Official Report 942KB pdf
Good morning, and welcome to the 18th meeting in 2025 of the Finance and Public Administration Committee.
The first item on our agenda is evidence on the latest cost estimates for the Care Reform (Scotland) Bill from Maree Todd, Minister for Social Care, Mental Wellbeing and Sport. She is joined today by John Paul Liddle, deputy director, national care service; Ryan Anderson, head of the digital health and care policy and strategy unit; and Lee Flannigan, head of national care service finance at the Scottish Government. I welcome you all to the meeting and invite the minister to make a short opening statement.
Good morning, and thank you for inviting me to speak on the financial aspects of the bill after stage 2. I have provided a summary paper of those costs in response to the committee’s request.
The national care service is moving forward with a revised approach. Parts 2 and 3 of the bill are going ahead, which will ensure that vital reforms are made to information records and standards, procurement, Anne’s law and a right to breaks for unpaid carers. Stakeholders have told us time and again that all those areas need to be improved. However, as a result of the removal of part 1 of the bill, the anticipated costs, savings and changes to revenue that were expected to arise are no longer relevant.
Part 2 of the Care Reform (Scotland) Bill, as it is now named, relates to health and social care information, with provision giving ministers the power to set up a statutory scheme to permit data sharing and produce information standards. Part 3 relates to reforms connected with the delivery and regulation of social care, with provision for a right to breaks for carers; rights to visits to or by care home residents—that is, Anne’s law; powers for the Scottish Social Services Council to require information; protection of adults at risk of harm; a national social work adviser and agency; and independent information, advice and advocacy.
I firmly believe that the provisions in the bill, as amended at stage 2, are highly reasonable and balanced reforms to the existing system. As politicians, we must ensure that we effect the real change and improvement that people who use social care services require and, more important, deserve.
Financially speaking, the bill will cost far less to implement than it would have done when introduced. Our forecasts to the end of 2031-32, as per the previously revised financial memorandum, are now between £329 million and £545 million, of which £306 million to £512 million is directly related to breaks for carers. The previous range of costs prior to the stage 2 amendments, as presented in December 2023, was £843 million to £2,149 million over the same time period.
We already spend more than £6.1 billion a year on social care, as per the 2023-24 local finance returns data, but that spend is not transparent and it is not clear to people who need social care who is accountable for the service that they receive. However, we cannot think about the financial cost of care reform in isolation; we must think, too, of the many plausible benefits to people that will be delivered. For example, improving information sharing or independent advocacy and advice in care and support services could help to reduce the barriers to an individual’s ability or opportunity to work, to increase their working hours or even to take up a new job, thus enabling more people to contribute to the economy.
My financial summary of 20 May 2025 sets out those changes, which will substantially reduce the cost of the bill since the removal of part 1. There are costs are associated with introducing a right to breaks for carers, independent advocacy and the establishment of the national social work agency and Anne’s law, as set out in the financial summary and the revised FM, but overall costs are greatly reduced.
As the committee will be aware, we are now driving some of that work forward on a non-statutory basis. We have set up the interim national care service advisory board, which met for the first time last week and comprises people with lived experience of accessing care—social care workers, care providers, the national health service and local government—with the ultimate aim of improving the sector.
The Scottish Government has worked enormously hard to reach a consensus with stakeholders and MSPs ahead of stage 3 scrutiny, and I am confident that we are in the best position from which to move forward. I hope that I have given you an overview of where we are with the NCS and social care reform, and I am happy to take any questions that you might have.
Thank you very much for that helpful opening statement.
I have to say that it is quite difficult for the committee to have confidence in the figures that the Scottish Government provides when we were given a set of figures last week and already—only this morning, in fact—they have been altered quite substantially.
In the letter that you sent to the committee this morning, the figures in the “Information, advice and advocacy” and “Carer’s Breaks” rows have been revised downwards, so the totals now range from £97.1 million to £160.9 million. Previously the range was between £114.2 million and £189.6 million. I understand the reasons that you gave in your letter for those revisions, but these projections go up to 2032 and the figures have already been changed since we were issued with the papers, only last Thursday.
I apologise for that. There was an error in one table in the letter that we sent to the committee last week, and it was quickly spotted and corrected. Do you want to say more about that, Lee?
That was my fault. The letter said, in error, that the phasing of implementation started from 2025-26; for carers’ breaks, it should start from 2026-27. That was our fault—it was a mistake in the phasing.
