Official Report 947KB pdf
The next item of business is a debate on motion S6M-19977, in the name of Jackie Baillie, on crisis in social care. I invite members who wish to participate in the debate to press their request-to-speak buttons now or as soon as possible.
14:53
My constituent Charles McGarvey was an English teacher, but in 2018, his life changed forever. Following an accident, he became quadriplegic. He cannot use his arms and legs and must rely on support from carers. Life being paralysed is challenging enough, but in the past year, the specialist team that has supported him has disappeared, and he learned only through word of mouth that his overnight care would be terminated.
Mr McGarvey’s care needs have not changed. What has changed is the relentless drive for cuts in social care, and his story is typical of many of those who receive social care across Scotland. The United Kingdom Labour Government has delivered more than £10 billion of additional funding for Scotland since 2024, but it is up to the Scottish National Party Government to spend it.
So, where has the money gone? It has not gone into social care. For years, the SNP has underfunded health and social care partnerships—the local bodies that are responsible for the delivery of social care—and now the system is on the verge of collapse. There is a black hole in their budgets of almost £500 million in this financial year, so it is no wonder that they are being forced to make cuts. At least £90 million has been cut from services, at least £72 million has been cut by reducing social care capacity and at least £68 million has been cut from staffing budgets—the list goes on.
Social care providers in the voluntary sector are in danger of going to the wall and care homes are closing. Across Scotland, it is the poorest and most vulnerable who are paying the price. We are now funding only crisis care and only those who require critical care will get support. Everyone else who asks for help will have to fend for themselves.
In North Ayrshire, £500,000 has been slashed from the care at home service. There were cuts of £200,000 to residents’ care packages and £200,000 to day care. They did not want to do that, but the Scottish Government is underfunding them.
In Aberdeenshire, there are eight projects closing and there is reduced eligibility for day care centres, while the number of activity hubs for older people has halved. They did not want to do that either, but it is down to the Scottish Government underfunding them.
There have been 145 jobs lost in Glasgow to cover a £42.5 million gap. That has led to the loss of a supported living service for elderly people, including people with dementia, and the loss of a counselling service for victims of sexual assault. They did not want to do that, but it is down to a lack of Government funding.
In West Lothian, there is currently a consultation on cuts of £14 million, including a reduction in the number of adult day service support days. Care hours have been capped in Argyll and Bute, where the health and social care partnership is funding only critical care at the same time as closing day services and a care home. In Edinburgh, the health and social care partnership is cutting almost all funding to community mental health services. None of them want to cut services, but they are forced into doing that because they do not have the budget that they need.
Every few months, the Cabinet Secretary for Health and Social Care stands up in the chamber to say that we need more preventative care in the community—and I agree with him. However, that is not the reality on the ground. The reality is that preventative services are being slashed, leaving families to struggle on until they are in crisis. Experienced social care staff are losing their jobs at a time when the sector is struggling to recruit. For example, despite increasing clinical need, there are 28 per cent fewer registered nurses in care homes for adults compared with in 2013.
A recent survey by the Coalition of Care and Support Providers in Scotland found that 82 per cent of its members are funding shortfalls in contract costs themselves—that has been going on for years. More pressure is being piled on unpaid carers, who are yet to see the breaks that they are legally entitled to. As the story of my constituent shows, even those who have the highest care needs are having their support downgraded.
The SNP Government’s neglect of Scotland’s social care shames us all. It wasted £30 million and years of Government time on the so-called National Care Service (Scotland) Bill, which was a mess, and failed to pay for a single extra carer. The Government promised to scrap non-residential care charges, but we are still waiting for that. To add insult to injury, the £20 million that was recently announced to improve social care capacity over the tough winter period is being given to health boards rather than being directed at social care.
In the meantime, our population is growing older and sicker. The number of people who are waiting for a social care assessment is 30 per cent higher than at the same time last year, and nearly 2,000 people every month are stuck in hospital because of delayed discharge, which is mostly due to a lack of social care packages. We simply cannot afford for this to continue any longer.
At best, social care is delivered locally by a range of partners—by the public, private and voluntary sectors working together. That delivery is informed by the views of those who are being cared for and their families. Social care helps people to remain in their own homes without needing to go into hospital, but we are reversing that because of the serious lack of funding. The Scottish Government needs to stop patting itself on the back and spinning the amount of money that it is putting in, which simply fails to match the level of need that is evident and required.
I ask the Government, in all sincerity, to just implement the recommendations of the Feeley report, which the Government commissioned, and to raise the minimum wage for social care workers to £15 an hour, so that doing a challenging job—caring—does not pay less than stacking shelves at Aldi. For five years—I am nothing if not consistent—I have asked the SNP to do that but, for five years, it has said no. For years, the Government has blamed its failures on absolutely everybody else—it is never its fault—and it continues to do so today in its amendment, instead of facing up to and dealing with the crisis.
Scotland has a record budget settlement. This is the opportunity to make deep and meaningful change. The SNP Government must learn the lessons of the past two decades and prioritise social care. It must close the funding gap, prioritise the needs of vulnerable people and show that it values our vital social care workforce before it is too late.
I move,
That the Parliament believes that the Scottish Government’s failure to prioritise social care has fuelled a crisis, harming some of Scotland’s most vulnerable people, and calls on the Scottish Ministers to work to close the funding gap facing health and social care partnerships and value Scotland’s care workforce.
15:00
I start by thanking those in our incredible social care workforce for all that they do. Their hard work and resilience ensure that those who need care receive it with dignity and respect, including members of my family and those of colleagues across the chamber.
I do not hide from the issues facing the social care sector that lie in Scotland and for which the Scottish Government holds responsibility—far from it. I know that there are complex challenges that require long-term action. That is why my amendment specifically references the need for the Government to continue to work closely with partners across the sector, including funding local government and the community and voluntary sector, to continue making improvements for the social care workforce and all those whom it supports.
We need a sustainable and fair approach to funding the sector—on that, we can all agree. That is why, despite what Jackie Baillie said, our investment in social care has reached record highs. Our amendment references the 2025-26 budget, to which the Greens and Liberal Democrats contributed and which includes more than £15 billion for the local government settlement and almost £2.2 billion for social care and integration, exceeding our commitment to increase funding by 25 per cent early and by nearly £350 million.
