Meeting of the Parliament

Meeting date: Wednesday, November 2, 2022

Official Report 1110KB pdf

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National Care Service

The next item of business is a debate on motion S6M-06523, in the name of Craig Hoy, on national care service viability. I ask members who wish to participate to press their request-to-speak buttons now or as soon as possible.

I encourage members who are leaving to do so as quickly and quietly as possible.

15:23  

This Scottish National Party Government is setting out on the most radical reform of Scottish public services in the history of devolution, but ministers cannot deny that they have been warned about the risks around the establishment of a national care service. The Government has been warned by its own MSPs, Michelle Thomson and Kenneth Gibson; by charities, about the risks to continuity of care; by Audit Scotland, about the financial risks; by integration joint boards, about the risks to care across the country; by councils, about the risks to local democratic accountability; by care home providers, about the impact on the independent and third sectors; by rural councils, which warn of the risks of creating a central belt-focused service; by health and social care partnerships, about the risks of proceeding with a framework bill when we know so little detail of the scope of the service; by alcohol and drug charities, about the impact on services for those with dependency issues; by unions, about the risks to workforce planning and development; by labour groups, about the risks to pay and conditions; by social workers, about the impact of detaching social work from local services such as housing and employability; by council chief executives, about the risks of shifting 75,000 council workers to a bloated bureaucracy; by the Scottish Parliamentary Corporate Body, about the risk of a grab on Holyrood’s powers of appointment; and by the legal profession, about the risks of losing cohesive responsibility for the care provided in complex cases. It has even been warned about the legality of pushing through sweeping changes in a framework bill and delegated legislation.

Despite those repeated warnings, the SNP Government continues to sail towards the iceberg. Humza Yousaf is still, apparently, supremely confident that he can captain the national care service, despite sinking Scotland’s national health service. Under the SNP, our NHS and social care systems are in crisis, so it is all the more reckless for this Government to embark on wholesale structural reform when urgent action is needed at the front line.

The minister is ignoring warnings about the crisis that he faces today. He simply dismisses criticisms of that reckless and unaffordable legislation. He ignores the present funding crisis in local government and social care. He dismisses concerns from a workforce that is underpaid, worn down and burned out. He overlooks the acute lack of staff and provision in care at home. He sets aside the skills and workforce crisis in residential social care and ignores the crisis in drug and alcohol services. Instead of taking concrete steps to properly fund social care at the local level, the SNP wants to embark on a massive restructuring, which will divert the millions that are needed to invest in staffing away from the front line and into the pockets of civil servants and administrators.

Why can the minister not see that social care organisations and unions are terrified about that misguided plan? Those bodies include the Convention of Scottish Local Authorities, Unison, Community Integrated Care, NHS Lothian, Scottish Care, Parkinson’s UK, Highland Council, East Lothian IJB, the City of Edinburgh Council, Angus health and social care partnership, the MS Society and the Faculty of Advocates—the list goes on.

The SNP’s members have raised their heads above the parapet to express concerns about how the Government will fund its national care service. After destroying councils’ finances, it is looking to do the same to social care. Audit Scotland is warning that the already eye-watering predicted costs of £1.3 billion are likely to be an underestimate. Even after the framework bill has been published, big questions remain. How is a top-down system consistent with the Christie commission’s view that services must be designed “with and for people”? How will the system eradicate the postcode lottery in care? How will commissioning and collective bargaining work coherently and consistently on a national basis? How will care boards be comprised? Where will the democratic accountability be? What impact will that massive shift have on local authority budgets? If efficiencies are gained in the economy of scale that is achieved through the NCS, will they not be wiped out by the equivalent loss in economies of scale within local government? Where are the calculations on the cost savings that an NCS will achieve? The financial memorandum is very vague. What impact will the NCS have on capital investment in social care today? Councils are pulling back. Is it not the case that that power grab is likely to be an asset grab as well?

The nationalists have learned nothing from the shambolic centralisation of Police Scotland—a move that left the police service plagued by financial problems, a lack of accountability and cuts at the front line. The NHS is in crisis. The SNP has pushed our police service to the brink and is now determined to go the same way with social care.

The member mentioned the NHS, and I note that his party voted against the creation of the NHS 22 times. Does he not recognise that people with lived experience fed into these proposals and are asking us to create the new public service?

The Conservative Party might not have given birth to the NHS, but Conservative Government after Conservative Government has nurtured it through good times and bad. That is why, today, in our motion, the Scottish Conservatives call on the SNP to scrap these wasteful plans and put every penny back into front-line social care.

We want to see a local care service that empowers communities. We want a change in culture and a change in delivery at the local level, with a service that is underpinned by a simple commitment to ensure that people access care in their local area, close to their family and close to their support networks. Centralisation poses risks not only to those who work in the care system, but to those who need care and the families that need to be around them.

The national care service poses a very real risk of an increase in cruel, out-of-area care that splits families from loved ones. The SNP falls back on one justification alone—that the reforms will create consistency—despite having no real plan to achieve it.

The only thing that is consistent about a national care service is the opposition to it. There is opposition from councillors, NHS boards, the unions and the workforce, charities, royal colleges and the independent and third sector. There is now opposition from normally supine SNP back benchers. However, there is a way out—the iceberg can be avoided. The SNP can urgently U-turn on a national care service and back our commonsense, local care-driven approach. Unless it does so, once again, overstretched care workers, vulnerable patients and their families will suffer.

I urge colleagues across the Scottish Parliament to support quality local care and to back our motion tonight.

I move,

That the Parliament notes the significant cross-party and cross-sectoral concern about the monumental risks involved in the creation of a National Care Service; warns that the financial memorandum to the Bill estimates that the creation of the service could cost up to £1.3 billion over five years and questions the accuracy of the Scottish Government’s estimates currently before the Parliament; raises concern about the rationale for creating a National Care Service through major structural reform at a time when social care is in crisis; acknowledges the considerable concerns from local government, trades unions and other industry stakeholders about the potential negative impacts of centralisation; believes that better value for money and better patient care will be achieved by directing investment into frontline provision and staffing rather than reorganisation, and calls for the creation of a Local Care Service focussed on better local delivery, underpinned by a local care guarantee.

I remind members that we are extremely tight for time and that they will need to accommodate any interventions in their time allocation.

15:21  

The bill sets out our clear principles for the future of a national care service, and it is against those principles that the bill should be scrutinised, the detail designed and the benefit monitored. We are not just suggesting change to address the challenges of today; we must build a public service that is fit for tomorrow.