The central point remains, though: how can the committee have faith in the Scottish Government’s projection of figures? We received the original financial memorandum in June 2022 and an updated one in December 2023, but they have been altered monumentally in the time that has passed since. How can we be confident that this is where we actually are and that this is the way that we will go?
Regardless of that, there are still huge differences—we are still talking about the difference between £97.1 million and £160.9 million in one area alone. Those are huge variations in cost.
I agree. The changes in the financial memorandum over the years largely reflect the changes to the bill. The bill has been refined and we have, as the committee will be aware, substantially changed course a number of times, and each time we have provided the committee with fresh estimates of what the bill will cost to deliver, according to what is intended by it.
We are getting very close to delivery point. There are still some unknowns about what refinements might occur at stage 3, but we have greatly narrowed the range and are pretty confident about the direction of travel.
The reason that the numbers were different in the letter that I sent last week—and the reason for the correction that I have sent today—was simply human error. A box in a table was completed and, as a result, the phasing started one year earlier than it should have, which knocked the whole table out of sync. The error was quickly spotted and corrected.
The reason for the range in the figures is that we are projecting 10 years in the future and the ranges get broader the further they are from the moment in time at which we start. Therefore, we are taking into account the projected increase in the number of carers and things like that, but we cannot know specifically how many carers will use the service in 10 years.
The supplementary FM states:
“The amended section does not specify the sort of provision that regulations are to make about independent information, advice and advocacy in relation to social care and therefore the potential cost implications of those regulations are wide”.
How wide?
We have given you a range, which is the best estimate that we can give at this stage. We are expecting some stage 3 amendments on that provision, and it depends on them.
You will forgive me, convener, but I am trying really hard to be as open as possible with the committee. I have said since my first day in this job that I will try to ensure that you are well informed and are able to scrutinise the bill. However, it is quite unusual for a bill going through the Scottish Parliament to experience such financial scrutiny between stages 2 and 3. Part of the reason for the range in those figures is that we expect some refinement at stage 3 that will narrow the cost.
Do you want to say more on that, John Paul?
Part of the reason for the range in the independent advice and advocacy figures is the need to work with the independent advocacy sector and the services to which an advocate might make representations on behalf of people to ensure that appropriate capacity is built up in the system over time. That work with providers and public sector partners will be on-going after the bill passes.
As John Paul has said, the costs that we have provided are at the top end of what we predict, based on what we have heard from our co-design work and engagement with people who access social care. We are keen to work with small-scale local providers, because they know their communities best and can often link better to other local supports and networks. We are looking at this as a possible expansion of capacity over time and are pretty keen to ensure that we deliver a sustainable increase in capacity by working with those small local providers.
I appreciate your commitment to transparency. However, the committee is keen to look at this again, because there is virtually no resemblance between the bill as it was when it was first presented to us, in 2022, and the bill as it is now. It has been monumentally changed, which is why we have to look at it, given the amount of public money that we are talking about.
The supplementary FM says:
“At this stage it is not possible to provide a position on the total cost or how the costs will be phased.”
That uncertainty is a cause for concern.
I agree that we are in a difficult situation, and I do not really want to say more about when we expect to get clarity on the figures, but it is a function of the bill being at stage 2 rather than stage 3. The bill has not yet been finalised; Parliament will amend it and we will then be able to provide you with figures. At the moment, we are in negotiation with Opposition parties that are proposing amendments and talking about hypothetical figures for what it might cost to deliver on those amendments.
One of my concerns is that what the bill originally set out to do—which it is still keen to do—was to ensure the same quality of service in my constituency of Cunninghame North as in your own constituency, in Caithness. That was the worry that preceded the development of the bill.
There are already huge staffing problems. For example, in Arran, in my constituency, the Scottish Government helped to build a new facility called Montrose house. It was opened by Shona Robison some years ago, cost £6 million and had a capacity of 30, but it is now half empty because we cannot get staff to work in it. The ferry issues make it difficult to bring people in from the mainland, and that should be seen alongside the demographic change in rural areas and the many opportunities to work in hospitality and other businesses.
How will you be able to deliver the staff, especially when that is likely to become more, rather than less, difficult as a result of Brexit restricting the number of people who can come into the country? How will we be able to deliver on the ground? We have gone through a huge process, which, I have no doubt, has kept you up many nights, but what difference are we going to see on the ground? Where will we get the staff to deliver on the Scottish Government’s ambitions?
You are absolutely correct to point to the issue of staff, particularly in rural areas. There is variability across Scotland, and when we dig into that, we find different underlying reasons.
