Health, Social Care and Sport Committee

Meeting date: Tuesday, October 3, 2023

Official Report 668KB pdf

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National Care Service (Scotland) Bill: Stage 1

The second item on our agenda is an update from the Minister for Social Care, Mental Wellbeing and Sport on the National Care Service (Scotland) Bill. I welcome to the meeting the minister, Maree Todd, and, from the Scottish Government, Donna Bell, who is director of social care and national care service development, and Rachael McGruer, who is deputy director of social care and national care service development.

I invite the minister to make a brief opening statement.

Thank you very much for inviting me to provide an update on the National Care Service (Scotland) Bill.

During the summer, we used the time to respond to stakeholder concerns. We have agreed proposed changes to the overarching structure of the NCS, which will help to achieve our ambition of improving the quality and consistency of social services. We have also carried out extensive co-design engagement across Scotland to understand how to achieve the change that is needed.

After being out and about over the summer speaking with people, I know more than ever that the status quo is not an option. We must act decisively so that people can have the improvements that they need as quickly as possible, and we must make wise decisions in a new fiscal environment in which resources are under pressure. That is not an easy task, but we are absolutely committed to getting it right by listening to the voices of experience. I want to outline how we propose to go forward, having listened carefully to those voices.

In my recent letter to the committee, I described our extensive summer programme of local co-design activity. We held regional events across Scotland and online. Hundreds of people participated and shared valuable and diverse feedback on the NCS. I attended several events in person, and I whole-heartedly thank everyone for sharing their experiences and knowledge. We have now published our analysis of those events. They will shape our thinking going forward and they will shape the second NCS national forum, on 30 October.

Our other major discussions over the summer were with the Convention of Scottish Local Authorities, the national health service and trade unions. We reached initial consensus on a partnership approach with COSLA in July. That will provide shared legal accountability for integrated health and social care services. Those discussions are still continuing, and more detail is being developed that will inform our proposed amendments to the bill.

It is important that we have effective national oversight and governance to drive consistency and improved outcomes for people who access support. The proposed NCS national board will provide that.

At the local level, local government and NHS boards will retain statutory delivery functions and the staff and assets to deliver services. We are considering how local integration structures can be reformed and strengthened as part of the NCS.

Additionally, we regularly discuss the bill and current challenges in social care with trade unions. Although we are limited in legislating on employment, we are committed to promoting fair work as far as possible through ethical commissioning and procurement. We will provide funding to increase the pay of social care workers and to improve workforce planning, practice and culture, and we will take into account trade union views on issues such as workforce representation in designing the national board and local delivery.

In summary, I say that the summer was very busy, with many productive discussions and positive developments.

I hope that that is a useful overview before our discussion.

Thank you very much, minister, and thank you for attending the meeting.

As you said, the summer was obviously very busy, with a lot of engagement across the country. Can you expand a little on what you said in your opening statement about the impact that the accord with COSLA and shared accountability will have on the national care service and the relevant provisions in the bill?

There are a couple of important things to draw out about shared accountability. It is shared, rather than joint, accountability, which is a significant distinction because we have different groups to which we are accountable.

As ministers we are accountable to the country; local authorities are accountable only to the local authority area that they represent; and the national health service is accountable to the NHS boards. We all have different groups to which we are accountable, but if we share that accountability we get really good coverage and oversight of the country. The three of us together will definitely have an impact in terms of delivery of better standards and qualities.

We are still working out the detail around the national care board, but I do not think that it will be just the three of us. There will be more people around that table. I expect that there will probably be an independent chair. I think that the voice of lived experience will be absolutely vital on that board, and I think that it should include representation of the workforce and the national social work agency. Those are the things that will give that board teeth and make sure that it delivers an impact.

I have heard criticism from many people that the board is just the status quo, but it will be different. At the moment, I have no control over the social care system; I am held to account day in and day out for things over which I have no control. In the future, Scottish Government ministers will have some control, which they will share with a national body. That will absolutely ensure that we deliver improved standards.

Thank you for that. You have covered a bit of my next question. This issue has been raised with me, as an MSP, and I am sure that it has been raised with you, as minister. It is about individuals who are disappointed that accountability will be shared because one of the recommendations of the Feeley report was that there would be ministerial responsibility. There is concern that, if responsibility and accountability are shared, the existing postcode lottery—as people see it—of access to care services will continue. How will you ensure that that is not the case?

I hear that criticism loud and clear. I hear it very directly because we are engaging so closely with people who have lived experience of accessing care. Undoubtedly, there are many people for whom the situation with access has been traumatic and disappointing. They are absolutely clear that change is required, as am I. As I said, the shared accountability that we foresee will, I think, give ministers control over the system, while ensuring that local delivery is still done by the local democratically elected body. That is probably the best combination.

It is really important that the board has the power to take action when there is system delivery failure, so I am determined to reassure people that it will have sufficient power to take action when it needs to. We are envisaging something similar to the arrangements that are currently in place for health boards, where there can be intervention, if there are challenges, and escalation of interventions. We envisage something similar for the national care service, in that its board will have the power to intervene.