Today, in Scotland, at least 232,000 people—one in 25—receive care support. Demand will only grow, and we need to recognise the risk of increased pressure on an already fragile system by acting now.

Our ambition for the national care service is to establish a social care system that not just enables people to survive, but empowers them to thrive. Health and care support is an investment, and it must work to remove barriers and tackle inequalities. The principles of any new system should be person centred, with human rights at the very heart. That means that the NCS must be delivered in a way that respects, protects and fulfils the human rights of people who access health and care support.

Another fundamental principle is inclusion. This morning, I visited Tiphereth, a Camphill community that is based in Edinburgh, to learn more about its work in supporting the life and work of adults with learning disabilities and autism. We must get it right for everyone. We have an opportunity to include many people across society in a conversation about their needs—a conversation that, traditionally, they have been excluded from.

I thank carers, both paid and unpaid, for their remarkable work to provide critical and invaluable support to people across our country. The cost of living crisis is having an impact on everyone in Scotland, including the social care workforce and unpaid carers. By working in collaboration with our partners, we want to see improvements in recruitment and retention, fair work and ethical commissioning.

Liz Smith (Mid Scotland and Fife) (Con) rose—

Jackie Baillie (Dumbarton) rose—

I do not really have time, but I will take Ms Smith’s intervention.

I will be quick. The minister has spelled out laudable aims, but why are so many stakeholders opposed to the bill?

There are stakeholders who are not content with all aspects of it, but I point out to members that it is about people, and, in the consultation, people backed the national care service overwhelmingly. It is about people—that is who we need to listen to. We, as a Government, are fully committed to improving the experience of the social care workforce and increasing its levels of pay, as we recognise and value the work that those staff do.

The Government is taking action. From April, we provided funding of £200 million to local government to support investment in health and social care, to embed improved pay and conditions and to deliver a £10.50 an hour minimum wage for all adult social care staff in commissioned services from 1 April.

Jackie Baillie rose—

The Scottish Government has been leading the way in the United Kingdom to improve pay and terms and conditions. I am shortly due to chair an event with COSLA, unions and providers to discuss how we will work together to make further improvements now. Government alone cannot do that, but we can make significant improvements by working with all our partners.

The principle of financial sustainability is set out in the bill. We must ensure that we can deliver continuity and security of service for those who access services.

Will the minister take an intervention on that point?

The Government has already committed itself to increasing spending in social care by 25 per cent by the end of this session of Parliament, to lay the groundwork for the establishment of a national care service. Through plans for an ethical commissioning framework, we will ensure that there is increased financial transparency, allowing us to prioritise quality of care and to understand better cost and profit across the mixed economy of providers.

Will the minister take an intervention?

I have a lot to get through, so I will not take Ms Baillie’s intervention.

We must reintroduce a focus on early intervention and prevention. We must limit the number of people who end up in crisis. People want and need quality services that are delivered at a time and by a method that best suits their needs and that builds on their strengths.

Last week, I met representatives from the Fife social work team and heard about its social work off the books initiative, which delivers in the Pathhead and Dysart areas of Kirkcaldy. That community approach aims to reduce crisis care. It is critical that we learn from existing good practice from across the country.

The National Care Service (Scotland) Bill sets out a framework for change. The detail relies on us all, including those of us here in the chamber today as well as those outwith it, working together.

We need to grasp the opportunity to deliver public service improvement together, to ensure that we are getting the detail right for everyone. Such an approach requires trust and confidence in each other and in the process. We need to recognise the implementation gaps between legislation and delivery that the independent review highlighted.

I have been honoured to chair the social covenant steering group over the past 12 months. It will be critical in holding us to account for maintaining the priority of the voices of lived experience in the design phase.

People confirmed to us that they are supportive of the proposals in last year’s consultation. The sooner we start, the sooner we can deliver better care support for everyone.

I move amendment S6M-06523.3, to leave out from “notes” to end and insert:

“that the experience of the COVID-19 pandemic highlights the imperative for the National Care Service (NCS) to end the postcode lottery in the provision of adult social care; believes that there must be a rights-based, user-led approach to social care with consistent and fair access to high-quality care and support; further believes that the NCS should embed ethical commissioning that promotes fair work and climate change ambitions; recognises that the key consideration is how improvements are made for people who rely on the services of the NCS; welcomes that the NCS will be shaped by co-design and that services will be delivered locally; supports the creation, in line with the recommendation of the Independent Review of Adult Social Care, of a system of national collective bargaining on pay, terms and conditions within the social care sector and for workforce representatives, such as trade unions, to be involved in the governance of the service, including through full membership of Local Care Boards; notes that, in establishing the NCS, including any transfer of financial resources from local authorities to reformed integration boards, the Scottish Government should take into consideration the impact on local authorities’ ability to resource and deliver other services; understands that the UK Government’s mismanagement of the economy has heaped more pressure on care providers who were already adversely affected by the consequences of Brexit, and recognises the importance of local authorities, health boards, and the Scottish Government working constructively together to deliver improvements to social care in the interim, while mitigating the impact of the UK Government’s actions.”

15:38  

More than a decade ago, the Scottish Labour Party called for the creation of a national care service. Our vision was rooted in a belief that social care could be transformed to deliver exceptional national standards of care across Scotland. That is about changing the culture, not the structures, by ensuring that our social care system treats people with dignity and by ensuring that our care staff are respected as skilled professionals. Sadly, the Scottish Government’s proposal lacks substance, lacks vision and, increasingly, lacks the confidence of key stakeholders, including trade unions, COSLA, care providers and staff who are working on the front line.

At yesterday’s Health, Social Care and Sport Committee, COSLA’s health and social care spokesperson, Councillor Paul Kelly, clearly outlined on behalf of councils across Scotland—of all political stripes, including SNP-led councils—huge concerns about what the bill would do to local government. It would take away power from local communities and place it in the hands of ministers, who would then use secondary legislation to design the national care service. He raised concerns that many councils might become unviable.

I and the Scottish Labour Party have serious concerns about the Scottish Government’s vision of the national care service. If the minister will not listen to me, perhaps he will listen to his own colleagues, who are also losing confidence in their Government’s ability to deliver what it has promised.