In remote and rural areas, including where I live in the Highlands and in Arran, in your constituency, there are challenges in finding a workforce. There are labour shortages across the board. As you have said, that has been the case since Brexit, which Scotland did not vote for, and there has been an impact on Europeans, many of whom have left Scotland. Many of those people worked in hospitality, and others have since moved from social care into the hospitality sector. There are labour shortages right across the board, and we certainly feel them acutely in remote and rural parts of Scotland.
The United Kingdom Labour Government’s most recent announcements on immigration will be catastrophic and devastating for rural communities. I can think of examples in my own area of communities that have very few young people, and that ageing demographic is hitting our rural highland villages harder, faster and earlier than the rest of Scotland. There is no bank of young people who are waiting for jobs to walk into. Until recently, the problem was solved by immigration, but the Labour Party’s announcement that it is stopping immigration for social care workers will undoubtedly be problematic in that regard.
09:15We need to increase investment in social care, and the Scottish Government is doing that, despite the financial constraints that we have faced over the past few years. Everyone in our workforce is professional; they are regulated by the SSSC and are paid at least the real living wage, an investment that now costs the Scottish Government nearly £1 billion. It is significantly more than their counterparts are paid in England and Northern Ireland—I should say that Wales pays the real living wage, too.
However, we need to do more. We need to work from where we are now towards parity, and we need to invest in our social care workforce. Of course, there are challenges all over. I do not feel quite as nihilistic about it as you sound, convener; I think that we can rise to some of those challenges, and—
I am not sure that “nihilistic” is the right word. Perhaps “pessimistic”—or, more likely, “realistic”.
The Scottish Government is providing a really good offer for carers. We are talking about an average of four weeks’ respite care per carer per year, of which 65 per cent is assumed to be residential care for the person being cared for, with the remainder being intensive home care at 22 hours a week. However, how many staff will that require by 2031-32, and where will we find them? It brings us back to the very beginning and what the bill is all about. As I mentioned a few minutes ago, it is trying to ensure equitable delivery of services across Scotland to the requisite standard. However, we cannot do that without people. How many people are you expecting to recruit over the next six years?
Do you mean the number of people simply to deliver the breaks for carers? Is that what you are specifically discussing?
Yes, because that is quite a substantial part of the update that you have provided—your table shows that that element will cost between £97.1 million and £160.9 million a year. We are talking about needing quite a few people.
That is why we have begun work already with the providers and stakeholders who will be involved in delivering that commitment, and it is why the introduction is being phased over 10 years. We recognise that there is a need to build capacity between now and when it is fully delivered.
Right, but do you have any specific numbers for the people whom you would be looking for?
I do not think that we have specific numbers.
The number of new carers—
How can you work out how much it will cost if you do not know how many people you will need to spend money on?
We have taken the number of carers who are currently in the system and looked at the number of people who would require a break and the number of hours that are to be delivered. There are four different categories in that respect: less than 20 hours; 20 to 34 hours; 35 to 49 hours; and 50 hours and above. We have also looked at the percentages in the Carers (Scotland) Act 2016 to see what the target percentage would be for each of those tiers. Furthermore, we have engaged with stakeholders on what the potential number of weeks in replacement care would be and the associated costs per hour driven by that.
Although we have not looked specifically at the number of carers, we have done a lot of calculations to work out the hours that would be required, the number of carers who would be involved and the replacement care time that would be required, and we have tried to come up with what we think is a reasonable estimate of the total cost for carers’ breaks. However, we have not specifically related that to the number of carers who would be required in the system.
I do not quite follow that—it seems illogical to me. However, I will move on, because colleagues want to come in and we have a heavy workload this morning.
On the number of people who will be required, uptake of the service is expected to increase sevenfold between 2026-27 and 2031-32, according to your figures. If people are being offered the residential and weekend care that the bill intends to provide, surely there will be a much greater demand than is being anticipated. Why would you expect demand to peak in 10 years and then reach a steady state, which is what is being suggested? I think that there is an issue about the availability of staff and facilities, obviously, but surely that just means that there will be a huge pent-up demand that is not being met by the service.
Lee Flannigan can come in if I do not cover this adequately, but our trajectory is based on our experience with the Carers (Scotland) Act 2016. There were similar concerns when that legislation was introduced that there would be huge pent-up demand and that delivery would require far greater capacity early on, but that was not what actually happened.
There are challenges. Carers often do not identify as carers, and they struggle to find out what is available to them. We are fairly confident in our trajectory, because of our experience with the 2016 act.
