local area. I suppose my appeal in finishing off is less of the headline grabbing claims about 1,000 more of this or 2,000 more of that and good quality local planning that doesn't grab the headlines but delivers for our constituents. Many thanks. Now a call on welcome to them to be followed by Sandra White up to seven minutes. That, Presiding Officer, as Jenny Marra reminded us, quoting the BMA structure, structure order form is not an end in itself. While much of the guidance and regulations over the last few months has been about structures, the truth of the matter is that structures are unnecessary but not sufficient condition for successful integration. During the course of the bill, various experts kept emphasising that the key issues were culture change, leadership, bringing teams together on the ground and locality arrangements, which are meant to be the engine room of integration. I suppose my first concern is that there doesn't yet seem to be any clarity about those locality arrangements. I tried to introduce an amendment at stage 3 to put something about locality arrangements on the face of the bill, and Alex Neil, the cabinet secretary at the time, said that it wasn't necessary because there was going to be statutory guidance, but the statutory guidance hasn't yet turned up. I think that there's a general issue that some of the guidance in general is being delayed. I know that the City of Edinburgh Council told me that it finalised its scheme with NHS Lothian at the beginning of November, and then suddenly a guide to reviewing an integrated scheme appeared on 14 November, and it had to make major changes to its scheme. Anyway, that's water under the bridge now, and it has finalised its scheme. In terms of locality arrangements, the Scottish Government needs to establish clear frameworks and responsibilities. We need to know what localities decide, what is their role in delivering outcomes, who is going to be involved, and will budgets be devolved to them. It's very important in particular that all health professionals are part of that process. We don't want the problems that we had with CHPs where GPs weren't enough involved, but equally we don't want the problems that we had with LHCCs before them, where other health professionals, apart from GPs, weren't sufficiently involved, so clearly nurses and all health professionals need to be involved. Clearly a lot of the hopes for integration are around dealing with problems about unplanned admissions, so it's welcome that the specialities commonly associated with the emergency care pathway are all going to be the responsibility of the integrated joint board. I'll talk about that because all areas apart from Highland are following that model. Clearly, avoiding unnecessary emergency admissions is the kind of holy grail of health policy for over a decade, and the associated problem of eliminating delayed discharge, so it's very welcome that the cabinet secretary has said that the indicators for those two issues will be absolutely central in terms of evaluating the success of integration. Jenny Marra rightly said that investment in social care services has to be absolutely crucial to that, and I certainly know from a recent constituency example what problems there are in social care. We all know about the 15-minute visits, but the example that I've had recently over a period of weeks is a man who, I think, is in his nineties, and he needs to have two people visit him four times a day, and it's just not happening on a regular basis. Sometimes there are mis visits, sometimes one person comes instead of two, which is no good since he requires to be lifted. It's a private provider who says that they can't deliver this because staff are leaving and they can't get staff. The council can't take it over, so to me it's kind of encapsulated the problems of social care currently. Now, I think that, while welcoming the fact that we've got the specialities commonly associated with the emergency care pathway in the integrated joint board, there is, of course, a potential downside of that, and that's been highlighted to us by the Neurological Alliance, who are out in the member's lobby, all of this week. Their point is that neurological care is going to be part of the non-integrated services because there aren't a massive number of emergency admissions, and it's the number of emergency admissions that dictates whether the speciality is going to be in the integrated board. So, neurology won't be there, and they're worried that those who are left as it were with the non-integrated services will see little change in their care. They point out that specialist nurses that we all know about for neurological conditions and other NHS professionals must have good links to colleagues in the community. When I talked to one man, particularly at the Neurological Alliance last night about the problems that he had getting care at home and care workers weren't relating to the health service and care workers weren't allowed to touch his medicines. It's just encapsulating that hard divide between local authorities and health service, which we're trying to get beyond. I'm just noting the concerns of neurological organisations because they're not going to be formally part of the integrated process. Again, talking to some of those organisations last night in the Neurological Alliance reminded me—I'm sure that we don't really need to remind you—of the absolute crucial role of the third sector in services in the community. I think that it was Jim Eadie that hosted a reception for this A Stitch in Time report a few weeks ago, which was really about older people with degenerative neurological conditions in Lothian and how the work of the various third sector neurological organisations not just prevented avoidable hospital admissions but also optimised their independence and wealth being. It really leads to the general point that we must have the third sector centrally involved in the new integration arrangements, both in terms of providing services, co-ordinating care and contributing to strategic planning. Of course, the other people—it's unfortunate that this is coming at the end because they're more important than anybody else—the people who use support and services must be full partners also in the design, delivery and improvement of health and social care. Clearly, bringing together five health board executives and five councillors is a good start for integration, but it is only a start if integration is to realise its full potential. Many, many thanks. I now call on Sandra White to be followed by John Pentland, a generous six-month. Thank you very much, Presiding Officer. I welcome this debate and as the cabinet secretary has already mentioned, the progress made towards the integration of health and social care. I look forward to the implementation of the new integration joint boards. However, I would like to stress that health and social care integration must be patient-centred. Patients, in particular older people, must be part of the design and treatment—I think that Malcolm Chisholm has already mentioned that—about design and treatment. I believe that it should start from the bottom up. Patients, as I said, in particular older people, as I am the convener of the cross-party group in age and ageing. I must say to Jim Hume that we look upon older people and getting older as something to celebrate. When you see how active lots of older people are today, you can put a lot of younger people to shame. I would like to make that point, Presiding Officer. We need to look at that to make sure that they are, at the beginning, part of the design and treatment to ensure that this legislation does, indeed, benefit all who needs it. I note the amendment in the mill's name, which highlights the challenges that integration presents, particularly among health boards and local authorities, which I have already mentioned. Perhaps we should go a little further. I think that Bob Doris mentioned that as well. I suggest that, in a number of areas, culture change is probably the best way to go forward in that. It is certainly required to ensure that all agencies work together and that this legislation can benefit everyone that is supposed to benefit. I think that Malcolm Chisholm, once again, has mentioned that. That probably took part of what I was going to say, but I think that it is very important. I think that it must include the third sector. It does a fantastic job at the moment within our communities and beyond. If I could just raise a couple of points that have not been mentioned, but are certainly within the integration opportunities. It was outlined in the Public Bodies Bill policy memorandum that one of the key outcomes for seeking to integrate health and social care should be about the utilisation of talents, capacity and the potential of all of Scotland's peoples and communities in designing and delivering health and social services. Also, the integration agenda should be about power balance. I think that that is an important issue that has already been mentioned between health boards and local authorities. People must have greater control over the policies and services that impact on their lives. That is certainly acknowledged by the Government in its 2020 vision. Building on the Christie's recommendations outlines the need to shift the balance of power to and build on the assets of individuals and communities, support the self-management of long-term conditions and personal action and support partnership working, which includes a clear role for the third sector in community planning partnerships and new health and social care partnerships. I wonder whether she would agree with me that neighbourhood care schemes, which are more significant in England, involve significant numbers of volunteers supporting individuals who are vulnerable before or after hospital or indeed at the end of life in their communities, is a model that we should be supporting. I thank the member for that, but I do not think that there is any usefulness putting one agency against another. On Monday, we visited Easterhouse with the committee that we have equal opportunities. I saw some fantastic agencies, such as the Food Train, which were the soldered people. Perhaps one size wouldn't fit all for everything, but I take on board what you are saying. I think that we do have agencies here in Scotland that deliver fantastic opportunities for older people and others in their area. However, there is another issue that I wanted to mention. Obviously, the old population has been mentioned in numerous occasions, and as the population increases, we need to look at the housing providers, which have not been mentioned in the old Hanover Trust housing association and others. We need to ensure that they are fully utilised within the partnership. I am sure that every MSP here has visits in their constituencies, and they deliver a fantastic service from people who have been able to live independently to people who are having help, and they also have a community hub in their area. It is something that perhaps looks slightly overlooked in integration. I think that it should be utilised more, because not only do they deliver localised services and adapt housing for people who need it, but they create community hubs. Obviously, they offer various levels of support, whether it be care, specialised care or independent living. It is something that we should be looking at to fully involve in health and social care integration, along with the other agencies that we have already mentioned. Basically, people want to live independently. That is what the legislation is indeed for. If we look at the housing associations, along with the other community agencies, we will be able to give people a choice, and that is what it should be about, not fitting people into pegs, but giving them a choice of which way they want to live as well. I do appreciate and welcome Jenny Marra's amendment and the recognition of some local authorities working well, along with health boards and others and I do take on board and welcome the suggestion. I think that you might have mentioned a benchmark for some form of care within the community, but then again I do not know if it is possible to make one size fits all. If you have a large local authority and a large health board, would that work the same as small