 Welcome to the 14th meeting in 2015 of the Health and Sport Committee. As usual at this point, I ask everyone present to switch off mobile phones as they can sometimes interfere with the sound system. Although I also draw people's attention to the fact that members and officials will be using various electronic devices instead of the hard copies of their papers, our first and only item today is the round table evidence session on the Care of Scotland bill. This is our first evidence session at the committee, which begins today. We are a wee bit later this morning because we had a briefing from Scottish Government officials on the bill prior to coming along. As normal and a round table, we introduce ourselves, my name is Duncan McNeill, MSP for Greenland Inverclyne, convener of the Health and Sport Committee. Andrew Strong, policy and information manager at the Health and Social Care Alliance Scotland. Bob Doris, MSP for Glasgow and deputy convener of the committee. Fiona Collie, policy and public affairs manager from Care Scotland. Mike McKenzie, MSP for Highlands and Islands region. Dennis Robertson, MSP for Aberdeenshire West. My name is Heather Nollar, I am the policy officer for the Careers Trust Scotland. Colin Kerr, MSP for Edinburgh Western. Claire Kerr, network coordinator for the Coalition of Careers in Scotland. Richard Lyle, MSP for the central region. Scott Richardson Reid, policy and development worker for the Scottish Transitions Forum, part of ArcScotland. Lynette Milne, MSP for North East Scotland. Suzanne Munday, chief exec of MeCop. Rhoda Grant, Highlands and Islands, MSP. Ben Hall, communications developer from Shared Care Scotland. Do you have a committee member to ask a question? Rhoda, thank you. Dennis, I see. Are there things that are missing from the bill that people would have liked to have seen in that? There's probably a couple of things. Probably one of our primary focusses has been around hospital discharge. We know that this is a time that's very difficult for carers. Quite often it's the first time that they've become a carer. Large proportions of carers from our surveys say that they're not consulted or involved. Probably one of the main difficulties with that, not just about them not being consulted and involved, is that about 20 per cent say that the person has to be readmitted within one month. We think that it's very important that carers have a choice about caring, but also that they're fully involved in decisions from admission to discharge and that social care services are in place. Without involving carers fully, that can't happen. We did research in 2001, and the picture was exactly the same. There are so many discharge policies and protocols in place, but at the moment they don't appear to be working. That's why we would like to see a duty to involve and inform carers. Anyone else? That's sort of that white piece that we have. Gosh, sorry. Just on your knee and not on you. You're making me blush now. We would also like to see the inclusion of an equal opportunities clause on the face of the bill. We feel that this is necessary because there is a substantial body of evidence to show that very limited progress has been made in supporting carers with one or more protected characteristics. Normally, this is seen in relation to black and minority ethnic carers, but we are talking the whole range of protected characteristics. For example, carers within the LGBT community, disabled carers, and that's a growing number from the evidence that we have. We do feel that the bill could be strengthened with this inclusion. Clear. We would also like the bill to include a statement or principle around carers as equal partners in care. The Community Care and Health Act 2002 recognises carers as key partners in providing care, and this was strengthened in the carers strategy, where carers were recognised as equal partners in care. It's something we had a consultation session with our members recently in March, and it was something that came across very strongly with them. They would like to see carers as equal partners within the bill. It's also something that a lot of people put in their submissions to the Health and Sport Committee, both carers, local car organisations, but also local authorities recognise carers as equal partners within their submissions, including COSLA. Scott, did I see you indicating there? No. Well done. Make a bit here, that's you. Andrew. Yeah, in terms of the question what is missing from this bill, we at the Alliance and I know all of our members think that the bill could be strengthened with the inclusion of emergency planning on the face of it. We think that a specific provision to be included in the content of the adult carers support plan, and in the content of a young carers statement would really make a difference. I'd probably like to take this opportunity to remind the committee that this issue was first raised in 2004 with a petition from the Murio and Carers Group on the impact of caring for the growing number of older carers who were caring for people with long-term, people with lung disability specifically. Some limited progress has been made across the country, but to see that that provisions around about this have not been included in the bill surprised me. The issue hasn't reduced since 2004. There's more older carers out there, 11% of over 65s across the country, and our carers, according to the late Scottish Government statistics, over half of those provide 35 hours or more a week in terms of care. While the Scottish Government has responded to those calls, it's said that emergency planning is not for all carers, all carers won't require one, an emergency plan. I joined enable Scotland to a member of the Alliance in contending that all carers do require some discussion of what's going to happen in the future when they're no longer able to care. If we haven't thought about what happens in an emergency, we run the risk of carers falling through the gaps and not having had that discussion at all. Many of these carers just want peace of mind about what will happen in the future. We're aware of situations where someone with a lung disability, their care is no longer being able to care and their mothers maybe died, and they've been placed in an emergency respite place for a longer period of time than you would really expect. Carers are worried that that's what's going to happen to their son or daughter in the future, and we really need provision around that in order to be more preventative to that kind of thing happening. Thanks, Andrew. Any other panel members wish to chip in at this point? I just want to add a couple of other things. They're really about the bill being an opportunity to explore those issues. I think that the role of the wider NHS is mentioned, but possibly not explored as deeply as it could be. The role of GPs will be absolutely critical. They already have GP registers, which we think are very good, but the question is what happens when someone is on a GP register. There's an opportunity here to formalise or make more clear what should happen. That could be referral to a local care support centre. It could be referral for an adult care support plan. It could be something as simple as a trigger for an appointment to have a discussion about your caring role and what that means to your health and whether you need, for example, a health check. That might be around what services the practice already offers. I think that there's also the issue of the wider NHS involvement in the development of carer strategies. It's very clear that local authorities will have the duty to produce it, but we believe that those should be produced jointly, particularly in the light of integrative services, so that carers have a journey across both services and are very clear what they're entitled to expect. We also highlighted, and a number of carers highlighted with us, the opportunity to look at a method of redress. Now, this has been something that has been on the table for quite a long time. I look back on it, and I think that it's been since 2008. It moved forward to the review of social work complaints in 2011. That recommended that there would be a role for the public services ombusmen in the final stage of social work complaints at the moment when people have a complaint around social work services and go to the ombusmen. It can only be on service failure or maladministration. The recommendation was that there was balance, and it was the same as it was for the NHS, where there was an opportunity for the SPSO to make decisions on professional judgment. We think that there's something missing here for carers to be able to have an opportunity to get redress, to get an answer to a problem without having to go to judicial review and involve solicitors and legal advice, not only the cost of that but the very significant stress. We think that there's possibly an opportunity for the committee to explore this further and to find out where this is at just now and how it can link in, not only with the carers bill but obviously with the wider integration agenda. Scott, and then Claire. I'm not scratching my