There was a target for uptake of care assessments in the Carers (Scotland) Act 2016—it was about 34 per cent. The total number, therefore, should have been in the region of 256,000. At the minute, though, only around 6 per cent of the adult population have an assessment—the figure is 42,000—so we are currently significantly under the estimate made under the 2016 act.
We considered the percentages under the 2016 act—that is, 34 per cent for adults and 64 per cent for children and young people—and tried to reach that target population. Because we are so far under that level at the minute, we have phased things over a 10-year period. Given the slower uptake so far, we think that that should allow enough time to reach full delivery, as was intended under the 2016 act; it is based on the fact that the level is currently so much lower than where we had expected it to be. The 10-year timeframe will allow us to reach that target proportion of carers with assessments, which would entitle them to breaks.
I know that colleagues are keen to come in. First up will be Michael Marra.
For clarification, minister, is it correct that the bill no longer establishes a national care service?
Yes, and its name has been changed to the Care Reform (Scotland) Bill to reflect that.
That is useful. There is already some language in terms of civil servants, names of departments and so on. I understand that changing those might not be a priority, but, for clarity and for the public, I note that you started out by saying that you want there to be transparency as to those who are accountable. It is important to recognise that.
It is still the Government’s intention to deliver a national care service, and there will be national aspects to how we deliver social care. We have created an advisory board that will have some national oversight functions. We are still aiming for a national care service, but the bill will not deliver it—you are correct.
So, this bill does not do it.
Not in its whole sense.
Okay. That is useful.
In your opening remarks to the convener, you said that the state of the financial projections is a function of the bill being at stage 2 rather than at stage 3. You have to recognise that we cannot evaluate a financial memorandum on that basis. Financial memorandums are presented at the start of the scrutiny of a bill, with projections. We look at them and consider whether they are realistic, and we ask the kind of questions that the convener has been asking. We cannot just have a blank cheque, waiting for what might happen at stages 2 and 3. That is not a reasonable position, is it?
No, it is not reasonable, and that is why we have been in front of the committee quite so many times. With each substantial change to the bill, we have come back with financial information for you to scrutinise. I am keen for Parliament to do the job of scrutiny effectively.
There are other reasons why you have been back in front of the committee. One of your predecessors, Kevin Stewart, objected to the idea that the bill might cost up to £1.2 billion. We then had evidence from civil servants and from you that it could cost up to £3.9 billion. The range of figures that you have brought to the committee over the past several years has been staggering, given the difference between them and the lack of clarity. We are still in a position, now, where we are referencing three different sets of documents across different timeframes in trying to understand what the variety of cost impacts might be. Do you think that that is being transparent to the public?
I think that it is reasonable. The bill has been substantially refined since its introduction and, at each step of the way, we have provided fresh financial information. I think that it is reasonable and allows scrutiny by the Parliament.
You started by saying to the convener that you have to be accountable to the public. Do you think that the public could understand that variety of different documents and the fact that we are comparing them? For instance, the original financial memorandum was extrapolated over 10 years, with a sum of £1.8 billion to £3.9 billion, but the new financial update covers seven years, with a cost of £436.6 million to £724.8 million. Even the timeframes over which you are undertaking the analysis are not comparable. Is there a reason for that?
When we drafted the revised financial memorandum, back in December 2023, we kept the same essential timeline up to the end of 2031-32, to provide some level of consistency instead of extrapolating it further. You will recall that the first financial memorandum covered a five-year timeframe. To provide a greater deal of information to the committee, we extended that out to a 10-year timeframe, but that did not allow for comparability between the two. In subsequent issues, we decided to keep it extended out to the year 2031-32, to allow for some comparison between the figures that were presented previously and the current figures.
Do you think that the explanation that Mr Flannigan has just given would be understandable to the public, minister?
A member of the public with an interest in finances and who is used to looking at financial memorandums would understand it perfectly well.
Really?
Yes.
Okay. I have my doubts.
Let us go back to the first point, about the accountability side, and also to your point that you still do not know what the costs will be across different parts of the bill, including from any amendments that might be made to the bill at stage 3. You said that new sections 37A to 37E, on information standards,
“do not significantly alter what was said in relation to costs”
in the original financial memorandum and that
“Costs do not arise from the primary legislation, they will arise from the information standards created under it.”
Going back to the point about co-design, there are significant areas of the bill that just cannot be costed—is that correct?
Yes, some significant areas will be delivered by secondary legislation. There will be some areas of which the final format has not yet been decided.
Okay.
As of January 2024, there were 170 civil servants working on the bill at a monthly cost to the taxpayer of approximately £1 million. Is that still the case?
