Chamber and committees

Social care reform is happening alongside health service reform. Professor Derek Feeley, who authored the “Independent Review of Adult Social Care” in 2021, gave evidence to the committee last week, and it was interesting to hear from him. As you have recognised today, a lot of the changes that are needed in social care are not necessarily structural. There are also questions about collaborative and ethical commissioning and workforce development and recognition, which are issues that we have already touched on in this meeting.

The lesson that we learned from five years of discussion about the national care service is that such cultural and procedural aspects can sometimes can get lost in discussions about structure, and there are concerns that that might happen again. How do we ensure that those aspects are actioned and recognised in policy decisions and the budget?

I have a question about neurology. Last week, in Dundee, a few of us here today met people living with Parkinson’s, and I recently met the Neurological Alliance of Scotland. I was struck by the fact that, in the UK, we have something like 1.1 consultant neurologists per 100,000 people whereas, in western Europe, the average is 1 per 12,000. Given that that area includes the treatment of people living with Parkinson’s and multiple sclerosis and, increasingly—with an ageing population—forms of dementia and Alzheimer’s, there seems to be an issue around the scale of our specialist neurology workforce. That is particularly the case given that people sometimes feel that, when they are of an older age, they do not get a specialist referral to a neurologist, but simply get referred to older people’s services. Is that issue on your radar? Has there been an assessment of our neurology capacity, given the changing demographic that we see?

10:15

We probably need to come back to a few questions about NHS reform. However, while we are on the topic of prevention, in the Parliament there has been quite a lot of cross-party consensus that a preventative agenda is both welcome and needed. There is good support for that. A few questions come out of that aspect.

I will ask about budget tagging. Much of the spend that is indicated as being preventative is about tertiary prevention—that is, how we prevent people with significant challenges who are already in the system from having further and more complex challenges. We are interested in seeing a shift to secondary and primary prevention, and what that would look like in the budget. I suppose that there are risks around that. Will we end up tagging as “preventative” things that are already happening, or will there be a shift in the budget towards prevention? How would we achieve such a shift while meeting the immediate pressures that you have laid out for us?

How might we expect to see that laid out in the forthcoming budget for the coming years?

That is welcome to hear for those of us who have a background in the sector.

Another big part of care delivery is the workforce of unpaid carers—the 700,000 to 800,000 people who deliver unpaid care for loved ones, friends or people close to them. In my constituency, I hear it said a lot that, at the moment, we simply do not have the infrastructure to provide breaks for carers—the respite support that was a fundamental part of the Care Reform (Scotland) Act 2025. I know that we are due to have plans soon to action support for unpaid carers. I think that they were due to come out within 12 weeks of the consultation ending in May.

I heard recently that, in Fife, somebody with a child with very high support needs was told, “Well, your son goes to school, so that’s your time for respite”; I have also heard that, in Perthshire, people had vouchers to access respite care but the infrastructure was not there. I hear from providers that respite care is financially quite difficult to provide and would require some sort of core funding. There is that infrastructural question about how we provide support for unpaid carers. What is your reflection on that point? When might plans come forward? What might the budget commitment look like around supporting unpaid carers?

I will follow up on that with a question about a different area, which is the learning disabilities, autism and neurodivergence agenda. As usual, I refer members to my entry in the register of members’ interests, as a former director of Scottish Autism.

There is some difference of opinion between the Parliament and the Government about whether changes to support people with learning disabilities, autism and neurodivergence need to be on a statutory footing. However, there is consensus that we need better support now. That has absolutely been recognised across the board.

We have had a ministerial statement about extra spend that has come in this year, particularly for children and young people. However, as Adam Harley pointed out in his earlier question, there is continued concern about the fact that a lot of people are accessing and spending money on private diagnosis, and the funding package that was announced earlier this year did not contain a huge amount for adult support.

Given both the Government’s statement of ambition in relation to supporting these communities, and the consensus around the need for action, what will the commitment in this coming budget look like in relation to improving support for people with learning disabilities, autism and neurodivergence?

No, I think that Heather has something to say on this point in particular.

The biggest investment in social care is in the people who support those who use such care—our workforce, in essence. I was very struck by the focus on the relational element of care and support in Professor Feeley’s review. Professor Needham, is there an evidence base on the pay, conditions and training that we invest in our workforce, and on quality-of-care outcomes for the people we support? To open that to Professor Knapp, do we have evidence of an investment in quality relationships in social care more generally?

We will start with Professor Needham.

I think that we would all agree on the importance of having a preventative agenda, and we will all recognise Mr Dunlop’s statement that all sport is, in some way, preventative. However, we are in a budget process right now, and we need to look at budget tagging and at lines and sub-lines in a budget. Therefore, I will get a bit more granular with my question. If we are considering, for example, widening participation in areas of socioeconomic deprivation and inequality, what would budget tagging that takes account of that and ensures that investment is in place look like? I would be interested in hearing how your organisations do that. How do you identify, ring fence or determine the proportion of your spend that goes into widening access in those areas? What should that look like in a Government budget?

I notice that we are coming towards the end of our time, so I will take this opportunity to ask a final question. Professor Feeley, you have mentioned a couple of things from your review. We are about to embark on some big structural change but, as we have acknowledged, not everything requires structural change. In the conversations about a national care service, which became very much about governance and structure, what do you feel was lost from your review that we should go back to and hold on to? I open that out to our other guests today: what do we need to hold on to during structural change?