We continue to invest in our workforce through the real living wage, with an estimated £950 million that enables adult social care workers in the community and private sectors to be paid at least the real living wage. We have committed to establishing voluntary sectoral bargaining arrangements in Scotland, and we have been working through the fair work in social care group to progress that. No one should have to wait for care assessments, families should not be in any distress and their loved ones should be supported and provided with the appropriate care package. I recognise the need for the Government to do more, collectively and in partnership with the Convention of Scottish Local Authorities and social care providers, to make improvements.
Will the cabinet secretary take an intervention?
If I can get the time back, Presiding Officer, I will take an intervention.
You can get the time back, cabinet secretary.
On collaboration and co-operation, the cabinet secretary might be aware of my constituent six-year-old Brie McCann, who is urgently waiting for a transfer to Great Ormond Street hospital for a heart transplant. Is he aware of that case, and is he doing something to expedite it? It is a matter of hours that we are talking about, which is why the issue is so urgent.
That is not directly related to social care, but of course I am aware of the issue. I spoke about the issue on BBC Radio Scotland’s “Breakfast” programme this morning. I understand the situation, and I have asked for proper collaboration to happen between Great Ormond Street and NHS Greater Glasgow and Clyde to ensure that Brie can get the treatment and support that she needs.
I do not shirk the Government’s responsibility to work to improve social care. We are delivering on the commitments of the Care Reform (Scotland) Act 2025, which was passed by the Parliament, and we will establish a national social work agency by spring 2026. I am very open to working collaboratively on the issue with anyone in the chamber who wants to do so.
Despite Labour’s claims of what it would do in power, I note that, far short of £15 an hour for social care workers, the Chancellor of the Exchequer, Rachel Reeves, did not mention social care once in her budget speech last week.
Vic Rayner, the chief executive of the National Care Forum, said that
“the truth is that the cupboard is bare”
and that the
“budget which neither recognises the contribution or the real cost of adult social care”
feels like
“a missed opportunity”.
I must point out the glaring hypocrisy that is on display from the Labour Party today. Jackie Baillie spoke about recruitment challenges, but it is her party that has presided over some of the most restrictive migration policies that are delivering a hammer blow to social care.
Will the cabinet secretary take an intervention?
I know that Jackie Baillie does not want to hear that, so instead I will share with her some comments from the sector. In May, Donald Macaskill of Scottish Care said:
“When the United Kingdom Government, without consultation and engagement with the care sector … unilaterally decided we can no longer recruit from abroad, they did so with little appreciation of just how damaging their actions could be.”
In November, he then urged Scottish Labour to challenge the latest migration proposals on settlement, after 15 years of branding them
“insensitive to Scotland’s distinct needs”.
He went on to say:
“Their impact especially in Scotland’s remote and rural communities is incalculable. They also send a damaging message that the invaluable contributions of migrant care workers are not fully recognised or valued.”
Does Jackie Baillie support the UK Government’s approach to migration that is undermining our communities? I will take her intervention.
That is fantastic. This challenge has been on-going for years now. Year after year, there have been vacancies in social care that the Government has been unable to fill because you do not pay them enough and because your terms and conditions are rubbish. Migration has been a recent phenomenon in the past two years—[Interruption.]
Thank you, Mr Gray.
You had the power to do something about it, but you have failed.
Always speak through the chair, Ms Baillie.
I challenge Jackie Baillie to defend her Government’s approach to migration, which, in the words of the industry, is undermining our approach to recruitment and retention. She failed to do so because her leader describes it as “brave”. There is nothing brave about sacrificing our critical services for our people, in the cause of supporting a Faragist approach to migration.
We came to expect the draconian and Faragist approach to immigration from the Tories, but under a Labour Government, we have seen an even more severe approach, with a 77 per cent drop in the year ending June 2025 in the number of health and care visas granted by the Home Office. Labour went even further and closed the social care worker visa entirely, completely undermining our ability to provide care to the most vulnerable members of our society.
Labour will undoubtedly say today that its focus is on supporting jobs for Scottish care workers, but the reality is that the demographics of our ageing population mean that we do not have enough workers in Scotland. We not only need international workers to bolster our workforce; we also deeply value the contribution that they make.
Those international workers make up an estimated 26 per cent of our social care workforce. It is not brave—
You need to conclude.
—to undermine our critical services; it is a disgrace.
[Made a request to intervene.]
I think that I need to conclude.
Scotland has many talented and compassionate social care workers who have settled here and who call our communities home. We are determined that they will be allowed to remain in Scotland, making a difference in the lives of our most vulnerable.
I move amendment S6M-19977.1, to leave out from “Scottish Government’s” to end and insert:
“UK Government must reverse its hostile and damaging migration policies, which have led to a 77% drop in the number of Health and Social Care visas granted, which in turn is having a devastating impact on the social care sector across Scotland; welcomes the valuable contribution that international workers make to Scotland’s care sector, communities and economy, and notes that the Scottish social care sector has called for the reversal of these harmful policies; reiterates that Scotland is a welcoming nation and that the Scottish Government must continue to ensure that those who have chosen to make Scotland their home can continue to do so; calls for a reversal of the increase in employer national insurance contributions, which has placed an additional £84 million pressure on the sector; recognises that the 2025-26 Budget includes over £15 billion for the local government settlement, including almost £2.2 billion for social care integration, but agrees that the Scottish Government must continue to work closely with partners across the sector, including funding local government and the third sector, to continue making improvements for the social care workforce, and all of those who they support.”
I discourage members on the front benches from carrying on a conversation while someone else is on their feet.
15:08
I declare an interest as a practising NHS general practitioner.
Scotland’s social care system is in crisis—not by accident but because this SNP Government has failed to prioritise it year after year. When a range of organisations as broad as Scottish Care, Age Scotland, Alzheimer Scotland, COSLA, the Accounts Commission and the Scottish Fiscal Commission all use the same language—"breaking point”, “unsustainable”, “a perfect storm”—it should shake the Government out of its complacency, but alas, no. Instead, ministers behave as though acknowledging reality would somehow be disloyal to their own mythology, created in their ivory towers, surrounded by quangos telling them how great they are.