What would become of health and social care partnerships? How would they relate to the national care board in terms of governance?

We are still in the thick of discussing local governance arrangements. I might ask officials to come in on that, in case I have missed anything in answers that I have given. However, I envisage that the structures that already exist will be strengthened.

At the moment, we have quite a disparate pattern of integration, which is one of the reasons why we have a postcode lottery. There is more integration in some parts of the country than there is in others, which is probably not serving us particularly well. There will be a move towards more integration all over the country, and the structure of integration joint boards and health and social care partnerships will evolve and probably strengthen in order that they can oversee local delivery of social care.

There is a distinction to be made between integration joint boards and health and social care partnerships. IJBs have a legal foundation, but health and social care partnerships are a way of working. That sometimes creates a bit of confusion. We are keen to bring a bit of clarity about accountability and how all that works, as we go along.

Do you want to bring in your other official?

Do you want to say anything more, Rachael?

No. I will just reiterate what the minister said about the discussions being under way and that we have to work out exactly how we can strengthen local integration under the model.

In the programme for government, there was a pledge to set £12 per hour as a minimum rate of pay for all social care and support staff. How will that be implemented effectively?

During the past number of years, we have effectively introduced a floor level of payment of social care staff. We have introduced that nationally, and we did so by providing funding to ensure that that pay can be passed on to staff. I think that we will manage to do so again using the mechanisms that we have used for a number of years. I am absolutely delighted that we are delivering on that commitment.

I know that people are, as ever, pushing for more and would like even better pay in social care, but I am absolutely delighted, given the financial constraints that we face as a nation, that we are delivering on that, and that we are setting a path of year-on-year significant improvement in pay for social care staff, because that is one of the very important things that we need to do to strengthen the system as a whole.

How can ethical commissioning change the nature of contract competition?

One of the challenges that the Scottish Government has is that we do not have control over employment law. We would like to see many changes in the employment of social care staff in the sector, but we do not have the power to intervene directly. Ethical commissioning gives us some power to ensure that, where we use public money, staff are treated well. That is an important part of what we hope to achieve with the national care service.

When I think about the change that we are trying to make, the two groups of people whom I have in mind, day in and day out, are the people who access care—from whom I hear every day about just how difficult that can be—and the people who work in social care. I am pretty confident that ethical commissioning gives us a tool with which to improve their pay and conditions, to hear their voice and to build fair work principles into the procurement process.

Donna Bell, do you want to say a little bit more about that?

Yes, I am happy to do that. Current procurement legislation provides the opportunity for ethical commissioning. The National Care Service (Scotland) Bill, as introduced, places duties on ministers and care boards to produce ethical commissioning strategies as part of their strategic plans, which is a key part of implementation. There will be an opportunity, through that, to support consistency and enable us to focus on the important issues that the minister has already picked up.

We have some detail to work through on what exactly those ethical commissioning strategies will look like and what will be the expectations that sit behind them, and then to implement them. However, I certainly think that the bill is a very important step towards embedding that in all our social care practice and beyond.

09:30  

We move to Carol Mochan, who is joining us remotely.

Good morning. I am interested in a couple of issues that follow on from Evelyn Tweed’s questions. Will you give us some idea of how sectoral bargaining might operate within the care sector in the future across the public sector, the third sector and the private sector?

Sectoral bargaining is probably the toughest area to deliver and a lot of work is going on in that regard. Usually, it is fairly straightforward once you define the sector, but even defining the sector has proved to be difficult in this sphere. It is very complex, and the way in which care operates in Scotland is pretty complex.

Generally, in sectoral bargaining, there is discussion between a group of employees and an employer or two. Clearly, there are multiple employers in social care. Government also has an interest, because we provide a lot of the money to pay for commissioned places and to increase wages. As a result, more people are around the table than there would normally be in a straightforward case of sectoral bargaining.

We are getting into the detail of it now, though. On the recommendation of some of the trade unions that we work with, we have approached a couple of academics and involved them to help us to unlock the discussions and make progress. I am reasonably confident that we will make progress on sectoral bargaining, which will be crucial to the delivery of fair work in the future.

Lovely—that was very helpful. You mentioned engaging the trade unions. I am assuming that you will assure us that you will continue to work with the trade unions as we go through the National Care Service (Scotland) Bill.

My last question is, to what extent and in what ways do you expect the new accord with COSLA on shared legal accountability to address the concerns of trade unions about the bill? How will that agreement work as we move towards the national care service?

You are absolutely right: the trade unions will be crucial to the development of the national care service. I spent a lot of time working with them over the summer, and I would expect that work to continue.

I have said a number of times that one of the reasons why the social care workforce is so disadvantaged is that it is largely female and barely unionised. It is 83 per cent female and there is less than 19 per cent unionisation. I would like there to be a stronger role for unionisation within the workforce, in addition to me working with the unions to develop the national care service.