eye this time. I'm going to clear that. I would second the fact around accountability within the carers bill and where does accountability sit. Looking at the issue of transitions for young carers, especially the bill seems to be a little bit vague, but it kind of meshes with the Children Young People's Act and Child's Plan, risk to wellbeing and how this also meshes with the co-ordinated support plan with the additional support for learning. It very much looks as though in the legislation that the young carers support plan will be something that's supplemental to already existing quite robust planning exercises and it would be good to see that under the duties of the Children Young People's Act there will be one child one plan to prevent duplication across. For accountability to be in place if these carers plans from young carers to adult carers or carers plans aren't actually followed through is the accountability with the local authority or is it with, as my colleague said, something bigger than that? Is it with the ombudsman or something larger? Claire. Thank you. We welcome the duty on local authorities to develop a local carers strategy. We'd like to see in addition to that that they should have a financial breakdown of the resources that they're going to direct to carers support. The financial memorandum itself says that there isn't adequate data at the moment in terms of what resources are directed towards carers support locally. We think that needs to be part of local carers strategy but also part of joint strategic commissioning plans locally. One of the particular reasons for this is new resources will be directed to local carers support through the bill for the new duties. We need to make sure that they are in addition to current resources directed to local carers support. I think that the best way of doing that is through those two mechanisms. Ben. What Claire just spoke about in the carers strategy, I think that there is a missed opportunity to require local authorities to plan for the provision of short breaks to allow for carers to have choice and flexibility. About the services that they access locally. I think that if there was a requirement within the carers strategy that local authorities did that, then that would be a strengthening of the bill from a carers perspective. Okay. That was a quick run-through. I think that it was a pretty good summary of the submissions that have come in. I suppose that maybe we should attempt to get behind some of the issues. I mean, we've got that single journey between community and the hospital and back and forth and the hospital discharge, we've got equality, we've got emergency planning, the financial resources to be identified that's going to improve it from carers, the short breaks and the legislative landscape and the clarity that needs to exist there. So there's a number of issues there. I don't know whether we can, in the next hour or so, usefully explore some of the issues to add to the evidence. Would anyone want to take this a wee bit further or would it be a helpful direct question from a committee member in some of these areas? Yes, Scott. I'll take it forward for now and then pass out to colleagues. The number of transitions, point of view, we have carers that have come to us and the stories are really, really unpleasant. When a young person who they're caring for leaves school, they don't meet the eligibility criteria for health and social care services in Scotland, which means that the person that was caring for them that used to be in full-time employment has since had to quit their job and it means that they might end up divorced from their husband. I'm painting a very bleak picture but these are the stories that we hear. Eventually, they have been known to put themselves at risk to get the services to support them and their young person because of the eligibility criteria is such a big issue for carers and not having access to services. In terms of transitions for an adult carer, that is one area of concern. If we look at the area for transitions of young carers becoming adult carers, again, they have to go through a whole reassessment process and what we're hoping with this bill is that it will come with some financial input into local authorities. The question remains for our members that is the carers assessment unlocking funds to the carer or is the carers assessments only unlocking the ability for carers to access respite or is there any services that the carers assessment will be unlocking in local authorities and we have to bear this in mind within a self-directed support budget. Will it all be in one pot? Will a carer have a pot of money of their own to provide services for themselves to continue supporting and how all this kind of mix together within the Children and Young People Act and all the other legislation, it looks like quite a bleak picture at the moment. The question is then what gives you hope that there will be sufficient and additional funds that would lead you to believe that we'll be able to meet the additional demand that would arise out of this legislation and give you those individual pots of money. Does anyone want to pick up on that? I've got some figures. There was £176 average cost per carers assessment per person. Someone can correct me if I get these wrong and there's looking to be around about £88.5 million put into the local authorities, I think, at stage 2, which is roughly doing very fast maths and I'm not an expert at maths, £2.5 million per local authority to provide these services, but it's kind of wondering will this be fed into a self-directed support setup budget or will it be sitting separately for the carer to get support to continue caring and how will this look in terms of the legislation rollout? Will it be joined together or will it be separate monies? Clare? I'd love to say about Jan to this question, but probably what I'm going to do is ask some more questions. This is the opportunity to do that and we will ask questions here on behalf from the Governments and Ministers. Thank you. As the National Care Organisations, we have also put in a submission to the Finance Committee and obviously we've looked through the financial memorandum and doing that and how costs have been estimated and what the demand is likely to be in terms of care support. So we've got a few questions around resources that go to the bill and obviously it's incredibly important that the bill does have adequate resources because otherwise what will happen is it will be very difficult for local authorities to implement the duties and it may result then in cuts to other services as well. So we want to avoid that happening because any cuts to service users will automatically impact in carers as well because it's a family unit. But some of the questions we have around is firstly, there's quite a few funding streams which are coming to an end when it comes to carers. So for example, the respite funding of £2.28 million is coming to an end. We had, through the change fund, 20 per cent of resources were directed to care support. The same thing hasn't happened through the integrated care fund so there is insecurity around that funding and the care information strategy funding of £5 million is coming to an end. There are resources, for example, in the financial memorandum directed to the NHS so that may cover the loss of the £5 million but I suppose our question is if the financial memorandum is costing the additional duties of the bill and we're already losing funding from other streams, will it be adequate because you need to take that figure away, you need to take away that deficit. We also have a question around preventative support. The financial memorandum costs additional duties but what will be very important in providing a framework for care support is that early preventative support very often provided through the third sector. Now it's really important that that funding continues because apart from anything else the demand will increase when you're providing information and advice in a universal way and you're also providing adult care support plans universally. Naturally those carers who don't meet eligibility criteria will still need some form of service and that will be likely to be preventative support provided through the third sector so that needs to be considered as well and no money is going towards care support in the third sector as indicated through the financial memorandum so we're a bit concerned about that. Another one, for example, would be costings in the financial memorandum for example there are new posts costed in order to look at the duty around information and advice but there are already posts for example in the third sector providing that service what we need to make sure is that these will be additional posts to cope with the increasing demand rather than simply replacing the funding that exists already. So as apologies for not providing solutions it's more questions. That's useful to provide that context. No money else on that one. Dennis, you couldn't come in on something else and then I've got Mike I think that wants to come in, Bob as well. Thank