That is exactly what Neil Gray’s amendment is—another exercise in SNP exceptionalism and an attempt to airbrush out 18 years of failure by blaming anyone and everyone else. It is, to be frank, extraordinary. At a time when delayed discharge is at record levels, when one in five care homes has closed and when thousands wait months for assessments, we are presented with an amendment that is so self-congratulatory it reads like the greatest hits album of an SNP campfire song.
I recognise that there will be differences in viewpoint on the issue between us and the Conservatives, but I hope that you can see quite clearly that I have set out in my amendment the need to work more with local government and our care providers. It is acknowledged and it is our responsibility to do so.
I had also hoped that there might have been consensus on the point in the amendment around the need for the UK Government to scrap the increase in employers’ national insurance contributions, which are costing our social care providers £84 million.
It is very clear that the Labour budget was damaging to our social care sector and our charities, but we cannot get away from the fact that the SNP has had 18 years in which it could have funded councils appropriately and done the right thing by social care.
The SNP seems to be a legend in its own mind. This Government wants to tell us that the crisis is all caused by UK migration policy. Let me be clear: international carers make an invaluable contribution, but the idea that Scotland’s social care crisis began this year or last year is simply delusional. We have had a workforce crisis since 2015 because the workforce has shrunk. The number of nursing staff in care homes has fallen by 28 per cent in a decade and providers are relying on financial reserves just to stay afloat—none of that was caused by a visa rule change.
What was caused by this SNP Government was the waste of £30 million on the now-abandoned national care service—money that could have employed 1,200 care workers or delivered 1 million hours of care, all squandered. When that collapsed, what did we get? Another talking shop that was boycotted by trade unions and that cost thousands more. That is not reform; it is panic and drift.
Meanwhile, delayed discharge has become the norm. In October alone, nearly 2,000 people were trapped in hospital despite being medically fit to go home. More than 61,000 bed days were lost. Every delay that is backed up into accident and emergency or cancelled operations grinds staff into the ground. Let us not forget the human cost beyond the NHS. There are 627,000 unpaid carers, nearly half of whom are cutting back on food and heating, and a third of whom have been driven into debt, with only 13 per cent receiving a break. If that does not sound the alarm bells, I genuinely do not know what will spark ministers’ action.
We must close the funding gaps in health and social care partnerships, properly fund councils, establish a real workforce plan and finally recognise the workforce’s value—not with press releases but with pay, training and respect. Scotland does not need more excuses or more constitutional diversions; it needs competence, honesty and a Government that is willing to fix the system that it has allowed to deteriorate before our very eyes.
I move amendment S6M-19977.2, to leave out from “, and calls” to end and insert:
“; recognises the significant impact that delays to social care packages and inadequate community-based social care provision have on the NHS, including longer avoidable stays in hospital; condemns the waste of £30 million for developing the now abandoned plans for a National Care Service; urges the Scottish Government to address record levels of delayed discharge and rising waiting times for social care assessments, and calls on the Scottish Ministers to close the funding gaps faced by health and social care partnerships by ensuring councils are appropriately funded, establish a proper workforce plan for social care to improve recruitment and retention of staff, and make sure that the value of Scotland’s care workforce is properly recognised.”
15:12
I pay tribute to the social care staff and unpaid carers of all ages who work so hard to take care of people under often very difficult circumstances. Low pay, understaffing and a lack of access to proper breaks from caring have all placed enormous pressure on people who give their all day in, day out, and it is not an exaggeration to say that the sector is in crisis. Historic underfunding has led to long waits for care and support, which is too often only available, if at all, when people reach crisis point.
We can all reflect on the real experiences of our constituents and our own families. Parents are denied social care for their son when a package would transform the lives of everyone in the family. A grandfather is trapped in a hospital bed, waiting for social work and the NHS to finally agree a package so that he can return home. Despite the passage of the Care Reform (Scotland) Act 2025, fundamental reform of the sector is still needed, because the ambitions of the independent review of adult social care have not yet been realised.
For example, we are yet to achieve ethical commissioning, which would recognise the value of the third sector as equal partners in delivering social care. Representatives from the sector are clear that the current commissioning model is harmful and unsustainable. According to the Scottish Association for Mental Health,
“Ethical commissioning should be based on partnership and cooperation between commissioners, social care providers and people in receipt of social care, rather than the existing model of competition which prioritises cost.”
In their closing speeches, I want to hear from ministers about what steps they are taking to ensure that genuine ethical commissioning is taking place in the sector.
In 2021, the Scottish Government committed to ending non-residential social care charges, but no meaningful progress has been made since then. As a report that the Joseph Rowntree Foundation published last month highlighted,
“disabled people face deepening poverty and rising costs”.
Disabled people’s access to social care support is critical to the realisation of their human rights, but they are all too often denied those rights by a system that brutalises them and fails to meet their basic needs. A Glasgow Disability Alliance survey that was conducted last year revealed what that means in practice for disabled people—93 per cent were worried about money, 71 per cent could not meet their needs on their income and 67 per cent could not access social care that actually met their needs.
The Joseph Rowntree Foundation report found that, at the same time as disabled people and their households are facing rising costs, local authorities are making decisions to increase non-residential social care support charges and raise eligibility thresholds for accessing support. The report is clear that the Scottish Government and COSLA should work together, without delay, to deliver a clear timeline for removing non-residential care charges.
The SNP’s amendment is right to note that the UK Government’s hostile immigration policies are starting to have a “devastating impact” on the sector. Scottish Care has warned that UK Labour’s proposal to extend the qualifying period for settlement for legal migrants, particularly the increase from five to 15 years for those on health and social care visas, will have a “profoundly negative impact” on care services across Scotland. We cannot afford to lose those hard-working people from the sector. I urge Scottish Labour to acknowledge the impact that those policies will have, and are having, in contributing to the crisis that exists in the social care sector.
Will Mark Ruskell take an intervention?
I am in my closing sentences.
I urge the Scottish Government to redouble its efforts, using all the powers that it has, to fund and reform a social care system that is genuinely fit for the 21st century.
15:17
I am grateful to Labour for making time to discuss this important issue. As we convene in the chamber this afternoon, any number of our constituents might be waiting for an ambulance, either in their home or, worse still, in the street; any number of our constituents might be in an ambulance waiting to get into an accident and emergency department or trying to leave an accident and emergency department to get into the wider hospital; and any number of our constituents might be receiving a dispiriting telephone call to say that the elective orthopaedic surgery that they were expecting to have tomorrow has now been cancelled. That is all for want of capacity in our hospitals.