At last week’s Finance and Public Administration Committee, Kenny Gibson compared the Government’s approach as being akin to using a

“sledgehammer to crack a nut.”—[Official Report, Finance and Public Administration Committee, 25 October 2022; c 24.]

He also mentioned the “monumental risk” in relation to the financial memorandum and the lack of detail therein.

Will the member take an intervention?

I have a lot to get through, so I want to make some progress.

The loss of confidence in this proposal has been growing, week on week. That is why, today, Scottish Labour is calling for the bill for to be paused. Let me be clear: this is not about trying to get one over on the minister or opposing for the sake of opposing. What we are debating is far too important for that. This is about a fundamental principle—the principle of good lawmaking—and creating a national care service that is worthy of the name.

It is irresponsible to press ahead with legislation that is not fit for purpose and that does not command the confidence of key stakeholders. We cannot afford to get these reforms wrong. Indeed, we have had 15 years of this Government ignoring social care. Half-baked solutions will only deepen the problems in the sector.

Presiding Officer, if Emma Harper wants to speak, I am happy to give way.

Fantastic. I thank the member for taking an intervention. I just want to ask Paul O’Kane, as a member of the Health and Sport Committee—which I am as well—whether he would concede that we are just two sessions into the scrutiny of the bill and that there is time to submit changes and to take evidence. Everybody is dumping on this right now, as though there is a massive issue with it. Do we not need to take the time to scrutinise it and allow all the voices to come out?

What I recognise is that the Government has been talking about this and consulting on it for months. I recognise that the Convention of Scottish Local Authorities, in its evidence, said that it found out about the Government’s framework legislation proposals on the night before they were published. I do not think that that is acceptable, and I think that there are growing calls from across all sectors to take a pause and reflect.

I say again to the minister that, if he will not learn from me and does not want to listen to me, perhaps he should learn from John Swinney. In 2018, the Deputy First Minister listened, reflected and took the sensible decision to pause the Education (Scotland) Bill when he recognised that stakeholders had serious concerns about the move to legislation. The process that flowed from that was co-designed with councils, teachers, parents and staff, and it is the reason that we have the improvement collaboratives that we recognise today.

Will Mr O’Kane give way?

I am running short of time, as I am into my final minute. I am sure that the minister will be able to raise his point in his concluding remarks.

The Scottish Government needs to go back to the beginning of this process to substantively and meaningfully engage with the key stakeholders in co-designing legislation. In the meantime, let us get to work on improving social care right now. As a first step, the Scottish Government should immediately act on the key recommendations of the Feeley report, including by removing non-residential care charges and tackling poverty pay in the social care sector. It is clear that we do not need to wait for a national care service to begin to address these problems. Indeed, we have been making that argument from the Labour Party benches for many months. The Government could take action here and now to improve the social care sector if it had the political will to do so.

What the Scottish Government is proposing is, in its current form, a national care service in name only. The Scottish Labour Party aspires to see a properly funded and well-planned national care service. That means local delivery while maximising standards, making it a race to the top by forcing bad actors who do not deliver high levels of service out of the system. The Scottish Government must listen and reflect on the growing worry of stakeholders, including trade unions, front-line staff and local authorities, and it must show some humility. It is time for the Government to pause and to meaningfully listen and properly engage, so that we can create the national care service that Scotland deserves.

I move amendment S6M-06523.2, in the name of Jackie Baillie, as an amendment to motion S6M-06523, in the name of Craig Hoy, to leave out from “raises concern” to end and insert:

“; recognises that Scottish Labour first proposed a National Care Service over a decade ago with the aim of improving national standards for social care, while also supporting local delivery and accountability; regrets that, instead, the Scottish Ministers have published a bill that is completely lacking in a vision for a National Care Service; acknowledges the serious concerns from local government, trades unions and other stakeholders about the potential negative impacts of centralisation; considers that meaningful reform should focus on changing culture and not structures, so that care users are treated with dignity and staff are valued as skilled professionals; believes that the immediate priority must be to address the current challenges in social care, and calls on the Scottish Government to pause the bill and take stock, and urgently deliver on the recommendations in the Feeley Review, including ending non-residential care charges, and to tackle poverty pay in the sector, in the midst of the cost of living crisis.”

15:43  

I am pleased to rise for the Scottish Liberal Democrats, and I am grateful to Craig Hoy for securing the debate.

Words matter. What we call things matters. In the nomenclature around the national care service, the Government has sought to dress it up as our most treasured national possession. It is small wonder, then, that the public response has been to regard it as a mirror image of that thing that they, and we all, hold so close, but it is anything but that. The NHS was forged out of the rubble and poverty of war. It is free at the point of delivery. Nothing of that is emulated in the proposed national care service. The Liberal Democrats have made no secret of our opposition to the plans from the very start.

The SNP-Green Government has stood and watched the disintegration of our health and social care sector—this is on their watch. Instead of taking the immediate action that is so desperately needed across the sector, it has responded with an ill-fated, bureaucratic exercise, which is already turning into a mess.

Even I am surprised at how quickly the wheels have come off the wagon. Already, legal experts, auditors and council officials have slammed Government plans. This week, the chief executive of East Ayrshire Council said that local authority leaders

“have no certainty ... on what services are going to look like in the next three to four years”,

and he described the current circumstances as “truly unstable” for social work and social care.

As we have already heard, at this week’s Finance and Public Administration Committee meeting, officials described uncertainty about how much the plans would cost, and there was a suggestion that the cost could spiral beyond the Government’s estimate of £1.3 billion.

The alarm has even been raised from within the SNP’s ranks—we have heard something of that this afternoon—in a rare act of dissent among the collective, although that is becoming a little more common these days.

I want to put it on the record, as somebody who raised some of those points, that I am absolutely in favour of the national care service. It is the kind of audacious and ambitious project that we should be doing. However, I am carrying out my function of financial scrutiny, and other parties, such as the Tories, would do well to heed that.

I can only imagine that Michelle Thomson’s mobile phone must have been red hot between the time that she made her remark that she had “no confidence whatever” and the intervention that she has just made. However, she said that and she said that she was completely surprised by the lack of detail in her Government’s financial memorandum. Sadly, it does not come as much of a surprise to the rest of us.

Many of us have rightly questioned the wisdom of spending huge amounts of money on structural reorganisation rather than supporting hard-working staff.

Will the member give way?

I am afraid that I must make progress, as I have only four minutes.