you very much, convener. I want to explore a bit with you the eligibility criteria because from some of the evidence that we've actually received already it seems a very polarised issue to some extent. Some people prefering the national approach to setting the criteria and others prefering a local a more local approach to setting the criteria. I believe that the majority of you here today are supporters or in support of the national framework in terms of the eligibility criteria. If that's the case why do you prefer the national over local and do we have enough there I'm picking up Scott's point earlier in terms of that transition to ensure that especially from young people going into adult carer situations that the eligibility criteria would meet that. I'd like your views as to why you think the national criteria is a better pathway than the local one or perhaps maybe I'm wrong, maybe some of you do prefer the local one. Scott I'll get the ball rolling. Members find that their favourite phase when referring to eligibility criteria is postcode lottery that every different local authority has a very different approach to funding services and this should be based on a need based measurement within the local authority and local authorities should also potentially be catching unmet need. What we're finding is the work of people like Colin Salisburg and Kirsten Stalker in the Children's Commissioner is the eligibility criteria across the whole of Scotland might be set at critical or substantial but what services are provided under the moniker of critical and substantial vary very differently across the whole of Scotland. Some people offer quite a wide collection of services under substantial eligibility criteria. Other people might just offer one and two other local authority areas depending on rurality and things might not be able to offer very much at all. What we have is a very mixed Scotland-wide picture on eligibility criteria and for people who might have out of authority placements coming from a school where they have been looked after and moving back into a local authority that can cause a lot of issue for people. In regards to the eligibility criteria and a national model it would be helpful but there is also the problem within the eligibility criteria that means that it doesn't allow for preventative work to be happening in health and social care and if we look at the work of Sir Harry Burns and the chief medical officer in England they are very much proponents of a preventative model of health and social care and if we're setting eligibility criteria around risk prevention rather than preventative work it's meaning that we can't support people who might need a little bit of support to stop them going into crisis what we're actually doing is waiting for these people to go into crisis and then we're getting people who are then accommodated or taken away from parents because they can't manage the support anymore so that's my two pence is why it would be a useful model. Thanks for the clear. Thank you. We consulted with National Eligibility Criteria when they were doing consultation around proposals for the bill we consulted with over 500 carers around Scotland and over 95% actually said that they supported National Eligibility Criteria and the reasons for wanting it is very much alongside what Scott was saying they wanted an end to the postcode lottery I think for most carers what the bill is about is having rights and entitlements to support for the first time and then knowing that you will be able to get the services you're assessed as you're needed providing you meet eligibility criteria which is why the eligibility criteria is so important and what they have said very much is they want to know what they're entitled to they want to know what their rights are and the trouble is if you have local eligibility criteria there will be variation across 32 local authorities there will be 32 different systems it will be very difficult for carers to know what they're entitled to it will also be prone to more variation so for example if local authorities are allowed to vary eligibility criteria it means when carers finally get to a point where they get the support they need and a lot of them say they have to battle for it it means that they won't be secure in that support because it could change in a year or two times so I think setting National Eligibility Criteria means that you're ensuring carers know what they're entitled to and what level of support they're entitled to in addition if you look at other countries so for example England and Wales have both introduced national eligibility criteria and if you look across Europe as well there are many examples of countries where they have national eligibility to social care support in fact there are no examples we found where they have local eligibility so examples show that it's the best way to provide equity for people and transparency and ensure that people know what they're entitled to and certainly as well in terms of the submissions having read through them what's interesting to note is that of the 69 submissions only five were coming out in support of local eligibility criteria the rest were in favour of where they stated their preference were in favour of national and that would include all submissions from local and national care organisations carers themselves but also from a few interesting places from a couple of local authorities were also in support of national eligibility criteria and the Scottish Human Rights Commission and Equality and Human Rights Commission both said they were in support of national eligibility criteria because otherwise you would have a lack of equity across Scotland Anyone else on that one? Andrew? I'll let the panel sing for me Just going on from what Claire was saying at the end there about the Scottish Human Rights Commission their concern is about portability and local authority and you receive services they're not able to move into another local authority where you won't receive services so we're in agreement with the need for national eligibility criteria the postcode lottery situation is already happening in some cases around about health and social care talk about charging for non-residential social care where there's 32 different systems or charging different amounts and if you live on one street and you're in one local authority you'll be paying more than someone who's on the next street in another local authority and it creates a divide between people and I think that issue's currently being progressed through the petitions committee we would like to see this bill go down a different track altogether Fiona? Just a very brief point is to say that portability and local discretion to develop services in different ways because each area will be different services in Glasgow will be different to services in a rural area what we're talking about primarily in the first instance is looking at where thresholds are set and that carers are very clear if I meet this threshold I will receive support and it may be different in different areas but you've got a bit of an idea on something Ben? You can, but I'm going to take the panelist always these things Denison I've had a bid for from Mike I don't know if it's on this subject Exactly the same territory and I think that Denison's covered it very well so I'm happy to withdraw my question in favour of Denison's pursuit I'm just explaining for Denison's benefit that I see the different bids and I'm just communicating to Dennis that there are other bids so first of all I'm going to take the panelist Ben I think Thank you very much and it's a very quick point I just thought that it might be useful that I've just given a very concrete example about the differences in short breaks that are provided around the country and it's a very simple example that some local authorities provide holiday play schemes for families with disabled children and some families don't and so that means that some families struggle throughout the whole day period and it has impacts on their health and wellbeing and on their employment possibilities and I thought that if an equity across the country would be a desirable thing Yes, I'm going to give you more judgments here but is there not a cautionary tale in this because the expectation if you've got a national then everybody applies that high standard but if you're working out a national standard then it's more likely to be the middle road in terms of negotiation so there are I'm just wondering whether there's just a note of caution here about applying a national standard and an aspiration and you can apply a national standard it doesn't equal you know an eligibility assessment could become the standard could become 12 weeks and there are people doing better than that now and or or children are the example that you've just mentioned so there are two different things am I right or am I wrong in my thought there right or I've got a response so I've got Claire, I've got Tarn and Ben and I think Scott wants back in and everybody wants back in Claire Oh sorry, I didn't realise it was first Yes, just to sort of follow