Meeting of the Parliament

Meeting date: Wednesday, February 8, 2023

Official Report 1297KB pdf

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Social Care

The next item of business is a debate on motion S6M-07813, in the name of Alex Cole-Hamilton, on investing in the future of social care. I advise members that, at this point, we have no time in hand.

16:36  

Hello again. I am pleased to rise once again to speak for the Liberal Democrats in this afternoon’s debate and to move the motion in my name.

Social care staff care for the most vulnerable people in our society; they look after our nearest and dearest, and even us when we are not able to; and they are there when no one else is. However, every day, Scotland’s hard-working social care staff are being let down. More than 200,000 people work in social care in Scotland. They do so under immense strain, and they have been underpaid and undervalued for years.

I might note the cognitive dissonance of ministers, who sought to delete the word “crisis” from our motion on dentistry, now attempting to delete the line in our motion on social care that relates to how our social care staff have been neglected. That is shameful, because they have been neglected. Twenty per cent of them are not on permanent contracts, and many of them are on zero-hours contracts. Poor terms and conditions contribute to rising absence due to sickness and burnout.

Social care staff deserve better pay and working conditions, and they need those now, but instead of being rewarded for the vital work that they do, their efforts are being sacrificed on the altar of a £1 billion ministerial takeover of social care. It is therefore no wonder that there is currently a vacancy rate of 47 per cent across the social care workforce. There are of course many reasons for that, and I will pre-empt the minister by saying that of course the impact of Brexit is one of those reasons, as is the trauma that care staff faced during the pandemic. However, it is clear that the sector needs the Government’s support. Why, then, is the Government content to wait for the introduction of its so-called national care service to improve pay and develop collective bargaining, when those things could happen right now?

The Government often speaks about the financial constraints under which it is forced to work. However, it is utterly baffling and indefensible that it continues to press ahead with its plans for the ministerial takeover of social care, which will create a vast and unnecessary bureaucracy that will rip away control from local authorities and will have a huge and hefty price tag attached. Estimates from the Scottish Parliament information centre are that it could cost as much as £1.3 billion over the next five years.

I take the member’s point, but does he accept that, in the coming year, actually very little money is being put into that, and that there is not enough money to increase pay substantially?

John Mason’s idea that £56 million is “very little money” to spend on a vast and unnecessary bureaucracy that nobody wants says a lot about his priorities. In the midst of a cost of living crisis that is disproportionately impacting those on low pay—social care staff make up a large part of them—I can think of better ways to spend that money than wasting it on that towering bureaucratic mess. The plans will not address the problems in social care; they will only consume huge amounts of our time and staff time, and they will actually cut the funds that are available for the delivery of that care. It is hard to imagine a worse idea for the sector than that.

If the Government does not want to listen to me, it does not need to. It can listen to the Finance and Public Administration Committee, which has said that it is “difficult” to assess whether the Government’s plans are “affordable or sustainable”, or to the Convention of Scottish Local Authorities, which has said that, for those in need of support,

“waiting four or five years for the establishment of the NCS is not an option.”

The Government could also listen to health board bosses, trade unions or even its own back benchers. Who can forget Michelle Thomson’s comments? She said that she had “no confidence whatsoever” in the Government’s plan and was “completely surprised” by the lack of detail in her Government’s financial memorandum. I could cite numerous other organisations that say that the Government’s proposals simply will not work, and the Scottish Liberal Democrats agree.

It seems that social care staff agree, too. A report by Unison revealed that 71 per cent of them think that the Government’s plans will have a negative impact on standards of care. That is from the people who work at the coalface every day. No one understands the system better than they do, and the Government would do well to heed their warnings, which are legion. Seventy-seven per cent of social care staff said that the Government’s plans would lead to greater staff insecurity. They all agree that what is needed is more investment in staffing and resources, better pay and better conditions, not a towering and clunking bureaucracy, and that is what Scottish Liberal Democrats want to see, too.