The crisis in our health service is not caused by a deficiency in emergency care or in orthopaedic surgery; it is caused by the fact that, on any given night in Scotland, 2,000 of our fellow Scots are trapped in hospital, well enough to go home but too frail to do so without a care package for them to receive at home or a care bed in a local care home. That reality causes an interruption in flow throughout our whole health sector.
This week, it was revealed that that is not the case just in our hospitals.
Will Alex Cole-Hamilton take an intervention?
I am afraid that I have a lot to get through.
It has been revealed that, notwithstanding the people I have just talked about, more than 11,000 people are currently waiting on social care assessments and care-at-home packages. Those figures are a stark reminder of just how badly things have been allowed to drift.
Make no mistake—bad policy choices are driving the crisis. The funding gap that health and social care partnerships face is widening, and the care workforce—the very people who hold the entire system together—is still not properly valued and not paid enough.
Research that my party conducted found that 476 care homes for older people have either collapsed or been sold off since 2015. That includes 56 in Glasgow, 46 in Fife, 43 in Edinburgh, 36 in South Lanarkshire and 24 in the Highlands—that means that the care offer in the Highlands has been decimated. Behind those numbers are uprooted residents and families panicking about where their loved ones will go and how they will travel the distance required to see them. Many of those care homes were forced to close because they simply were no longer financially viable, and some had to close because they could not recruit staff.
The sector is under impossible strain, and care providers feel that they are on their own. It is clear to see why. The SNP wasted four years and £30 million of taxpayers’ money chasing a bureaucratic takeover of social care that it eventually abandoned. That money could have paid the annual salary of 1,200 care workers. It makes people want to cry. That is four lost years, when the gaps in home care were glaring, costs were soaring and homes were closing month after month.
The UK Labour Government has not covered itself in glory, either. It has hammered care providers with a hike in employer national insurance contributions, which has made recruitment and retention all the harder.
Will the member take an intervention?
I am afraid that I must make progress. I am in my final minute.
The care crisis is interrupting the flow of the whole NHS. As I said, it is one of the biggest reasons why A and E departments cannot move patients on into the wider hospital.
When social care fails, the NHS fails. How do we solve that? Ultimately, Scotland needs a change of Government next May. The Scottish Liberal Democrats are the party of care: we introduced free personal care for older people, forced the ill-fated centralisation of social care out of this year’s budget and created a new pipeline of care workers into Scotland’s colleges. For unpaid carers, who too often are overlooked, it was our party that secured the right of family carers to earn more from this year on and that passed the Carer’s Leave Act 2023 into law, which gave new rights to 2.4 million carers to help them to better balance work and caring responsibilities.
We need to value the care workforce. We need to make care a profession of choice again and pay workers a living wage that they will find attractive. That is the fastest and simplest way to attract new staff and to stop existing workers leaving the profession entirely. Only by fixing social care can we fix our NHS, protect our communities and ensure that people in Scotland get the dignity and support that they deserve.
15:21
I extend my gratitude to all health and social care staff, who provide an extraordinary level of care and service to so many across Scotland.
Having listened to others’ contributions so far, it is clear to me that the value of social care and its workforce cannot be overstated. Social care provides invaluable and tailored support to thousands across the country; it improves quality of life and allows as many as possible to lead an independent life. However, we know that many are missing out.
Social care forms an integral part of our health system. However, as in many other areas of healthcare, a crisis has been growing in social care for quite some time. It seems as though, for 18 years, that has been blanked from the minds of the Scottish Government. With increasing demand, funding constraints and workforce pressure, the question of how we value and invest in social care has never been more important, but the question of how the Scottish Government values and invests in social care needs to be answered.
A failure to prioritise has fuelled challenges and, despite repeated warnings to the Government, health and social care partnerships now face serious budget shortfalls. That has led to local communities’ care packages being cut—“viciously cut”, as one carer described it—which is forcing people to wait months for necessary support. Integration joint boards’ finances are at risk of collapse, and the continued trajectory of overspend, depletion of resources and reliance on one-off, rather than recurring, savings has, according to Audit Scotland, left a £457 million funding gap.
The lack of funding for health and social care partnerships is not a new phenomenon—it has been a problem for some time. Year after year, the Scottish Government chooses to ignore it. The Government might cite the rising demand in the sector or in other areas as evidence that care is becoming more complex, but that has been exacerbated by a lack of funding in the first instance—the funding has just not kept up with demand.
Underfunding is not an isolated issue; it is a systemic problem that is seen right across Scotland. In my South Scotland region, South Ayrshire IJB faced an end-of-year overspend of more than £2 million, which has left the IJB with concerningly low reserves. That significantly limits its ability to respond to unexpected budget pressures. Levels of delayed discharge in South Ayrshire already sit well above targets. That is a symptom of overspend and a reduction in the funding that is available. There is a need to look at the root causes of that.
Will the member give way?
Of course.
Very briefly, please.
I will be very brief.
Does Carol Mochan welcome the work that is being done by the frailty unit that has been established in Dumfries by NHS Dumfries and Galloway and the work that is being done at the Garrick hospital in Stranraer to get people out of hospital faster and into their homes in a safe and timely way? That really is a good example of Scottish Government-led priorities.
I can give you the time back, Ms Mochan.
Thank you. The reality is that we might talk about these initiatives, but when we talk to our constituents, we find that it is very difficult for the funding to follow. The crisis is such that, even though there are small pockets that we can talk about positively, they are not replicating themselves across Scotland, so many of our constituents sit waiting for care.
In closing, I make it clear that the long-standing underfunding of social care in Scotland is not a new problem. It is a direct result of mismanagement and, I think, a lack of leadership by the Scottish Government. Thousands are waiting for social care assessments and support; delayed discharges remain stubbornly high; and, as we have heard, the number of care homes has plummeted.
In the summer, I did a piece for the Scottish Parliament on whether we value social care in Scotland. This will be my last word—that the conclusion from not just me but the sector and carers is that we do not value it in Scotland. It is time that this Government valued social care, and the money should come forward for it.
15:26
I would like to give the debate some context, of which members will be well aware.
