Local Government and Regeneration Committee

Meeting date: Wednesday, September 4, 2013

Official Report 552KB pdf

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Children and Young People (Scotland) Bill and Public Bodies (Joint Working) (Scotland) Bill: Stage 1

Agenda item 5 is an oral evidence-taking session on two bills that are currently undergoing parliamentary consideration: the Public Bodies (Joint Working) (Scotland) Bill and the Children and Young People (Scotland) Bill. The bills are being considered by the Health and Sport Committee and the Education and Culture Committee, respectively.

Although this committee is not a formal secondary committee for the consideration of the bills, each of the bills might have a significant impact on the functions of local government in Scotland in relation to the delivery of adult and children’s services. In keeping with the Presiding Officer’s agenda for more focused and joined-up working by committees, we have decided to hold this one-off evidence-taking session on both bills with some key witnesses and to report our findings to the lead committees.

The aim of the session is to ensure that the bills are scrutinised from a local government perspective as well as to deliver joined-up scrutiny of cross-cutting legislation by the committees of the Parliament. This session will also inform the committee’s on-going work on the implementation of the Christie commission principles across the public sector in Scotland.

The witnesses have made written submissions, which members have before them. We have also received a further 13 written submissions from other organisations, and we have had regard to the written submissions that were given to the lead committees.

I welcome Jim Carle, the child health commissioner with NHS Ayrshire and Arran; Dr Anne Mullin, from the general practitioners at the deep end group; Eddie Fraser, the head of community care in East Ayrshire Council; Carol Kirk, the corporate director for education and skills at North Ayrshire Council; and Mary Taylor, the chief executive of the Scottish Federation of Housing Associations and a member of the housing co-ordinating group.

We are rather short of time, but do any of our witnesses wish to make a short statement?

I would welcome the opportunity to do so. I will try to be brief.

It is clear that housing seems to be absent from the debate about the integration of health and social care, so we are delighted to have an opportunity to speak to the committee today. The housing sector—on whose behalf I am speaking; I am not here solely on behalf of the SFHA—supports the broad aims of joined-up working and improved outcomes in relation to health and wellbeing. We see ourselves as already making significant contributions to outcomes around healthy living and independent living, and positive outcomes for individuals and communities.

We support the broad thrust of what is happening, but the focus on the institutional and structural aspects of integration without reference to housing creates a risk that, in our view, this committee could do something to address. For example, in the papers for today’s meeting, there is virtually no mention of housing, other than in the paper from the housing co-ordinating group. That might be what you would expect, but I am here to make the case for revising the proposals as they stand in order to allow better strategic engagement with the housing sector, from strategic commissioning down to locality planning at whatever scale that turns out to be.

Unless the housing sector, which has experience of strategic planning and has the practical capacity and appetite to make a contribution on the ground, is involved, there is a risk that there will be poorer-quality and more expensive outcomes than might have been achieved with housing involvement at an earlier stage. That is not what we want for ourselves or for our older generations and relatives.

That was an extremely useful contribution, so I will begin by following it up.

In the past, there were moves to create homes for life. However, we have seen various welfare reform changes, with more to come, which kind of impede that ambition—I am thinking of the bedroom tax and so on. Of course, this Parliament does not have powers to address those issues at the moment, which is probably an impediment to what you would like to see. Do you wish to comment on that?

I am not going to elaborate on the bedroom tax, in the interests of time. I could go on at great length, but all that I would say is that it does not completely undermine the sector’s capacity, although it certainly erodes it and we are working to address that.

There are all sorts of issues, particularly in the engagement of the housing sector in strategic planning through the local housing strategy and housing contribution statements, and, as I said earlier, it would be a risk to the objectives and goals of the integration exercise to miss the opportunity to involve housing in those things.

Would it be fair to say that those changes do away with the concept of homes for life?

Not necessarily. There are a number of people affected by the bedroom tax, but there are also a number of people who are not affected by it, and there is no requirement on anybody to move as such. The English regime for housing policy is quite different from the Scottish one, and Alex Neil, when he was Minister for Housing and Communities, made it quite clear that there was no suggestion that the homes for life notion was going to be done away with.

I point out that, in speaking for the housing sector, I am speaking not only for social housing providers. Our housing co-ordinating group involves people who work right across the spectrum, including care and repair projects that help elderly owner-occupiers to undertake repairs to their homes and to engage the services that they need to keep them living independently in their homes. This is not just about social housing.

Thank you. There are obviously high expectations for both bills and for what services can be expected to achieve. People are obviously looking for improvements once the bills come into place. When do you think that the benefits will start to be demonstrated?

I believe that the benefits are already becoming manifest and have been for some time. Children’s services, in the broadest sense, have been working towards a similar integration agenda, understanding that by working together we can produce better outcomes for children and young people.

The challenge for us is measuring the impact of, for example, the early years collaborative over a longer period of time. Public organisations are quite used to looking for short-term gains over one, two or three years, but we are not used to looking at someone who will be born today and the benefits for them or the reduction in their uptake of services in later life. Children’s services have been working hard on that agenda, and we hope that the two new bills will go some way to supporting that new process.

From a general practice perspective, working in deprived areas we have not seen benefits yet.

We are looking from a slightly different standpoint from other services that are represented on the panel. The deep end group thinks that there is potential in the legislation, and we would like to explore some of that potential with the Scottish Government. We have outlined specific proposals in areas where we feel we could and should make a difference, but that needs to be supported with all the things that we have suggested in our proposals, such as the additional time for consultations that we need when working with very comorbid people in deprived areas; support for serial encounters in general practice, which are key to people’s holistic and long-term care; attached staff who are specifically named social workers, addiction workers and health visitors; and a nationally enhanced service for vulnerable children. The list goes on.

We have outlined those proposals, and members can access those documents. If the proposals are incorporated and recognised, we feel that general practice can play its part with our other partners in primary care.

Having visited some doctors’ surgeries during the recess—everybody thinks that we take long holidays, but it is actually more work—I am aware of the need for increased consultation times. Surgeries that I visited made a plea for that, but I believe that your contract is governed by a deal with the UK Government. Is that correct?

10:30

There is perhaps some scope for that now. I am not involved in contract negotiations, which are for the British Medical Association, but there is some appetite to revisit the contract and consider what could be more appropriate for the national health service up here. The primary care services in Scotland and England bear no resemblance to each other any more. We feel that primary care is far more protected up here and we want to develop the role of general practice, particularly in the equalities agenda. We feel that it is very important for us to get involved.

You would say that it would be best for the BMA to negotiate with the Scottish Government rather than the Westminster Government over many of these things.

That is my opinion, yes.

I concur with Jim Carle that we are already seeing a lot of the benefits. I chair our integrated children’s services partnership, which has representatives from the police, health, social services, housing and the voluntary sector. Over the years—particularly the past two years—we have seen a significant coming together in specific actions in relation to children. Before that, we would come together much more around a project.

The situation has now changed and we are looking at significantly different ways of working together. We are considering the co-location of health visitors within our early years establishments and we have established a multi-agency domestic abuse team, which is having a major impact on the number of children who are referred to the children’s panel. There is a lot of good joined-up working on specific issues such as those, and it is beginning to bear fruit.

Within the North Ayrshire community planning partnership, we are considering putting our children’s services into the health and social care partnership along with adult services. With my other hat on, I am the director of education and skills, and it does not cause me anxiety that health is no longer going to be part of the council as such. I think that the networks and the work on the ground are solid enough that it does not matter what headings we have on the management structures. If there is working together in an integrated and effective way, it matters less where the budget sits and where the managers and the reporting structures are.

Our partnership reports directly to the CPP, which takes a very active role—as does the chief officers group—in monitoring the outcomes for children. As Jim Carle said, that proves a challenge, as some of the short-term measures are not easy to define. In some of the work that we are doing, particularly with our youngest children, we are seeking long-term societal change and there is a challenge in that. I am happy to see the focus on integrated children’s services in the bill, but we need to be careful that we are not creating additional planning structures instead of refining the planning structures that we have both at the corporate level and at the level of the individual child.

Thank you. It is refreshing to hear that a CPP seems to be working well in that regard. Getting it right for every child has played a part. Can you outline the importance of what that programme has achieved? Has there been any resistance within the CPP to a move to preventative spend?