up from that point what we would see the national criteria being would be a minimum standard local authorities would still have the power to provide carers over and above that service because the bill provides both the power and the duty to support carers but what we believe needs to happen is in some areas carers are not being provided with the same level of service so we need to bring them up to a minimum standard but like I say in other areas they may decide to continue at the level they're at which is possibly higher and we've discussed this a lot with carers and we've said you do realise that if it is an eligibility criteria then there is a possibility that your support could go up as well as down and across the piece they say well do you know we want it to be fair if we don't understand that position what we want to know as carers is what we are entitled to I don't know whether that's an answer but it doesn't answer the postcode lottery I don't think that's clear in terms of the big objection if people can apply a minimum standard but some local authorities given their particular circumstances could do better that's a postcode lottery though which I think is the we're only exploring now we're just exploring the idea of what was important to and I think that some strong points in terms of people moving from one area to another area could still find themselves in a situation given your scenario that their package could be different Scott I was just going to add if we think about eligibility criteria rather than what services are provided rather than access to services because they're gatekeeping tools eligibility criteria you have to meet them to be eligible for our service what that service is is then up to the local authority to meet but it's that idea that if you don't meet the gatekeeping eligibility criteria you will not be able to access any statutory potential help or third sector help from that local authority so what we're trying to do is make sure that the keys to access services across the whole Scotland are equal and then the services that are delivered behind that are bespoke in the local authority depending on need I think that's how I would view that That's clear I think that you're right to say that there will still be differences across the different local authorities and probably still within the local authorities but I think those differences would be reduced and what the eligibility criteria do is they add to the transparency of access to services and therefore then the local accountability of people to providing services and that for me then leads on to a democratic process where people can challenge their local services or not as they choose but without that people and we're told this time and time again people don't know what services are available how to get to them what the routes are and this applies to front line support stuff and social work stuff as well as to carers and there isn't a clear record of what is available to everybody so it's very much a question of how things fall for you Sussan and then I'm going to bring in Mike and Bob Doris Sussan for anyone on that I think my colleagues have said much more eloquently than I could but I would like to reinforce Claire's point where we have evidence of carers having to wait a significant amount of time for a carers assessment and by the time the carers assessment comes around the caring situation has ended either through bereavement or perhaps the person going into longer term care so we do feel that we need greater clarity and consistency across Scotland in terms of the rights that carers do have and the eligibility criteria Mike and then Bob Thank you convener Of course to me that obviously you know local authorities have got different cost pressures and particularly in these difficult times there could be a tendency to manipulate or ease their budgetary pressures through raising eligibility criteria and that seems to me to be profoundly wrong but I just wondered what the panel members felt about that Ben, please Just very briefly I work with a network of local authority workers providing what are called short break bureaus and these sort of in house offices to support accessible breaks and breaks from caring and we've already just anecdotally heard that there is increased pressure to move from preventative forms of breaks into crisis intervention and that's already happening Scotch I would just briefly draw the committee's attention to the paper written by the Children's Commissioner by Dr Coestestalker called entitled it's all comes down to money she very much explored the situation of the experience of people who use services versus the experience of a local authority and compared and contrast eligibility criteria across the whole of Scotland and people's experience with it and the picture that it did paint was local authorities are changing their eligibility criteria because of austerity and budgetary concerns and it doesn't paint a very good picture but I can provide the information after Thank you Anyone else? Yes, Dennis, you can Thank you very much It's in a point that both Claire and Fiona really were pursuing and it's with regard to some of the discretionary aspects and I'm just wondering we have the duty to dilute things down to powers local authorities can either do or not in some respects because there's no enforcement aspect when we get to the power Do you think that in that instance where we've maybe got situations where remote and rural aspects are there that you mentioned postcode lottery I'm just not particularly comfortable with that term but do you think that there is a problem then in actually taking forward that minimum standard that you've mentioned Claire because discretion is discretion and I'm just wondering sometimes if you don't have the resources the discretion is you're just not going to provide the service Yes, Claire Yes, I think there's probably two points there one is yes we think it is important that the power to support carers who don't meet eligibility criteria and it's what we were saying earlier about the importance of preventative support that's not to say in a way that support isn't insecure and that's why we welcome the bill also providing firm rights for carers because at the moment there is a really excellent network of local carers support across Scotland which is envied by many European countries and it's really important that that's protected and we would like to see the bill also provide resources towards that preventative support because of the increase in demand that's going to be on it but as times are tight carers support has always been insecure because there's been no statutory right to support carers previously which is why we're very keen to see this happen but like I said we also need to keep an eye on that preventative support which goes with the power with the bill the other point you made about rural and remote and how difficult it is in terms of supporting people from rural and remote communities and we do have a rural and remote carers working group and we did put in a specific submission from them some of the difficulties they have there is for example whenever the person they look after or the carer themselves is provided with an element of support it's often very difficult for them to take up that support because the services just aren't there so for example we have examples from the western Isles where people have been given a direct payment being able to purchase a service or employ a personal assistant because there's very low unemployment and you have problems with geography as well so we put forward in our submission a few solutions around some of the challenges in working in rural areas there's some very good examples of good practice within our our network where for example local third sector organisations have been either able to employ outreach workers who can extend over a larger areas and provide support to carers particularly in island communities or where they've been able to work through for example in Argyllun Bute the local carer centre in Loch Gilpedd works through GP practices on some of the islands in order to support carers they've set up your support groups and they've employed sessional workers on the islands as well to make sure carers in the very remote areas in Scotland get support so we believe our solutions to supporting carers and implementing the duty for example require more resources particularly when you look at transport costs Scott, if things want to comment on that as well then I'd just like to support what Claire has said we've recently travelled all around the whole of Scotland on behalf of the autism strategy looking at very similar issues in rural areas of Scotland and a very similar picture where the more rural you are the harder it is to even have services put in place and a lot of people are just getting direct payments and having to leave their jobs as care is to look after the young person because they can't employ a personal assistant under option 1 for self directed support which is potentially the only recourse for services there and again there are very very inventive