like Highlands? I think that it might be looked at, but I think that it is a really good suggestion. I look forward to the minister coming back on that particular issue in regard to that. I do look forward and welcome also to the annual reports that the cabinet secretary mentioned. I think that it is really vital that we look at if it is working or not. I think that it is really important that we see the results because without that we cannot implement this legislation. I look forward to the implementation of the legislation to ensure that people can live and be looked after with Dignity. Presiding Officer, I look forward to the better health and social care integration along with the improved partnership working to achieve that. Of course, certain things will be necessary to ensure that partnerships work as efficiently and as effectively as possible. For example, make sure that the IT systems used by NHS and local authorities are compatible and that the systems put in place do what they are supposed to do. Unfortunately, from what I hear, this is not going to be a straightforward task and perhaps that should not come as a surprise. Consider that IT projects have a history of being overdue and over budget over and over again. I sincerely hope that lessons have been learned and that we do not find ourselves debating the negative side of integration on such matters in a year's time. Obviously, the NHS and councils are the big hitters in these new arrangements. They have the budgets and the responsibility to get their systems working smoothly in the new setup. However, I want to make sure—indeed, they need to make sure—that this does not exclude or obscure the importance of other players in the partnership, namely the third sector, whose input is crucial to making sure that the system works for the benefit of patients and families that the systems are supposed to serve. However, I believe that the third sector has a really important role to play as part of the partnership, delivering the integration of health and social care services. I believe that there are certain basic principles of partnership working that are essential to the success of the new arrangements from the viewpoint of patients, staff and the third sector stakeholders. I recently spoke to the mental health stakeholder group Lanetshire Links about the importance of ensuring their organisation and others can influence decision making and ensuring that they are not forgotten or pushed to one side when it suits those who hold the power strings or who have a different agenda. For starters, I think that it is very important that the structure and the processes of partnerships recognise the importance of all stakeholders and voluntary sector organisations and facilitate their participation. In a true partnership, decision making is an inclusive process and consultation involves more than just decision makers giving information to those who are affected by their decisions. Consultations should not just be a lip service exercise, it should mean that there is a genuine opportunity for people's responses to be taken on board and a genuine chance to influence outcomes. My second point is that it is important when stakeholders are harassed to sign up for plans, all options are on the table. I believe that that should include options that require support or action by others such as the Scottish Government, other public bodies or a group of professionals. Sometimes it is necessary to do the best we can with available means, but we should not ignore or pretend that other alternatives do not exist, especially when they are preferable and would be feasible if only the Government, however, signed up for them. Transparency is pivotal, so if a plan has been adopted because a better plan has been blocked, then that should be made clear so that those who have blocked better options are held responsible. Thirdly, when a plan is good to wider public consultation, the public as stakeholders should be made aware and get a right to comment on all possible options. Consultation documents should not conveniently ignore options, particularly when stakeholders have specifically stated that they think that certain options should be included in public consultations. Finally, when a plan is agreed, after stakeholders and the professionals have come together, they voted a lot of time and effort in giving careful consideration to the issues before reaching agreement on the best way forward, Big Brother should not ride roughshod over their views. For I know when that happens, particularly if working relationships and careers and funding might be adversely affected, it is very tempting to suffer in silence, so hats off to those who are prepared to put their heads above the parapet and be counted. In conclusion, the integration of health and social care will no doubt have to deal with early teaching problems and obstacles, but I am sure that those people tasked to deliver the changes that will do so regardless of those challenges. As the cabinet secretary has already referred to, he has already referred to providing the leader-sile helmets at the door. I now call on Kenny MacAskill to be followed by Gil Paterson, seven minutes or thereby, as well as interventions. Thank you, Deputy Presiding Officer. I, too, join in the spirit of confidence census and agree with a great deal of the points made by John Pentland. I would like to put on record that this is the right thing to do. Arguably, it is long overdue, and that is why we have such consensus equally. The reason perhaps that it is long overdue is that it is not without its great difficulties and its great complexities. The driver in many instances and probably the biggest driver is the fact that we have an ageing population in the stresses and strains that put us not simply upon our ageing bones but upon the services that are required to provide for them, whether in the national health service or whether at home through local authorities and social care. That is in itself a good thing. I do recall not in this chamber, I think that we were in a previous chamber getting a briefing from a dayer turner then doing research into the age for the national pension. I always recall him mentioning that even in the period of simply, I think, over a year, the average life expectancy had increased by a factor considerably more than that. That is a good thing. The days of perhaps in my parent's generation when you received your gold watch and your sunset was luckily if it was perhaps six months or a year before you departed from this earth was shameful in many ways. People should be able to enjoy their retirement and the benefits that they have accrued over a lifetime, but it does bring challenges, especially for those who have to deal with those who are perhaps more vulnerable, who have difficulties that come with ageing or, indeed, simply difficulties that they have acquired through ill health or other misfortune. It does cause bed blocking, it does result in wasted resources. All of us MSPs know the humiliation that this can bring to an old vulnerable person seeking to go home. The frustration that it can bring and lead to those families desperate to get them out, looking for resources to be able to care for them, a home for them to go to and not to be stuck in a hospital bed, does not come about because of anybody's desire to see that occur. It does not come about because people either in local authorities or in health service do not care. It comes around because of institutional difficulties, and that is why we have to overcome the bureaucracy. I think that the point that was made by John Pentland about people in silos and tin hats has to be put beyond us. I think that, with all experience, the constituency MSPs perhaps are toying and froing that is not reflected well either on the NHS or, indeed, sometimes on local authorities in terms of people trying to get out or places trying to be found for them. Thankfully, they are few and far between, and the overwhelming majority of instances see people coming together to try and make sure that we end that. However, it is not easy. It is not going to be simple. It is very complex, because, as John Pentland correctly said, we have multiple agencies. It is not simply personalities but bureaucracies, but they have to be overcome. I think that all of us of whatever political party, whether we are representing a particular agency of local or national government, the health service or whatever, are obliged to do that, because it is the right thing, as I said, to do at the outset, but it is also necessary and will not be easy. What I want to comment on in the final few minutes, Deputy Presiding Officer, is the law of unintended consequences. I think that we need to guard against that. That is not so much for the cabinet secretary or, indeed, for the Government agencies. It will, though, be for local authorities. I think that we have to guard against the unintentional consequences, and, in particular, on criminal justice social work, because we have to take account of the fact that criminal justice social work is already, perhaps, as sometimes its perceived mental health is less important in terms of public perception, in terms of resources and allocation of the spotlight. Certainly, criminal justice social work is a smaller section of the wider social work family. There can be a great difficulty that, as health and social care integrate, what is already marginalised within social work could be further jeopardised or endangered. I do not think that that would come about through any deliberate attempt by anybody, but because of the pressures that will be brought to bear upon social work, I think that there will be pressures that may impact upon criminal justice social work. We do have some history of that. In Edinburgh, I am old enough to recall the difficulties that we have with Caleb Ness, and it is a consequence of the tragedy that befell that child that changes took place in Edinburgh. Social work was brought within the education ambit within the city of Edinburgh Council. That, I think, was probably pressing in the right thing to do in a world of challenged resources. We had to limit the number of departments, and we had to make sure that we limited the bureaucracy, but there were implications for social work. As a consequence of the implications for social work, there were certainly implications for criminal justice social work. That is but a microcosm of what we are going to see as we go towards integration of health and social care. Therefore, I think that it is incumbent upon those who are dealing with social work and in dealing with challenges with the resources allocated to social work to make sure that all the challenges that they face are significant, including the mental health and the issues that we face there—again, commented on by John Pentland—and the issues that we face in terms of child exploitation, historic sexual abuse and all those issues that cause great public concern and put great pressures upon social workers. If we do not take into account the requirement for the basic job of criminal justice social work, then it is a danger that it may fall off the edge. Where I come from is the requirement to monitor the law of unintended consequences. That is the right thing to do. It will not simply be in criminal justice social work. There will be other aspects of social work where the clear pressure will be on health and social integration. That is where the driver will be, that is where the spotlight will be, that is where many of the indices that are sought by local and national government will be focused. We have to make sure that the consequence of that is that we do not see a debilitation of resources, morale or whatever else. That has to come about. I think that our people expect no less. Our society requires it. The circumstances in the limited budget means that it is necessary. It is the right thing to do, but sometimes when you do the right thing you can take your eye off the ball. That is why my plea to the cabinet secretary is to ensure that she urges those dealing with the challenges that will be in social work to ensure that they do not forget not simply their core responsibilities because they will always have to be that social worker in court for an SCR but to make sure the wider aspects of criminal justice