GIRFEC has been a catalyst in changing a lot of the thinking. We have established local resourcing groups, which have been in place for four or five years. That has meant that multi-agency teams can provide a very quick response for children who need additional support but who are not at the level at which the reporter is approached and compulsory measures of care are sought. That has served us well both in keeping children out of compulsory care and in preventing situations whereby they are either out of school or out of the local authority. We have seen significant change around that.

A significant piece of work around GIRFEC has been carried out across the three Ayrshire councils. The information-sharing project, which is called AYRshare, started in South Ayrshire and has been rolled out to North Ayrshire. In essence, the three integrated children’s services planning groups came together to take things forward. We think that the approach will help all the agencies that are involved to get a handle on issues much more quickly and to be able to share information at that level.

GIRFEC has significant strengths and I think that people are signed up to it. There are issues to do with the planning around GIRFEC. We still have additional support needs planning, so there is sometimes an issue for us and for people in health about which plan to have for a child. There is still a bit of a cluttered landscape, but that will probably change over time.

I have not detected a reluctance in relation to preventative spend. However, there is significant difficulty in disengaging in relation to costs that are incurred for children who require a residential placement or intensive support, in order to invest in support further down in the early years.

Our joint chief officers and the CPP have made significant investment. We have put more than £1 million into preventative spend for young children, which meant that hard decisions had to be made elsewhere. There is not an unwillingness to spend in that way; it is just that there are groups of young people at the upper end of the spectrum who need continuing support, and it is difficult to disengage the money that is being spent on them so that it can be diverted elsewhere.

The message is beginning to get out that preventative spend is having an impact. It is having an impact on the number of exclusions from school and the number of young people whom we place outwith the authority, and there are fewer referrals to the reporter. There is hard evidence that spend is effecting change.

The convener asked when the benefits will materialise. As other people said, to some extent the benefits are already materialising.

That is true even in relation to housing planning and the development of new services that are preventive in essence and that aim to be low cost. That can happen where there are good relationships such as my colleagues on the panel have described. However, for every area where there are good working relationships there is an area—if not many areas—where working relationships are not necessarily good.

In particular, I cite the experience of the reshaping care change fund. Change fund plans have often been developed without reference to housing and without recognition that housing can achieve a huge amount upstream, at costs that are relatively low in the context of health budgets. Until relatively recently, people had not even got to the point at which they had the opportunity to sign off change fund plans—and that has happened only after a lot of pushing.

That is part of the argument for stronger recognition of the role that housing can play and for not leaving things to chance and the accident of good relationships.

As members might have anticipated, I concur with most of what other witnesses have said. I emphasise the need for continued partnership working with housing in the new health and social care partnerships. We all know that there will be demographic change and that the number of older people will grow. Older people need appropriate housing so that they can continue to live in the community.

In my area, the focus of the council house building programme has been on houses for older people and how we can build houses that can support adults who have complex needs—that is the other area in which close partnership working with housing is needed.

We absolutely support de-institutionalisation and people living in their communities, but the fact is that we have individual support packages costing £200,000 dotted all over a town instead of some way of delivering them effectively through a type of core and cluster model. The issue is very much to do with the link between care and housing, and we in East Ayrshire have been able to deliver some successes in that respect.

I also agree that through housing we can get some early wins not just for organisations but for individuals. If by working through care and repair we can get simple things such as handrails installed without the need for elaborate assessment processes, people get what they need quickly and it proves cost effective. Indeed, one of our major successes has been the ability to put money into such areas through the change fund.

We have also been able to give money to the voluntary sector in order to give people practical support. Older people get depressed if they have to sit and look at an overgrown garden, and providing money to certain voluntary organisations that get young people into work and to do Scottish vocational qualifications while, at the same time, giving older people some practical support has proved to be a big success for us.

As for other early wins, co-location of certain services has been a really positive move. We have a number of good examples where such co-location has helped to increase communication. For example, the co-location of all our mental health and learning disability services has given us immediate wins.

We have also been able to develop our intermediate care and enablement services to support early discharge from hospital and prevent admissions. Indeed, our statistics show how successful we have been in consistently improving the delayed discharge situation and, most important, in helping older people stay at home.

One of the positives of the proposed changes is that everyone will be clearer about how to access services. It will certainly help if, instead of general practitioners making referrals to a whole range of different people, we have clarity about who they can refer to. Having quicker decision making instead of decision making by committee will also make things clearer for us.

We also have to look at locality working, because we cannot have separate approaches to that issue in the various bills that are around at the moment. We have single communities, and we have to consult those communities together; after all, the priorities for those communities and how they want some of the national priorities to be implemented should come from them.

In that respect, it is essential that we have real engagement with local communities and that our local GPs are involved in that process. With the development of community health partnerships, we have lost the engagement of GPs in local healthcare co-operatives. We need GPs to come back into the process in a meaningful way that allows them to see the changes that are being made and to influence what is going on in communities.

The bills contain many opportunities, but it only makes sense to do this together on the front line at community level.

Do our health colleagues foresee any practical issues for local authorities and health boards in trying to implement both bills together?

Yes, there are a number of issues. Aligning both processes will be problematic and what could be regarded as strategic planning systems will give us issues. However, we are not going to run away from them; instead, we are going to grab and make the best of them.

There will be problems in ensuring that the two processes communicate well with each other. In planning for the implementation of the Children and Young People (Scotland) Bill, we need to be conscious of actions that are being taken on the other side. The recognition of the need to work better together did not come as early in the process as we would have wished, but it is now there and we are starting to build from that basis. However, the fact that we are dealing with two separate processes that come from slightly different perspectives has been problematic, and it would have been much more helpful had they been brought together much earlier in the process.

An awful lot more could have been learned from the experience of children and young people’s services under GIRFEC and the processes that we have had to go through. Carol Kirk mentioned a number of gains. Under GIRFEC, we have had to look at culture, systems and practice. What we have done well is to change our culture and move away from our silo working practices towards having, on occasion, large meetings at which we work through all of our issues, recognise that we have more than one audience for anything that we are trying to deal with and move forward from that. However, we see the potential hurdles and are working towards dealing with them.

10:45

We could have a long discussion on where things could again go very badly wrong in Glasgow, as happened last time, so it is important to get it right this time. Purely from a GP perspective, one of the biggest lessons is on the need to engage directly with general practice. There are different models in Glasgow’s community health partnerships but, in Glasgow south, where I am from, we have a large established GP committee that engages with senior management to discuss policy and to consider local initiatives. That committee has minuted meetings, we report back to local colleagues and we have set up learning events and so on, so the situation is progressing. We feel that that should be built on, because it is a good way of implementing stuff that comes to us that sometimes seems very hierarchical and full of bureaucratic speech.

For example, we just want to know whether, if a GP identifies that someone has an unmet need, there is actually a service that the patient can be put into. At the moment, there is a mismatch. In our anticipatory care planning, we go out and visit housebound elderly people, who were traditionally chopped out of the QOF, or quality and outcomes framework. We now identify a lot of unmet need, but we do not have the resources to match the need. The discussion needs to be linked into the views of those experienced professionals who can inform the process about what needs to happen in parallel as the work progresses. We realise that that is not quick work—it is slow work—but it has to be a two-way thing.

There have been particular issues for health colleagues, who have some very complex arrangements. For example, I know that health representatives on our group often have complex reporting arrangements that they need to go through. The two chief officers in the CPP have managed to cut through some of that, but a considerable amount of work is required. Therefore, there is potential to simplify a lot of what we do. We need to learn from the work on integrated children’s services in taking forward integration of health and social care, but we also need to learn from the work that has been done in adult services on how we create the momentum to make some of the changes. Perhaps a bit of joined-up learning still has to happen on that.

Ms Taylor, do you want to comment?

We did not comment on the Children and Young People (Scotland) Bill at all. All that I would say is that, in the consultation on the integration of health and social care, children’s services and housing services were lumped together. Given that, in this committee, a focus on children’s services tends to exclude a focus on housing services, my only plea is that, in the absence of housing provisions in the Public Bodies (Joint Working) (Scotland) Bill, the committee should still pay attention to the housing dimension of the argument.

I think that you have got that message across, Ms Taylor.