Is the team still the same size, John Paul?
It is a slightly smaller team now. This year, the budget for the national care service central team is £11 million, so it is slightly less than £1 million a month, if that was the right figure.
So, it costs about 10 per cent less than it did. However, the bill is a fraction of the size that it was and its ambition is significantly less than it was—part 1 was deleted entirely. I understand that there is no direct relationship between the number of words in a bill and the number of civil servants who work on it, but the bill is a significantly different beast from what it was. Could the committee have clarity on that monthly cost? It would be fine for that to be given in writing.
Yes, that is fine—I will certainly provide you with more information. As I have said nearly every time that I have been in front of the committee, the national care service team works with social care as well, and, at the moment, we collectively spend £6.1 billion per year on social care.
I will leave my questions there. However, as a genuine point, minister, although I consider myself to be pretty well versed in financial memorandums—I have higher-level degrees in economics and other areas of finance—there are big parts of this financial memorandum that I find difficult to understand, because we are not comparing the same things. We are not comparing apples with apples; there are different timescales and approaches. Would it not be better to start again with a proper bill and a proper costing, so that we could understand what it is meant to do?
It would not be appropriate to start again. The parts of the bill that remain are the parts that everyone has agreed are required to fundamentally improve social care. It is time for us to crack on with that.
But you cannot tell us how much big parts of the bill will cost.
As I said, and as you have stated yourself, the changes that have occurred relate largely to differences in approach. The most substantial change in the figures is because the approach in the bill has changed. We are settled now, in the main, on what will be delivered by the bill, and the range of potential costs and our confidence in those costs have improved greatly because of that. There is a settled position, and I think that the public would like us to get on with delivering it.
I am glad that your confidence has increased.
09:30
Good morning. The document makes reference to the savings that carers currently provide to Scotland. The estimate that the Scottish Government has come up with is £13.9 billion per year, which totals £14.3 billion when healthcare costs are taken into account. Where does that figure come from and what confidence do you have that that is the net saving at the moment?
Lee, would you like to answer that?
Our economic colleagues arrived at that figure by assessing the number of unpaid carers in Scotland at the moment, attributing a value to their time and working out what it would cost if the state were to provide that care.
Footnote 11 says that the estimate is based on a
“Scottish government calculation of replacement care and hospital days avoided”
that used data from between April 2022 and March 2025. However, it then says that the estimate also used results from 2014 that are set out in “Weaver et al”. A lot rests on that modelling, but, if you look up the Weaver study, you see that it involves data that was gathered in Switzerland between 2004 and 2007. Therefore, effectively, the savings estimate is based on census data from Switzerland in those years. From talking to people in the care sector, I know that, since that time, there have been significant changes in, for example, models of care, treatments, the need for hospitalisation and technology in relation to care. Going back to an earlier point, that does not give us much confidence in the estimate. The central element of the proposals is that, presently, unpaid care in Scotland saves £14.3 billion, but that estimate rests on data from Switzerland in 2004, so we should not have a huge amount of confidence in that number.
Would you like to respond to that, Lee?
I will need to check with my economic colleagues who did the calculation, but, overall, we are talking about a notional saving. It is a figure for what the cost would be if the state were to bear the burden of all the care that is provided by unpaid carers. We are not stating that that sum is a saving that would be realised in any system. However, I will talk to my economic colleagues about the calculation.
I want to go back to a point that Michael Marra raised. Minister, you said that the costs of preparing for the national care service were £1.6 million in 2021-22 and £12.3 million in 2022-23. A written answer that I got from the Government on 1 October last year said that the total cost to that point was £28.7 million—that is, effectively, £30 million for a project that, in large part, is not going to happen. Can you provide the committee with an update today on what that figure stands at?
I do not think that we have that figure.
We have a figure up to the end of the financial year 2024-25. At that point, the cost of the NCS programme was £35.5 million.
What is it projected to be by the end of 2025-26?
The projection for 2025-26 is currently sitting at around £11.4 million.
As per the earlier remarks. To go back to Mr Marra’s point, given that the scope of the bill has been reduced and the national care service initiative has been set to one side, why are we still looking at a run rate of more than £1 million a month?
As I said, the national care service team does not work entirely on bill delivery—bill delivery is a great deal of what they do, but the ambition behind the national care service initiative, which is to reduce variation in the level and quality of care, is greater than the bill. The bill team delivers a large amount of work in that regard outside the work on the bill itself.