In terms of the shared agreement, I have mentioned the national care board. The board will be broader than just ministers, local authority representatives and NHS representatives. I would expect the voice of employees—the voice of people who work in social care—to be at that table as well. I would envisage an on-going space at the table for dialogue with them.

We envisage that the national social work agency, which will not be a union but a professional organisation, will be a strong voice for social workers in the national care service. Social workers are key to effective delivery of the ambition that we have set out. There will be a strong role for people who work in the sector, not just in the development of the national care service but in the on-going delivery and the national governance of that delivery.

As I said, I cannot commit to those things yet, because we are still discussing it. Today, I am laying out how I envisage that taking shape.

I will pick up that theme of engagement with trade unions. I declare an interest as a member of Unison. Minister, do you envisage that there will be any specific changes to the contents of the National Care Service (Scotland) Bill following your on-going discussions with trade unions?

I am wondering which of my officials is best placed to answer that. We are working with the unions on amendments.

I cannot recall how many questions we received from the unions, but there were quite a lot, which is totally reasonable. We have been working through amendments with them and on further amendments that we might need to make. We have not yet reached any conclusions, but that dialogue is certainly under way.

Thank you. We move to our next theme with questions from Emma Harper.

Good morning. I am interested in the co-design process. I know that regional events on that took place over the summer, at which you focused on rural as well as urban issues. For example, in my area such events were held in Stranraer and Hawick. I would be interested to hear a little more information about the co-design process and whether it was different from other processes that had taken place previously.

Generally, when we go out to consultation there is a set of proposals on the table. When we have gone out to speak to people, one of their criticisms has been that there is not enough meat on the bones. We would usually have a set of proposals and we would ask people whether they liked them. We have taken a step back from that approach and adopted a co-design process, spending a great deal of time understanding the current situation and trying to imagine a different way of doing things that would deliver better.

That is a step back, I think, from consultation. It delivers the voice of lived experience right at the heart of the design of the national care service, which is really important. I do not envisage that process having a hard stop at the end, when the bill is delivered. I envisage the voice of lived experience continuing to be a strong part of how the national care service evolves. It will help us to get the policy right in the first place and to deliver it according to our ambition.

Is that sufficiently clear for you or should I bring in my officials to give a little more detail?

I am interested in the fact that we are taking a step back to involve people right at the beginning. Involving people with a wide range of experience does seem to be valuable.

We have heard about the support that is required right across the social care spectrum. Here I should probably remind everyone that I am a registered nurse. Over the summer, I spent time visiting the social care delivery team at Stewartry Care in Castle Douglas. Its work is varied and the people there are skilled and competent in delivering care for people in their own homes.

I am keen to ensure that people understand what the co-design process is. They might just assume that co-design and co-production are the same thing, but they are not. Did that point about there being co-design and not co-production come out in the consultation process?

I am happy to say a bit more about that. As the minister said, the response was fantastic. We had more than 500 people at our in-person events and hundreds at the online ones. We thank those people for giving up their time.

The people to whom I spoke found it to be a valuable process but quite a different one. We were not presenting them with proposals and asking whether they liked them. Instead, we were getting into the depth of their lived experience and their understanding of how the current system works for them.

The five co-design themes were: keeping care support local; information sharing; making sure my voice is heard; realising rights and responsibilities; and valuing the workforce. It is also important to say that when we talk about lived experience we mean the experience of people who work in the sector as well as that of those who receive support or services.

The reports were published last week. We could send the link to them to the committee if that would be helpful, convener.

There is excellent information and insight in there about how people feel and how they engage with services, which will, as the minister said, help to inform delivery of the bill and the national care service more broadly. I could go into a lot of detail about that; I will not, but I am happy to answer any further questions.

There is a lot of information from the six reports on the Government’s website, and they are available in an accessible format. The reports are pretty comprehensive. I will probably need to read them in more detail, but I appreciate that.

Co-design delivers a sense of empowerment—it really is about empowering people. It is about handing the power over to them and saying, “If you were in charge, what would you do? How would you do it? How would you design a service?” We hear from people time and again about where things go wrong and how difficult that feels, so it is about making sure that we get it right from the conception stage rather than just rubbing the edges off delivery. I have heard from people who are involved that it feels very different. They say to me, “We have been saying these things for years; it’s not like we’re saying anything new.” The difference is that the system, which includes us all, is now listening, which is an important part of the process.

I have a final quick question. You talk about empowering people. Over the past few years, I have heard people say that they want to work with people to support their care, not to do stuff to them. Are we making progress on the language in relation to working with people rather than doing stuff to them?

Definitely. The first time that I met the social covenant group, it corrected my language. I made the rookie error of talking about person-centred care, and members of the group said, “Excuse me, minister, it is person-led care,” so they absolutely want to be in charge. It was a useful early lesson for me to listen carefully to what people are saying and always to make sure that they are in charge and as independent as they possibly can be. That is part of the purpose of designing the bill in this way.