We need to be careful that we do not lose anything in the changes. Community health partnerships currently have a responsibility for people from cradle to grave—for children, adults and older people. If we move to health and social care partnership committees that have a responsibility only for adults and older people, we need to be careful that children’s services are not left sitting without an easy strategic voice in community planning partners such as councils and health boards. In taking the agenda forward together and planning across both bills, we need to ensure that the change is for betterment and that there is no loss of strategic planning.

Does Anne McTaggart want to respond to any of those comments?

No, that is fine. Thank you.

Dr Mullin mentioned that GPs are doing good things but they sometimes run out of resources. One way of addressing that—I put this point to all the panel—would be to ensure that positive outcomes are assessed and logged. Particularly for local authorities, will the new requirements be integrated into benchmarking? How do you assess the outcomes—both positive and negative, as you can learn from the negatives, too—and then do things differently? Perhaps we can go round the panel and ask people about that.

We have heard positive things this morning about how people are sharing and integrating services, which is welcome news. Equally, we have heard good things from CPPs in the past that have not then materialised in local communities. It would be helpful to have a little more detail on how you will pin this down.

We can evidence that through numbers. Sometimes, that is about the number of hospital admissions for people over 75. We can also evidence it through measures such as the number and proportion of our elderly population who stay at home. It is much harder to look at less tangible issues such as wellbeing in communities and longitudinal things. If we do preventative spend, we need to do it so that people do not need certain health and social care services in 20 years’ time. That applies to everything from the 50-year-old male with an alcohol problem to unborn children. We must look at how we do that, but it is sometimes difficult to do and it will be longitudinal.

We can use indicators. One issue is the extent to which we put together anticipatory care plans. I accept that, unless we follow those up, we have gone through a process without improving someone’s life but, if we can put such plans in place, we can show that we have improved someone’s life. We currently have indicators that show what the situation is, but it is much harder to capture the positive and tangible things that we will see as we take the approach forward.

First, some of our colleagues in the housing co-ordinating group are actively working with the outcomes group on the definition of the outcomes and on the targets and indicators that go with all of that. Our general view is that wellbeing is not sufficiently addressed and that there is still too much focus on the costs and impacts of existing services rather than on the services that there might be in future, but I do not want to rehearse that in greater detail now.

Secondly, some members of the SFHA have undertaken social return on investment studies into the impact of the benefit of services and those have shown the value of the services concerned. I can send you details of a project done by Link Housing Association, which showed that, for every pound that it invested in an advice and information service, it got £27 of value back. A study by Hanover (Scotland) Housing Association, Bield Housing Association and Trust Housing Association looks at the value of adaptations for older people. I can send you details of those studies.

I think that we have seen them before, but we would be happy to see them again.

An issue with benchmarking is that it tends to be done against individual services and individual parts of the service. For example, it is easy for me to benchmark in education and we are benchmarked to the hilt across other services. Schools benchmark against other schools and benchmarking is embedded in the system.

We are also good at benchmarking against children at the acute end, if you like. We are good at benchmarking around looked-after children and children who come into the child protection world. Benchmarking around children when there are issues of wellbeing or neglect is quite difficult and we tend to rely on input measures—on what we are doing to address the issue—as there is a conceptual difficulty in benchmarking the impact that we have. However, we have done quite a lot of work to try to identify indicators and we think that we are getting there by looking at the stretch aims of the early years collaborative. We are working back to establish how we get there and which measures tell us that we are getting there.

We have taken forward an investment in the Solihull approach to parenting jointly with East Ayrshire Council, South Ayrshire Council and NHS Ayrshire and Arran. We can measure how many people are using the approach and what impact they feel that it is having on their clients or the families that they deal with, but it is difficult to develop hard measures of what it is saving us and what difference it makes to the wellbeing of children. A lot of work is going on in that area, but it is still in its infancy.

Previously, you gave us a good example of something tangible when you referred to the number of exclusions from school going down, but I take the point that it is not always possible to give such examples.

We could look at the epidemiology of the statistics that are being collected on issues such as unscheduled admissions to hospitals and the number of days that elderly people spend in hospital before they get moved to a nursing bed. I agree that some of the more qualitative outcomes take longer to develop, because we often need to involve the patient or client in the research agenda, and that work requires commitment.

There are a lot of short-term measure outcomes, but there are not a lot of long-term measure outcomes. A lot of our evidence on early interventions comes from the Olds study, which is on-going. We have nothing similar to that here, but we were prepared to look 20 years down the line at what happened earlier, and how we prevented something from happening. Social return on investment was mentioned. Action for Children published an interesting report about a family intervention project in Northampton and the money that was saved if it intervened early on.

There are ways of pulling together research strands into an integrated proposal. The GPs at the deep end group is working on that. We are very keen to do that research, but it would need to be resourced to give us the staff and the ability. At the moment, there is very little evidence to show for all the work that is going on.

The question is excellent and quite difficult to answer for a number of reasons, but I agree with what my colleagues have said.

GIRFEC gives us the model for change and a common language so that we can communicate with one another. However, we need to develop a number of areas in a much more integrated way. We need to develop better systems for looking at contribution and developing the contribution analysis that looks at all the different systems that contribute to the wellbeing of a child, at how we measure or quantify the benefits that those systems can bring together and the impact that they have on the child.

We need to move away from looking at children in the sense of talking about what we do with a five-year-old, for example, and pick up on the life-course approach. What do we do when we are preparing young people for parenthood? What do we do to help new parents to develop? How can the issues that were identified during the early years be carried forward into primary and secondary school? How do we measure that across the life course of the child? There needs to be some sort of longitudinal analysis of the benefits of the different contributions that are made across the different systems.

One key benefit of joint working is that we all come to the table with a number of different skills. A public health approach to the issues would be extremely beneficial and helpful. As a science, public health has the skills to enable us to develop a proper contribution analysis. We need to ensure that, once we have established an agreed way forward, we stick to it over a long enough period of time to see the benefits coming from the process in which we engage just now. For example, the early years framework is helpful and positive. It gives us a good focus on prevention and the early identification of issues and it gives us the opportunity to engage positively with parents.

One of the key things that has been missing from our discussion so far is the contribution that communities can make to the process. How many of the answers to the questions that the professionals are asking lie within communities? They can inform professional practice.

The combination of approaches from the different disciplines and sciences that are involved will help to take us forward. However, we do not yet have systems that can measure the total contribution to an individual child over their life course, and that is very much what we want to have a look at and start to develop.

Finally, I want to ask about the implications of the provision in the Children and Young People (Scotland) Bill that every child should have a named person. Do the witnesses have concerns about that? Is it necessary? Sadly, some children have chaotic lifestyles, so many different public bodies might have to share information. It would be helpful if you could give us your views on that.

In Ayrshire and Arran, systems are well advanced. We know that our health visiting team will pick up the role of named person for the under-fives. Our midwifery service will be working hard to take that forward.

If we are to do more than just implement the wording of the bill and instead try to achieve the bill’s aim of a much better society in Scotland, and if we are to improve our culture, we have to consider the amount of time that it will take to engage with more difficult families. We believe that that is a significant burden that will, I admit, build up over a period of time for our midwifery and health visiting services.

11:00

We have time to meet our statutory obligations and we are doing that fairly well, but if we are to have a conversation with a new mum around alcohol, how it relates to foetal alcohol syndrome and the impact that that could have on her, her children and her family over the later life course, that requires the development of a relationship. The current systems do not allow for that on every occasion. That approach also requires the development of good communication skills and the ability to raise difficult issues and agendas, which will be problematic.

We are asking the health visitor, as the named person, to co-ordinate all the information that comes from a number of services and pull it together to adopt a basic analysis to identify whether there are issues for the particular family, and then to pass on those issues. However, that will take a significant time, and we are not confident at present that the resources are there in those services to enable that.

We will be able to perform our services according to the word of the legislation, but that is not our issue. If you really want us to get behind the issues that exist and find resolutions for them, that will take time and resources, and at present they are not there. We expect to see investment being recycled, if you like, from the money that is being put into the early years collaborative later in the life course. We hope to see a reduction in the number of children who are looked after and accommodated, for example. However, we do not have systems that can identify where those savings have been made, because that will perhaps happen 10 to 15 years later. Then there are questions about how to recycle that funding back into the early years to continue the process and build on it.

There are a number of challenges in the issue that Margaret Mitchell asked about.