To put those costs into context, that £30 million over three years relates to work on understanding a system that costs £6.1 billion a year. That means that less than 0.2 per cent of the cost of the system is being spent on understanding how it works, on consultation and on the creation of ways of achieving improvements in the system.
Over the past few months, I have raised many concerns in the chamber about some of the changes that have hit us in social care in Scotland, such as the increase in employer national insurance contributions, which has had a devastating impact and will undoubtedly lead to some care providers going under, and the changes to immigration arrangements. I wish that all Governments spent time understanding the sector before making substantial changes.
With due respect, minister, the work on understanding was done by the Feeley review, with the Government then introducing a bill, so the money has not been spent on developing greater understanding. It has been spent on the pathway towards the creation of a national care service that you are no longer pursuing, so you could argue that a large chunk of that £30 million is taxpayers’ money down the drain.
I do not agree with that. A great deal of the spend by the bill team has been on co-design. Perhaps John Paul would like to say a little bit more about the work of the national care service team of civil servants.
Some elements of the work done by my team were previously part of the bill but no longer feature in it, but we still intend to make improvements in those areas, either on a non-statutory basis or under existing legislation. For example, the team that was previously working on the aspects of the bill that relate to creating a new public body are now supporting the work of the national care service advisory board, which met for the first time last week. That is driven by the co-design work that we have carried out over the past two years around how people with lived experience can be supported to be represented and to participate in a decision-making forum. That work has directly informed and supported the establishment of the advisory board, which started meeting last week, as I said.
Similarly, there were provisions in the bill on improving how complaints in the social care sector are handled, and, although those are no longer in the bill, there is work that we can do under existing legislation—working alongside the Scottish Public Services Ombudsman and in partnership with local government, Social Work Scotland and a range of other stakeholders—to consider ways in which the existing system for complaints can be made easier for people to access and to progress through. Again, that draws on the co-design work that has been carried out over the past couple of years.
It almost sounds as though you are making the case that a national care service is not required, if all those things could have been done by simply reprofiling existing workstreams. Surely the huge monolithic national care service is not actually necessary, minister.
You will understand that we substantially changed our approach to the national care service. The original bill, as introduced, is no longer happening, but it would have involved lots of staff changing employer, and the Government would have had direct control. We changed to a shared accountability agreement, but, as you will understand, last year, the shared accountability agreement broke down, with the Convention of Scottish Local Authorities publicly stating that it no longer supported that.
This was not my intended approach. I believed that this level of substantial change required to be underpinned by legislation in order to deliver the change that people need to see. However, our partners—in local authorities, for example—have persuaded me that the changes can be made, and nobody is saying that the status quo needs to persist. What local authorities have told me loudly and clearly is that they can deliver the change that we want to see without legislation and without structural reform, so that is what we are doing. The work is continuing, as you say, on a voluntary basis, but a great deal of the current work on improving social care sits outside the bill.
I think that you are making the point that it is unnecessary. Let us look at one element that will happen, which is the creation of the national social work agency. There are quite significant costs in relation to building the organisation and creating dedicated human resources, finance and business management functions. On a point of clarification, the financial memorandum notes:
“The costs will be met by repurposing the existing budget allocated to the Office of the Chief Social Work Adviser”.
Are you saying that all the costs will be met by making a saving from the office of the chief social work adviser, or do you anticipate the creation of the new body incurring additional administrative costs?
Once everything is up and running and established, we assume that, in 2031-32, that will add costs of about £950,000, taking over the existing budget of the office of the chief social work adviser in addition to that. We think that the total cost of the body in 2031-32 would be around £14 million, of which £13 million would come from the existing budget.
For clarity, will the existing body be removed completely? No sponsoring element in the Scottish Government will remain, so there will be no duplication.
No, the understanding is that the office of the chief social work adviser will no longer exist and everything will be transferred to the new agency.
Okay. Thank you.
The Government has made great play of the co-design principle—which, I note, is still one of the underlying principles behind the change. At the start, minister, both you and your predecessor, Kevin Stewart, made a great play of the co-design. What went wrong that led to such a substantial change being made to the proposed legislation?
I would disagree with the premise of that question. I do not think that anything went wrong with the co-design. It has been absolutely vital for the Government to listen to individuals who access and work in social care and to learn from them about the changes that they want to see.
One challenge that we have faced over the course of the bill is that there are strong stakeholder interests, not all of which are aligned. When the decision was made by local authorities to walk away from the shared accountability agreement, I said repeatedly that the voices that we were not hearing in the public debate at that time were those of the people who were accessing care.