Covid still casts a long shadow over health and social care services—that is true across the UK. It has not only caused delay; there is no doubt that, because of the restrictions during the pandemic, some people found their health deteriorating even more. That has brought additional pressures on the NHS and care sector. Of course, we must add to that our increasingly ageing population, of which I am one.
Much of that can be attributed to the UK’s economic climate. Funding has been mentioned, so I will talk about that. We have had the continuation of decades of austerity, exacerbated by the damaging actions of Liz Truss; we have had continuing inflation of food and energy costs; and we have had the financial impact of increased employer national insurance contributions. All of those have affected the health, care and voluntary sectors, including hospices. Finally, we have Brexit, and now damaging migration policies. All those things are at the hands of Westminster.
The national insurance increases are costing the NHS £191 million each and every year for its directly employed staff, and a further estimated £40 million for contracted services such as GPs, dentists, optometrists and pharmacists. We are seeing an additional recurring burden of £84 million to the care sector and £75 million to the voluntary sector year on year. No wonder hospitals are under threat.
Will the member give way?
I am afraid that the member has chosen to have a very short debate about what she calls an emergency, so I am going to continue.
The Scottish Government has introduced a 21.5 per cent increase in the independent living fund, which provides crucial support to disabled persons to enable them to live fulfilling and independent lives. The Government has increased the voluntary sector short breaks fund by 62.5 per cent to £13 million, giving short-break support for adults and young carers. It is expanding hospital at home services. We have free personal care and no prescription charges, neither of which is available in England. That is all preventative spend—and I should also point out that there is no resident doctors strike here.
Against that, we have Westminster’s hostile approach to immigration, which, as has been mentioned already, could spell disaster for Scotland’s care sector. According to Scottish Care’s latest workforce survey, from May 2025, international staff make up at least 26 per cent of the current care workforce, and international workers make up more than 90 per cent of the workforce at some organisations. More than 6,800 of those workers are on visas, and they would be directly affected by proposed changes to UK immigration policy by the current Labour Government.
It is all about funding, migration and the economy, and nobody on the Opposition benches wants to attribute any of those issues to the difficulties facing the public sector throughout Scotland and in other parts of the UK.
Will the member give way?
I am in my last minute.
The international staff I have referred to are not just filling labour gaps—they are the backbone of care in many communities in Scotland.
All these issues have been neatly dodged by Dame Jackie Baillie. I will quote my favourite man, Wes Streeting, who himself has said that
“all roads … lead back to Westminster”.
He has also said that
“The NHS is in crisis”
and that the
“decisions that are taken in Westminster don’t just affect England, but Wales, Scotland and Northern Ireland.”
I could not say it better myself.
15:30
It is a pleasure to speak on an issue that is close to my heart. If it was not for the incredible women who work with me, I would not be here today. Most days, members see them racing around this place doing their job brilliantly. What members do not see, though, is that, on top of all of that, they get out of their bed hours before I do, to help me get out of mine, and they go to their bed hours after me, because they had to help me get into mine first. They help me to the toilet, put my clothes on, do my hair and put on earrings; they give me pain relief, cook, clean, fix my wheelchair and help with shopping—the list goes on. Then, they attend the Parliament. Like the almost 200,000 other people who work in care in Scotland, they work their socks off and, in the process, I am empowered to work my socks off too. I say to them on the record today, “Thank you, from the bottom of my heart, for your service.”
However, we do that together not because of the social care system but in spite of it. The social care system has been plunged into crisis as a result of years of mismanagement and neglect under the SNP, and it is a crisis that leaves tens of thousands of people fighting for their care, only to end up without the care that they need. It sees unfair charging policies that leave working-age people in households with very little income, masks unmet need and causes significant financial hardship. It sees social care staff fighting day in, day out for better wages.
Despite what its wildly out-of-touch amendment says, it is the SNP that has presided over the workforce crisis because it refused to deliver a wage of £15 per hour. It is the SNP that has cut £38 million that was meant to deliver fair work in social care and that wasted £30 million on its botched national care service plan. All the while, this crisis, which is of the SNP’s making, leaves a yawning gap in funding for social care. In Glasgow alone, that gap in the integration joint board’s resource is £42 million, and it is triggering cuts, increased charges and, possibly, 145 job losses. Investing in social care is not a cost—it is an investment.
Good social care systems support people into employment and help users sustain jobs; at the same time, they also deliver for carers—who, predominantly, are women. Good social care systems are critical to the realisation of equality and human rights for disabled people, yet today, on international disabled people’s day, countless disabled people are left fighting for the basics. For example, a woman from the north of Glasgow has not had a shower in weeks because she does not get allocated enough care. I say to the Government that providing so little funding, leading to only a meagre 30-minute visit, certainly does not make caring an attractive job to apply for. It is that and the Government’s choices that are driving the workforce crisis—a fact that, sadly, is entirely ignored in the SNP’s amendment.
Another example is the young woman who lives with her mum, who works part time and who fought tooth and nail for care to be able to do so. When she finally got care in place, she was told that the council would charge her more than £100 a week from her wages to pay for it. Her mum said:
“If we had this kind of expendable income, we most certainly wouldn’t be living here. I seriously don’t know how we can meet this bill.”
It is not right that disabled people should have to fight for care to live, and it is certainly not right that they should have to pay for essential care—care that means that they can work. Taking wages from disabled people to pay for their care is asking them to do the same job as a non-disabled person for less money. In other spheres, that is called an equal pay claim. This Government said that it would end those charges, yet my constituent is left facing them.
Good social care can help people contribute to society and lead ordinary lives. That was the shared ambition on independent living that the SNP Government signed up to in 2009. Where are we now, 16 years later? We are deep amidst the social care crisis, and our Government’s contribution to recognising that is an amendment that, as usual, denies reality and blames someone else. That is a disgrace.
I have no doubt at all that the SNP Government will take no responsibility for the policies that have led to this crisis. I wrote a speech on social care that was almost exactly the same as this one, back when that ambition was signed up to in 2009. Nothing has changed; in fact, things have got worse.
The SNP has had nearly two decades, and it has failed the people who needed it the most. It does not deserve more time, and I am pretty sure that, in May next year, the people of Scotland will not give it more time.