social work. We want to keep it local. We want to keep it at that point of interface, which is why the cabinet secretary for justice will not be going down the road of a single agency, but we have to ensure protection for the necessity of criminal justice social work and not see it thrown out with the bathwater as we see the integration coming together rightly as it is. I now call on Gil Paterson to be followed by Paul Martin, a generous seven minutes. I am pleased to be making a contribution in this debate as a non-member of the health and sports committee. However, at the time of the evidence taking on the public bodies joint working act, which covered the integration of health and social care, I was indeed a member of the committee. I listened intently to the evidence that was before us and I came to a conclusion fairly early from the outset. I speak as an individual in this respect and not in behalf of the committee at that time. It was clear to me that we were dealing with two massive beasts with vested interests in terms of not only delivery and responsibilities of those services but also the size of their individual budgets. From a personal experience, I know that it is very difficult to spend your budget in areas that you are not directly responsible for, whilst, on the other hand, wanting to do your very best with what you have in order to live up to what is expected of you in terms of your own delivery. It was almost inevitable that there was reluctance in some quarters to move outside of their direct sphere of influence, which could be said as a natural state of mind. It is very challenging for Governments in these circumstances. I would like to acknowledge that Governments in the past put a lot of time and energy into attempting to bring about the integration of health and social care, and they have to be congratulated for having the political will to do so. So, when it comes to the present situation that we have now a statutory obligation for the integration to take place, I am confident that the majority of the members across the chamber are committed and supportive of ensuring that this vital process is a success. Although the Scottish Government had to legislate to place a legal obligation on the two big beasts, I do not think that it was anything more than a simple cultural shift that was needed, but that did not materialise. However, the legislation will now, hopefully, encourage this shift to take place in a meaningful way. There are a number of people who are relying on us to ensure that this integration is a success from the service providers themselves to the service users, and we cannot just not fail them. It should be acknowledged that we have had some very successful examples of integration taking place without the need for legislation. For instance, in Weston-Bartonshire, part of which I represent, you can see an exemplary joint working model functioning at a high level, and this occurred without any legislation. The agencies, if I can describe them in that way, could see the benefits of integration not only to the public, and particularly those in need of critical support but also to health and local government as well. Before people forget, we should put on record their thanks to places such as Weston-Bartonshire, which overcame the cultural barriers that still exist in many parts of Scotland to deliver the integration of services. While talking about Weston-Bartonshire, another benefit from the consensus that exists between the health and social care agencies is also at a political level within the local authority. Although there was a political shift and change of colour of the administration, all the parties were still signed up to what was best for the local people. At present, the council is planning a very ambitious programme to provide new state of the art care homes in different parts of the council district. That is all by political consensus and a decision that will have a number of positives, including, for example, providing an opportunity to prevent bed blocking, which will have a positive impact on the health service at a national level and at the same time do a great job for the local people. For integration to be a success, there must be a consensus and that is exactly what the Weston-Bartonshire model shows. I see consensus locally in the commitment to delivering an efficient fare in the high level of service to those in need and care and support that is required. I also see consensus that I have alluded to at a national level to ensure that integration is a success through the working together of the Scottish Government, this Parliament, local authorities and the health boards. I hope that the country and the people that I reap the rewards that I hope flows from what is taking place. We can all take heart and some credit for any success as the work of integration was started by previous administrations and continued and delivered by the present administration. If what we are proposing is a success when all the services work seamlessly together, the end product is what the general public will be satisfied and receive the highest level and care of support just when they need it. It sends a strong message to those that we seek to represent the people of Scotland that, when our Parliament works together, it will be they who will benefit most. I believe that this measure is of the utmost importance. I thank all those from across the chamber and former colleagues and other administrations who have worked for years to deliver it. I am sure that it will be by statute that things will happen fairly fast. I commend not only the motion but the amendments to it. Let us hope for a very successful outcome. Thank you very much. Many thanks. I now call on Paul Martin to be followed by Christina McKelvie. It is not often reported, but there are many occasions in the chamber when all the various political parties represented here agree with each other. The fact that we agree with each other on the principles of what has been brought forward here is the very fact that all of our constituents suffer as a result of the fact that integration has not taken place for something like Kenny MacAskill made a valid point when he said that this should have happened before now. The very fact that it has been interrogated through the various levels of scrutiny in Parliament, and we are going to implement it, I think, is extremely important. We have all heard the familiar tales and the constituents, the caseload that we receive, of those constituents who suffer as a result of the paperwork, the bureaucracy, the work passing that has gone on for many years, and whatever the Government, regardless of the political parties that are represented in the Government, has been a challenge that has faced us for many years. I hope that we can enforce the principles that have been set out in the principles that the minister set out. That is the challenge for me, though, is that, on many occasions, we have heard the kind words and the exchanges in the chamber, but ensuring that the principles that we set out here today and that there is leadership shown by whatever Government is in place is extremely important in ensuring that the legislation is effective because we have passed legislation, the past that integrates levels of Government, but has not been enforced as effectively as it should be. In the interests of consensus, although it is not always the case, I would take issue with the point that Bob Doris raised in terms of the time bomb, the demographic time bomb that I would refer to. I think that we have to face up to it. I can illustrate it in another way that two days ago I turned 40. I was born on 17 March 1967. I know that I do not look it, but I do not expect any other consensual comments in that respect. Can I just make the point that, in the year 2037, I hope to be at 70? Can I make the point that, by that year, it is projected that there will be 1.4 million pensioners in that year? There is a ticking time bomb in the respect of that. I do not think that we have prepared ourselves for the challenges that we will face in that very year. I think that Sandra White made a valid point when she referred to some of the challenges that we will face at that point in housing. I think that it is a valid point for her to make that, in enforcing many of the challenges that have been laid out by the minister. If we face the challenges that I face as a constituency MSP almost on a weekly basis, OTSSments have to be carried out to ensure that someone is able to be released back to their home, and many of those other housing challenges have to be faced. Are we absolutely satisfied in this chamber that our housing organisations across Scotland are preparing themselves for the decades that it faces in the future? I cannot say with any degree of confidence that that is absolutely the case. I will give way to Bob Doris. I think that that is a really helpful point that you make. During earlier on to my speech, I was trying to make the point that sometimes having that OTSSment take place in a Saturday morning might be more important than a natural nurse in a Friday afternoon. I know it is not either or, but I agree that we have to get a bit more sophisticated about our workforce planning and management at a local level. I think that, again, Bob Doris raises the practical realities that are in place. It is all very well for us to pass the legislation. It looks very good in paper. It looks good in a document that is presented to the integration board. I am sure that it will have a number of documents to describe what those boards are meant to do, but when it comes down to ensuring that that is enforced and ensuring that the experience of those constituents and their various constituencies in regions throughout Scotland is enforced, I think that that will be the proof in whether that legislation has actually been effective or not. I can also highlight to the chamber the briefing that we have received from Marie Curie Scotland. I put on record and commend the good work of Marie Curie Scotland. There will be very few members, if any, in the chamber who have not been touched by the good work of Marie Curie. I do not think that we recognise as often as we should their good work and how effective their work is in ensuring that people can be discharged from hospital and that the end-of-life experience is as effective as it should be, but they do in their briefing provide a number of points that I think are extremely helpful. They make the point that so often that 60 per cent of those with a terminal illness would prefer to die at home. I think that that figure could actually be higher than that. I think that there are a number of people who do not even say that they want to find themselves in that position because they do not think that the support will be in place in the first place. I think that the challenge for us is ensuring that some of the points at this one point and many others that were raised by Marie Curie are faced up to it. We challenge that figure to ensure that those who want to die at home that we put in place an effective package to ensure that that end-of-life provision is provided at that point. I say in conclusion that this has been a constructive debate. I have spoken many constructive debates in this chamber, but it can only be effective if we ensure that the enforcement of that is taken forward and that we monitor that legislation and come back to that legislation at a very early stage. I suggest that we ensure that the integration boards are doing what they were set out to do. Thank you very much. We still have some time in hand for interventions if members care to take them. Christina McKelvie to be followed by Joan McAlpine. I start off by agreeing with Paul Martin on his very eloquent words and how we can all work together because the mechanics and the tools and the people who deliver the new integration boards are crucial to the success of its approach. The Scottish Government is well aware that proper financial resources need to be available and everybody has made that case today, but I am sure that they are taking care of that. Of course, it is not all about the money. As well as the undoubted commitment already in place through COSLA, the health boards and local authorities working for the benefit of the people of Scotland, we need