It would be helpful to the committee to receive that additional information from Ms Bell or the minister.

Thanks to the panel and the minister for attending today. There has been confusion about what co-design means and how it differs from consultation, so could you clarify exactly how much influence the learnings from this summer’s forum events will have? Are they geared towards how the national care service will operate in relation to the processes and procedures or the design of individual services in specific areas or in the territorial boards?

I will give an example to help to bring co-design to life. We did work over the summer under the realising rights and responsibilities design theme. We are committed to a charter of rights and responsibilities for people. We took the draft charter out to individuals in those sessions, and they have helped us to make sure that it is meaningful to them and that they feel that it has teeth. That is an example of direct working together on design. We want to use that principle in the development of the workforce charter.

Co-design is about getting people around the table and working together to help to find a solution, which is quite different from the traditional consultation approach.

On the framing of the work that we are doing, as my colleague said, in areas such as the NCS charter, the workforce charter, informing the bill and, in due course, the national board, we are not at the point of doing any service design.

As Maree Todd said, as we move into the implementation of the national care service, there will be a strong expectation that co-design will form part of the future of service design in the national care service in Scotland. Does that help, Mr Sweeney?

I think that it does, and it brings us neatly on to the point about the charter being critical; it will be the linchpin of how the service will operate. There was a bit of dispute about having the charter in the bill. Will that opportunity be taken now, given that a draft has been produced and has gone out to consultation as part of the co-design process? Will Parliament be able to have sight of that and to codify it? Is it the intention of the Government that the NCS charter and the workforce charter be in the bill?

09:45  

The expectation is that we should have a form of the draft charter to share with the committee by early 2024. As the charter is co-designed—and co-design is an on-going process—to ensure that we have the ability to make the process iterative and for people to work with us, the preference is that the charter will not be enshrined in primary legislation. That is the intention, but we will definitely look to share a draft with the committee as soon as we think that it is in an appropriate format.

At what point does the charter become stabilised as a codified document? Is it the intention that it will be codified? You said that it is a fluid process, but clearly at some point it will have to be finalised, agreed and ratified by all the stakeholders. At what point do you envisage that that will happen?

We are currently in the sense-making phase of the co-design process. We will work through the different phases of the process, and then at a point when we feel that we have reached agreement as to the solid status, we will look to codify it. However, we want to review that document regularly and ensure that it is not set aside, because we need to ensure that it is meaningful. One of the reasons that we have enshrined co-design as a principle in the bill is that it is an on-going commitment of the national care service to check the charter, as part of a process of continuous improvement.

Could it be an option to have the initial codified version of the charter in the bill—even if it was added at stage 3—and then have provisions in the bill so that the charter could be amended in the future through delegated powers? That would at least make it a focus point in the bill. The NHS charter is very much the focus of the Patient Rights (Scotland) Act 2011, so it would be nice to have the charter feature as part of primary legislation for the national care service. Might the Government consider that?

We will certainly consider it. I will not give a promise today, because we need to discuss that with drafters and get technical guidance on whether doing so is a possibility, but we will certainly consider it and get back to you about whether it is possible.

Okay, thank you. My next question is also on the co-design process. There have been a lot of regional events to ensure that there is geographic coverage, but what other methods did you undertake to ensure that as many different stakeholders—underrepresented voices, in particular—as possible were given sufficient opportunity to input to the process?

I will bring in Donna Bell in a second.

As well as all of the regional events during summer, we have since added another three regional events, because of popular demand. We have a national event at the end of October, and we also held online events for people who could not attend in person. We have commissioned some specific work, with specific partners, to go out and reach the groups that, when we looked at the information that was coming in, we felt we did not have 100 per cent coverage.

I will just mention what we have done to follow up with those seldom-heard voices. We want to ensure that we maximise the reach of this work, and we continue to do that as we go along, so if we review the evidence that comes back from the co-design process and see that there are groups that are either underrepresented or not represented at all, we proactively seek input from those people. Going through colleagues in the third sector is quite often a good way of doing that, so we provided grants to a few organisations to provide some supportive engagement with the co-design process.

That is very helpful.

I am going to stay with Mr Sweeney to lead on the next theme.

You are on mute, Mr Sweeney.

Sorry. Unfortunately, I do not have control of my mute button. Apologies for that.

I will move on to proposals for delivery of services. We know that there is a postcode lottery in access to social care services. How does the Scottish Government plan to improve access in the new structure of the national care service?

How we improve access will be crucial to the success of the delivery. We all pore over the delayed discharge figures, particularly coming into winter. We are less good at capturing the level of unmet need that we know is in the community for people who seek care packages and have been assessed, but are not able to get them, which is equally important. We know that accessibility at every step is a challenge.

One challenge that we face is that there are different levels of integration around the country. As I have said, that makes it difficult to know where services are falling between cracks. We think that services sometimes fall between cracks because of the accountability in different models of design.