and useful models starting to arrive across the whole of Scotland but absolutely second what Claire has said OK, I think some questions Bob, please I feel we're moving slightly away now from eligibility criteria towards commission and promotion and development of services once needs have been identified and there's an attempt to meet them which is just very briefly on eligibility criteria because there does appear to be a, maybe it's my confusion but a conflation of working out what needs should be identified and making sure that's nationally consistent versus local discretion and delivering to meet those needs and it was Mr Hall, I think that gave me that conflation because we're talking about let's say someone takes a break from caring or you give a cared for person a break away with the care or whatever provision is put in place and you were talking about some local authorities may give X amount of days during the summer other local authorities may give nothing at all or somewhere in between for me that's a conflation between identifying a need that has to be met and the service delivery on the ground and those are two very different things and during the whole conversation about eligibility criteria it became evident to myself that the witness were perhaps talking about those two different things under the one term so I'm not sure how we'd get a system where every young person every adult carer gets in some respect an identical level of service provision so all of that is based on the resource allocation that each local authority decides to put in to those services but I do accept the issues around how you identify the type of needs that have to be met so I'd quite like some opinions on that because there did seem to be a conflation but just a second point to Rax, I won't come back in for a supplementary communer to allow you to move on so specifically in relation to the conflation of those two separate things I also note within the bill there's a duty on local authorities for local eligibility criteria but there's also the power for ministers for national eligibility criteria and within the duty I note that after three years that has to be refreshed could I suggest that as we develop what we do for carers and for care for people in Scotland, one of the things we might seek to do is acknowledge that the government has the power in this bill to make it national eligibility criteria if it is required and necessary and that after three years of operating the local eligibility criteria might be a way forward on that just particularly given the tensions I've got between resource allocations that local authorities decide to put in in others that prioritise other needs and that confusion between service delivery and eligibility criteria I hope that that makes sense to me I think that the others want me to respond to some of that and I'll take others I take your point around and I think that Scott made a point very well around eligibility criteria primarily and this is the first part of it is primarily about gatekeeping and about where is the point that carers know that they will get a resource and we very much believe that that should be national I take your point about in three years we could have national if local doesn't work but our view is it would be better trying to develop something that works nationally in the first place rather than waiting three years I think that the element of trying to decide what carers should be entitled to expect I think we should explore that and I think as the national carer organisations we are exploring that we're working on the threshold part but also examining what that might look like in practice it's about really trying to provide a solution rather than saying we don't agree with this trying to come up with a solution that we think might work but I think primarily the eligibility criteria is about thresholds and I think that we can work together to try and look at what those standards might look like what carers, when they come to the table get their adult carers support plan what it might look like and what that might look like across Scotland at the moment I know the term postcode lottery it's not a great one but I think at the moment carers have no rights or very few rights there are some powers to support which have not really been taken up locally only six local authorities have taken up the power under the social care self directed support act and we are looking to find a way to move forward and move forward consistently and I think that we have an opportunity with the carers bill to start with that consistent level rather than working in 32 different ways I just wanted to come back and on the conflating of the two issues and I'm sorry if I did conflate them but the what we're in favour of is the national eligibility framework and national thresholds for service provided but then with local decisions on the type and the provision of service and that when you take the bill in the round and you look at care involvement and the planning and provision within the carers strategies that local authorities have required to produce and allow for the accountability locally clear is to reiterate the points colleagues have made it's almost like there's three stages to this the first is what is the threshold what triggers it, what says a carer is eligible to a service, that's stage one and we absolutely fundamentally believe that should be national then the next stage is what level of support does a carer get so once you meet eligibility and you've been told you can get a service what level of support do you get there's two ways you could do that you could make the level of support national or you could make it local and I think that needs discussion certainly as Fiona said the national carer organisation we're looking to put forward a framework for that but it will be mostly around the threshold and what triggers support for a carer but the level of support needs looked at and then the third stage is once you know what support you're getting what form will that support take the level of support to carers through the self directed support choices may be that they take up a service locally and there will be local variation what services are available and what's offered but they may also take up a resource and use it in a different way for themselves a more innovative way so I would say those are the three areas you're looking at with eligibility the other point you were making about there is within the bill the possibility of moving to national within three years is they're going to have 32 local authorities developing local eligibility criteria and I think it's actually really quite challenge I know that certainly one of the submissions the council said that's going to be very difficult for us to do to set these thresholds so why have that happening in 32 different areas when we can have a really good national framework developed and co-produced by carers, national carer organisations local authorities and health and get it right the first time around secondly for example the 2002 community care and health act there is the provision for government to look at charging policies nationally whereas at the moment it's local charging policies there's been a lot of campaigning around this because of the huge variation and the very unfair charging policies across Scotland and it hasn't happened so I would say if it goes to within the bill it being local eligibility criteria the opportunity to change that to national will be very slim anyone else on that any members any other members wanting the net it's about the information advice service for carers it's section 31 part 6 of the bill and the concerns that local authorities could set up fresh services where there already exist of the information centres which are trusted by people they already provide a lot of advice how variable is the relationship between local authorities and these independent sectors and do you think if the bill states as it is that it's likely that local authorities some will actually set up their own services instead of using the ones that existed that's really kind of outlined the concern that we have all carers centres and carers services do get support in terms of funding from the local authority that they're situated in it's part of how local authorities meet their current criteria in supporting carers they do it through funding local services despite the fact that there are assurances in the bill that if services already exist they won't be replaced by local authority service we just think that that could be strengthened but it seems at the moment it doesn't respect the very kind of rounded holistic service that a bespoke carer service does provide you know information and advice is just that and what carer services do is as well as providing information and advice to all carers it then follows through with a much more rounded service to the carer that's very focused on what that specific carer needs it involves signposting to services as well if it's not a service that's provided by the carer centre they can signpost them or refer them to other services