I agree with a lot of what Mr Carle has said. For the under-fives—pre-schoolers—it is logical to have health visitors as the named person. For schoolchildren, there is a massive gap. If a child becomes vulnerable at four or five, they will probably still be vulnerable at six, seven and eight, but I do not believe that there is enough capacity for that work to be on-going in a meaningful way in the education system.

I am quite relaxed about the named person idea. Most people have a named general practitioner, and GPs are often the source of referral for many different agencies that are looking for bits of information or have something to tell us about a family or individual. I would like the GPs—and GPs at the deep end have stated this desire strongly—to have far more involvement with vulnerable children and families. There needs to be something more substantive in general practice.

There is a challenge for a lot of services. We have discussed whether, given that probably more than 98 per cent of three to five-year-olds are in early years provision where they are seen every day by nursery practitioners, the named person would have been better situated in that place. We have raised that on a number of occasions.

We have been operating with GIRFEC and the GIRFEC guidance for some time, but it is not easy. In primary schools, the headteacher or the additional support needs co-ordinator, who is often either a depute or a principal teacher, usually gathers information from a range of agencies. That can be quite complex and time consuming, even before the information is looked at. The issue is not that there is a lack of willingness but that the capacity that is required to do that is a strain on the system.

However, that is perhaps not as much of an issue as that of looking at a young person with more complex needs and the transfer from that approach to someone being the lead professional. That tends to sit with social services, but that is not necessarily where it should sit. In some cases, it would be better for it to sit with the school or with a health professional. A bit more work is needed on that to free up the time for the appropriate professionals to take that role.

In our consultation on the issue with parents, we had quite a kickback about the term “named person”. A number of our parent councils expressed significant concern about it, with people saying, “I should be my child’s named person.” When we explained the concept behind it, they were fine with it, but their initial reaction to the name was not one of unqualified approval. That is a challenge. We need to be explicit about what the role is and how it will be implemented. Some of the things around information sharing and the shared systems that will be used will make the process less onerous, but there is still an issue about how that comes together.

We are also concerned about the issue of who the named person is for children who are home educated. Local government education departments have no locus in that regard. With regard to health, who would take that forward for young people of primary and secondary school age? That is not explicit in the legislation. If we want to have a net to catch every child, we should be aware that there is a group of children that could slip through that net.

Miss Taylor, this is not really your field.

That is correct. I have nothing to add.

I concur with Carol Kirk. There is a difference between the most vulnerable children, who have a lead professional and multi-agency involvement, and the wider population of children, in relation to whom the concept involves allowing easy, named access to that world and enabling proportionate access to professionals rather than having people who are involved with them every day of their lives and who take over some of the role of parents.

Miss Taylor, do you have no locus in this? Some information about housing and what is going on in a home can be very pertinent. I would imagine the SFHA might have something to say in that regard.

A social landlord might have an understanding of what is going on in a home—that occurred to me as I listened to the responses. However, we have opted not to make any formal comment in that regard, and I do not want to simply react to things today. I think that the important point is that the landlord’s relationship is primarily with the householder, who will always be an adult, even if they are 16, 17 or 18.

It would be fair to say that housing assistants throughout the country play a major role in finding difficulties and pointing them out, but they are unlikely to be the named person in this regard. That is the key thing. That is why I said that this was not really your field. I am sure that housing assistants and housing visitors will continue to do what they have been doing in this regard for many years.

It is not because we are not aware of chaotic lifestyles or whatever. I could elaborate on that, but this is not the place.

Carol Kirk said that there was a potential to simplify structures to benefit services, which is something that we would all support. She also said that we need to be careful that we do not just create additional structures rather than simplify the structures in a way that will make the process easier.

Will the Scottish Government get that balance right? Obviously, we are also considering the Public Bodies (Joint Working) (Scotland) Bill. Is the balance right as the proposals stand, or does it need to be worked on further?

It possibly needs to be worked on further. Even in the Children and Young People (Scotland) Bill there is much more of a statutory imperative around children’s services planning, which I think that people would welcome, but I would ask why we need a plan on corporate parenting that sits outwith that. I cannot see why that would not be merged into the same plan, given that the plan is concerned with a range of vulnerable children.

With regard to issues around the individual children, there is a complex framework, not only for local government but for parents. GIRFEC provides a structured and helpful way of planning for a child, in the round, and I am supportive of that. However, it crosses over with, for example, a co-ordinated support plan for a child who has complex needs. The additional support needs legislation does not sit entirely comfortably with the guidance around GIRFEC. It is possible to merge them, but it would still involve having two statutory frameworks, which does not make sense to professionals working in the area and probably makes less sense to parents.

I return to a point about GIRFEC. I mentioned that I visited some doctors’ surgeries during the recess. I am interested in systems that do not talk to one another and which complicate the spread of information. What are your experiences of that? Could a bit of common sense and a bit of gumption be applied to deal with some of that? Do we overly complicate such systems?

Yes, it is a real issue. The professionals are good at communicating with one another, but if we want to deal with the issues that are on the table, we need to have a better look at that issue. I will pronounce this really carefully, but the Scottish Government needs to GIRFEC itself; it needs to look at the interrelationship between different bits of legislation, how they cut across each other and the number of demands that have been put on different aspects of professional organisations.

We do not need conflicting legislation. We do not need legislation that tells us to report to 16 different organisations, all on the same subject. A number of issues that we are dealing with in local authority and health board areas come from that source.

A significant amount of work needs to be done to resolve the systems that we have and to ensure that we are working to a common system and a common language. In Ayrshire and Arran we have AYRshare; we hope that that will take us some way down that road, but there is still a need for the organisations that we work with—education, social work and health—to have their own systems underneath all of that. That is an industry in itself and they all have different reporting mechanisms that work within that.

Somebody who sits in my position frequently answers the same questions to a number of different aspects of the Scottish Government. Again, that is about public money and public time that could be used better and more effectively on the issues that we have to deal with—issues that the other members of the panel have outlined so well.

The term GIRFEC has to be said very carefully—I nearly did not say it the right way there.

Sensitive data sharing is a real issue for general practice and other agencies: how you filter what you talk about informally, in corridor chat and various other ways, and what you are prepared to put down on paper.

With child protection issues, it is fairly straightforward. I do not think that many GPs wring their hands over that. If they suspected anything, they would divulge that information quite readily. However, we are talking about the majority of vulnerable children in this country—probably about 20 per cent of 1 million children—who have unmet needs. The sharing of information around the subtleties of parenting and all the issues around deprivation and so on is a big piece of work that still needs to go on because some parents are very reluctant—naturally enough—for you to speak to other agencies about their own personal, private lives because that impacts on their parenting skills.

The only way round that is for extensive work to be done between the front-line GPs and social work, which is probably the main referral agency if you are talking about catapulting into the child protection system or legislative intervention. Otherwise, the majority of children who are vulnerable in general practice will just be signposted to other services for support; they are not being signposted into prosecuting the parents because they are battering their children. We are talking about parents who are not coping, for whatever reason.

A lot of such information comes into the consultation and the issue is how that is filtered. It is about experience—having experienced GPs who have met a lot of children and families in their lifetime—but it is also about having the work supported within the GP contract.

I ask everyone to be brief, because I am hoping to get another question in. Ms Kirk, please.

That is right. The particular issue is not at the child protection end; it is the very large group of children for whom poverty and difficult home circumstances are impacting. We need to get much better at direct communication around that issue that possibly does not involve social services.

With AYRshare, one thing that we have considered—in fact, we had a meeting about it yesterday—is how GPs can have automatic access to the system. They might have a wee concern because they do not feel that some information can be shared of its own right but, if they have access to what other professionals have put on the system, that maybe builds a picture and allows them to say that they have a real concern. Achieving that level of shared information as easily as we can is a real issue for us.

11:15

One of my responsibilities is to run out-of-hours social work services across Ayrshire. Working with three social work systems and trying to get out-of-hours health information is a difficult challenge. Improved information sharing, whether it be electronic or, better still, just talking to each other, would be a real move forward. That is where co-location comes in. I mentioned some of the services that we have co-located, such as mental health and learning disability services. In that situation, a social worker will just go along to the learning disability nurse and say, “Will you come out with me today and see this?” That communication happens and it works. On another level, we need to consider how to develop electronic information systems. I know that, through the Public Bodies (Joint Working) (Scotland) Bill, some money is being made available to move that on, but that has been a challenge for us for at least the past decade.