I see the national care service as the natural next step in integration. This is about further integration. We see different models of integration around the country. In some parts of the country, mental health is included; in other parts, it is not. As I have said, that gives rise to some of the postcode lottery and some of the challenge in taking steps to improve accessibility. We will look at whether that serves the nation well. The issue is probably improving integration in every part of the country.

The national social work agency will produce national standards. That will be an important part of improving delivery and ensuring that everywhere operates to the same national standard. I think that that will give protection to individual social workers, who will know what they need to do at each step of the way in their jobs. That is really important.

As I have said, I am determined that the national board will have teeth, so it will not be there just for decoration. It will absolutely be there to take an overview and to take action if there is service delivery failure in any part of the country. Where problems arise, the national care board will be able to take action to correct them.

One thing that will be really important—I think that we spoke about this when I was last at the committee—is the review of independent inspection and scrutiny that has just reported. We as a Government still have to reflect on and respond to that, but I think that that will provide us with another lever to pull to improve the situation and the standards nationally. Getting the inspection and scrutiny process right is a really important part of the process. One of the aims is to shift from what is perceived to be a punitive system in which there is reputational damage if things fall short to a more supportive system in which there is an ethos of continuous improvement and support is easily available to try to improve standards where they are found to fall short.

The point about continuous improvement, benchmarking and bringing everyone up to the highest common denominator is a helpful insight into the Government’s aspirations. However, an issue was brought up in discussion with the cabinet secretary. Last month, he told the committee that scrapping non-residential care charges by 2026 was not necessarily going to be achievable any more and it certainly was not going to be a key priority going forward. How does the Government propose to address the postcode lottery without scrapping non-residential care charges? Is that being considered in the development of the national care service?

As far as I know, that commitment still stands.

It remains.

We are in exceptionally difficult fiscal times at the moment. I do not think that there has ever been a more challenging time to be in government in terms of finding the money to deliver the commitments that we have made, but I am operating on a proceed-until-apprehended basis. Nobody has told me that we are not doing that, so, as far as I am concerned, we are definitely doing it.

That is reassuring. Thank you very much.

Good morning, minister. You have touched on some of this already, but what is the Scottish Government doing to support local authorities and health and social care partnerships with the current and immediate issues in social care and to support provision, including, for example, on staffing and capacity?

A lot of work is being done. Obviously, the delivery of £12 an hour is key, and I think that it will help, but it is not everything. As well as improving pay, work is going on across the board to improve conditions, focusing initially on maternity leave and sick pay—that is one of the fair work strands. Work is also going on with the Scottish Social Services Council and NHS Education for Scotland to provide educational opportunities to support the social care workforce so that, when people come into it, they feel well supported, know what they need to do, and have clear pathways to improve and to further careers, should they wish to study and move on.

As I say, a great deal of work is going on across the board, and not all of it requires primary legislation to happen—we can deliver some of it without primary legislation. A transformative change is required if we are to achieve one of the things that I hope we will achieve, which is an increase in the status of social care. I would love it if, in Scotland, we were talking about social care not just as something that helps the NHS when it is in trouble or harms the NHS when it is not functioning right, but as something that is valued in its own right and for its inherent ability to change people’s lives.

Social care totally transforms the lives of people who can access it, and it transforms their families’ lives. Day in and day out, I meet carers who are stretched to the limit trying to cope with the situations that they are in. An effective social care system takes the burden off families and it contributes to communities and to the economy. We talk a lot about the cost of social care, but we do not talk quite so much about its value. I am determined to move the conversation on to the value. On a very regular basis, I meet people who are struggling to work because of their caring responsibilities. If we get social care working right, it will have an impact on the economy. If we can articulate that better, we will stop thinking quite so much about the cost and start recognising the value, which is what we do with the NHS.

You are absolutely right. I am sure that we can all agree on how valuable social care is, and the pathways that you spoke about are so important, too.

I would like to ask you about the end of life. Not everyone will recover, and a substantial portion of the current health and social care budget is spent on caring for people who are approaching the end of life. At a previous committee meeting, Mark Hazelwood, the chief executive of the Scottish Partnership for Palliative Care, called for changes to the principles of the bill to include end-of-life care. How will the national care service be developed to respond to the growing need for palliative and end-of-life care? How are co-designed forums informing that approach?

Donna Bell can probably give more detail.

I have not been asked very much about palliative care. However, the reality is that the vast majority of people who go into a care home do so at the end of their lives and they pass away within an 18-month period. It is there, but it is not up front. I will let Donna Bell talk a little bit more about that.

10:00  

Talking about that final year of life, there are also all the hospital admissions and so on. We are always talking about bringing down the number of admissions, but obviously that is something that is not quite so movable.

Absolutely. I am absolutely determined to improve the situation, particularly because of where I live. The geography where I live is very challenging for social care. We do not have a care home in the village that I live in. If someone is unable to manage independently in their home in my village, they have to move away from their community and family to access care, probably on the other coast. That is the reality for people in the Highlands.