We must remember that, despite the incredibly important service that social care staff provide, they are among the lowest paid in our society. As a result, the cost of living crisis is hitting them the hardest and more must be done to help them. If we do not do that, they will leave the sector and seek fairer pay, and who could blame them?

No one is arguing that change and reform are not required. Of course they are needed, but we must have good change and genuine reform. Staff and service users need that change now, not in five years’ time when this bureaucratic monolith is finally set up. Were Liberal Democrats in government in Scotland right now, we would reward staff with better pay, better conditions, career progression and powerful national collective bargaining. We would set out national standards to get rid of the postcode lottery that currently exists in social care so that everyone had the same level and quality of care no matter where they live. Instead, the Government wants to remove power from local service providers, who know best how to use it, and place it in the hands of Government ministers, who have proven themselves to be incompetent time and again.

The playwright George Bernard Shaw once said:

“Progress is impossible without change, and those who cannot change their minds cannot change anything.”

The Government would do well to heed that lesson before things get worse. The Government’s plans could not have been more poorly thought out, so I urge it to think again before it is too late.

We move to the open debate.

15:47  

Last week, Jackie Baillie said that she has a long memory when it comes to parliamentary experience. Although I cannot compete with her on longevity, I can get quite close, and I certainly remember a couple of occasions when there were serious concerns about financial memoranda that were designed to underpin major pieces of proposed legislation. That happened with the Children and Young People (Scotland) Bill and with college regionalisation. However, never in my time in the Scottish Parliament have I seen a financial memorandum that is so out of kilter with the ambitions of a bill and so lacking in detail.

Michelle Thomson and Kenny Gibson were spot on last week, and Michelle Thomson is spot on again this afternoon, in saying that they have a duty of scrutiny—they do. They said that it is not possible to have confidence in the financial memorandum and that it is a “monumental risk” to taxpayers. That is not a good place for the Scottish Government or the Parliament to be in. When it comes to scrutiny of the bill, the financial memorandum certainly does not adhere to the request from Audit Scotland to ensure that we have more accurate financial memoranda accompanying proposed legislation.

In fairness, will Liz Smith concede that the larger and more audacious and ambitious a project is, the more difficult it is to achieve accuracy at the point in time when the financial memorandum is produced? I know that from my business experience of delivering large-scale transformational programmes.

During my time in the Parliament, which now stretches to 16 years, I have never seen a financial memorandum that is so lacking in that regard. As Audit Scotland points out, a number of costs associated with the bill are yet to be assessed, including those relating to national care boards, transition costs, pensions, VAT and capital investment and maintenance costs. Those costs are surely extremely important and are of considerable concern to stakeholders.

The Fraser of Allander Institute has suggested that groups that tried to estimate the costs had to persistently question civil servants to find out the additional costs—those beyond the core costs that are mentioned in the financial memorandum. Virtually every stakeholder is asking those key questions, and I would have thought that that would be of considerable concern to the Scottish Government. I suggest that it is entirely the wrong way round to have a situation in which it is not possible to scrutinise enough of the bill. That is why COSLA, councils, trade unions and front-line staff in the public and private sectors are getting angry. They simply do not have the answers that they need.

Let me turn to the evidence that Ralph Roberts presented on behalf of NHS chief executives. He rightly cited the Scottish Government’s very welcome focus on improving social care, on developing better quality and consistency when it comes to data and on ensuring that some of the intense workforce pressures on the NHS are addressed. However, when he was asked about the extent of the restructuring, which is on a scale that is equivalent to major reforms such as the centralisation of the police force and college regionalisation, he was much more sceptical. He said that what is proposed by the Scottish Government is not supported by NHS chief executives at this time, when they are having to deal with other pressures and when all spare capacity is already being taken up. Mr Roberts suggested that we should consider other ways of tackling the issues at stake before this leviathan new structure is even contemplated, given that so many costs are unaccounted for.

People are asking whether the bill is necessary to deliver the desired ambitions, not just because of the current economic challenges but because of the extensive disruption that is likely to take place through structural change.

I have every support for the motion in the name of Craig Hoy.

15:52  

Here we go again with these Opposition debates, with members talking down the SNP Scottish Government’s commitments and, indeed, our hard-working NHS and social care staff. Such debates in this chamber are becoming wholly tiresome. Last week, it was Labour and, this week, it is the Tories. It is becoming increasingly harder to see the policy differences between the two better together parties as they come back together and make a massive muckle midden together in the lead-up to our indyref. Mibbes that is just what is going on.

Anyway, to dispel the drivel in the Tory motion, I note that the establishment of a national care service will be the most ambitious reform of public services since the creation of the national health service. The national care service, as proposed in the bill, will bring together social work, social care and community health to strengthen health and social care integration for adult services.

I accept the situation that the member has outlined, but does she really think that, given what stakeholders are saying, they are comfortable with the bill? Every one of them who has given evidence to the Finance and Public Administration Committee and spoken to us has said that they are not.

I know that at the heart of the bill is the idea of caring for human beings and looking after people whose verbal responses to the consultation indicated that they want a more joined-up service that brings all the care providers together.

By the end of the parliamentary session, accountability for adult social work and care support will transfer from the Government to ministers, who will be accountable.

Will the member take an intervention?

I am sorry, but I dinnae have time. These wee four-minute speeches do not allow us to get on the record everything that we want to say, but I am happy to speak to any member after the debate if they seek a more detailed response.

The bill will increase transparency and standardise delivery of care to eradicate the current postcode lottery care system. Importantly, it will take the focus of social care away from today’s for-profit industry and will lead to a system that focuses on human rights and high-quality care.

Contrary to what the Tory motion states, the bill does not centralise social care. It is a framework bill, which means that other regulations will come after it—affirmative regulations that we will, again, be able to scrutinise. That means that it allows—

Paul O’Kane rose—

I am sorry; I want to proceed, because I have particular points to make.

For example, regarding how the approach will work better, Dumfries and Galloway and the Scottish Borders are large, rural areas that require a bespoke approach to the challenges of distance and rurality. The bill allows for that, but ensures standards of care. Dumfries and Galloway and the Scottish Borders are separate areas with bespoke requirements, but certain standards will be matched nationally, which has to be welcomed, as it will ensure high standards of care.

I would have thought that the Opposition could get behind improving care standards and ensuring equity of care, but instead they simply continue to moan.

