Malcolm argues for continuous integrated care in the community
Taking Scotland Forward: Health, Wellbeing and Cities Strategy Malcolm Chisholm (Edinburgh North and Leith) (Lab):
I originally applied to speak in the debate so that I could consider the issues to do with care home inspection that have been thrown up by recent revelations at the Elsie Inglis nursing home in Edinburgh. However, that is clearly more appropriate for tomorrow’s debate, but since I still have the slot in this debate, I shall try to cover a few other health issues.

The first half of the cabinet secretary’s speech was on issues to do with the care of the elderly that are quite apart from the issue of care home inspection. I believe, on reflection, that my party’s front-bench members, and all of us, should agree with the analysis that she gave of the demography of Scotland and the way in which we ought to respond to that challenge. The analysis and solutions that she presented were identical to the analysis and solutions that were given in the David Kerr report six years ago. We all know that too much money is spent in acute and institutional care and that the ideal should be continuous integrated care in the community in order to reduce emergency admissions. We all know that that is the way in which we will have to deal with the increasing number of older people with complex needs and conditions.

Shifting the balance of care in that way has been the holy grail of health policy for most of the time for which the Parliament has sat, but it has proved to be an intractable problem, as the increasing number of emergency admissions - which Mary Scanlon mentioned in her intervention - has highlighted. One of the biggest challenges in health and community care policy and, indeed, in the current session of Parliament, is for us to work together to address that fundamental problem and to come up with solutions to it.

Community health partnerships were devised as a mechanism to deal with that but, as we know from last week’s report, they have not been entirely successful, although we should acknowledge their achievements in many cases.

As members, including Jim Eadie, have said in the debate, health and social care integration is absolutely fundamental, and we need to work together on it. Labour proposes to use CHPs for a national care service, and the Scottish Government has a proposal on lead commissioning. There are differences between those solutions, but there is some overlap, so we urgently need to work together in Parliament to reach a solution to the integration issue.

We should remember that CHPs were also set up to bridge the divide between primary and secondary care. If primary and secondary care commissioners do not work together more collaboratively, we will not shift the balance of care. Again, there has been progress on that, and we must not be negative. There are wonderful examples of that shift, such as at the Leith community treatment centre in my constituency.

We set up an integrated system, on which we all agreed, a few years ago. Unlike the situation in England - for this I think we can all be grateful - the challenge for us in this Parliament is to make that integrated system more integrated. Nicola Sturgeon acknowledged in her speech the significant progress that has been made under the current Administration and previous Administrations, and we agree with that. A big area in which there has been a lot of progress over the past 12 years is the quality of care and the monitoring and inspection of that quality.

Problems have been thrown up in relation to the care home inspection regime, which we will deal with tomorrow, but we should be grateful that we have such an inspection system, which never existed before this Parliament was created. Inspection is fundamental to quality, but I am sure that we all agree that staffing is, too; Jackie Baillie highlighted important workforce issues. We recognise the financial difficulties, but we must make the wisest choices to protect the quality of care.

The Royal College of Nursing sent in a briefing for this debate, and I met its representatives last week. It has several concerns; for example, around the skill mix in care settings and around the end of the one-year guarantee, which members may not know is being replaced by a 22-hour internship programme. That is very disappointing, although we understand the financial pressures that have led to it. Let us value the whole health workforce, especially nurses in the settings in which they are required, and let us not go too far down the skill-mix route if it is not appropriate.

The financial pressures and the demography that the cabinet secretary described could easily lead us to the conclusion that all the health money should be spent on older people. However, with due respect to older people, that cannot be the case. The cabinet secretary highlighted in the second half of her speech the importance of prioritising preventative spend and supporting parenting and the early years, which was the conclusion that the whole Parliament was reaching before the election. I was on the Finance Committee, which highlighted the importance of preventative spending.

The reality is that even in the very difficult financial situation that we face, we must think long term and ensure that we invest in particular in the first three years of life. Some of that is a health issue; the Conservatives have understandably emphasised the importance of health visitors. We must ensure that we invest in the early years because it is, apart from anything else, an important way of dealing with inequalities. The “Growing Up in Scotland” report that was published this week contained an important section on parenting and children’s health, which emphasised not only the importance of parenting but the wider societal issues that underlie inequality.

I am being told to wind up by the Presiding Officer. I have not been able to use my peroration on the Royal hospital for sick children in Edinburgh, but I think that the cabinet secretary can anticipate what I was going to say about it. Perhaps we will find out in her winding-up speech how quickly it will be built.

Read Malcolm's question to the Cabinet Secretary for Health and Wellbeing the following day >>>
June 8th 2011 (14.23-14.29)