One of the reasons for our focus in the national care service on shifting care upstream and getting into that early intervention and prevention end of things, to support people to live independently and healthily at home for as long as possible before care is needed, is about enabling people to grow old and frail, and potentially die in their own communities. We are determined to deliver that. I will hand over to Donna Bell to give a bit more detail on palliative care.

We have engaged very broadly through the co-design process, particularly with people who have looked after relatives who have received palliative care. We have avoided naming multiple conditions or situations in the bill because people find themselves in many different circumstances. The importance of the charter is crucial here: dignity, respect and equalities are going to be critical, particularly in palliative care. We want to ensure that the aspects of the charter that we want to draw out can be applied across all aspects of people’s care, not just to palliative care specifically. However, those aspects would have a clear role in ensuring that people have the dignity and the care that they need as they go through the palliative process.

I hope that that answers your question on what is in the bill. There are other mechanisms to draw all of that in. We would be very happy to look at that and to pick up on palliative care with Mark Hazelwood.

Are you getting the feedback to help to inform the charter through the national care service forums or is there more work to be done in that area?

There is always going to be more work to be done. We are getting some really good feedback, particularly on the charter, about how those rights can be made to feel real and on how clear they are. One of the key things was to make sure that the charter is unambiguous so that people can really see what their rights are and how they can hold partners and the accountable bodies to account for those rights. We are getting that feedback. However, as the minister has already said, we will continue to have that engagement. We have not just the individual lived experience panel of experts, but also the stakeholder register, which has more than 300 organisations on it.

Great, thank you.

My questions are on the current status of social care. The national care service will cost upwards of £1.3 billion and is already overdue. You have said this morning, minister, that there is a great deal of work going on, but you also said that you currently have no control over social care. What are you able to do in the interim period to support the current social care provision?

One thing that we are doing is putting a lot of extra money into social care. We have made a commitment during this session of Parliament to increase the amount that we spend on social care by a quarter, which would mean £840 million going into social care. We are already at £800 million, so we are ahead of the trajectory on that and are vastly increasing the amount of money that we put into social care.

If I am correct about what you are asking, it is about whether we should pursue structural change at a time when the system is under so much pressure. Derek Feeley was clear that, if we just keep doing the same thing again and again, we will just keep getting the same outcomes, and we are clear that the system is not working as we want it to for the people who are accessing care at the moment. We need a transformational whole-system change to be delivered to meet the aspirations of the nation.

Minister, I was asking about what you are doing now. It is great to hear about the £840 million but what is that being spent on?

It is going on things such as increased wages. We have drastically increased the amount of money that people who are working in social care get paid. In the past couple of years, they have had a 14 per cent wage rise. That is one clear improvement that will be felt by everyone who is working in social care. People who work in social care in Scotland are now paid more than their counterparts all over the United Kingdom.

There is more to be done, but that sets us on a clear path, and I expect to do more of that.

You are saying that that £840 million is going on public sector and private sector pay increases.

Yes, because we have a mixed market.

Thank you.

In 2015, Shona Robison pledged to end delayed discharge. Why, after such a long time, has the social care sector not been given the resources to end bed blocking in the NHS?

That is a tricky thing to fix. If it were easy to fix, we would certainly have done it by now. Lots of work was being done across the system all last winter, and as soon as the winter was over, we began to reflect on how to rise and face the challenges that we expect to be faced with again this winter.

Scotland’s situation is not unique; it is similar all over the United Kingdom and in many developed countries. There are a number of challenges. As your question implies, there is no doubt that we were not rising to the challenge of delayed discharges prior to the pandemic, but we are now in a really difficult situation because of the pandemic. The whole of our health and social care system has been under sustained pressure for a number of years, and that is one the reasons why we are in such a difficult situation on this issue.

Of course, we have to cope with a new condition and several hundred people will be in hospital today with Covid and Covid-related complications. There is, therefore, a whole extra condition to be coped with as well as the fact that the staff and systems have been under sustained pressure for the past three years during the pandemic.

What are we going to do to improve the situation? That is the crux of the issue: how are we going to move forward from where we are now? A lot of work is being done across the system, including a lot of collaboration with local governance systems. We are producing dashboards of data, so during the past few months, we have spent some time on improving the data that we can provide to ministers and to local governance structures to try to ensure that quick action is taken where problems are brewing.

There is a suite of things that we know work, such as discharge before 12. Programmes such as home first are in place. That is an interesting programme and early results are impressive, so we probably need to ensure that that programme increases at pace and is delivered at a high level right across the country. In that programme, instead of an in-patient waiting for an assessment in a hospital environment, they are discharged to their home and assessed there. The clear finding is that a smaller package of care, with immediate support, is required to support people at home if they are discharged quickly. We are striving to spread that practice all over the country.

There is a lot of work to be done, but there is no magic pill. If there was, we would do it, and everyone else in every other country in the UK would be doing it, too.

Thank you. It sounds as though you are doing a lot of work on delayed discharge.

Yes.

I move to Sandesh Gulhane, who joins us remotely.