I turn to self-directed support, which I have worked on since my re-election. SDS allows people to receive money from their respective local authority, to be spent where people feel is most appropriate for them. That might be help with the management of a health condition or disability, help with buying technology, help with getting out and about, or even support for attending work or college. Over the summer, the minister came to Dumfries where we heard directly the lived experience of people who were receiving self-directed support.

That is all part of how we move forward—by engaging with and listening to people and through co-production with them in order that we have the best bill to take forward.

I realise that I am out of time, Deputy Presiding Officer. Thank you.

15:56  

I ask the members sitting opposite me to consider the fact that it is our responsibility as parliamentarians to debate the issues—we have that right. I hope that the member who spoke before me asks for some Government time so that we do not have to have short debates.

The bill on a national care service has promised a great deal but, with each passing month, the weight of that ambition has been forgotten. Instead of building a truly revolutionary service, the Scottish Government is tinkering around the edges of what the service would mean on the ground, while concentrating power in its own hands rather than in those of carers or people who require care.

I think that Carol Mochan is asking the Government to take information forward. We have just begun scrutiny. Will we not have a stage 1 debate, in which we will be able to debate the bill in the chamber again?

We have to scrutinise the bill, and part of that is for the Government to bring more debates to the chamber so that we can debate the issues more fully, which are important and on which people have concerns.

The national care service is a mere shadow of what a universal care service could be, and it does not, at this stage, seem worthy of the name. The Scottish Government is not proposing a national care service in this plan; as it exists currently, it would lead only to a national procurement and commissioning service, dressed up in the language of radical change.

The profit motive is at the heart of everything in this plan, and the harsh reality of low pay and poor conditions for most workers are not set to change in any substantial way—there is no drive from the Government for collective bargaining or the improvement of pay and terms and conditions of the poorest-paid workers.

Will the member give way?

I will make progress, because I am running out of time.

As members might expect, I believe that, through their trade unions, workers understand the drawbacks better than most, yet very few of their concerns have been taken into account when drafting the bill.

Unison has, quite rightly, called the plans “not fit for purpose” and has asked for them to be recalled. I have a lot of sympathy for that position and share the view—made explicit in my party’s amendment—that the process must be paused immediately and that it requires the recommendations that are laid out in the Feeley review to be delivered as a priority. We can do that. If we do not take stock and allow for that to happen, we will create a service that, in essence, is set up to fail and built on the broken foundations of this care service.

The overt centralisation at the heart of the plan is designed to further disempower councils. Unite the union has expressed concerns about the proposal to hand power to

“unaccountable local care boards to deliver services”

with no democratic mandate.

It is clear that COSLA is firmly against the plans. It has stated that the Government is planning to remove

“decisions around locally delivered social care services ... from communities”

and hand them to

“Scottish Government Ministers in Edinburgh.”

That does not sound like a step forward to me; it sounds like an old-fashioned power grab that will put the future of many jobs firmly in the hands of ministers who are far away from what happens on the ground. Given the state of negotiations with public sector staff, we can understand why care staff and trade unions have serious concerns.

We are not here to simply tick boxes and say that a national care service has been built and then move on to the next manifesto promise. We are here to build something that, like the NHS, will stand the test of time.

I reiterate that the Government must pause the bill, listen to the concerns of carers, service users, councils, trade unions and MSPs, and get it right the first time round. Anything else would be a dereliction of duty.

16:00  

I do not often tell personal stories in my speeches, but today I will repeat the story that I shared in my very first speech in the chamber.

My grandpa fell in his house shortly before the council elections in 2017. After that fall and his recovery, he required care in his home for the rest of his life. His carers were far more than help around the house—they enhanced and enriched his life. He loved to tell stories, and what his carers and, often, their families were up to became part of the stories that we were told. We knew that he was safe with them, and they often stayed to make us a cup of tea when we needed it, too. Words could never express how grateful I am to each and every one of them.

His experience, and the fact that not everyone has that experience, is what drives my approach to the national care service. We must ensure that people receive person-centred care. I acknowledge the anxiety about the lack of detail in the bill. Framework bills do not give the immediate certainty that is needed, but the bill provides people who receive care, their families and their care workers with the ability to offer input to how the service runs. Let us not pretend that our current system is one in which their voices are always heard. The bill gives us the chance to get things right.

Fair work must be at the heart of that. I was hugely frustrated to hear from my grandpa’s carers about the lack of holiday pay, sick pay and maternity pay, and even lack of consideration for something as basic as local knowledge.

Will the member take an intervention?

I am really sorry, but I have a lot to get through.

I heard about carers being sent from one end of the local authority area to the other because a manager who did not know the area thought that the trip from Bo’ness to Larbert could be done in 10 minutes, only for the carers to come back to Grangemouth after that. Caring for care workers must be at the heart of the bill. That is why I will lodge amendments to further embed, at the heart of the bill, fair work as part of ethical procurement. I will work with the minister and unions to address concerns.

We know that there is a mixed picture across the country, but social care workers in Falkirk should have the same terms, conditions and working culture as those in Argyll and Bute. For people who receive the care, how they receive it and what they are entitled to should also be the same everywhere. That is a fundamental principle of the national care service and one of the main reasons why we want to see the bill progress.

Culture change must be a key part of any social care reform, and as I said in the Health, Social Care and Sport Committee meeting on Tuesday, culture change does not often come without huge costs attached. I agree with Mr O’Kane—as, I am sure, the minister does—that any of those issues could be tackled now. In the joint working group involving COSLA and the Scottish Government, I would like to see discussion and agreement on ways to do that and to advance it now.

In yesterday’s HSCS Committee meeting, we heard COSLA’s concerns about appointments to care boards being the minister’s decision. Might the minister address that in his closing remarks?

Will the member take an intervention?

I am really sorry, but I need to keep going.

We can agree that there are some good things in the bill. We all recognise the importance of Anne’s law. I met campaigners outside Parliament, as did others from across the chamber. The pandemic robbed many people of their last precious hours and days. I want better and consistently offered bereavement support for unpaid carers, as well as support with manual handling and, crucially, the right to short breaks. We need to ensure that that is implemented consistently to ensure that breaks are available, in a way that is useful to them, for people who have multiple caring responsibilities.

In reality, there is too much to cover in four minutes. There are real opportunities through co-design and secondary legislation to be flexible, to listen, to take account and to change things that do not work as anticipated. I recognise the anxiety around the lack of detail, but I look forward to working with carers’ organisations, with people with lived experience and with care workers in order to ensure that the bill delivers on its core aim, which is to make things better and more consistent for people who use the social care system and people who work in it.