15:34
Across Scotland, social care is in crisis, and nowhere is that clearer than in my home city of Glasgow. Day in and day out, I hear from families, unpaid carers, care workers and members of community organisations who are simply exhausted. They are doing everything that they can, but they are being failed by a system that is underfunded, overstretched and increasingly unsafe.
Glasgow’s social care system is not just creaking—it is breaking. Local authorities are struggling with unprecedented pressures. The Accounts Commission has already warned that councils face a £650 million black hole, which is being driven in large part by rising social care costs. In the past five years, Glasgow City Council alone has spent almost £100 million on overtime and agency staff simply to keep services afloat. That is not a sustainable workforce model—it is a crisis response that is becoming the norm.
Charities know that, too. Two hundred and forty organisations, including Age Scotland and Alzheimer Scotland, have already warned the First Minister that the sector has been “pushed to breaking point”. Those words were not used lightly.
However, instead of fixing those problems, the SNP Government ploughed ahead with its disastrous national care service and spent £30 million on a plan that everyone told it would not work, before being forced into a humiliating climbdown. That £30 million could have delivered 1 million hours of care or paid for 1,200 care workers. Instead, it was just squandered.
While ministers wasted years on an unworkable centralisation project, the real issues were left to spiral. In Glasgow, we are seeing the consequences every single week. Older people are waiting months for basic care assessments, and families are begging for care-at-home packages that simply do not exist. Carers have told me that they are leaving the profession because they cannot cope with the pressure, the hours or the pay. Charities have told me that they are using reserves just to stay open, and 67 per cent of not-for-profit providers have said that they will not survive for more than four years without change.
We are not talking about a functioning social care system. We are talking about a system that is held together by overstretched staff and unpaid carers, the majority of whom are women, who are being pushed well beyond breaking point.
Glasgow deserves better than that. Our city has one of the highest levels of health inequality in the whole of the UK. We have an ageing population and a growing number of people who are living with long-term conditions. Those pressures are not going away, but the support to address them has gone away.
If the Government was serious about improving social care, it would start by listening, not to consultants or central Government committees, but to the workers on the ground: the carers, the nurses, the home support teams and the charities and volunteers who keep Glasgow going every single day. It would listen to the families who tell us that they are at breaking point. They are tired of being passed from pillar to post and tired of hearing promises while their loved ones have to wait for months for help that should be available within days.
Labour’s motion rightly highlights the scale of the crisis, but we need more than warm words. We need the Government to finally admit that its approach has failed and that the people of Scotland cannot wait any longer for meaningful action.
I say to the ministers: stop wasting money; stop defending the indefensible; start funding local care properly; start valuing care workers as the essential professionals they are; and start treating Glasgow’s vulnerable people with the dignity and urgency that they deserve.
Glasgow’s social care crisis is not abstract—it is real, it is immediate and it is harming people right now. The Government must finally get serious about putting it right.
I call Jamie Hepburn, who will be the final speaker in the open debate.
15:38
I very much welcome the opportunity to speak in the debate in support of those who rely on Scotland’s social care services and—just as crucially—those who work in the sector.
These matters are important to those we represent. Indeed, just last weekend, when I was out and about doing my usual canvassing, I met a constituent who told me about the quality of the social care provision that her mother receives, but who also expressed concern about the support that social care workers receive. It is right that we reflect on such matters.
We are fortunate to have a social care workforce that is made up of dedicated, skilled individuals who support people to live with independence, dignity and security. Their contribution towards a fully functioning society is essential. Across Scotland, social care staff assist people with an array of complex needs, providing vital daily support and helping to prevent unnecessary admissions to hospital. They sustain independence in the community and strengthen our health system by easing pressures on acute care. That is an important area for us, and it is right that we debate it.
I express some reservations about the motion that the Labour Party has lodged, which asserts that the Government has failed to prioritise social care and is fuelling a crisis. I cannot accept those charges. The 2025-26 budget provides £21 billion for health and social care, £15 billion for local government—both record levels of funding—and £2.2 billion for social care integration, which the cabinet secretary has already mentioned.
Will the member take an intervention?
I am afraid that I am not able to give Mr Gulhane the time—I have only four minutes.
We all recognise that there are pressures on the sector; we know that there are recruitment challenges, demographic change and rising complexity. However, ignoring the sustained efforts that have already been made, including the investment to ensure that social care workers are paid at least the real living wage, does not help us find solutions.
Jackie Baillie reiterated the call that we have heard from her previously for a £15-an-hour minimum wage for social care workers, although I could not help but notice that her motion is silent on that matter. We can all understand and recognise the aspiration for higher pay—who could not? However, aspirations must be matched by costed and credible funding plans. On that point, Labour has been consistently silent.
Will the member give way?
I am afraid that four minutes is not enough time for me to be able to do so.
By contrast, the Scottish Government has taken an approach that has ensured that the living wage, as a minimum, is in place for social care staff, delivering a real and affordable uplift for tens of thousands of workers.
I very much support the Government’s amendment. It rightly highlights the severe harm that has been caused by the UK Government’s restrictive migration policy, which has resulted in a drastic fall in health and social care visas and has placed real strain on recruitment. Although it has been interesting to hear that problem diminished by some Opposition members, it is a problem—we have heard that very clearly from Donald Macaskill, and it has already been articulated in the debate.
I reflect on the fact that, if someone is a migrant who has come here to work in social care, how can they feel that they are a valued care worker if they are unsure whether they continue to be welcome in this country? In contrast to the practical impact of the migration policy—and to the Reform UK-lite rhetoric that we are now hearing from the Labour Party and the harder rhetoric that we might hear from the Conservative Party on these matters—the Government’s amendment recognises the enormous value of our international workforce and references the challenges that are being posed to the sector through the increase in national insurance contributions. The amendment is worthy of support for those reasons.
I am glad that we have had this debate. Although I recognise that there are challenges, I reject some of the siren calls that we have heard about the crisis in the sector. I will support the Government’s amendment.
We move to the wind-up speeches.
15:43
I rise to close on behalf of the Conservatives. It is disappointing that this has been such a short debate. As my colleague Sandesh Gulhane said, we should have discussed how the 700,000 unpaid carers interact with healthcare, because we have certainly not got that right. Similarly, we could have discussed social work, palliative care and the role of the third sector, all of which are important topics for debate in their own right.