Minister, you are correct in saying that, at the time, there was substantial stakeholder engagement—obviously, the bill has a substantial impact for the country. However, by and large, those stakeholders were telling you that what was proposed in the initial bill was not at all satisfactory and that, on a cost basis, it was going to be unaffordable. That is what was coming back and, as you know, four committees of the Parliament had considerable concerns about the original bill.
My question is about the co-design principle. If co-design is to work well, surely the stakeholders with whom the Scottish Government is engaging must be able to flag up those concerns early doors, so that we do not get into this kind of situation, in which there has been a very substantial change—part 1 of the bill has completely gone—and we are repurposing four attempts at a financial memorandum. Do you accept that the principle of co-design has not worked in this instance?
No, I do not. I will bring in John Paul Liddle to speak more about the value of co-design. The member is oversimplifying the stakeholders’ feelings about the bill. As I have said, the people who access social care particularly loved the first version of the bill. They thought that it was the most true to Feeley’s recommendations. However, local authorities and the unions were very strongly against it.
The stakeholders who access social care were less comfortable with the shared accountability agreement. They were concerned about the power resting with local authorities, the NHS and the Government. They went with it as something that was workable, but it was not necessarily their first choice. Then, without coming back to the table to discuss it with the Government, the local authorities made the decision to walk away from the shared accountability agreement. Local authorities and unions were very strongly against the shared accountability agreement that they had jointly signed up to.
In the co-design work with individuals who access social care, those people said very strongly that they would have liked the first version of the bill. So, I think that you are misunderstanding the level of complexity—there is no one view from stakeholders on what they want to see in improvements to social care. There is no single view; there are a lot of strong, powerfully expressed different views. My challenge is to bring everyone with me as we make improvements to social care in Scotland.
But that did not happen with the first iteration.
It did not happen with the first iteration—that is correct. It did not happen with the second iteration. The core elements of this third iteration are the issues that everybody is agreed on and the changes that everybody wants to see.
My point is that the principle is one thing, but the workability and the delivery of whatever is going to take place are a different issue. As I understand it, having read the Official Reports of the various committees that were involved at the time, the principle was generally pretty well accepted, but how workable the Government’s proposals were was a completely different issue. That is where the opposition came from.
We started with one bill, which no longer exists, and we now have a second attempt at a bill that is based on what is seen to be more acceptable. Why are you confident that, when it comes to stage 2 amendments and possible stage 3 amendments, the on-going co-design will make the new bill much more acceptable to people?
09:45
I am confident because, for a number of years, I have worked closely with all of the stakeholders involved. I am confident about where we are and what we are planning to do, and I am confident that we will find an impactful way forward. We all agree that the status quo is not acceptable and that change is needed, and we see the bill as containing the elements of change that are largely universally agreed upon.
The continuing work on co-design is moving into a more detailed phase of work. The earlier co-design work was around the principles of establishing a national care service and what that might look like. The work that is now under way is a natural evolution from that. For example, there will be co-design work around any development of a record, to see how individuals would access and use that. The aim is to ensure that the development work that is carried out is informed by the experience of a real person trying to access the system. Similarly, the work that we will be doing on independent advocacy will involve individuals who have accessed advocacy support in the past or who have worked as advocates. We will ensure that the more detailed changes that we make to improve and increase advocacy support are informed by that experience.
Given that on-going co-design, can I ask the minister what kind of amendments she is expecting at stage 3?
I am working closely on the amendments with Opposition parties and stakeholders with an interest. On Anne’s law, for example, I am very proud of the amendments that we lodged at stage 2. We worked closely on those with care home relatives Scotland, whose input I am very grateful for, and we think that they delivered a substantial improvement. Care home relatives Scotland has said that it wants further refinements that would ensure that the balance of power is appropriate between care homes and relatives. We are also working with Opposition parties to reach agreement on such amendments.
The convener was asking about the possible costs. Do you predict that the stage 3 amendments may push up costs?
In relation to Anne’s law? I do not think so. As was clear at stage 2, some Opposition colleagues, including your Conservative colleagues, have lodged amendments that, should they be passed at stage 3, would have significant financial costs, but we are working together to find a satisfactory resolution. As was committed to at stage 2, we are working to reach agreement and to understand your colleagues’ objectives and aims, so that we can achieve them in a way that is affordable and sustainable.
Okay. So, there is the potential for some increase.
I have one final question. In an answer to Michael Marra, you said that you think that the new bill is, in the main, fairly settled. What evidence do you have for that?