I want to follow up on a point that Mr Fraser made earlier, although my question has been partly answered in the previous round of answers. Mr Fraser referred to the fact that GPs are not as actively involved in the community health partnerships as they could be. My concern about the named person and protecting vulnerable young people is about how we ensure a smooth transition from pre-school to the school period and that the appropriate professional is the named person. For pre-school, that person could be the health visitor, but when the child starts school, it could be a social worker, a teacher or someone else. Might that give rise to issues? We must ensure that every child has a named person who can not only gather information but give it to other professionals to ensure that the child is protected.

At a very basic level, one measure of success is that the child and family know who the named person is. Sometimes, in my service, when someone is asked whether they have a social worker, the answer will be yes, but they will give the name of somebody who left two years ago. Sometimes, the answer will be no, but we know that the person has a social worker. There are real issues about whether the role of named person will fulfil its function. You are right that children move through systems. If the approach is to be successful, who the named person is must be clearly communicated to the child and family. Families continually tell us that the lack of continuity in the people who support them is a real issue. I know that GP colleagues will say that, a lot of the time, the continuity comes through their practice.

The key to the issue is good relationships between early years establishments and health visitors. Health visitors will have a huge case load of children for whom they are the named person. When those children transit from the early years establishments to school, the named person will become someone in the school although, if the child is very vulnerable, the health visitor might retain that role until an appropriate time for handover. The key issue is to ensure that transition meetings take place and transition plans are produced for any children about whom a health visitor has a concern. Linking the health visitors directly to the early years establishments and involving them in the transition to primary 1 is the key way of ensuring that that happens. Another key issue is ensuring that, when a child moves into primary 1, the parents know who the named person is.

I wanted to come back on the previous question, but I am happy to wait until the end if you want.

Fine. Dr Mullin?

I do not want to go into too much detail about the named person for over-fives. That is still something that has to be worked out. We are still often the referral point for older children, because agencies have withdrawn for whatever reason, because they do not need help any more, or because they have become vulnerable again. Because most people have a named GP, services or people will come to the GP. There is a big schism between education and general practice; there is not enough dialogue there.

The deep end has talked about integrated working and attached workers, but the only way to make any of the systems work is to have integration of communication. It is about professionals being able to communicate with and understand one another, and child health in general practice has been peripheral to many of those developments, although we are often the central point of referral for many agencies. The deep end has a clear view on that, which is outlined in our proposals.

I agree 100 per cent with what Carol Kirk said. We need to align health visitors carefully with early years establishments, and a good relationship needs to be built and maintained in that process. My concern for health visitors is about the resource requirements and the additional burden that that will bring. GPs are the critical partners in most of what we do in children’s and young people’s services. They are the pivotal point around which families revolve, so communication systems must be developed well to support their practice. If there is a hierarchy within the system, they are among the most valuable partners.

Our difficulty is in assessing what happens with health visitors beyond the age of five, when the burden of being the named person is placed on our education colleagues, who must have good support systems in place. We are new to the whole process. We do not yet have a huge amount of experience of those transition arrangements, but good communication and professionals talking to professionals to ensure that we are talking the same language and that we understand the issues will be critical to the whole process. The strength behind that is that we have well-established communication frameworks where we can raise those issues, and we will find shared resolutions. However, the problems should not be underestimated, either in terms of the additional resource required or in terms of the critical nature of the relationship between health visitors and early years establishments.

Miss Taylor, I shall let you come back very briefly.

On the general issue about systems not talking to one another, there is an operational dimension, which we have spent a lot of time talking about, and a strategic dimension. The operational dimension intersects with the housing system in the sense that, for example, someone who is leaving care and who may have had a history of social work interventions as a child may then be at risk of homelessness and may enter the housing system as a social tenant through the homeless route. There is an interesting issue there about how much information passes with that person to the people who take him or her on as a landlord, to enable them to understand what interventions have worked and who has been involved in the past. Operational practice is much patchier than it really should be.

With regard to the other side of the operational information, I know that there are projects in Glasgow where housing associations are actively working with police and fire services to ensure that they get effective data sharing, information sharing and knowledge sharing at a local scale, so that they can tackle problems on a preventive basis. They have been able to document the extent to which they have saved lives and extensive budgets on vandalism, fire damage and other things.

However, I return to the point that I made at the beginning, about strategic information. There is a whole lot of information around strategic planning that relies on decent data sharing and integration of practice around strategy, and that is where housing can make a significant contribution—but only if it is required.

I have no further questions.

I thank the witnesses for their evidence, which has been useful.

11:24 Meeting suspended.

11:33 On resuming—

We move to our final panel. I welcome from the Scottish Government Alex Neil, the Cabinet Secretary for Health and Wellbeing; Aileen Campbell, the Minister for Children and Young People; Kathleen Bessos, deputy director for integration and reshaping care; John Paterson, divisional solicitor for food, health and community care; Alison Taylor, team leader for integration and reshaping care; Philip Raines, head of child protection and children’s legislation; and Magdalene Boyd, solicitor for communities and education.

I ask the cabinet secretary to make opening remarks.

Thank you for inviting Aileen Campbell and me to make statements and answer questions. I will confine my remarks to the Public Bodies (Joint Working) (Scotland) Bill, which deals with the integration of adult health and social care. The bill’s purpose is to provide a framework for the integration of health and social care, with the aim of improving outcomes for service users, carers and their families. That is at the heart of our policy.

We are legislating for national health and wellbeing outcomes that will underpin the requirement for health boards and local authorities to plan effectively together to deliver quality and sustainable care services for their constituent populations. It is important that the bill aims to bring together the substantial resources of health and social care to deliver joined-up, effective and efficient services for the increasing number of people with longer-term and often complex needs, many of whom are older.

The bill requires health boards and local authorities to establish integrated arrangements through partnership working and it requires statutory partners to integrate via one of two models—delegation to a body corporate that is established as a joint board, or delegation to each other as a lead agency, which involves three possible models. Health boards and local authorities will be required to delegate functions and budgets to the integrated partnerships, and secondary legislation will set out such matters and will cover adult primary care and community care, adult social care and aspects of acute hospital services.

Integrated partnerships will be able to include other services, such as children’s services, when a local arrangement is made to do so. That already works well in areas across Scotland, such as West Lothian and Highland.

Each partnership will be required to establish locality planning arrangements, which will provide a forum for local professional leadership of service planning. Integrated partnerships will also be required to prepare and implement strategic commissioning plans that will use the totality of resources that are available across health and social care to plan for local populations’ needs. It is important that professionals, service users, GPs and the third and independent sectors will be embedded in that process as key decision makers.

The bill is in the context of public service reform. Alongside the Children and Young People (Scotland) Bill, which Aileen Campbell is leading, it is part of the Government’s broader agenda to deliver public services that better meet the needs of people and our communities. The Public Bodies (Joint Working) (Scotland) Bill provides a legislative framework for partnership working at strategic and local levels that involves professionals, service users and partners. The planning and delivery principles in the bill encapsulate the Christie commission’s principles by putting the person at the centre of service planning and delivery and require a focus on prevention and anticipatory care planning.

As for why we need to legislate, my predecessor, the Deputy First Minister, proposed to Parliament in December 2011 the introduction of the bill, which had cross-party consensus. We are all aware of attempts in the past to integrate the services, with greater or lesser success. Underpinning the process with a legislative requirement is essential to achieving our objective.

We are not starting with a blank sheet. In many areas across Scotland, bodies are already working in partnership to deliver integrated services. We have considered the evidence from across the UK and we are mindful about applying it in Scotland. However, I am clear that, to achieve consistent progress, it is necessary to set out in legislation a framework that is not too prescriptive and will deliver the necessary changes to meet the future demand on services. I welcome the opportunity to provide further clarity on the bill to the committee.

Does the minister have anything to add?

Yes. Good morning and thank you for inviting me to give evidence on part 3 of the Children and Young People (Scotland) Bill—on children’s services planning—which was introduced in Parliament on 17 April. The bill is fundamental to securing the Scottish Government’s aim of making Scotland the best place in the world to grow up in. Through the bill, the Scottish Government aims to ensure that children’s rights properly influence the design and delivery of policies and services. The bill aims to improve how services support children and families, to strengthen the role of early years support in children’s and families’ lives and to ensure better permanence planning for children and their families.