16:04  

The Tory motion is, quite frankly, a disservice to the social care sector here in Scotland. The establishment of a national care service will be the most ambitious reform of public services since the creation of the national health service. The aim is to ensure consistent, fair and high-quality care for everyone in Scotland, thereby reducing the current variations that many folk have raised over recent years.

The Tory motion is simply wrong. A national care service is not about nationalisation of services. The bill—maybe Tory members should actually read it—sets out that, at national level, the functions will be focused on consistency through national oversight. Services will continue to be designed and delivered locally. That is right in order to support delivery with and for our communities and the people whom those services serve.

Will the member give way?

I am sorry. I normally take interventions, but today I have only four minutes.

National oversight will allow for better sharing of good practice and innovation, which we know takes place right across our country. For example, for years Aberdeen City Council and Aberdeenshire Council have pooled resources to get best value, when possible. It can be done. The proposed changes will bring forward new power-sharing arrangements at national and local levels. They will deliver a mix of the clarity that people want on ultimate accountability and, crucially, they will deliver the flexibility to meet local needs, including the needs of our island and rural communities.

The Tory motion questions the Scottish Government’s financial estimates for the National Care Service (Scotland) Bill, as well as the rationale for it, but the bill follows the independent review of adult social care, which showed the need for change and recommended reform and strengthening of national accountability for social care. The review found that the current way of working has not fully delivered the improvements that it was intended would be achieved by integration of health and social care. It showed that the current approach to social care is simply not working, because the current system focuses on profit over people, and it said that that must change.[Interruption.]

Mr Hoy!

The Tory motion appears to support the findings of the Feeley review, but it would deprive Parliament of the tools to deliver the change that is needed. The Tories’ so-called local care service would fail to address the fundamental issues of consistency, quality and access. It would add to the postcode lottery of care that the current system provides. For example, it would allow differences between delivery of care in Aberdeen Donside and delivery in Glasgow city. Perhaps in their summing up, the Tories could clarify how their plan would deal with the current postcode lottery, which they constantly complain about.

Any spending decisions that are made on the national care service will be backed by rigorous evidence-based decisions. The costs in the financial memorandum largely represent investments in service improvements and terms and conditions for our vital front-line care staff. Any suggestion that the figures relate exclusively to admin costs are totally false and misleading. The bill will also remove unwarranted duplication of functions, thereby providing best value for public funds, which is to be welcomed.

The creation of a national care service reinforces the Government’s wider commitment to taking long-term action to change our society and make it a fairer and more equal place in which to live, work and play.

We need to grasp this opportunity to deliver public service improvement together. I encourage the Opposition to work constructively with the Scottish Government on the bill. Let’s get this right for a’bodie.

16:09  

I am grateful to have the opportunity to contribute to today’s debate on the national care service and the crucial proposed legislation on it. I have been engaged with local authorities on the matter for some time—in fact, I spoke to the chief executive of East Ayrshire Council, Eddie Fraser, on Monday in preparation for this debate.

First, it is important that, as a Parliament, we accept the current situation and work together to develop a solution to what is a continually developing crisis.

Health and social care in this country is in crisis; quite frankly, it is much worse than is being reported. Front-line staff are working flat out, way beyond what should be reasonably asked of them, to look after people who need healthcare. We are all truly thankful for everything that they do, but we cannot rely indefinitely on their good will.

Earlier this week, the Cabinet Secretary for Health and Social Care suggested that it will take five years to redress the current crisis. There are two things that I would say to that. Given that the issue existed long before Covid but has been exacerbated by it, the first thing that I would ask the cabinet secretary is, “Why didn’t you start to redress the problem five years ago?” Secondly, I say that it will take a lot longer than five years to get a fully functioning and fully staffed NHS and social care sector. That is a couple of decades away—four parliamentary sessions, so the Parliament in this session will not get the credit. A long-term strategy has to be put in place and initiated. Will the cabinet secretary be brave enough to put those wheels in motion?

Let us accept the situation that we are in and discuss it with a view to developing solutions. First, the social care sector says that it is an entity in itself, and its message is that it is not to blame for the current NHS issues. Childcare, child social care, adult social care and general social care are all part of the mix. Although we talk about a postcode lottery for social care, it is only when things go especially wrong that we hear about it. There are many positive outcomes across the country. The message from local authorities is that structural change is not required where things are not working. What is required is targeted support for areas that are struggling to deliver services. We should not throw the baby out with the bath water, but should instead learn from areas that are delivering really good services and apply that learning where improvement is needed.

There are substantial differences in how councils deliver social care, especially between rural and urban areas. Local authorities understand what dictates how services should be delivered, so the proposed SNP centralisation of services will not solve the current crisis. Where is the evidence that this is the path to take? Why does the SNP think that it knows better than local authorities, professional healthcare workers and the many stakeholders—as my colleague Craig Hoy said—who already deliver the services?

Finally, we need to retain staff. What is required is a system that is financed properly to account for the work that social care does through both public and private providers. Finance should also include provision to offer a decent pension, as part of the package. It must value our social care workers and ensure that staff retention is at the top of the agenda.

Social care is about relationship building and continuity of care to provide better patient outcomes. There is no evidence that a national care service will help the situation in any way. What is needed is a system-wide evaluation of health and social care that is designed for need, not demand. Social care being provided in the way that the SNP is proposing is not just unworkable; it is unaffordable.

16:13  

I found the motion to be quite puzzling. The Conservatives cannot seem to decide what point they are making—whether the issue at hand is getting good care to people who need it, or not spending public money on public services. I believe that the system should be about getting good care to people who need it.

“Postcode lottery” is a favourite term of the Conservatives, but today they are criticising the Scottish Government for taking forward proposals to create a national care service—an idea that is overwhelmingly backed by the public and would standardise care across the country—and are instead suggesting that we implement what is, essentially, a formal postcode lottery.

I am a Highlands and Islands MSP and I hate centralisation, but this is not centralisation. We can have national standards without centralising. From everything that I have heard so far about the proposals and the overall intention of this ambitious public sector overhaul, I am not worried that it is a power grab. The proposals are about combining national standards with local expertise to get rid of a postcode lottery.

As the bill takes shape, colleagues can count on me spending the rest of the process making sure that Highlands and Islands voices are heard and that their local expertise and local good practice—where it exists, and it does exist—are taken forward.