I declare an interest as a practising NHS general practitioner.

Minister, since the Scottish Government’s decision to go back out to consultation, what has been the cost to the taxpayer for the National Care Service (Scotland) Bill to tread water?

I would challenge that narrative. We are not treading water. This is the second time that I have been in front of this committee to explain exactly the level of work that is going on across the country.

We paused and then worked very hard with partners, local government, trade unions and people with lived experience to try to find a way forward. You will be aware that we were pretty much in a situation in which we could not move forward because the level of opposition to the bill was so great. Therefore, I am really pleased that we have achieved consensus and that we are moving forward now.

I think that, last week, we provided the Finance and Public Administration Committee with costs for the bill so far. If you check the papers for that meeting, you will be able to see exactly how much spending there has been on the bill at each stage.

What is that number, minister?

I do not have the numbers in front of me at the moment, but it is significantly less than was predicted because the pace of delivery is slower. The slowing of the pace, the pausing and the phasing of the introduction of the national care service mean that it is costing less.

Donna Bell might have the table in front of her.

I do not have the table in front of me. We probably also need to make a distinction as work would have been under way anyway. We had always planned to do the work on co-design over the summer. Stage 1 of the bill will now be completed by 31 January 2024.

It is quite difficult to make a judgment on whether there has been a cost to the delay or not, because the effect has simply been that the work that we had planned to do has been rescheduled. As Ms Todd said, we have provided information on the costs to develop the bill and the programme of activity. The bill is one part of the work. Various engagement activities are under way, as are policy development and broader activities.

We can certainly provide to the committee the information that we provided to the Finance and Public Administration Committee on spend to date on the bill, if that would be helpful, convener.

Yes, I think that that would be helpful. Thank you.

Let me get this straight. The Government created a bill. You said to me, minister, that despite the significant opposition to the bill that the Conservatives brought up and discussed many times, the Government said that it was just going to press ahead, but that, because of that continued opposition to the bill, you stopped to reconsider. However, you do not consider that to be treading water, and you do not have figures to tell me what the cost was.

If I say that the figure is £15.4 million, would that be accurate?

I am really sorry, but I did not hear that figure. Could you repeat that figure, please?

£15.4 million.

I do not recognise that.

No, we do not recognise that figure.

I did not say that the Conservatives slowed the delivery of the bill. The Conservatives were one group that was opposed to the bill as introduced, but there was significant opposition to the bill as introduced. I think that it is reasonable in the face of significant opposition that the Government pauses and works on the direction of travel with the people who are concerned about the direction of travel, and that is what we have done.

The bill will be delivered. We will finish stage 1 by the end of January next year. Of course, it will be down to Parliament how fast the legislation progresses, but I would expect there to be significant progress in the next few months.

Okay. Thank you, minister.

10:15  

Just to go back a bit, I recommend that people look at the Government’s website. There is comprehensive information on the national care service, with all the reports and information on the engagements over the summer and the work that has been done to connect locally. It is great that Stranraer was one of the places involved, because folk fae Stranraer always feel forgotten.

How does the Government get the message out that people should look at what is on the Government’s website to find out about the power of work that has been done over the summer? What is the best way to share that information?

That is a good question. There is a lot of work and a lot of evidence there—perhaps there is almost too much, and people are finding it hard to navigate the volume of information. We can reflect on how to communicate. We have specific forums where we meet, hear from and talk to people with lived experience. We also have on-going engagement with trade unions, which has been vital to improving communication. When I first came into post, a number of people were concerned about things that just were not correct. Correcting those myths has been an important part of the work that has been done during the pause.

We have a social media programme, which is a really rich way to bring the information to life. As members, we all love reading, and we read a lot for our work, but it can be tough for Joe Bloggs to read through pages and pages of information in somewhat dense text. There are “Voices of Care” videos that bring to life different aspects that we are working on. I recommend that people have a look at those, as they really bring to life what we are trying to achieve.

My question is not a criticism; I am just raising the fact that there is comprehensive information out there. There are easy-read documents for people, and the videos that you referred to are another great way for folk to get information—they can watch the videos on their phones or whatever. My point is that a lot of work has been done over the summer and it would be good for people to be able to see that.

Absolutely. We will certainly reflect more on how we can highlight that to folk. You are absolutely right that there is a lot of detail out there.

I have a question for the minister or the officials, just for clarity. The figures that Sandesh Gulhane was asking for were made available to the Finance and Public Administration Committee, so are they published?

I think that we sent a letter with those figures.

Yes. We can certainly provide the figures to this committee, if that would be helpful.

That would be very helpful—thank you.

Good morning. Some unpaid carers are concerned that the pause in the national care service might mean a delay in the right to breaks from caring coming into place. Will you update us on what work is being done to progress that while the bill is still being worked on?

You are absolutely right. It is crucial that carers have a life alongside caring. I mentioned that I meet regularly with many people who are involved in social care. People who are caring for members of their family are often at the end of their tether, which is one reason why I am absolutely passionate about shifting care higher upstream towards early intervention and prevention, so that people do not get to crisis point before help is available to them.