to make sure that we extend those improvements beyond the immediate core of integrating adult health and social care, community health and some acute services. With any substantial initiative that changes management structures, we need to be careful to avoid the traditional risks, which are financial wastage and adequate or poorly positioned staffing arrangements. Being on the unison side of many and integration and change to an establishment, then having the staff in the right place at the right time is always very beneficial to the smooth changeover. Then there could be the danger of neglect in the stakeholder groups. I do not think that there has been danger of that here because given the amount of briefings that we have all had sent to us, we can see that there is excellent engagement from stakeholder groups. I fully respect that something like that is not going to happen. It is a nice neat overnight package, and we would love it if it did. My mamma used to say that nothing worth doing was ever easy. Different joint integration boards will probably introduce the system in slightly different ways, but it will be important to ensure that consistency in the delivery of the services is paramount. The vital elements include stakeholder engagement, as I mentioned earlier, clinical and care governance arrangements, workforce and organisational development, data sharing, financial management, dispute resolution at earliest opportunity and the particular local arrangements for each board. It is on the theme of stakeholder engagement that I would like to concentrate my remarks today. As colleagues are already aware, I have been involved in representing the interests of motor neuron disease sufferers for many, many years now. The neurological alliance of Scotland, who have a stall just right outside the chamber, have been testing all our neurons with their tests this week. I am pleased to say that I get 9.5 out of 10. I did not believe that smoking was good for you if you had Parkinson's disease, but there you go. Of course, there were actually 12 questions. Christina McKelvie told me that I get 9.5 out of 10. I obviously missed to pay the ones around the page, so I will go back and do it again. Push me right back down the list and hear me. I thought that I was sitting sitting top there. Anyway, the neurological alliance of Scotland is the umbrella body of organisations and group representing people who are affected by a neurological condition such as motor neuron disease. Nas points out that living with a neurological condition can be a huge challenge for individuals and their families and friends. Neurological conditions are often complex, highly individual and impact on several aspects of a person's life. It is important that everyone involved is able to access the NHS, caring community support that is right for them throughout their life with any condition that they face. The authors add that integration has to be about people rather than structures. It seems so obvious that it should not need to say, yet it is on the present danger that bringing an organisational change to a big entity—two big beasts, as Gil Paterson described them—should never lose sight of the fact that it is for the end users, that those services are directed. The end users are real individual people with their individual needs and we must never, ever forget that. Person-centred care is exactly what integration is designed to deliver. I am concerned a bit less about what it currently takes in rather than what it leaves out. Neurology services will not be integrated within the compulsory requirements demanded by the legislation. I know that it is a work in motion. That is a missed opportunity. As Nass put it on a quote again, that means that most people with long-term or degenerative neurological conditions will receive their on-going neurological care, including out-patient care solely from the NHS. Meanwhile, social, community and primary care will be delivered via the local and decreated health and social care partnerships. It is, I fear, an example of what we need to avoid, where structures become more important than patients. Unplanned admissions to neurology wards account for 54 per cent of all admissions, which is short of the 85 per cent threshold required, but the percentage is misleading. Most people with neurological conditions will not be admitted to a specific neurology ward from accident emergency. They are much more likely to be on a general medical ward because of issues like a fall for an infection. The driver behind integration of health and social care needs to be breaking down barriers so as to help people to access more person-centred care. Nass fears that unless the spirit of integration prevails across all services and not just those that are subject formal integration, those whose care is delivered in non-integrated services will see little change in their care. I would hope that we proved Nass wrong on that. In other words, to make this work, partnerships need to be between the NHS, community, social care, third sector and people, more importantly, the people who are receiving those care services. In a society in which people increasingly suffer from a multiplicity of different conditions and where each person's home situation has a real impact for good but sometimes for bad upon their physical health, we need to grasp that opportunity now. Let us not then use the legislation as an end result, rather let us use it as a framework upon which to build stronger, better and more patient-focused services than the current structures allow. In my 19-year career in social care, a career where, a few years into that, I first met the cabinet secretary, we did not meet through politics, we actually met through our profession, then she knows just as well as me that a big change to win buy-in and support from those who work in it and those who use the services, we need to show that outcomes are going to work. With the imaginative approach and the co-operative approach that I think we are taking in this chamber today and I know that all the organisations are taking to ensure this work, I think that we have the tools and we have the people and more importantly we have the will to make this happen for those who need it, the people who are at the end users, the people who need the services. I remind members that there is some time in hand for interventions, but I also remind members who are making interventions to address the remarks through the chair, because if they turn away from their microphones then unfortunately I cannot hear them, but worse than that the official report perhaps will not pick up the points that they are making, it is more difficult for them to do so. I call Joan McAlpine to be followed by Elaine Murray. Thank you very much, Presiding Officer. It has been mentioned on a number of occasions today, and Christina McKelvie, my colleague, concluded on this point that this debate should be about people and not structures. However, much of the material produced on the subject by a range of organisations that has to be said is heavy on jargon and light on the human touch. Now, of course, we do need to get the management and operational structures correct, and there is no getting away from the fact that this is a very complex process involving a wide variety of organisations and professionals with different cultures and different management styles. However, at the end of the day we are doing this for people, often vulnerable people, and everyone involved in this process must focus on their care, their needs and their individual wishes, including ourselves politicians. That is why I welcome the very specific focus on individuals and their wellbeing in the course suite of indicators published today by the Scottish Government. I welcome the fact that their person-centred outcomes are based on feedback from those whose lives this change is meant to improve, and I welcome the scale of their ambition. The Government has set a high bar, which could be described as courageous, particularly given the financial pressures that we face in delivering public services, something underlined in the budget yesterday, which again confirmed another £30 billion of deeper cuts to come. It is in this context that we view the outcomes published by the Scottish Government. It tells us what success looks like. It will be judged on the percentage of adults, for example, able to look after their health very well or quite well, the percentage supported at home, who agree that they are supported to live as independently as possible, who agree that their health and care services are well co-ordinated and can be described as excellent or good. There are 10 such indicators published today based on feedback, and another 13 indicators based on administrative data, which are no less ambitious or indeed person-centred. Behind every statistic, there is a human being. Those statistical indicators include judging success by reducing premature mortality, emergency hospital admissions and, of course, readmissions after discharge. It also measures the number of falls, the percentage of adults with intensive needs receiving care at home, the quality of care in care homes and the amount of expenditure on end-of-life care. There are 23 such outcomes, and it is vital that we keep a close eye on every single one of them. I therefore welcome the establishment by the Scottish Government of the person-centred health and social care collaborative, which brings health and social care together to help to roll out best practice right across Scotland. That is particularly important, given that those changes will take place at a local and ideally at a community level. Although, of course, we expect national standards of care, different communities will take different approaches. In the south of Scotland, in Dumfries and Galloway, for example, the current local authority and health board boundaries are identical, and they have therefore chosen, some would say, a more radical and ambitious plan for integration. Perhaps the most ambitious in Scotland, I have to say, has still to be approved by the full council and health board later this month. In addition to the services required through the act to be delegated to the integrated joint board, the ambition shared in Dumfries and Galloway by the NHS board and the council is to include the entirety of acute hospital services, including facilities management and women's health services, alongside services as they relate to the provision for people under the age of 18. Full delegation of those services will also serve to alleviate any concerns. It is hoped, such as those that are expressed by the neurological alliances, that some services will not be part of compulsory integration of health and social care. The intention behind the proposal in Dumfries and Galloway is to ensure flexibility and full accountability for the effective deployment of resources to enable the integrated system to focus on the whole health and social care pathway and the ability to redesign right across the system. I very much welcome that it very much hope that it will be a success and offer models to best practice to other parts of Scotland. A number of members, I was pleased to hear, raised the issue of the third sector. I have in preparation for this debate been speaking to David Coulter, chief officer of third sector interface in Dumfries and Galloway. The interface has an excellent relationship with their community planning partnerships and is fully committed to and engaged in the integration agenda locally. The interface recently got agreement from the integration programme board to fund posts that will enable them to have staff dedicated to this particular policy agenda. The money will come from the integrated care fund, which was announced by the Scottish Government in July last year. That is welcome and demonstrates a real desire amongst public sector partners to work with the third sector. However, funding is for one year only, so it is difficult to make plans beyond March next year, which is a challenged third sector organisations that often face at local level. Perhaps Scottish ministers could give some guidance and direction to the joint boards in relation to resources that will be required for the third sector to effectively fulfil its role. I also, in the context of talking