I have already heard extremely helpful, constructive and thoughtful input to the proposals from people with lived experience of caring or of receiving care. This is a huge opportunity, and it would be a real shame to chuck it out instead of putting in the work. As a Conservative colleague asked only minutes ago, why throw the baby out with the bath water?

Besides the fact that it is ridiculous to say that because the care sector is in crisis it is the wrong time to fix it, I find the brass neck of the Tories in talking about the care crisis at all astounding, because nothing has harmed care services recruitment more than Brexit, which their party forced on this country. Despite the best efforts of the Scottish Government, we are haemorrhaging EU nationals who worked, or would have worked, in those roles.

I mentioned earlier the fact that the Conservatives voted against the creation of the national health service—our NHS—22 times. I would have hoped that by now, in 2022, we would have got to the point at which we do not need a war to get folk behind us in looking after our citizens.

Out of interest, I looked up Hansard for the debate on the 1942 Beveridge report—which was not the first attempt at creating a national health service but was the beginning of the successful one—because I suspected, correctly, that there might be some similarities between that debate and today’s debate.

On 16 February 1943, Sir William Davison, a Conservative MP, questioned the cost of delivering that massive overhaul of social security, and asked:

“What about the millions of money for those who are not in want?”

Arthur Greenwood, of Labour, responded:

“They ought to thank God that they are in those happy circumstances”.

Scottish Unionist Charles MacAndrew also worried about the cost, and told the House:

“It does not satisfy me to be told that we cannot afford to be without it”—[Official Report, House of Commons, 16 February 1943; Vol 386, c 1620, 1646.]

However, I think that all of us here today agree that NHS Scotland is vital—that it is a core institution and that it is worth spending massive amounts of money on for the sake of saving and improving lives—and that we also agree that we cannot afford to be without it.

I encourage members to think about the following question when they speak. In 80 years, what will folk who are living in a country with a national care service think when they dig up some members’ comments in the Official Report, and will they be on the right side of history, this time?

We move to closing speeches. I note that some members who participated in the debate do not appear to be here. I will expect an explanation for that.

16:17  

As Paul O’Kane rightly stated, Scottish Labour called for the creation of a national care service more than a decade ago. It was rejected by the then health secretary, Nicola Sturgeon, but now the SNP has finally caught on to the idea. However, the SNP’s lack of understanding and vision has led to a pale imitation of what a national care service could be.

Demand for a national care service has never been greater as we emerge from the pandemic. Social care has been underfunded for too long, with the rationing of care based on budgets rather than on the assessing and meeting of need—and, ultimately, dealing only with crisis rather than with prevention. Social workers and social care workers have been holding together a system that is fractured and under strain.

Cultural change is needed. Let us liberate our social care professionals to do the jobs that they were trained to do—that is, to help people live independently, to focus on prevention and to meet need. Furthermore, let us fund it properly. Today, however, we have learned that £70 million has been reprioritised, which sounds like a cut to me. I will be happy to hear from the minister on that point in his closing speech.

The SNP lacks ambition and views a national care service as entirely about structural change with little, if any, new money on the table. A framework bill with no detail reminds me of the tale of the emperor’s new clothes—there is simply nothing there. It is simply not good enough to say that the details will be worked out later and to bring in sweeping changes by secondary legislation.

We believe in co-design and co-production—we share the Government’s view on that. However, that really needs to be done in advance of legislation, not after. The bill should have laid out plans for the creation of the biggest publicly funded social care system since the creation of the NHS. It should have laid out a coherent vision for the future of care in this country—improving standards, investing in staff and enhancing care. However, it falls far short of that. It is so bereft of vision that millions of pounds have been paid in fees to private sector consultants to tell the Government what to do. We must listen to the experts—that is, those receiving care and their carers, or the many social care staff—but we must do so in advance.

We know what some of them think, though. Social Work Scotland, which is the key professional body, has asked the Scottish Government to pause the bill and think again. Unison, which represents many social care workers, wants the bill not just to be paused but to be withdrawn. COSLA has made it clear that the wholesale transfer of staff must be removed from the plans entirely before it engages any further, and countless voluntary sector groups have major reservations about the proposals. I agree with Gillian Mackay’s comments about staff, and I am sure that she shares my disappointment that the bill is silent on all those issues.

Let me turn to money. The Finance and Public Administration Committee savaged the financial memorandum. It was only doing its job, because it did not think that the money stacked up. We have no idea, for example, whether VAT will have to be paid or what happens to pensions if people are transferred, because that is not covered. The committee was followed swiftly by Audit Scotland, which said that the financial memorandum is

“likely to significantly understate the margin of uncertainty and range of potential costs”.

It is clear that £1.3 billion is the tip of the iceberg. The Feeley review identified a funding gap of £660 million a year, but the Government is committing to only £800 million over three years. We cannot get decent social care on the cheap, and if the Government underfunds this from the start, it will fail. The Government should pause now and take the time to think this through and get it right, because we cannot afford to fail. There is a pressing need to do things now.

In closing, I say to Emma Harper and Jackie Dunbar that we want the bill to be the most ambitious reform of public sector services. As currently drafted, it is not. We want to work constructively with Government, but let us do the right and mature thing: pause the bill to strengthen it, because it is too important to fail. We need to get this right.

16:21  

The ultimate establishment of a national care service will be the most ambitious reform of public services since the creation of the NHS. It will end the postcode lottery of care provision, ensuring quality, fairness and consistency of provision that meets individuals’ needs.

A lot of the focus of today’s speeches has been on structures. The Government’s focus is on getting it right for people, which is why co-design lies at the very heart of what we are going to do to achieve the best possible national care service.

This is not about centralisation. The bill sets out that, at a national level, the functions of the service will be focused on consistency through national oversight. Services will continue to be designed and delivered locally; it is right to support delivery with and for our communities and the people whom they serve.

Does Mr Stewart agree with COSLA that consistency does not necessarily mean an increase in quality of care?

Consistency does not necessarily mean quality, but what will bring quality is the national care standards, which will eradicate the postcode lotteries that Mr Hoy and his colleagues regularly moan about. I hope that at the very least they see the benefit of those national high-quality standards.

A change of this scale will take time. We will not rush the design process, and we will develop the detail in partnership with people who have experience of using the services, people who are delivering them on the front line and our stakeholders and partners. No decisions have been taken on whether children’s services, justice or social work should be included in the scope of the national care service. The Government is establishing a programme of evidence gathering and research to inform those future decisions.