The report of the Christie commission on the future delivery of Scotland’s public services highlighted that services must better meet the needs of the people and communities that they serve. In welcoming the report, we set out a vision of reform through early intervention and preventative spending, greater integration and partnership locally, workforce development and a sharper and more transparent focus on performance.

The Children and Young People (Scotland) Bill will be fundamental to our achieving those ambitions on rights and services. It aims to put Scotland at the forefront of providing services that give children, young people and their families what they need and deserve, and find better ways of offering better life chances to each and every child in Scotland.

I am delighted to have an opportunity to speak to the committee about part 3 of the bill, which is on children’s services planning. In recent years, there has been increasing integration in how public bodies develop, plan and operate services to support children and young people. However, unless services work together, there is a danger that something important will be missed and a child or young person’s wellbeing will suffer. Children and young people need not just co-ordinated services but services that share an holistic approach to wellbeing and early intervention. Children deserve services that routinely and consistently consider the full spectrum of their needs.

Part 3 sets out the duty of local authorities and health boards, with the assistance of other public bodies and third sector organisations, to work together to develop joint children’s services plans every three years. The intention is that bodies that are responsible for expenditure and for planning and delivering services will work together to improve the wellbeing of all children and young people in their area.

Currently there is no requirement for public bodies to report collectively on how the lives of children and young people are improving. To give the public and children and young people a full picture of how wellbeing is being promoted, supported and safeguarded, local authorities and health boards will report each year on the extent to which they have achieved the aims of their children’s services plan. That will enhance the implementation of getting it right for every child and make a direct and accountable link for the public between local services and outcomes for children and young people.

I hope that I have given the committee some useful background information. I will be happy to take questions from the committee on part 3.

Thank you, minister. The evidence that we heard today on the difference that GIRFEC has made was mainly positive. However, a few things cropped up, one of which was the perennial question about communication and systems that do not talk to one another. How will we tackle the issue, which causes great difficulty sometimes?

Another interesting issue that was raised was how we deal with named persons for children who are home educated, given that an educationist would normally be the named person for a child of school age. Will you respond to those points, minister?

It is good to hear that you had such a positive session on GIRFEC. As you know, GIRFEC has been around for a while. The bill provides the opportunity to embed the approach further, putting the child at the heart of the design and delivery of services.

You asked about communication. Part 3 is about ensuring that joint working happens. I think that this morning the committee heard good examples of joint working and the strong relationships and good communication that are crucial to the delivery of services that a child or family needs.

There is the joint services element of the bill, and we want a reporting mechanism that brings together local authorities and health boards. We will ensure that such an approach is standardised and embedded in the bill, to ensure that there is an holistic approach that reflects the child’s holistic needs and promotes the child’s wellbeing.

As the bill progresses through the Parliament, I know that the Education and Culture Committee, which is the lead committee, will take a strong interest in the named person aspect, because of the issues that have arisen in that regard. From our point of view, the named person is a big part of the GIRFEC approach. It is about ensuring that services are delivered consistently, that families have a point of contact and that support is in place.

We are well aware of the issues that have arisen in relation to home-educated children. We are working with stakeholders to ensure that, through guidance for example, procedures are put in place to reflect the parental choice to educate a child at home—it is right that there is such a choice, because the parent is the person who knows the child best. We will ensure that that is reflected in the bill and in the guidance.

Mary Taylor, the chief executive of the Scottish Federation of Housing Associations, told us this morning that the housing sector is not really taken into account in either bill. She thinks that the sector has a major part to play in integration. Will you comment on that, cabinet secretary?

11:45

Absolutely. I agree with Mary Taylor that it is essential to involve the housing sector, particularly the social housing sector. Many of the issues that we are dealing with, whether delayed discharge, aids and adaptations or a range of other issues, clearly require the involvement of housing associations and local authority housing departments. We have a stream of work going on, which I commissioned a few months ago, to see how we can best ensure that the housing function is involved at grass-roots level in the partnerships. It may not necessarily be the case that housing bodies are separately represented on partnership boards, but I think that the most important element is what happens in the localities underneath the partnership board area. That is where the close working relationship between health, social work and housing is vital. Both the ministerial steering group and the bill steering group are looking at how best to achieve that.

Minister, do you want to follow up on that?

Yes. Section 10(1)(b)(ii) in part 3 of the Children and Young People (Scotland) Bill explicitly refers to consulting

“such social landlords as appear to provide housing in the area of the local authority”,

when the local authority is preparing a children’s services plan, so there is explicit recognition of the role that housing can play in a child’s wellbeing.

Thank you.

Good morning. It is clear from the very comprehensive opening statements from the cabinet secretary and the minister that both bills contain provisions that require consultation on their respective shared services provision. Section 6(2)(a) of the Public Bodies (Joint Working) (Scotland) Bill requires consultation to be with

“such persons or groups of persons appearing to the Scottish Ministers to have an interest”.

Section 10(2)(a) of the Children and Young People (Scotland) Bill requires consultation with organisations that

“represent the interests of persons who use or are likely to use any children’s service”.

However, neither bill appears to require consultation with individual service users.

Despite your emphasising that the provisions are based on the Christie commission recommendations and that we are putting children at the heart of the process, the fact of the matter is that, as you have explained it so far, there does not seem to be a requirement to consult the child or the young person.

As Margaret Mitchell correctly notes, the ethos of the bill is getting it right for every child and putting the child at the centre of service design and delivery. The bill mentions setting out guidance on how consultation might take place on potentially bringing into the planning process third sector providers and whoever else is appropriate, which will include the child and the families. However, as we develop the guidance, we can certainly make it explicitly clear that consultation should recognise the role of the child and the family and ensure that they have a full and active role in the service design and delivery that is going on around them.

May I put a specific, quite technical question to you, minister? You will be aware that the Children (Scotland) Act 1995 drew everything affecting children into a single act. The act had three overarching principles, but the key one was to require the child to be given the opportunity to express their views. Obviously, their welfare is required to be a paramount consideration and there is the requirement that the minimum proportion of state intervention be preferred over disproportionate intervention in family life. Subsequent legislation affecting children and young people—for example, on children’s hearings and adoption—has ensured that those requirements are incorporated, but that is not the case with the Children and Young People (Scotland) Bill. Why is that?

Again, the bill takes appropriate account of the child and the family. That is the ethos of GIRFEC, which is about ensuring that services provide support to families when they need it and that such intervention is appropriate and timely, and is delivered at the right point to avoid crises, given that intervention is most effective when it is done as early as possible.

It is worth recognising that the 1995 act is still in place and that our aim is to ensure that we make the bill as good as it can be, that we can work things through in consultation with stakeholders and that our guidance reflects the points that you have raised as much as it can.

Philip, do you have anything to add?

Section 9, which relates to the aims of the children’s services plan and sets out many of the principles that we want to underpin the planning of children’s services—and, by extension, the way in which children’s services are carried out—makes it clear that planning should take place in a way that

“best safeguards, supports and promotes the wellbeing of children in the area concerned ... is most integrated from the point of view of recipients, and ... constitutes the most efficient use of available resources”.

We wanted to make many of those principles explicit in the bill to ensure that they underpin the planning that takes place. As the minister has said, we will work with stakeholders on the detail of that and how that will work in practice as we develop guidance.

The fact that the issue is not implicit in the bill as it has been in other bills has led some to comment that this is a duty on public services rather than anything in particular to do with the rights of the child. That, I think, is the technical point.

Do you wish to comment on the suggestion made by an earlier witness that, in view of this legislation and potentially competing legislation, the Scottish Government should GIRFEC itself?

Should what itself?

GIRFEC itself.

They were referring to getting it right for every child. The suggestion was that the Scottish Government should look at the various bits of legislation that might compete with, conflict with or duplicate one another.

The bills complement one another; in fact, a lot of work has been done to ensure that not just these two bills but all the bills that we introduce complement one another. From my point of view, the Children and Young People (Scotland) Bill is about ensuring that the United Nations Convention on the Rights of the Child is taken far more into account in the work that we as a Government do. That applies not just to this bill but to all our work across Government, regardless of whether we are talking about legislation. The Government has been working in a joined-up way to ensure that the bills are complementary and that the work of Government in future dovetails and provides the good outcomes that we expect to emerge from the bills that we are presenting today.