about the third sector, take this opportunity to also commend the briefing from Marie Curie and her comments on effective partnership working. The third sector is extremely wide and varied with different organisations able to offer different levels of support and services. Marie Curie makes the point that they have been widely recognised for their expertise in designing and delivering palliative and end-of-life care. They should be involved in the co-design of services, even if they do not actually sit on the joint boards. The consultation with the third sector has to be deeper and wider than simply having the interface sitting on a board and organisations with a specific expertise, like Marie Curie, should be consulted directly. One of my concerns in taking part in this debate was not only would I have an extra seven minutes or so generous timing, but that somebody would already have spoken about one of the things that I want to speak about, which was the radical proposals from the Dumfries and Galloway area and John McAlpine has already described part of that. Obviously, that is taking a little bit out of my speech also. It is important, as John McAlpine said, to realise that there is no agreement. That has to be got from the council, the health board and ultimately from the Scottish Government. It is an interesting proposal and, as to be commended, it was easier for a solution of this time to be developed under Dumfries and Galloway because of the co-terminosity of the council and the health board. It is easier, obviously, for two organisations to deal with each other rather than one council with several health boards or one health board with several councils, which is obviously a more difficult thing. One of the exciting things is that the health board and the council are going to transfer some £300 million of resource budget if that goes through. That is fairly significant. They are doing so because the health and social care partnership board believes that that sort of major transfer actually offers the best chance of real change and also of devolution of decision making to localities. That is important in a large rural area such as Dumfries and Galloway. It means that sort of locality management would occur in the four area committee regions of Dumfries and Galloway. Although the assets would remain with the health board, decisions over implementation of the capital programme, for example, would rest with the locality board and that there would also be democratic accountability through the area committees. Of course, the model could extend further if it is successful. There could be further extensions of this model. I think that Kenny MacAskill made an important point about the potential threat to criminal justice social work, for example. I think that there is also an opportunity in there as well in terms of looking at how well the services managing to work together. There are other opportunities. If you are looking at things such as criminal justice social work, there is a need for agencies and the third sector to work together to tackle things such as re-offending and to look at things such as how to stop young people getting involved, people who are under threat from getting involved in the criminal justice services or system, and how agencies work together to provide services to prevent people from getting involved. As we take those forward, there is a lot of opportunity for other service providers and other services to learn from the experience of integrated care. The model that is being developed could be of particular benefit to communities. In Langham, in my constituency, the health board and the council have already been working together and the private sector providers to tackle the issue where there is strong support for the Thomas Hope hospital, but it is not really a modern hospital. It is an old-fashioned community hospital. It is not really up to what is required now. The only privately owned care home closed down because it refused to take on-board recommendations of the care inspector in the sector over a prolonged period of time. There is also a shortage of suitable housing for an aging population. Those discussions have been going on for a long time, but I think that the implementation of the integrated joint board will help to bring a solution. It does look as if a solution is there, and it will help to bring that solution forward. It means an ability to develop local solutions for the needs of local communities. The way in which social work services, GP services, community hospitals can be managed locally should have the flexibility to respond to need. The combined budget should mean that problems such as delayed discharge can be tackled across the services. In my area, it is not just about people not wanting to pay for care home places. It is not quite as simple as that in parts of Andale and Neathdale. In fact, it is in parts of Neathdale and Upper Neathdale as well. Delayed discharge is often caused by an acute shortage of care providers. It is not because anybody is unwilling to take on provision of services, but the care services are not there. In some of the towns and villages, the majority of the cases that come to me with those sorts of problems are under the discharges. We have not got the services there. There are issues to be addressed in terms of the payment that care workers have, respect for care workers and promoting that as a career. The £3.4 million that was announced in January for Dumfries and Galloway is very welcome, but it is not going to immediately solve the problem. There is other work to be done, and there will be challenges that the IGB will have to face in trying to solve some of those issues. One of the things that I am excited about is that it is only five years since the closure of most of the community hospitals in my constituency, Angam, Llock, Mawthorne, Tharnhill and the centralisation of services in Annan and Dumfries, which was being proposed by the health board. Jim Hume will remember that. He led a member's debate five years ago on that issue. I think that the consultant behind him came and paid me a visit and more or less told us to politicians to keep their noses out because they did not understand the issues. Those of us who were involved said that we are representing our constituents in doing that. I think that that has been a tremendous amount of progress. From the position five years ago, where community facilities were being closed, we are now going to have locality management of those community facilities. That is not going to mean to say that it is easy. It is going to be difficult decisions. Arndale and Estee will inherit area and have four community hospitals, and it is going to be difficult. It is about how you prioritise things for which communities and what takes precedence. It is not going to solve everything, but I think that the important thing is that nobody is going to look at it, hopefully, and say that it is just people in Dumfries making that decision for our communities that should be proper community engagement from service users and their families. It is exciting. I really look forward to seeing how it works in practice, because I think that there will be a lot that can be learned from how we work across services. I very much welcome it. It is a very consensual debate, obviously. That is very gratifying in itself. There is a lot as we go forward and see as the IJBs become established over the next year and then start taking over the work. I think that there will be a lot of interesting things that we can learn and that we will also be able to apply probably across services and to other areas of service provision as well. Thank you very much. Before I call our final open debate speaker, can I indicate to the chamber that there are members missing from the chamber who have participated in the debate? I would encourage them to return to the chamber for closing speeches, as Richard Lyle is now our final open debate speaker. Mr Lyle, I can give you seven minutes or so. Thank you, Presiding Officer. It is unusual for me to be last and get the full seven minutes channel. It is cut down to four or either three or two, or even none at all. It happened to me a couple of weeks ago. Mr Lyle, on this happy occasion, I can give you extra time. Yes, I am more than pleased to take the extra time. Thank you, Presiding Officer. I begin this afternoon by saying how pleased I am to speak in this important debate on health and social care integration. I am particularly delighted to speak as a member of this Parliament's Health and Sport Committee. I thank all organisations for their briefings. Public Body's joint working Scotland bill was passed by this Parliament in February 2014. The bill finally puts in place the framework for integrated health and social care here in Scotland, and has one that has received widespread and cross-party support in this Parliament. I am very happy to hear this afternoon that it is still the same. The bill allows health boards and local authorities to integrate health and social care services in two ways, which continues the approach by this Government in its efforts to devolve decision-making further by allowing health boards and local authorities to agree which approach is best for local needs. First option available to local authorities is delegating the responsibility for planning, resourcing, service provision for adult health and social care services to an integration joint board. This board will include health and social care professionals, the third sector, user care is another key stakeholder. The very minimum is that the health boards and local authorities must delegate. Broadly speaking, it is adult social care services, adult community health services and a proportion of adult acute services. As I am sure those in the chamber know, it will be the discretion of the local partners to decide whether to integrate children's services either now or at some point in the future. In order to achieve the best possible results, health boards and local authority must involve and engage their key stakeholder in the development of a draft integration scheme and will take into account the views and opinions expressed during this process. The second integration model option available to local authorities involves either the health board or the local authority taking a lead, responsible for planning, resourcing and delivering integrated health, adult health and social care services in their area. As with one option one, the lead agency can decide to include children's services in the integration programme either now or a future date. The chief executive of the lead agency will have the responsibility to develop the strategic plan for the integrated services and its choir to set up a strategic planning group. We have the advantage of strategic plans for older people services already being placed in every partnership area in Scotland, which will provide a good staffing place for this work, ensuring that plans should be fit for purpose and as possible regardless of whatever integration option is adopted by a local authority. Integration is an ambitious programme of reform to improve services for people who use health and social care services. Integration will ensure that health and social care provision across Scotland is joined up, seamless, especially for people with long-term conditions and disabilities, many of whom are older people. To this end, the Scottish Government has announced that additional resource of £100 million will be made available to health and social care partnerships in 2015-16. That money has been provided to support delivery, to improve outcomes for health and social care integration, to help to drive the shift towards prevention and to further strengthen this Government's approach to tackling inequalities. I wonder if the member would give way. Mr Doris, sorry. I apologise, Presiding Officer. Yes, indeed. Have you mentioned £100 million that we will in 2015-16? Do you believe that the additional £200 over the subsequent two years that has been announced today was £100 million for 2015-16 and £200 million for the following two years? That gives local boards the opportunity not to think in the short-term but a long-term strategic approach and consistent funding over a longer period of time. I certainly agree with Mr Doris and