I listened to the cabinet secretary and SNP back benchers use the usual excuses of visas and migration for the lack of places in our social care service.
Will the member give way?
I will give way in a second.
Meanwhile, in my constituency, Ayrshire College had to turn away 71 applicants for apprenticeships in social care because the funding was not there. I have already raised that matter in the chamber. If you are going to have a debate on staffing in the healthcare service, you must recognise your own failings, and that is one of them, for sure.
I give way to the cabinet secretary.
I remind the member to speak through the chair. Please be brief, cabinet secretary.
It is not just me saying that. I was quoting the sector and sector leaders, who have referenced the fact that migration policy at Westminster is destroying our ability to employ staff in the social care sector.
I do not think that those are quite the words that were used. If we are going to debate social care and its funding, we must recognise our own failings, and responsibility for the way in which we fund training in the social care sector lies at the feet of the Scottish Government.
The failings that we are talking about today are consequences of a whole series of decisions that successive Governments have taken over the years, not merely on social care but on health and healthcare. They have failed to think for the long term and see that social care is on a par with healthcare, and they have failed to properly integrate health and social care. Although we may have spent years correctly identifying the issues in the social care workforce, we have failed to take the necessary steps to address them.
In the context of the NHS, successive Scottish Governments have prioritised ever-greater inputs, with more staff, higher salaries and more money, while ignoring outcomes and solutions such as interoperable and integrated technology. The term “interoperable” was unfamiliar to the then Minister for Social Care, Mental Wellbeing and Sport when she declined to support my stage 3 amendment during consideration of the farcical Care Reform (Scotland) Bill because she did not understand it and did not like the Google definition.
That is why the SNP has achieved record-high spending but record-low outcomes, despite the incredible efforts of our healthcare professionals. The Scottish Government has let down both patients and our health professionals.
In social care, the situation is, if anything, worse. The stress on the system, with a lack of investment, is starving essential services. The irony is that that eventually creates problems in our NHS. Delayed discharge from hospitals will never be solved if the sector that provides post-discharge support is fighting just to keep its head above water.
Fantastic innovations are under way. Some health boards are using care home spaces for more appropriate step-down care for patients so that they do not have to languish in hospital beds waiting for care packages. That must be considered more formally for those areas in which that solution is appropriate.
However, there can be no solution to the crisis in social care if we do not address the workforce challenges. Proper workforce planning is not simply about how many staff are in particular roles, where they are located, or who is leaving and who is coming into the profession. It is also about ensuring that there is career progression so that we can attract new staff and retain the vital knowledge and experience of existing staff.
I want to look at the revolutionary potential of technology as an example. What would health and social care look like in a world in which the patient’s entire medical history could be analysed by software and used to predict what care they are likely to need both before they arrive in hospital and once they are discharged? How much more accurate could that history be if their social care package included data from sensors in their home on how often they get up in the night, the temperature in their home or how frequently they lose their balance? The technology to do all of that exists—it is not even complicated—and with that information we could transform patient care and deliver more effective workforce planning. All that seems to be lacking is the political will to make it happen.
Health and social care are inextricably linked yet, today, they are fragmented rather than aligned. They are spending time competing for scarce resources rather than co-operating to put them to their best use. That must change, because neither can survive without the other.
15:48
I thank members for their speeches in the debate. I put on the record my profound appreciation and gratitude to all those who work in the social care sector across Scotland, and particularly our 700,000 to 800,000 unpaid carers, without whom we could quite simply not function as a society. They are unsung heroes who deserve our everlasting praise and gratitude—and not just our words, but our actions.
I am about six months into my ministerial post, and I listened carefully to the speeches of members across the chamber, which has built on my many engagements since my appointment. It has struck me that discussions about social care tend to fall into one of two broad areas: the question of funding or resourcing and the question of structures. In addition, there are specific issues to do with workforce and the recruitment and retention of social care workers from overseas. In this afternoon’s debate, the questions of resourcing and of our hugely valued social care workers from overseas both featured strongly.
I will touch on funding first. It is profoundly important, and it would be remiss of me not to recognise the significant pressure that exists across the system and the decisions that are being taken locally by integration joint boards. If we are to engage with the matter seriously, it is incumbent on us all to understand the nature of the financial challenge that we face. We have been through a profoundly challenging economic period in the past decade and a half, with a global financial crash, austerity, Brexit, a pandemic and a war on the European continent that precipitated an energy and cost of living crisis. That has placed strains on the public finances that none of us could have contemplated.
Will the minister take an intervention?
I need to make some progress. If I have time, I will give way to Mr Cole-Hamilton later.
Prior to the election, inflation was running at around 0.4 per cent and the Bank of England’s interest rate was 0.1 per cent. Within 18 months, inflation was in double digits and interest rates were at 3 per cent.
Will the member take an intervention?
I need to make some progress to articulate my point.
That has placed significant pressures on the public finances.
It is important to recognise that, during the 26 years of this Parliament, there have been only five years in which one party has commanded an outright majority. On every other occasion, it has been necessary for at least one other party to engage in relation to each piece of legislation and each budget vote. When we consider questions of resource, it is therefore incumbent on Parliament to work towards and build consensus and not simply to make proposals. Parliament also has to have the honesty and integrity to state how those proposals would be paid for.
Will the minister take an intervention?
I need to make some progress. I have limited time and I have barely made any progress. I listened patiently to everyone else.
If members wish to ask for additional resource on top of the £15 billion that has been given to local government this year, the £21.7 billion that has gone into health and social care overall, the £2.2 billion that has gone into social care and the £125 million uplift to enable payment of at least the real living wage, it is incumbent on them to engage and not simply to abstain and sit on their hands.
Will the minister take an intervention?
I am afraid that I have only a minute remaining.
Otherwise, it is just rhetoric. This does a disservice to those working in the social care sector and to unpaid carers.
It does.
Come the budget, we will see what happens. [Interruption.]
I am hearing members on both sides chuntering from a sedentary position. One party has consistently voted against every Scottish budget and the other party either votes against the budget or does not bother engaging in the first place.
The second important issue at the heart of the Government’s debate is that, despite all the systemic challenges that we face with the public finances, we have seen actions from the UK Government that have exacerbated and compounded them. It is pandering to the worst instincts of the populist and reactionary right and pursuing a reform-light agenda—which is becoming a full-fat-reform agenda—on immigration. It is a disgraceful approach, and the sector has rightfully highlighted the devastating impact that it has had.