As I said, the bill team and I have a great deal of engagement with stakeholders with an interest, as we have had since day 1. I am now confident that the elements of the bill that remain are ones that everybody is agreed on and that will deliver the changes.
We have spoken a lot about whether those changes could be delivered in other ways than primary legislation. What is left in the bill are the things that absolutely need primary legislation to be changed and that everybody agrees on—I am very confident of that.
And secondary legislation, too?
There will be secondary legislation as a result of the bill, yes.
That has exhausted questions from the committee. I have only a couple more. The first is about Anne’s law, which you touched on. You said:
“It is expected that there will be some costs for care home providers and those supporting care homes, to promote and champion Anne’s Law through staff and provider awareness sessions, formal training, updating visiting policies including the identification of the Essential Care Supporter and for printing leaflets and other administration.”
You then went on to say those would be
“absorbed within the usual costs of following current guidance around named visitor policy”
and so on. Surely, if there are additional responsibilities and training, additional costs will be involved.
As I have previously explained during various committee appearances and in the chamber, a great deal of Anne’s law has already been delivered by secondary legislation—indeed, many of the changes that we need to see have already happened on the ground. The Care Inspectorate is a passionate advocate for Anne’s law now, so I think that the cost that will be associated with the final iteration’s introduction will be insubstantial, because much of the cost has accrued already in the course of normal work.
Okay. Thank you. In relation to data, you have said that there is
“an associated ‘integrated health and social care record’ technical development which will”
make it
“easier to specify what information should be fed into the ‘record’ by what organisation. However, the Scottish Government considers the scope of the information sharing and information standards provision to be broader than this. For the avoidance of doubt Section 36, as drafted, will not in itself legislate for the creation of an ‘integrated health and social care record”.
Why not? The committee was in Estonia last year, where we looked at X-Road, which is a tremendously integrated health data record in which everyone can look back through their individual health data, as can professionals. There are real issues about data interoperability. Will the data that the bill creates be interoperable?
I ask Ryan Anderson to respond to that question.
Sections 37A to 37E, on information standards, are all about creating interoperability across our system, so that data is able to flow neatly and in forms that allow the different systems to talk to each other.
Section 36 then gives you the legal gateway that allows that information to be shared. Through section 36, we are seeking the ability to share the information in order not only to create a record but to do various other things that we must do across the health and social care sector in order to share information appropriately.
Sections 37A to 37E are where we will be able to set out an information standard that sets the format and the means by which that kind of information is transmitted, so that there is better interoperability of systems in Scotland, thereby improving the flow of data.
How much is that likely to cost to deliver, and when will it go live?
Information standards can be a multitude of things. I could not give you one specific cost today, because a variety of information standards are in existence.
To make the changes that you have just discussed, how much are we looking at?
Those changes would be rolling. The rate of technology change is such that new information standards come and go all the time. I can give you a figure for a large information standard and a figure for a smaller one, to set some context. The outline business case cost for the systematised nomenclature of medicine clinical terms over the course of 10 years, including optimism bias, is £33.4 million, and the Scottish Government is already investing in that. We are not likely to have to adopt many large international standards like that. In 15 years, we might have two to deal with: the 11th revision of the international classification of diseases—ICD-11—is the other one that is on the horizon.
In the previous memorandum, there were specific sections on IT. Mention has been made of the fact that we are somehow expected to read the two previous financial memorandums in conjunction with the financial update. Would it not be easier to have one comprehensive document that laid out all the costs, as the committee requested some weeks ago? What is the point in looking at what the costs were projected to be in 2022 or 2023? That needs to be put to one side. We want to know what the position is as we go forward, and one comprehensive, easy-to-access document that included IT as a component would provide that.
When we bring forward secondary legislation on each of the information standards that we seek to bring forward, we will do impact assessments on them at that point. At this stage, it is not possible to say which information standards we will bring forward, because they change so rapidly. They need to be developed over time to ensure constant interoperability. Interoperability is not a static thing, so, at this point, it would not be reasonable for us to measure the cost of that over the course of a number of years.
That is a worry, but I shall leave it at that.
I will give the minister the final word. Are there any further points that you wish to relay to the committee before I wind up the session?
No, thank you. I am very grateful for the committee’s time and its on-going scrutiny of the bill. I think that the changes that the bill proposes are ones that everyone in Scotland is now agreed upon, and I am keen to crack on and deliver.
Thank you very much for your very helpful evidence. We will now take a break until 10 o’clock, to allow for a changeover of witnesses before we move on to our next agenda item.
09:56 Meeting suspended.Previous
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