it is £200 million, not £200 million. You said £200 million. The £100 million being provided will build upon the reshaping care of older people change fund, which has been a powerful lever to support the third sector. NHS local authorities, among others, to work more effectively together and to share ownership of local change plans and delivery. The new integrated care fund will be accessible to local partnerships to support investment in the integrated services for all adults. The funding will support partnerships to focus on prevention, early intervention and care and support for older people with complex and multiple conditions. It is important that we continue with the health and social care integration as a country because the people of Scotland are living longer, healthier lives, which is great news, meaning that the needs of our society are changing and so the nature and form of our public services must change along with them. Over the past 10 years, overall life expectancy has increased in Scotland and our older populations like to increase around two thirds in the next 20 years, as most people have said this afternoon. We need to change however. We need to deliver health and social care now in order to prepare for the future. Presiding Officer, I hope that, by improving the quality and constituency of care for our older people, we can stop the cost-shunting between councils and NHS and put results in older people languishing in hospital when they are fit enough to be sent home. I, for one, will welcome that. To finish, Presiding Officer, I think that it is important that this SNP Government remains absolutely committed to free personal care, which delivers a better quality of life for older vulnerable people in Scotland. I firmly believe that it is only right that older people feel fully supported to live at home or in, as a homely setting as possible, within their own community for as long as possible. The independence and the dignity in Scotland should be celebrated for older people. Thank you very much. We now turn to closing speeches. I call on Jim Hume, Mr Hume, around seven minutes or so. There is still time in hand for interventions. Thank you very much, Deputy Presiding Officer. I think that we have had a quite consensual debate today. I think that there has been good recognition that the extra £200 million on top of £100 million to help with integration has been welcomed from all sides. However, there has been some acknowledgement that there is work to be done and, of course, there will always be work to be done. A lot has been said in this debate about the importance of incorporating all the relevant stakeholders into the implementation of health and social care, providing enough support to the communities, doctors and, very importantly, carers to achieve proper integration is a considerable task that must be planned down to the last detail from the very beginning. A key part of our Liberal Democrat amendment, my amendment today, recognises that. We are happy to support the Conservative amendment, which reflects the need for stakeholder involvement. I emphasise the importance of integrating health and social care and its impact on our NHS, as members have recognised. As I mentioned earlier, we know that there are concerns about the increasing pressures that NHS is facing. The Royal College of Emergency Medicine expressed its grave concerns to me recently that NHS is close to bending under pressure of having an increasing number of patients to care for, with resources not being at the right place at the right time. I want to make it clear to Sandra White and Bob Doris that I absolutely celebrate that we are having more and more older people who are having active lives. Paul Martin helped to clarify matters by stating that there is still that pressure from having an ageing population. For the record, in 23 years' time, I will be a part of the 75-plusers. Let us be clear. By the quarter of October to December 2014, nearly 170,000 bed days were lost by delayed discharge patients. The majority of them, more than 100,000 bed days, were occupied by those patients aged 75 and over. We know that, since 2010, geriatric beds have been cut by a third, so there is a misbalance there. Bed blocking and lack of beds is causing jams in our systems. There are too many people who are ready to go home who are still in hospitals as we speak today. As of January of this year, there were 3,000 patients waiting to be discharged. Those waits extend to more than six weeks. That is no good for patients or, of course, very important for staff morale. In 23 years' time, Mr Hulmo will be a time bomb. I will put that on the record. In terms of the delayed discharge and the serious point that you are making, there are significant challenges to a number of professions, including allied health professionals, to change their working patterns, be they physiotherapists, OTs or clinicians such as pharmacists. I believe that they are all up for it, but do you agree with me that there could be significant changes in working patterns that are required to assuage the pressures of delayed discharge going forward? Absolutely. We have to look at how everybody works. I know that the Government is working on that. We have to look at GP practices as well. That might not be that popular with many, but we have to look at changes in opening times perhaps. There are hundreds of people waiting more than 12 hours in A&E units because of some of those shortages. We know that A&E admissions for older people are also at an all-time high. With that in mind, Liberal Democrats are also happy to support the Labour amendment. We look to the cabinet secretary for some assurances that she will indeed keep true to her word, as I am sure she will, on the commitment to end bed blocking. From terminal diseases, heart conditions and neurological illnesses that are mentioned by Christina McKelvie and mental illnesses to other physical conditions, the smooth transition from care establishment of care in a community environment is the holistic approach that experts have been arguing exponentially on to improve a person's health. That is why we want to see meaningful engagement with the specialists in the community. We want to see real support for GPs, carers and nurses, but also for the family members who are taking care of their loved ones. As others have said during my carpine, that must be person-centred, which is why involving primary and secondary care clinicians is fundamental to have an all-rounded input into the right direction of community care. As I said, the carers have been mentioned. It is vital that we look after them as they are the ones who will be delivering much of that. We should look at career structures for carers and see whether they can progress their careers within the NHS and towards local authorities as well, so that we can see ways of giving them a more career structure that might be an interesting approach. The implementation of a successful integration of health and social care is a major task for stakeholders. We welcome the Government's announcement, as I said, to allocate that extra £200 million funding over the years. We cannot afford to leave this major project underfunded at a time when we know that there is an aging population and more people having to live with multiple complex and long-term conditions. Integration of health and social care is not a static process. Like Paul Martin, I would support Marie Curie's calls for regular reporting, particularly on palliative end and end-of-life care services. We must look to preventative measures, especially as targets to our older population in their homes. I wonder if the cabinet secretary could confirm today if part of the budget would be allocated for housing adaptations and aids that will allow people to live independently. I note that the health secretary's announcement today talks about telehealth and building up mental health care capacity. I welcome these things. There is a severe lack of service provision for children, adults and older people's mental health services, and I needn't remind the health secretary that treatment times of mental health are being missed. To this end, Lib Dems believe that the health secretary and her ministers should take that bold step that I have mentioned about enshrining and law parity between mental health and physical health. That move would be a clear signal that the Government is taking mental health seriously. I know that the cabinet secretary won't be surprised that I will be mentioning that. It's vital that we focus our attention on alleviating pressures. We know that we exist in the NHS to allow staff to do their jobs and patients to get the care that they need. Integration will be key in achieving that by ensuring that the NHS and local partner authorities work together. Elaine Murray mentioned the Dumfries and Galloway community hospital. That's quite correct. I did have a member's debate on that very subject here. Within a day or two of that, the Dumfries and Galloway Council did withdraw their consultation and you're quite right. That clinician actually said into my office, hell mend you if this doesn't go through, so hell will have to mend me. As we approach 1 April, the role of the new joint bodies should be to develop care strategies not by listening to their constituent authorities and various stakeholders and responding to their needs. Similarly, the role of the minister must not be to dictate to the Government positions but to assist in delivering optimum outcomes. There is still much work to be done, as members have recognised, and I hope that the cabinet secretary will respond to the issues raised in today's debate. As I said, we shall support all amendments and the motion today. Thank you, Presiding Officer. I agree. If I were to leave it at that, I realise that it might not be entirely helpful to the chair, but it has been an afternoon in which I think there has been a great deal of consensus. It's clear that the unprecedented number of representations that we've received have been drawn upon by members all across the chamber in informing the debate that has taken place. Therefore, I want to make some specific points as well as some general ones. However, I have to say, Presiding Officer, that it's been itching my conscience all afternoon since Bob Doris's intervention, in which he told us that poor Mr Tommy Taylor on his 100th birthday had the highlight of being visited by Mr Doris. I simply wanted an assurance from Mr Doris that there were greater treats in store for him as the day wore on. I really wish to give him the opportunity to reassure me. Bob Doris. He was very pleased that he was having a celebratory lunch this afternoon and a surprise party tonight, so I'm sure he won't be telling anyone. However, I did also give him a bottle of malt whiskey signed by the First Minister. I'm sure he'll do the same for his 100th birthday Nicola Sturgeon's First Minister. I think that that's quite marvellous. To know that the duty had been cut on that bottle as well would be a great boost to Mr Taylor as well, I'm quite sure. I can only put on record, Presiding Officer, that where I've fortunate enough to live to be of that venerable age, I wish no visit from my local MSP on that occasion. It was otherwise quite a saintly contribution from Mr Doris, because he was quietly admonishing those of us who feel that maybe another 1,000 nurses for the health service might be useful, funded by one mean or another. I only hope that, where the Government next year to come forward with a similar proposal, Mr Doris will be equally circumspect at that point. I'm wondering whether that really is nothing more than just a headline that's being advanced at that time, but I'll wait and see. What, of course, brought him to his feet was the intervention, the comment from Mr Hume, of a time bomb. Now, I don't look at Drs Milne and Simpson and think that there is a ticking time bomb. There is a challenge certainly for the population ageing that we have, but I understand that I sympathise with Mr Hume. A ticking time bomb is obviously something very much on the minds of Liberal Democrats as we move forward to the general election, although I was a little concerned to hear Mr Martin publicly acknowledge the ticking time bomb metaphor as well. I wondered whether that presaged something