It is absolutely crucial that carers have their own life alongside caring and that they can sustain their own health and wellbeing. As you are well aware, we are doing a lot of work through the bill to enshrine the right to breaks. However, we are acting now to expand easy access to short breaks support ahead of the legislation—we are not waiting for the legislation to make that change. We increased the voluntary sector short breaks fund by £5 million to £8 million, and we have maintained that fund at £8 million for 2023-24.

That is in addition to the Carers (Scotland) Act 2016 funding—the £88.4 million that goes through the local government block grant. We are trying hard to support carers before we create their right to a break by putting it in the bill.

The money is hugely welcome—I am sure that we all welcome it. Another particular concern that has been raised with me is that there is geographical variation in the ease of access to breaks—you will be well aware of that, minister, as a rural constituency MSP—and also variation in the support that is available. Not everyone will want what I am sure many members of the general public have traditionally seen as short breaks. Many people want to be able to take their loved one with them on holiday and to be supported to do that.

What specific work is going on in those two areas—addressing geographic variations and improving the diversity of short break offerings—in order to make sure that we will be ahead of the game by the time the provisions in the bill come into force?

That points to the fact that, as I keep saying, one size does not fit all. One general thing that we are trying to do with the bill is to make the approach more person centred—or person led, to correct my language as per the social covenant group guidance. We want it to be flexible and we want it to work for the people who need the support, so we will need to work really hard on the ground to ensure that there is a person-led approach to carer support.

I have been asked before about a definition of “sufficient breaks”. We could toil and come to an agreement on the definition of that, but the more important thing is whether the person who is accessing the support feels that they have had sufficient breaks.

As in all things, we need to build something that is flexible, person centred and person led, and which delivers the difference that we are hoping to see. That will be tough. At the moment, as you say, we have a variety of options across the country, some of which are easier to access than others and some of which are more enticing than others. However, we are already working pretty hard right across the board to improve that situation.

I do not know whether either of my officials wants to say anything.

To build on what the minister has said, I note that, as part of our co-design and our stakeholder engagement, we are working with the stakeholder working groups on that very issue. They are helping us to define what “sufficient breaks” look like and mean to them. The groups include representatives from island and rural communities. It is a very live issue and one that we have been discussing with them. It is really important that they have their voices heard to help us to work that through.

I was in a conversation just last week about the reality of what “sufficient breaks” means to a carer. This is where the voices of the unpaid carers in the room are really important, as well as the voices of the local carer centres, which understand their communities’ needs. We are very committed to working with them to help us to develop the regulations and guidance, in order to make sure that we truly deliver as consistently as possible across the country.

That is great. Thank you.

Tess White has a brief follow-up question.

Minister, you recently told social care providers in Shetland:

“it’s not our intention to come up here and tell you how to do things”.

How will the independence of local providers be respected when you are centralising social care across Scotland?

Again, I challenge that narrative. We are not centralising social care across Scotland. I was very clear about that when I went to Shetland. We were really impressed by the level of integration that is being achieved there and the work that is going on between the NHS and the local authority to ensure that a cohesive package of social care is available. I joked with them, saying, “Maybe what we’ll do is pick up the Shetland way and roll that out across Scotland; rather than us coming and imposing the Edinburgh way on Shetland, we’ll take the Shetland way and roll it out all over Scotland.”

However, even in the room at that time, we recognised that, while there are things that Shetland is doing excellently, there are things that it needs national support with. That is where we want to make the difference.

An example is information sharing. A little bit of primary legislation is required to make that easier. When we engage with people with lived experience, we hear that they are tired of telling their stories again and again to everyone whom they meet in the system. The ability to share information safely and appropriately within the system needs to be unlocked centrally, by central Government. We can do that, and it will enable better local delivery.

There are things that we can do to help. Another thing that we talked about was the challenge of recruiting professional social workers in Shetland. There are definitely things that we can do nationally to support that and make it easier to recruit and train by taking away some of the barriers to entry to training that exist in places such as Shetland.

I am keen to hear what the challenges are in every local area and to see what we can do nationally to unlock them. I am not interested in micromanaging from Edinburgh the entirety of social care all over the country. I have said that time and again.

I live in the rural west Highlands. Social care in Ullapool, where I live, looks very different from social care in Inverness, but both are within NHS Highland. Even within local authorities, if they are to be responsive to the needs of their communities, their geographies and the situations that they face in terms of labour shortages, they will have to be flexible in how they deliver. We are keen to create a system that supports that and empowers people while maintaining national standards. There should be a clear expectation that, wherever people are in the country, they know the standards and the quality of services that they can expect to access, even though services might look a little different, depending on where they are accessed.

I thank the Minister for Social Care, Mental Wellbeing and Sport and her officials for attending the meeting and for the information that they have provided.

I will suspend the meeting briefly to allow a change of panels.

10:26 Meeting suspended.  

10:35 On resuming—