Did you hear the previous panel’s evidence?

I did not catch it all. Did you wish to raise a specific issue?

I simply refer you back to the specific examples of conflicting legislation and duplication that were highlighted and suggest that the previous panel’s evidence on that specific point might be worth looking at.

I am sure that, as per usual, the minister will do so.

Although the previous panel was very enthusiastic about the potential for integrating and improving services through legislation, the witnesses asked that, in pursuing this agenda, we were careful not to create new and additional structures instead of simplifying things. How would you allay such concerns?

To some extent, the legislation will streamline structures and make it easier to see the focus for partnership working. We have clearly specified that one of two models must be adopted: the lead agency model that has been adopted in the Highland area or the joint corporate body model, which I think will be adopted in most if not by all of the rest of Scotland. As a result, there is scope for many existing committees to be streamlined. For example, one of the consequences of the enactment of the Public Bodies (Joint Working) (Scotland) Bill will be that there will be no need for separate CHPs because their work will in effect be incorporated into the partnership. Moreover, with the introduction of a much more formal structure, the many formal and informal organisations involving health boards and local authorities at local level can be collapsed. In that way, the legislation will simplify the structure.

The role of the chief officer in the partnership will also be crucial because they will do two things: first, report to the partnership board—or the lead agency, if a lead agency model has been adopted—but, secondly, report to the respective chief executives of the local authorities. For example, such an approach has been up and running very successfully in West Lothian for eight years now and integration and co-ordination at parent organisation level have been substantially enhanced as a result of the partnership’s work.

I should stress that, from day 1, we want the acute health sector to be actively involved in the partnerships. When we involve acute care in the community, many of the barriers that exist between the primary care sector and social care, and between the primary and secondary care sectors, start to get broken down. A good example of that is the hospital at home programme that NHS Lanarkshire initiated, which is now being rolled out across the country. I think that that will remove barriers and bureaucracy, cut red tape and lead to much more localised provision.

In addition, we have commissioned—jointly with our colleagues in the local authorities—some work to look at where the public health function would sit in future. In the post-war situation, the public health responsibilities were given exclusively to local authorities. Under Ted Heath, they were transferred exclusively to the new health boards. South of the border, they have been split up between the health boards or their equivalents and the local authorities. My view is that a successful public health policy requires the health boards and the local authorities, with their respective remits, to work in an integrated fashion. I think that an opportunity exists, particularly in public health, not just to enhance the service, but to break down the barriers that have traditionally existed between the different sectors and to streamline the entire process.

That is helpful, but there is still a concern about the details of what is proposed and how it will work in practice. In its submission to the committee on the two bills, Audit Scotland said:

“Significantly, the relationship between CPPs and the new integrated health and social care arrangements ... and changes to children’s services ... are not clear.”

Will greater clarity be provided on some of the working arrangements before the bills are finalised?

I am surprised by that comment, because I believe that Audit Scotland is represented on the group that is chaired by Pat Watters, the former leader of the Convention of Scottish Local Authorities, which is looking specifically at enhancing the role of the CPPs in relation not just to health and local authorities, but to the entire public sector operation at local level.

It is likely that the output from that group, which includes representatives from a wide range of organisations including COSLA and the Society of Local Authority Chief Executives and Senior Managers, will take forward in a substantial way greater co-ordination and integration of services across the board at local level. In particular, I know—because I am a member of the group—that it has had serious and in-depth discussions about the need for bodies such as health boards and local authorities, and others, to discuss annually their strategic budget proposals before they agree to implement those proposals, in an effort to ensure that across the public sector, in each local authority area, we maximise the impact of the public pound. Therefore, I am surprised that Audit Scotland has made that comment.

Well, it has made it, so—

I draw your attention to the work of the group that is chaired by Pat Watters.

I am sure that you and Pat will discuss the matter—

Absolutely.

I do not want to labour the point, but it is worth reflecting on the fact that Audit Scotland raised the issue specifically in relation to CPPs.

Pat’s group is looking specifically at the role of CPPs and how there can be much greater integration and co-ordination across the public sector in each local authority area.

I am sure that the committee will talk to Mr Watters again shortly, because we said that we would.

Good morning, panel.

My question is directed mainly at the cabinet secretary. The Public Bodies (Joint Working) (Scotland) Bill is, obviously, about public bodies; it is not about other organisations. Prior to the summer recess, the committee concluded the latest instalment of its inquiry into public services reform. An issue that came up in all three of the stages of the inquiry that we undertook was community and third sector involvement in the shaping and delivery of public services.

During one of the visits that I undertook over the summer, a council of voluntary services made the point that the Public Bodies (Joint Working) (Scotland) Bill appears to make no mention of community involvement. Now, I accept that the bill is about public bodies rather than about communities per se, but it appeared to that CVS that the bill is about something that is being done to people rather than in conjunction with the community. Should there be a wider discussion with communities to provide that involvement?

12:00

Let me make it clear that, as should be evident from the policy memorandum and from the bill itself, we see the third and independent sectors as having a very important role not just in the delivery of services but in the design and architecture of services.

I think that there is a bit of a misconception here, and let me explain why. Because the health board and the local authority are the public fund holders, only they have a vote on the partnership board. However, as we have seen in West Lothian and elsewhere, the third and independent sectors are represented on the boards. We would envisage that happening in every case because the third and independent sectors clearly have a major role to play. Obviously, we need to ensure that there is no conflict of interests, because we cannot have people who are competing in a tender for service delivery simultaneously sitting on the board. However, those governance issues are not new and have been with us for a long time.

You just need to look at West Lothian, which is a kind of exemplar for the joint corporate body model in Scotland, to see that the third and independent sectors have a role not only in terms of board membership but—more important, actually—in designing and delivering services at the locality level. They are heavily involved in that. Also, where there are any proposals for service redesign, the third and independent sectors are involved in the process and in the consultations on the redesign of services. I would take West Lothian as a very good example. We would expect that kind of standard of consultation with, and standard of involvement of, the third and independent sectors to be followed. Indeed, we will require that, and we will incentivise the use of the third and independent sectors where that is appropriate.

That is helpful, thank you.

Cabinet secretary, you have mentioned that West Lothian is probably the exemplar for this kind of work. In the evidence from East Ayrshire Council earlier today, we heard that co-location can help a lot in that regard. Obviously, West Lothian Council has its new civic building, where teams from across the public sector can work side by side at desks next to one another. That seems to make joint working easier. In your opinion, is co-location required to ensure that all these things work properly?

I would not like to prescribe that co-location is always a prerequisite to approving any delivery plan, but I must say that, in the examples that I have seen, co-location is definitely very advantageous. In the East Ayrshire Council headquarters building on London Road in Kilmarnock, the co-location of services there is definitely a huge advantage in providing for integrated delivery.

I draw your attention to a pilot project that is being run in the mining village of Dalmellington in East Ayrshire. That joint project, which involves the third sector as well as the local authority and the health board, is using telehealth to help older people with co-morbidities. Over the 21 months that the pilot has been running, the GP in charge says that, for the 20 older people with co-morbidities who are involved in the pilot, there has been a reduction in hospitalisation of that cohort group that has been of the order of 70 per cent. That is a very practical example.

Similarly, in your part of the world, convener, in Aberdeen and Aberdeenshire, social workers are co-located in some of the NHS Grampian community hospitals. In Fife, although the partnership boards have not yet been set up formally—they are still prototypes—there is already co-location of health and social workers, for example in Dunfermline, and there is no doubt that it adds great value to the quality and efficiency of service delivery.

We have heard your Dalmellington story before, cabinet secretary, and I am glad to hear it again, as I have been telling it elsewhere.

Minister, do you have anything to add on co-location?

The cabinet secretary said that co-location is not a prerequisite for greater integration, but the anecdotal evidence from the service user’s point of view is convincing. If someone needs a bit of extra support, they can go to a service that is co-located with social workers, GPs or whoever and they do not face the stigma that is attached to seeking help from that service because they are entering a building in which a variety of different services are provided. People can be a bit more proactive in seeking help and can feel reassured that there will not be any stigma attached to that and that people will not start talking about them. The anecdotal evidence from the point of view of the service user is compelling regarding how they feel when they enter a place where different services are co-located. They find that a good experience for them.