too, but this is a hugely important challenge, the whole challenge of health and integrated care. It's had the support across the chamber and through the health committee in all the stages that it's been discussed, but the great challenge is that it is being discussed in an NHS that has built on a sea of shifting sands at the present time, because it's not just this one enormous challenge and all the complexities that are associated with it. It's the fact that, in primary and secondary care and preventative care, in mental health and palliative care, there is a growing recognition that something very substantial and very significant needs to change there too. This challenge sits not just in isolation, but with all the competing challenges that we'll be facing the health service at the present time. When I was visiting an A and E department last week, they said to me, that it's great this social care if the patient presents Monday to Thursday, 9-4. However, if the patient presents after that, we've got a problem, because we don't have or seem to have the apparatus beyond the A and E department in hospitals or out there with social work to be able to put together the kind of package that's necessary. There's one of the big challenges. Another is, I suppose, my mother's example, and she'll not thank me for mentioning it, but she was in hospital recently, and her GP knew nothing about it that she'd been in repeatedly. When she came out, we tried to get an appointment with the GP, whose secretary said, well, if she's been just charged from hospital, she can't need to see the doctor, and the earliest appointment was five days hence in which she was at home, really, in what I felt a completely unsuitable condition. When the doctor finally came, I have to say something was done, but when she was in hospital, nobody gave me a leave. I thought, how are we going to organise any kind of support? Well, nobody discussed it, and I eventually had to rake through old drawers and open up the yellow pages and find something, and I thought, well, I've got the wits to do that, but there must be lots of people, despite everything we say about the excellent experience that many people will enjoy, there'll be lots of people who haven't got the wits who will actually find themselves floundering in a situation that is completely avoidable and totally unacceptable, and I think that's another of the challenges. Dr Simpson. Thank you for giving way. He may be interested to know that we're just completing a freedom of information inquiry that is aimed at determining how many social workers are actually sighted in the acute hospitals, and it is quite surprising how many of our acute units have no social workers actually based there, so his point is well made. I'd like to thank both Paul Martin and Sandra White for raising an issue that I brought up in debates before, which is the whole question of housing as we go forward, because it's not just social housing, it's not just housing associations. What we have to have now within planning is a recognition that we are enjoying a population who are going to live to a far greater age, but who want to stay within their community and want to be independent within their community. Somebody said to me, I don't want to go somewhere where the only conversation the following morning is who survived the night, and I understand how they feel. Thursday afternoon is quite often I feel that way myself, but we need to ensure that people are able to have the option of housing within the community, and as we plan new housing we should be planning that option because that's where they'll be safe. Very often many of the problems that arise are because they've lived too long an accommodation that was appropriate, which as they've aged has become less so, and then creates the problems that arise from that. There were lots of good contributions, I listened to John Pentland, Kenny MacAskill, Gil Paterson, Christina McKelvie, I agree very much with the point that she made in relation to the neurological alliance, they're not part of this, but I think we want to see the same culture shift there as well and not for people to feel that they're excluded from that. From Joan McAlpine, I think she made pertinent points as did Paul Martin about the whole issue of palliative care and the challenge that comes from there. We've relied very much as a nation on the generosity of so many people out there to sustain the palliative care option that we've got, and I think we are going to have to recognise that as a country, as a nation, as a government, as a state, we are going to need to contribute far more directly to that as we go forward as well. Finally, I'd also like just to say that your colleague John Scott, I know, is delighted that North Ayrshire and Arran and the three councils there are ready to take forward plans next April. This is, as I said, a NHS built in a sea of shifting sands. That's not a criticism of it, it's a reality of all the challenges that face it. We have tremendous hopes, which we hope will overcome our fears, some of which were fuelled by the community health care partnership experience, where some of the goodwill that was implicit at the start ended up being eroded, and we need to ensure that that doesn't happen now. But it would be naïve of us not to have some fear for our hopes. This will be something that, I think, will not be smooth. Despite all the goodwill and the expectation, it will create challenges. I think that we, as a Parliament, as a cross-party alliance in Parliament on this issue, will have to step up and face up to and meet those challenges as we go forward. Thank you, Presiding Officer. We in the Scottish Labour Party support integration of health and community care, and we also believe that health care must also be delivered in the community. The Scottish Government's 2020 vision states that care should be delivered at home or in a homely setting. I think that it was very clear today that the whole chamber is united around that aim. A number of speakers pointed out, Gil Paterson and Paul Martin, that it will take much more than legislation to make that happen. It is going to need a culture change within the organisations that we are asking to integrate. It will mean an end to the buck passing that happens just now, and people need to work together with the aims of providing the best service to their patients and clients. We do need more skilled clinicians in the community, more GPs, more nurses, and I disagree with Bob Doris in that. However, I would agree with him that we also need more professionals working, allied health professionals, OTs, physiotherapists, speech therapists, in the like, working in the community, supporting people at home and providing anticipatory care that keeps people well and independent in their own homes. I am sure that the member does not want to misrepresent the point that I was making. The point that I was making is to focus on one discipline that would be nursing and not how they link into multidisciplinary teams. It might not be the visionary idea that we want for health and social care integration, so we should not be simplistic about it. We are not saying more or less nurses. What we are saying is, let's get the right amount of nurses, but let's make sure that it's part of a multidisciplinary team and that it's all planned. Surely you would welcome that. Indeed, and that was the point that I was making, that we need all the health professionals working in the community to provide that kind of support. However, we need to go further, I believe, and we need to get consultants and specialists out of the hospitals and into the communities. That's not always easy, but we have the ability of using things such as telehealth to do that, linking hospital consultants and people who are experts in their field with community medical and care staff. I think that that would make a big difference. However, we also need to empower the staff who are working in the integrated service. They need to be able to intervene quickly. They need to make decisions about care so that they prevent people from going into hospital in the first place. I think that that is hugely important and where it has worked well. Staff on the ground have been empowered to do that. We welcome the cabinet secretary's commitment to ending bed blocking by the end of the year, but, as Jenny Marra said, it would be really good to see a plan of how that's going to happen and, indeed, to keep monitoring it, because I think that it's really important, because there isn't suitable care in the community just now. Elaine Murray pointed out that it's often a lack of suitable care, especially in very rural areas that leads to people remaining in hospital and not getting out. We need to also step up and step down care that prevents people from going into hospital in the first place, but it also speeds up their discharge home, where they would have more specialised care at home until they became more able. I think that it was Jenny Marra and Kenny MacAskill that talked about the effect of being inappropriately stuck in hospital on a person's health, de-skilling them, disenabling them and, indeed, weakening them. They are trapped there without their families around them, and they suffer the consequences of that and feel very disenabled and disempowered themselves. To do that, we also need to invest in our health, our home care staff. We need to have a career, we need to professionalise that service. It's really important that we recognise the skills of the workforce. We need to also make sure that they are trained for the job that they do and that they understand the conditions of the people that they are looking after. I was at a conference in Inverness quite recently where there were two home care workers. One had worked in a nursing home, one in people's homes, and they had done that for a number of years. It was only when they moved to work with Highland home carers had they received any specialist training in the field that they were working on. They said that they had made a huge difference, especially for those dealing with people with Alzheimer's. It's very important to have people care to train to look after them properly at home and, indeed, to be able to use some of the technology that is there to help to look after them properly, such as pressure pads, help calls and the like. A number of people talked about neurology, Christina McKelvie, Malcolm Chisholm. I think it's quite disappointing that this has been left out, because I think that those conditions have a huge amount to benefit from having integrated care, because a lot of their care will have to be provided at home and in the community to allow them to live their lives properly. We need to make sure that care workers are paid properly, ensuring that they are paid their living wage. After looking at how we compensate them for the skills and training that they have, it's really important. We need to end the 15-minute care visit, which I think is really difficult for everybody involved—the carers and the care providers—and have proper paid breaks for home care workers and, indeed, paid travelling time between clients. I think that, especially in rural areas, that is really difficult. Most of all, we need to make sure that the care that is received by people is required by them. It has to be designed by the client and, indeed, by their family and their own carers to make sure that it is, indeed, a person-centred. That is something that we need to bear in mind throughout this whole debate, because it has to empower people living at home. A number of people talked about the role of the voluntary sector and the third sector, both as service providers and as patient representatives. Those roles are very different. Where they feed into the process is different, but they are absolutely crucial. Elaine Murray and Malcolm Chisholm talked about locality planning. That is really important, especially for small third sector organisations to be involved in that, because they can bring a huge amount to the table that is not available uniformly throughout the area. In their localities, they provide that service. Organisations such as Avie More and Barinach and Strasby car scheme, which do an awful lot more than just provide transport in that area, come to mind because they can actually keep