This afternoon’s debate has allowed important contributions from across the chamber to be made on the proposals for a national care service. Some of them, including those from Gillian Mackay, Jackie Dunbar and Emma Harper, have been very positive and have had people at their heart. We also had a wee bit of a history lesson from Emma Roddick. History often repeats itself, and it is repeating itself on the Tory benches today.

We have heard repeatedly from people with direct experience of community health and social care and key stakeholders that the adult social care system needs to change in order to drive up standards to a consistent level across the country. The independent review referenced the current fragmented and dislocated system, and it is disappointing not to have heard more in the debate about the views of the people whom we represent.

Change of this scale naturally raises questions and concerns, and we have a duty to people to work through those with all of our partners, including local government, health and social care partnerships, unions and providers, to understand their position and use it to inform, design and, ultimately, deliver. I ask that all of us champion this, engage with it and contribute to the on-going discussion. My door is open to all, because we have a responsibility to people to get this absolutely right.

In order to support people to get involved in the discussion, we have identified a set of early co-design themes. They are information sharing; improving health and social care support; realising rights and recognising responsibilities; keeping health and social care support local; making sure that people’s voices are heard; and valuing the workforce. In September, we launched the lived experience panels to help us in that regard, and we have also established a stakeholder register for stakeholders to become involved in the co-design of our national care service. This is the biggest change since the formation of the NHS and we want to ensure that people are involved in its design.

Will the member give way?

I am in my last 10 seconds.

Community health and social care will, at some point, reach into all of our lives. Everyone should have high-quality services, regardless of where they live in Scotland, and I hope that everyone will join us in getting the national care service formation absolutely right.

16:26  

The Scottish Government needs to see sense and change its reckless and unaffordable plan to create a national care service. Prior to today’s debate, the plan has been described as

“a sledgehammer to crack a nut”

and

“a blank cheque”

from

“the public purse”—[Official Report, Finance and Public Administration Committee, 25 October 2022; c 24, 16.]

by none other than the SNP’s own members on the Finance and Public Administration Committee. Moreover, the chief executive of Ayrshire Council described the SNP’s plan as “truly unstable” for social work and social care; the Scottish Human Rights Commission was critical of the “vague” and unhelpful language round the proposed charter of rights; and many more stakeholders have voiced their deep concerns.

Frankly, the SNP and the Greens are not speaking for those organisations, for the hard-working social care staff, for those receiving care and certainly not for taxpayers. The SNP and the Greens do not have their backs, and they do not speak for Scotland.

When I leave today’s debate, I will be talking to Unison, and this morning, I spoke and listened to the Camphill communities. We have been out talking to the people at the forefront of care, both those who receive it and those who deliver it. No one can say that we are not listening, because we are.

To be frank, I do not think that the minister is listening, because if he was, he would not be going ahead with this awful plan.

The SNP has spent years hollowing out our local councils with savage funding cuts. Indeed, we see that today in SNP and Green-run Glasgow, which has a deficit 10 times higher than it was last year. The plans for a national care service would scrap local accountability; they impose total ministerial control; and they represent a direct assault on local government. Again, they would scrap local accountability.

The SNP’s plan for a national care service amounts to a blatant power grab. We agree that social care provision in Scotland is in crisis, but the last thing that we need right now is a major, bureaucratic overhaul of the system that would see precious resources diverted away from the front line into employing more management and more administration staff. The SNP needs to abandon these plans and put every penny into local care services, because we simply cannot afford to see £1.3 billion diverted away from the front line when we are crying out for help.

We support a local care service, because it is important to protect individual choice and control. No one should be forced to access care that is miles away from their community, family and support network. That is why our local care service would include a local guarantee that would ensure that support was delivered as close as possible to those who need it, especially those in rural and island communities.

Allow me to turn to some excellent points that have been made during the debate. Craig Hoy reminded the Parliament why the cabinet secretary and his ministers cannot deny that they were warned about the risks of the national care service. We are not talking about warnings from this side of the chamber; they came from charities and from Audit Scotland. Indeed, Craig Hoy went on to list a large number of warnings, which I do not have time to repeat.

My colleague Liz Smith reminded us of the numbers. The Scottish Government thinks that it will spend between £644 million and £1.26 billion, but Audit Scotland thinks that that is an underestimate. As we have been told, the Fraser of Allander Institute talked about groups that were trying to estimate the costs persistently having to question Government civil servants to get some clues as to the additional costs lying beyond the core costs.

In his opening remarks, the minister talked about having a clear bill. That is news to COSLA, which saw the bill only the day before it was published. He also spoke of transparency, but there is no transparency running through the rest of Government.

The minister went on to say that people were supportive. Why would they not be supportive of laudable aims? However, if he then goes on to say that the service will cost £1.3 billion to set up and that people will have no accountability—

Will Dr Gulhane give way?

No—the minister should listen to this. If he tells people that they will have no accountability, I believe that they will no longer support him—because the SNP fails to deliver.

Paul O’Kane reminded us about how John Swinney listened to stakeholders. Perhaps the minister should copy that and show some humility.

Alex Cole-Hamilton talked about how health and social care have deteriorated under the SNP’s watch. In contrast with Kevin Stewart, Mr Cole-Hamilton also pointed out that the bill’s financial memorandum contains no details.

Emma Harper does not seem to understand the difference between criticising the woefully inept SNP Government and talking about NHS and social care staff. Our heroic staff are burning out, yet despite the Scottish Government they are doing their best. Did she not hear Councillor Kelly at the Health, Social Care and Sport Committee say that staff are fearful about their jobs? The very staff she speaks about are terrified.

Carol Mochan talked about how the national care service would be a procurement service, which would not actually help the workers. She also reminded us that Unison said that the bill was not fit for purpose. That is a union that represents the workers that Emma Harper talked about but, like her Government colleagues, seemed to ignore.

Emma Roddick started by saying that she was confused, and she asked what people will say in 80 years’ time. What they will say is, “What a waste of money.” Moreover, if we are going to dig up Hansard records from 80 years ago, I will perhaps not tell her what her party wrote in a memo dated 15 August 1943. Perhaps I can get Ms Roddick to look that up for herself.

It is very important that Scottish ministers listen to what everyone has been saying. To quote Liz Smith, the National Care Service (Scotland) Bill is in deep trouble, and the minister knows it.

That concludes the debate.