That is why the Scottish Government is taking action, and it is why I am delighted to confirm that the Scottish Government’s £500,000 fund to help to remove employment barriers is now open. Eligible employers can apply from today for targeted support with the cost of hiring international social care workers impacted by UK Government changes to immigration policy.
You must conclude.
Much more could be said on the subject, but it is incumbent on all of us in the Parliament to work constructively with partners in the sector. If there is an ask for new resource—
Thank you, minister. I call Paul Sweeney to conclude the debate. You have up to six minutes, Mr Sweeney.
15:53
We have spent this afternoon discussing a system that is in crisis, but there is precious little in the way of a systemic approach from the Government. During the past near two decades of the Government’s rule, there has been increasing fragmentation, a system characterised by low pay and, indeed, a complete failure of political leadership, which has led to a social care system—if it can even be called that; it is a social care structure—that is harming some of Scotland’s most vulnerable people, who are reliant on it. That is a national scandal that affects almost every household in Scotland.
All the while, our hard-pressed social care staff struggle heroically to keep up a vital public service, despite low wages and poor working conditions. The minister was certainly right to praise unpaid and paid carers in the sector, but it is cold comfort when the system that exploits them and does not advance their interests is being defended by the minister.
Paul Sweeney points to low pay, and I recognise that, of course, we want to do more to support our critical social care workers. As I said, this Government has invested £950 million to ensure that at least the real working wage is being applied. Will Paul Sweeney confirm whether Labour-controlled Wales or, indeed, Labour-controlled England has gone any further than that?
The minister will know that the Employment Rights Bill, which is going through the UK Parliament just now, will result in a massive uplift in the rights and the bargaining power of care workers across the system. It will improve rights to sick pay and drive up wages. The cabinet secretary may also want to consider that he has been talking a lot about sponsored care workers in the system, but they are on £12.82 an hour or £25,000 per annum, whichever is higher. The minimum wage for adult social care workers in Scotland is £12.60 an hour. I do not know how the cabinet secretary can stand there and justify paying overseas workers almost £500 more than staff who are domiciled in Scotland are paid, or how he can echo calls from exploitative capitalist employers so that they can rinse more out of the system. That is utterly shameful.
We might also want to consider what the cabinet secretary is doing to advance the training pipeline for people who are seeking employment in the sector. Glasgow Kelvin College, in my region, said that there were 1,200 applicants for 300 places in the care system, so people are being denied the chance to get into the sector. Only one in four people who want to get into the sector are getting that chance.
We have heard time and again in the debate that this problem has nothing to do with the Scottish Government—that it is a hapless bystander or a well-meaning administrator and that the malevolent force is somehow outside Scotland.
I was shocked that the social care minister was too scared to take an intervention. Does Paul Sweeney agree that the crisis started in 2015, that it is a crisis of the SNP’s making and that the SNP is blaming everyone but itself?
We have had a decade-long decline. I was interested in Dr Gulhane’s observation that 2,000 people are currently trapped in our acute hospitals, at great expense to the public, although they do not need to be there for any clinical reason and cannot be discharged only because of a lack of social care capacity. He also noted that, over the past decade, the number of social care beds has been reduced by 2,100. Registered social care places have been reduced by almost the exact same amount as the number of people who are stuck in our acute hospitals. If I were the Cabinet Secretary for Health and Social Care, I would have those two numbers stuck up on the wall in my office in St Andrew’s house and would be asking my officials every day, “Why are you not driving that number down into balance? Why is that not happening with the pace and urgency that it needs to?”
As Carol Mochan said, it is because of a lack of leadership. It is much easier to simply point to recruitment agencies overseas and say that we cannot hire enough people from overseas. This system and model imports people from overseas to work in the social care sector, cruelly promising them a better life in this country but then not paying them the same as Scotland-based workers and burning them out through low pay and poor working conditions. As soon as they get the opportunity, they move out of the sector into retail unless they are, in effect, trapped by their visa conditions.
There has already—rightly—been a crackdown by the UK Government on exploitative rogue care providers, which has released around 40,000 posts in the UK for new visa sponsorships. Why is the Scottish Government not going further to absorb those 40,000 people in the system who are looking for new sponsors? There are around 650 in Scotland alone. It is not a matter of loading more people in; it is a matter of absorbing the people who are currently looking for visa sponsorships in the UK and bringing in more of the people who are applying for social care courses. I am sure that the minister will start to see that a systemic approach is needed here. It is simply not good enough to stand and point the finger elsewhere.
We are talking about 18 years of government. Surely some responsibility needs to be taken on board. Instead of creating an economic model of solidarity in which structural gaps in funding are addressed, a wage of £15 an hour is the norm and working conditions are improved, the Scottish Government hopes that there will always be a steady stream of people who are desperate to come in, to depress wages further. We should be training people here, in Scotland, and employing them under improved conditions, which is what Labour aims to do with the Employment Rights Bill.
There has also been an evisceration of local care. As members across the chamber will know, health and social care partnerships are lumbering under huge cuts. Every year, a depressing litany of services are unnecessarily and painfully curtailed or cut altogether because of the £0.5 billion gap in funding for local provision. That is causing all sorts of disastrous situations—for example, with the Scottish Huntington’s Association, which is an amazing charity that Glasgow city’s health and social care partnership is planning to defund from the start of next year.
We are seeing cuts coming quickly and regularly as a result of those funding gaps, which means that demand is piling up in our A and E departments. A couple of weeks ago, I met an A and E nurse at Glasgow Royal infirmary who had just come off shift. She said that there are already beds piling up in the corridors and that, just across the road from where she stays, there is a care home that cannot admit new patients because of a lack of communication with the social work department in Glasgow as a result of cuts. Again, there is system breakdown. The care homes cannot admit, the hospitals cannot discharge and staff are burning out. It is introducing more cost to the system, and the solution somehow appears to be just to import more labour into the system to exploit—
Mr Sweeney, could you bring your remarks to a close, please?
It is shameful that the Government has used that framing in its amendment, and it should be rejected by the Parliament. We can do so much better than that as a country.
Thank you, Mr Sweeney. That concludes the first debate this afternoon.