people enabled within their own community. It is really important that they are involved in that planning. A number of people talked about palliative care, and I think that I would join with them in paying tribute to the contribution of Mary Curie. They provided us with a briefing today as they have on many occasions prior to debates. They have talked about, as Jim Hume pointed out, that 20 per cent of non-cancer patients do not only get palliative care, so that is 80 per cent of non-cancer patients receive no palliative care at all. 60 per cent of people want to die at home, as Paul Martin said, but do not. It is really important that, when we are looking at this, we consider palliative care. The change fund was used to fund palliative care, where it had not been funded before. That is part of the integration funding. We need to emphasise to those integrated bodies that they need to look at how they provide palliative care in the community. Jenny Marra said that 400 people died in hospital waiting to go home. I am sure that most of them were waiting for palliative care at home, and specialist help and indeed equipment to allow them to go home. It seems to me very wrong that people who want to die at home are not given the opportunity to die with their families around them. A number of people talked about the role of GPs. I think that I mentioned that we need more GPs. People feel that they are not able to access their GPs, which drives them into hospital. I think that we need to look at their role and the role that they play in the integration process as well. A number of people talked about older people. I do not want to use the phrase time bomb. Indeed, some of the examples used in this chamber just say that people are living longer, which is good, but they are also living healthier and making a contribution, and we need to celebrate that. I think that this debate is hugely important, and we are willing to work together with the Government, but people receiving the care have to be at the centre of the debate. Many thanks. I now call on Shona Robison to respond to the debate. Cabinet Secretary, 10 minutes until 5 o'clock, please. Okay, thanks, Deputy Presiding Officer. It has been a very good debate, very constructive, very positive. I want to spend the time responding to as many points as I can. Jenny Marra asked about the plan for tackling delayed discharge. Of course, that had already begun over the winter period with the engagements with those partnerships where the problem was at that is most acute. However, going forward, I suppose to answer that in two parts. First of all, the plan for tackling delayed discharging in Glasgow will be different from the Western Isles and Aberdeen, because there are different challenges to tackling delayed discharge. Some have more developed intermediate care facilities, some have more shortages of care homes in other places, some have more challenges in recruiting care staff in other areas. It is very important that the plan is tailored to meet those local needs. Where the Government can help, of course, is to help those partnerships to identify what works, to share best practice and to support them in the development of their local plan. Of course, that is what we are doing and will continue to do. Healthcare Improvement Scotland will also work to support those improvements in the localities and help those local partnerships. Of course, where there will be common issues such as the focus on admissions, the focus on readmissions and making sure that the plans are robust and will work. The £100 million, of course, over the next three years, is a significant investment to tackle delayed discharge, which will help those integrated joint boards to take forward those local plans. I appreciate that the plans are local and specific and tailored. What I meant to ask the cabinet secretary was how will she ensure, as she pledged, that she will eradicate delayed discharge by the end of the year? I have just explained that the local partnerships will come up with the plans of how they will spend the £100 million significant amount of money that has been put into the system to tackle delayed discharge over the next three years. Where we have the expertise through the Scottish Government and the agencies is to support them in doing that. Of course, it will be the delivery of that resource locally to develop services and deliver services. It will get people out of hospital and avoid their readmission into hospital. Those are the local plans that will deliver the change. Our job is to oversee that and make sure that those plans are robust and do what they need to do. The net mill talked about the engagement of GPs. Of course, engagement of GPs is important, but as is the engagement of other health professionals as well as the third sector and others. Jim Hulme also talked about the primary care development fund. I can assure him that discussions are on-going with, for example, the Royal College of General Practitioners, who I met just the other day, who had a number of ideas about how that resource should be spent. What is important, though, is that that resource and any other resources face in the same direction as the direction of integration. What we want is for that fund to underpin and support all the other things that need to be done to make sure that we deliver the new world of integration. Bob Doris talked about some of the pilots that have been developed through that initial fund. I think that what is important is that the continuation of the fund gives the opportunity for a longer term plan. It can mean, for example, that services can be changed, staff can be recruited over a longer period of time rather than a one-year fund. I think that that is why the announcement today was very important. He quite rightly paid tribute to the development of the intermediate care beds. We have seen a doubling of intermediate care beds, but there is more to be done. That is a good model that we want to see developed in other areas as well. Malcolm Chisholm talked about locality arrangements and statutory guidance. First of all, the guidance and the draft will be shared with stakeholders very shortly, so it is on the cusp. We have kept in touch with partnerships throughout the last six months on the content of the scheme regulations on this. We are only passed in November, so guidance is going to come very shortly indeed. He also made the point about the need for more involvement in the integration of those other than statutory representatives. Of course, that is important. The act and the regulations assure a seat on the IGBs for clinical and professional advisers and the inclusion in the strategic planning group, which must also include the third in independent sectors and people representing, importantly, patients and service users and carers. Sandra White made a very important point. That is the issue of housing, and she is absolutely right. I have been in discussion with Alex Neil, the Cabinet Secretary for Social Justice, Communities and Pensioners, about bringing forward a joint approach on housing to support integration, and we will make an announcement about that shortly. Kenny MacAskill, I thought, also made an important point about criminal justice social workers. They are on the maybe integrated list, so they are not excluded. They are on the maybe integrated list, and we are working closely with those officials working on the forthcoming criminal justice social work bill to ensure alignment. I think that the points that he has made, I will make sure, are fed in and that they are captured, because it was an important point. Justine McKelvie and others spoke about the neurological alliance and some of the points and concerns raised by them. On the basis of what he has said today, I would be happy to look again at the issue, given the close links to other groups and some of the points that he has made. I think that we can do that in short order and make sure that the concerns that members have raised today and of the neurological alliance are taken on board and are addressed. Paul Martin made a related point about some of the practicalities, on a similar point to Sandra White, around getting someone home. Sometimes, actually, it is about an OT assessment. Of course, it is within the integrated care resources that they could use to make sure that there is more of that. Again, it is there to address local issues. If that is a shortage around getting those assessments done, then that should clearly be a priority for that local partnership to take forward. I think that Jim Hew made a similar point about adaptations. Again, there is nothing to stop those resources being used for that. It depends on what those priorities are. Joan McAlpine made a point about some of the ambitious plans that are being developed by Dumfries and Gallow. I would acknowledge that. I think that there are some very exciting plans emerging from the localities, and that is something that should be welcomed. In terms of guidance to help for the third sector and the involvement in the third sector, I think that, as I have already said, there is a requirement for the involvement of the third sector. Of course, we will be monitoring that to make sure that that is seen through on the ground in terms of their involvement. Elaine Murray asked about further integration opportunities. I have mentioned the neurological alliances views on the members that have raised that issue today. I think that, for example, if we look at children's services, a third of the boards will immediately include children's services, a third plan to, and there is another third that does not at the moment. I think that, in the light of experience, that might be something that we move towards on a more basis. If the practices that children set make sense to include children's services, then I think that that is what should happen. We will be working with the remaining third to look at how they can move forward on that issue. I think that, just to close, a number of people have talked about palliative care. I think that that is very important because, without a doubt, the integration of health and social care can provide a much more coherent service around end-of-life care. It is absolutely clear that many people want to spend their last few days and hours within their own home and do not want to be in a hospital environment. It is a duty upon all of us to make sure that a focus of the integrated teams is very much about enabling that to happen, and that should be an early priority of them going forward. Just on Jackson Carlaw's point about the issue of finding care out-of-hours, one of the things that Lewis Ritchie is looking at around the out-of-hours review of primary care out-of-hours—of course, he cannot look at that in isolation—is looking at other issues such as the availability of care services, because we need that cohesion. As we know, things happen not just in office hours and where care is needed. It is quite often not in office hours that can be through the night or at the weekend. Again, integration will provide an opportunity for that. I thank members for what has been a very constructive debate and some key action points have emerged from it. Thank you very much. Thank you for that conclusive debate on health and social care integration. We now move to the next item of business, which is decision time. There are four questions to be put as a result of today's business. The first question is at amendment 12710.3, in the name of Jenny Marra, which seeks to amend motion 12710, in the name of Shona Robison, on health and social care integration, be agreed to. Are we all agreed? The amendment is there for agreed to. The next question is at amendment 12710.2, in the name of Nanette Milne, which seeks to amend motion 12710, in the name of Shona Robison, on health and social care integration, be agreed to. Are we all agreed? The next question is at amendment 12710.1, in the name of Jim Hume, which seeks to amend motion 12710, in the name of Shona Robison, on health and social care integration, be agreed to. Are we all agreed? The next question is at the motion 12710, in the name of Shona Robison, as amended, on health and social care integration, be agreed to. Are we all agreed? The motion is there for agreed to. That concludes decision time and I now close this meeting.