and we just think that that is a much better service to be provided to a carer rather than something that is in-house within the local authority that could again, we're back to that kind of bare minimum standards that we've been talking about in terms of eligibility if there is only a duty to provide information and advice there's a risk that that's all the carer would get and whilst it is quite extensive in terms of what the information advice would be on it needs to follow through much more in the service needs to be there as well I mean, do you envisage that the local authorities could use this as perhaps a cost-saving exercise would they be paying less to themselves if you like than they would be to people running a more comprehensive service outside is that one of the concerns? It is a concern, yes I mean it's obviously with the financial memorandum at its current form it's not clear exactly how the funding would be kind of divided in terms of that and we'd need to compare what's in the financial memorandum to the funding that's already provided from local authorities to carer services we haven't been able to do that with a great deal of precision at the moment it's something we need to explore later but the financial memorandum does say that the costings are based on two information advice workers per local authority Claire made some interesting points earlier about outreach workers in different areas you know two local authority information advice workers might be fine in a small sort of averagely populated area but that wouldn't work for obviously for Highland for Argyllun Butes and even for the larger cities where two information advice workers just wouldn't cover the need in that area so again we need to see a lot more about what kind of variation would be there to match the needs of the carer population whether that would be a densely populated area or somewhere that's sparse and very spread out Susan it's picking up on Ben's earlier point also about transparency and accountability and unfortunately there is history around the reshaping care folder people change fund where 20% of the funds available were to support carers and as national carer organisations we found it very difficult to unpick that and to actually say definitively that those funds have been used to support carers and our concern is unless that money is in a sense ringfenced and I know people don't like the term ringfenced but it does go to accountability and showing that the money that is earmarked is actually being used for what it is intended for rather than disappearing into a black hole essentially we talked about the information and advice duty with carers they were very clear about what they wanted an information advice service that was local that was independent and it was expert and so following on from what Heather was saying the services that are currently provided through local carer services and we hope that something local authorities would choose to continue I was slightly concerned by COSLA's submission to the health and sport committee where they talked about information advice provision through more of a public awareness campaign which goes against that we very much hope that the regulations will be very clear and specific around the information and advice provision to carers that is expected Andrew, you want to come in on that? Yes on a couple of points the alliance has the dementia care of voices project which members will probably know Tommy Whitelaw who cared for his mum and co-ordinates that project and we did a survey of what carers wanted what issues were out there and lots of people came back and said local advice and information it certainly wasn't about a local awareness campaign it was practical support day to day on the day to day activities of caring information regarding financial and legal matters and a lot of that sits within the third sector lots of third sector organisations are the first contact for a carer and we really welcome within the explanatory notes for this bill the encouragement of local authorities and health boards to make the best use of the third sector and as acknowledged in that explanatory note that needs to be adequately and appropriately funded and again I'm welcoming the additional funding that's been included in that explanatory memorandum to the third sector but going back to Heather's point earlier run clear about how that money is going to be divided up so it says that 50 organisations will receive technical support IT support that kind of thing extra capacity around a bit that but if I would encourage the committee to kind of ask the questions about well who are these 50 organisations SCVO did a bit of research into what sort of organisations are out there and they found 81 specific carers organisations across the country but that only tells part of the picture there are hundreds of organisations who are providing conditions specific support who also support carers who would really welcome some of this funding too so what is the criteria going to be to decide who gets that additional money and resource anyone else on that area Ben you emphasised the importance of the information and advice services and we know from research that we did a few people around the table that in terms of short breaks the single biggest barrier to carers not taking a short break was the inability to access information and advice so rather than putting it at risk existing services we would want to enhance them OK thanks for that have we got any other members who want to come in at this point Dennis another question it's to do with carers involvement and there's been a proposal that we should have a duty for both local authority and health boards to provide to take in account of the views of carers and carers organisations it's one of what your opinion is at the moment because there is a route at the moment for public bodies to be involved do you think it's necessary to have a duty for involvement and if so it's practically reasonable which is something that you can't put in legislation in itself because it means nothing and I'm just wondering what your views are on the carers involvement and how we take account of those views do you set up a body and if so what's the divide between carers and the organisations is it a 50-50? Claire, go on the structures that are there already so throughout Scotland you do have a lot of carer forums for example which meet locally and take the views of carers and where the structures work particularly well you will have a carers forum and a carer within that forum will be represented on local planning strategic planning committees so they're bringing the views from the wider carer community into that planning structure and then taking the information from the planning structure back to the carer forum in my process what I think needs to be acknowledged is that these forums and so on need to be resourced and there hasn't been the resource implications of involving carers as partners in carer hasn't really been looked at very often it's through third sector organisations that that support is provided but these organisations are at full capacity and they're doing it on top of their other services so it's something which very often is the first thing to go and these structures are not in place and I think it's whenever you look at carers getting involved in some of these for example boards where integration boards for example it's quite an intimidating thing it's intimidating for anybody and the way it should work best practice would be that they receive training they receive induction through the partnership they receive all the resources that are required whether it's replacement carer, transport and so on but also not just for attending those meetings but also for attending the forum and providing that link and in some cases some areas where there is very good practice they have mentoring as well for carers who are on these boards I would like to see that being set as standard I would like to see the bill providing that through guidance and I would like to see resources going towards it to make sure that engagement is meaningful Ben? To the principle about why carers should be involved and we see through the short breaks fund at Shared Care Scotland that time and again where carers are involved in the planning and in the commissioning of services that they are more effective services and so the personal outcomes that people get are better Rhoda I think was wanting to come in weren't you Rhoda? I just wanted to go back to something Andrew had said much earlier about emergency plans I mean I suppose my understanding of emergency plans with a plan in place should something happen that the carer maybe takes ill or whatever that they have that back up but you touched on something that I thought maybe would have been dealt with under other legislation or should be dealt with under other legislation where you are looking at the transition for a cured for person say someone who has been looked after by a parent it follows that at some point somebody else is going to have to take that care and role and is it not the case now