Thank you very much.

Good afternoon, cabinet secretary and minister. Cabinet secretary, you have spoken about integration measures. According to our Scottish Parliament information centre briefing, there will be two broad models of integration, which will be broken down into four different models. The first model is the body corporate model, under which local authorities and health boards will come together to form a joint board that will be separate from the local authorities and health boards and will be led by a chief officer. Do you see that chief officer being separate from the health board and the local authority, and will that require the creation of a new post?

It will be a statutory post after the bill has been passed. That said, we must be pragmatic. Again I refer to West Lothian, where the chief officer has come from a health board background but is on the senior management team of both the local authority and the health board. The important thing is that the chief officer reports primarily to his or her own board but also has a line of responsibility to the chief executive of the local authority and to the health board. In West Lothian—and, indeed, in other areas where it is earlier days than in West Lothian—that arrangement has worked very well.

What I am trying to get at is whether we will see the creation of a new administrative structure for the delivery of services. If we create a new administrative structure, how will that be paid for?

By definition, the partnership board is a new administrative structure because such boards do not exist at present, and the role of the chief officer is a new position in that sense. The important thing in paying for that is the integrated budget. I will give you a good example. I have been encouraging local authorities and health boards up and down the country to follow the example of West Lothian and establish a step-up, step-down centre as one way of improving the transition from hospital back into the community. The centre has also contributed to the elimination of delayed discharges in West Lothian. If West Lothian did not have a partnership board, the health board’s and the local authority’s respective shares of the funding for the project would have to go through separate decision-making processes within both the local authority and the health board, through the committee structure and all the rest of it.

When you have integrated budgets, that is decided internally, within the partnership board. The decisions can be made quicker but, more important, they will be taken in the context of the strategic plan that is laid down and agreed by the partnership board, which would obviously have to be endorsed by both the health board and the local authority. You get much quicker decision making and much more co-ordinated and integrated approaches. The evidence from north and south of the border—from Torbay, for example—is that the quality of the decision making is far better. Most important, not only do you end up with far better outcomes, but those outcomes are delivered far more cost effectively, which is a big prize.

I welcome what you said about West Lothian, but you are not promoting the West Lothian model throughout Scotland; four different models of integration can be taken from the proposals that are before local authorities and health boards. Would it not have been better to have applied the West Lothian model of integration throughout Scotland, so that a uniform model would be adopted by all local authorities and health boards?

From day 1, including under my predecessor, Nicola Sturgeon, this has been an iterative process of discussion between us, the local authorities, which have been represented by COSLA and SOLACE, and the third and independent sectors. My approach to the development of the models, and indeed to the whole bill, has been to try to get consensus among the local authorities, the health sector, the Scottish Government and the third and independent sectors. On the basis of those bodies’ experience, track record and expertise in delivering the services, they are all pretty much of the opinion that there should be a degree of choice so that each area can decide how best to deliver in their area. Highland has decided on a particular variation of the lead-agency model and all the indications are that it is beginning to work well and to deliver substantially improved services and outcomes.

We have said all along that it would be inappropriate for us to sit in Edinburgh and prescribe every detail of the arrangement in each of the 32 local authority areas. How you would structure services in Glasgow, where you have one health board and six local authorities, is completely different from how you would structure them in the Borders, where you have one local authority and one health board with coterminous boundaries.

We are saying that the principles that matter to us are that there is a statutory underpinning to the integration of adult health and social care and that there is an integrated board, budget and strategic plan. That is why the bill sets out the framework. Within that framework, we are saying to local people, “You decide what’s best for your area, because politicians and civil servants sitting in Edinburgh don’t know enough about what’s happening in your local area to dictate to you how all the i’s are dotted and all the t’s are stroked.”

Having said that, can you assure us that the reporting and monitoring regime carried out by the Scottish Government will be consistent across all models of integration used by health boards and local authorities?

Absolutely. We have said clearly that, in measuring success, the key thing that we are interested in is the national outcomes. You might ask why the outcomes are not on the face of the bill. They are not there for two reasons. One is that outcomes change. The outcomes that you would set today would be very different from the outcomes that you would have set, say, five years ago. I suspect that they would also be very different from what they would be in five or 10 years’ time as service provision changes—how we do things in these fields changes continually. Therefore, if you put the outcomes in the bill, you would need to introduce primary legislation every time you wanted to amend them. The national outcomes will be set out in secondary legislation.

Secondly, I am not going to take a unilateral decision on what those outcomes will be. All along, we have proceeded on a partnership basis with our friends in the local authorities and the third and independent sectors, and I think that this will work much better if we can get agreement on what the national outcomes should be and on how we measure success. We are more likely to achieve success if from day 1 everyone is signed up to what has been defined as success.

12:15

I am well aware that outcomes should not be set out in the bill. After all, you will know from your own constituency, cabinet secretary, that things can change dramatically with one report.

They have improved enormously in the past two years.

I am glad that you have friends in local government throughout Scotland.

Now that we are into the afternoon, I wish the cabinet secretary and minister good afternoon.

I have two quick questions. How will the quite different mechanisms for integrating services that are set out in each bill improve children’s transition to adult services?

I will let Aileen Campbell take the lead on this question, but I point out that the Public Bodies (Joint Working) (Scotland) Bill, which deals with adult health and social care, does not make a statutory requirement with regard to the integration of health and social care per se. However, coming back to the examples of the Highlands and West Lothian, I note that, in both cases, even with their different administrative arrangements it was agreed almost from day 1 that they needed to integrate their children’s health and social care services.

I believe that there are two big differences between dealing with children and dealing with adults. First, there is the very crucial role that the education system plays with children and for which there is no equivalent for adults, particularly older people. Secondly, children by definition do not legally have the capacity to make decisions for themselves. However, adults do and I note that there are special arrangements for adults with incapacity. The fact that these two bills cross-reference each other means that we are singing from the same hymn sheet—and that is very important.

Some of the consultation responses to the lead committee have acknowledged that the transition from children’s to adult services can be challenging. The two bills allow for greater planning in both services; the Public Bodies (Joint Working) (Scotland) Bill will help to provide far more planning in adult services, while the Children and Young People (Scotland) Bill will require improvements in children’s services to recognise the breadth of different people and services involved in a child’s life. The fact that the two systems will improve planning will give us the ability to make the transition far smoother than might have been the case in the past. Indeed, that is the benefit of having these two approaches; greater emphasis on planning and improvement from children’s point of view to reflect the breadth of services involved in a child’s life will enable a better transition to adult services, which will also be improved through better planning.

With regard to CPPs, how do these bills tie into the proposed community empowerment and renewal bill?

Obviously, the community empowerment and renewal bill has a wider remit; it is not entirely about, but very much has an emphasis on, physical assets, how the community obtains such assets and such matters. However, the umbrella for all of this is the Government’s guiding principles and strategic objectives, which include not only community empowerment and renewal but public sector reform, to ensure that better-quality services are delivered more cost effectively and timeously; patient-centred healthcare and social care; and, indeed, person-centred education. Those underlying principles are not restricted to my bill, Aileen Campbell’s bill or Derek Mackay’s community empowerment bill; they are universal and part and parcel of our broad principled agenda for changing Scotland for the better.

I echo the cabinet secretary’s comments. When we seek to help families and children, we must ensure that we build from an asset-based approach—indeed, the chief medical officer is keen to promote approaches that build from a family’s strengths—and I think that that dovetails very nicely with the community empowerment work that Derek Mackay will be taking forward.

Local authorities already publish children’s services plans and West Lothian, for example, sets out very clearly how such plans integrate with the wider CPP family. The fact that structures are already in place to reflect community planning needs will also be reflected in how we move forward on this issue, with CPPs no doubt playing a crucial role in making the improvements that we expect to emerge from the Children and Young People (Scotland) Bill. I also imagine that our approach will reflect the single outcome agreements that local authorities will be finalising.

I hope that that covers your question.

Thank you very much for that useful evidence.

Before I move the meeting into private session, I ask for everyone’s co-operation in clearing the room quite quickly. We need to get through a lot of business before we meet the European commissioner at 1 o’clock.

12:21 Meeting continued in private until 12:45.