or is there something missing now that those transitions aren't taking place so that the young person leaves home becomes an independent long before they're actually bereaved of their parent to allow that transition to be over a period of time and not such a shock The simple answer to that is I don't really know but we're aware of situations where I'm talking specifically about older carers who are just after that kind of peace of mind about what's going to happen so I'm not specifically talking about what's in different bits of legislation I think Fiona will be able to help me out here Fiona? It definitely is the case that the legislation should ensure that carers are involved in planning for the transitions of the person that they care for be that a child to adult services and to older people services but what we're talking about there is the element of emergency planning what happens if I fall and break my leg but as well as the future planning part of it is what's going to happen as I age and that should be part of the individuals plan but in terms of confidence and security I know what's going to happen I'm not frightened of it I know that if anything happens there's going to be support for the person that I care for and that there's a plan for them moving forward there's another part we call it future planning anticipatory planning there's a whole lot of different names for it but in terms of carers being able to plan for their own life to plan for their own aspirations for example in the future I'm a young adult carer in the future I would like to be moving into education I would like to be doing this type of training I would like to be doing an apprenticeship and I can plan for that within my adult carer support plan or I'm a carer with a disability and I know that disability is going to be progressive so I'm going to need to plan for what the future looks like and carers should have confidence in being able to do that and I think that current legislation is part of that but it doesn't really cover carers' own lives and it doesn't really provide it's a way of bringing it into one place as well I don't think that's it No one else Dennis Bob you want a Dennis you mentioned something earlier at the briefing about young carer statements and the existing legislation maybe we'll get some of that on the record too please Bob I was going to ask about emergency planning as well I think in terms of my experience of it it would be with adults with learning disabilities in Glasgow where many of their parents are aging and the local authorities not always been as sharp as they could be and saying where are we going to be in 5 years time, 10 years time, 15 years time so I would probably call it anticipatory planning as opposed to emergency planning of course they might end up being one in the same thing if there's a kind of crisis crisis moment I'm just wondering if there's other legislation that sits just now where that emergency planning might be taking place but not in discussion with the carer because we was at palliative care we were looking at recently in this committee and we were talking about anticipatory care plans for older people in the residential setting for example and I think we're at 20-something percent which is pretty low it's higher than it was but it's still pretty low so I'm just wondering if there's a bit of connectivity there in terms of other legislation and responsibilities that sit on local authorities or health boards in terms of emergency anticipatory planning and it also probably because I'd written down all the things at the start about things that could be in the bill and the other one I'd written down was in relation to discharge from hospital now, if there's identified care in nature you'd be hoping for a six-week plan to be put in place when that person leaves hospital and that would seem to be an obvious hook to say well does this who's caring for this person and does this person already have a carer's assessment so is there some obvious connectivity that exists that wouldn't actually be that burdensome it would just be good connectivity to take some of this forward Scott I'm not sure I can comment on the connectivity connectivity in terms we have to look at the kind of process that somebody who is a carer with a say a young adult with a learning disability or a complex care need might have they would have had an assessment and that assessment would have said you would have met X criteria your criteria entitles you to X these are the services that are in place we will then review your services yearly annually those people will age and that young person might not have enough support will be able to move on enough so if we're looking at kind of like care planning and how you'll have to look at how care planning for carers or adult care plans fit in within the kind of whole review mechanism of social work and healthcare and the integration of that and in terms of kind of discharge planning there's a lot of work that needs to be done in linking together models of social support so supported hours people going into hospital and can use to potentially support that person at home rather than go into hospital I think there's been examples of things such as social prescribing by GPs that have been talked about in that regard and how the care plan then fits together with all of these different kind of planning mechanisms that are already happening so it's quite a kind of stromash of different approaches and legislation that would have to be drawn together to kind of fit the careers plan and I hark back to my kind of earlier comment first comment it's about what I would like to see in the legislation is about how this all dovetails together especially for people with young carers kind of concerns and how that fits in with the child's plan co-ordinated support plans otherwise you're at risk of having loads of plans happening and lots of professionals coming in and out of a young person's life who's also trying to maintain school and care for somebody potentially in their family where it could be just one person going in and answering the questions on the care plan that are needed Fiona I think you can answer to the question that there definitely are connections that can be made and we'll be very much welcomed within the policy memorandum around the bill and with the earlier consultation that the adult care support plan and support for carers needs to sit next to wider reform and wider policies and that's not just around social care but it's around health it's around poverty and inequality it's around employment and I think it's very important to try and make those connections and I think they are there I think it's just trying to make sure that they actually work in relation to hospital discharge which you mentioned and I mentioned at the beginning in terms of a duty what carers consistently report and we're talking about only a third have been consulted when somebody is discharged and that's a very low so it means two thirds of people aren't consulted at the very last minute it means that carers aren't involved in trying to decide what support is there there's an assumption you will provide care and without putting something in place it says talk to the carer do they want to care are they able to care because certainly when someone's older they may not be best willing of our old they may not be able to care and have those conversations before somebody leaves hospital and that's something about that wider policy we've got delayed discharge and it's button up against ensuring that people are discharged and are discharged in a way that carers can actually provide the support they need without detriment to their own health so I think we feel that we need some work in relation to that but I think there's definitely connections with a wide range of policies that are already happening so we can make it happen better you know the best well in the world there might not be a legislative approach but look at the needs of the carer we're also looking at the needs of that person who's been cared for and their overwhelming wish to be out of that clinical setting it's not maybe that the discussion isn't taking place but the discussion is a difficult one would you name it the pressure of the person who wants out of hospital setting the carers who are struggling to think how are we going to care for them now because they're at a new low and the options that they face are difficult options when you're dealing with a loved one because it may be a residential setting it may be an intensive package package you care so these discussions in my experience and wider experience actually take place but it doesn't there's no easy solution to them because we're dealing with very difficult circumstances that legislation can't really I would certainly agree that in these situations we are dealing with very difficult situations but I think the issue primarily is that carers report that they're not consulted and I think it may be that those difficult discussions still need to take place but it's that point that carers are involved in and carers at the moment are saying that they're not carers are going to fall on them they need to be involved to make sure that this happens safely because we're talking about from what carers report that 20% of people are being re-admitted within one month and that's again about these policies trying to make them all work together we don't want that we want these conversations to happen but our point is that carers must be involved in that in terms of the adult care plan that should be in that about because a lot of this is support for the carers and the family the role of the family should it because sometimes it becomes over you can be squeezed out of the situation in many cases there isn't a specific role in that adult care plan that says as a family this is what we want to do what we need to do and all the other bits fitting in with that in support of that family it's difficult to go along and play a role in a family if you don't want to be there when the carers are there at that particular time in the morning you exclude yourself or at that time in the evening you exclude yourself I'm just wondering if there is a discussion that should take place about the role that the family want to play in support of that person rather than looking at simply this is what the state can provide is that the wrong way rounder am I getting it wrong Claire's going to put me right I think I think you're right that is what needs to happen when you look for example at hospital discharge families very often do want to help provide care when somebody is coming out hospital but there may be restrictions around the amount of care and the type of care they can provide and I think the bill makes a good point it doesn't talk any more about the carers ability to care which is in previous legislation but whether they're able and willing to care and those are two important points so if you don't speak to carers for example at time of hospital discharge then you won't know are they in employment do they have other dependents do they have health conditions themselves which restrict the sort of care that they're able to provide which is why we think there needs to be a duty because it needs to be done in partnership and you were talking about some of the pressures whenever somebody is in hospital there's pressures from the person wanting to leave hospital that's really common but one thing you didn't mention was there's actually a lot of pressure on staff as well to discharge people because of the figures they're trying to meet there was recent research done looking at the attitude of nurses at the time of hospital discharge and it found that 72% of nurses in Scotland feel families need to take more responsibility for their older relatives and 78% said they don't think families should be blamed if there's not enough support in place but that means that almost one in four say that care and families should be blamed if there isn't enough support in place there is in some areas a culture from health professionals which says that people should be discharged as soon as possible and it's the family's responsibility to take that care on and there needs to be more involvement of carers in what care they're willing and able to provide and what they're able to contribute then needs to be part of the care package but there should be any assumptions made around that I think it's really key and where it falls down where that conversation doesn't happen is exactly when you go home and there's a crisis situation the carer can't cope not enough support is in place but we have sometimes discussion within the family a carer can exclude other members of the family almost by their commitment or overwhelming commitment there's not sometimes a discussion in families about everybody being able to contribute to the care of that individual anyway they're complex and emotional stuff Heather please and then I've got Scott and we're into the last six minutes Clare did actually make most of the points that I wanted to say but the example that you've just given there the reason for a desire for a legislative requirement for emergency planning is to make sure that those conversations are then had the future planning doesn't need to be the far distant future it can be the immediate future following hospital discharge a carer might be able to provide short term high intensity care if someone has been discharged from hospital but they might need to have a wider conversation with other family members or need to bring in maybe a care agency or something and that can be discussed in emergency and future planning as part of a care support plan but if a carer doesn't realise that that option is available to them to have that wider discussion with professionals and with other family members then they might not have it so that's another reason to bring that in and make sure it's a requirement I'm just wondering if there is a duty within the legislation for people to refer to a carer's support plan on discharge of family member kind of clause which would then circumnavigate people feeling excluded potentially Is there any other comments on that issue or I don't see any other bids from committee members at this point Dennis, I was prompting you about that children's one Just on this part I think I think conversations do take place they're just not recorded in some respects or sometimes and there's a perception there and looking at the complexity of discharge quite often we haven't spoken about it with the power of attorney we do have quite often a named person that is taking the lead in terms of the family and I know you mentioned Kyven that sometimes families disagree with one another as to whether or not a person does require what level of care but if someone has power of attorney they have that legislative requirement then or ability to actually make that decision on behalf of maybe the rest of the family because they've been given that power you invited me earlier to mention about children it was really in Scott you mentioned the dovetailing within the legislative frameworks with regard to the assessment in terms of the statement for a young person they struck me was that we have already GERFEC we're taking forward the named person for me there's already layers and I'm just wondering if the layers that we have currently are sufficient without going down another route or do we need this other one to ensure that no one falls through the net my concern is about too much planning and not enough action for people sometimes we can have a lot of bureaucracy and nothing really happens and within the GERFEC and the Shinari indicators we've got things like safe and healthy achieving, respected involved some of these indicators will obviously be well-being risks in terms of being a young carer if you're not attending school there'll be a well-being risk that will be activated under getting it right for every child the named person should then consider this well-being risk so there is that but the worry is that Shinari is looking at well-being in a whole and does it really really focus on the needs of a young carer specifically and do we need a more specific focus on that area of a young person or the ability if that is their only well-being risk to really kind of look at the support that that young person needs as a young carer rather than a well-being risk I don't know I've got to put that open to other people Heather what do you want to do? To answer both Dennis and Scott's questions directly I think yes we do need a specific young carer's statement for two reasons the first is that for a lot of young carers that are in the well-being need and therefore something that's specifically for young carers and designed to look at how to support them specifically as young carers it's really really important to have something that's just about that and for them and secondly in consultation with the young carers there is quite a lot of opposition to having a child's plan again if that is the only well-being need if that is the only vulnerability of the young carer a child's plan will not be suitable for them I think again I agree with colleagues and other members of the committee that there's quite a lot of differing pieces of policy and legislation that are going to be affecting young carers and it's not quite clear how that's all going to work in practice but again the importance is making sure that people don't fall through the net that the support is there and provided that the young person's wishes are respected and that confidentiality is respected information sharing needs to happen in as joined up as possible it seems like the best way to do that would be for something specific for young carers I have no other questions from committee members at this point it's a lift from me then to thank you all for your time here this morning for your written evidence that you have already provided committee appreciates that very much and we look forward to working with you through this scrutiny of this bill thank you very much for your attendance and your participation this morning thank you again bye bye safe journey home that concludes the business of the committee today thank you very much