We want to reward staff with better pay and conditions, as well as with opportunities for career progression. We want to make social care a profession of choice again, backed by the introduction of powerful collective national bargaining. That should begin this year, not on the Government’s current glacial schedule. We also want to accelerate the introduction of new national standards and entitlements for those who depend on our care service.

It goes without saying that we want the Government to abolish all its current plans for centralisation, because Liberal Democrats fundamentally believe that people in Shetland, Moray and Caithness are far better placed to understand the needs and the profile of their communities than Scottish ministers or officials are. However, the Government is determined to conduct an unprecedented power grab. The Delegated Powers and Law Reform Committee says that the proposals set a “dangerous precedent” and risk

“undermining the role of the parliament.”

I turn to delayed discharge. In recent months, we have heard a lot in the chamber about crippling waiting times in accident and emergency departments. Those delays do not represent a deficiency of care in emergency departments; they are rooted in the problems in our social care sector. A and E departments are full of patients who cannot be discharged to other hospital departments, and hospitals are full because, on any given night, more than 1,000 people who are well enough to go home are stuck in hospital because they are too frail to go home without a social care package. In November last year, more than 58,000 days were spent in hospital by people who were clinically ready to be discharged. The Government promised to eradicate delayed discharge back in 2015, yet here we are.

It is clear that the Government lacks the necessary foresight to see, and the humility to admit, the mistake that it is making with its current proposals, which do not address the manifest problems in our social care sector. Our heroic social care staff, and the thousands of people who rely on them, deserve much better than this, and they keep telling the Government exactly that. This afternoon, let us send an unequivocal message to the Government: scrap the plans for a national care service, go back to the drawing board and think again.

I move,

That the Parliament thanks all those who work in the social care sector for their dedication, but believes that they have been undervalued for years; acknowledges that there is a shortage of staff working throughout social care; believes that this shortage is impacting the waiting times of those who require care packages and leading to year-on-year increases in delayed discharges, which the Scottish Government promised to eradicate within a year in 2015, contributing to the crisis in the NHS, and calls on the Scottish Government and its social care partners to reward staff with better pay, conditions and career progression, backed by the introduction of powerful national bargaining beginning in 2023-24, the acceleration of new national standards and entitlements for users, and the abolition of the SNP-Scottish Green Party administration’s plans for a National Care Service, which will not address the problems, will consume considerable staff time, and will cut the funds available for social care.

16:43  

I welcome the opportunity to, once again, set out to the chamber the principles of and ambitions for the National Care Service (Scotland) Bill.

We have heard repeatedly from people with direct experience of social care and community healthcare that the system needs to change to address standards and consistency across Scotland. Our aim in delivering a national care service is to end the postcode lottery in care provision in Scotland. We look forward to continuing to work with service users to design a new service with human rights at its heart.

Has the Government decided whether children’s services will be included yet?

Mr Rennie knows the answer to that. We said that we would carry out more analysis of children’s services, which we are doing.

Our aim is to establish a social care system that empowers people to thrive, not just survive. The NCS will ensure consistency and fairness at a national level, with services being designed and delivered locally.

We are not just suggesting change to address the challenges of today; we must build a public service that is fit for tomorrow. Today, at least 232,000—or 1 in 25—people receive care support in Scotland. Demand will continue to grow and we need to recognise the risk of increased pressures on an already fragile system. We must act now.

Carers—paid and unpaid—continue to do remarkable work, providing critical and invaluable support to people across Scotland. I take this opportunity to thank them all again for their efforts.

The establishment of the national care service will ensure that our workforce is supported and rewarded. However, we are not waiting for the introduction of the NCS to bring in better conditions for our workforce. We are already increasing pay, improving terms and conditions in the sector and developing clear career pathways, all of which are backed by fair work principles.

The effects of Brexit and the cost of living crisis have had an impact on everyone in Scotland. That includes 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. National pay bargaining will deliver more equitable terms and will ensure that all adult care staff will experience fair work in their employment. Rewarding and valuing the workforce will be key to delivering the best possible service for the people of Scotland, fit for the future and attractive to more people coming into the profession.

Currently, the £10.50 hourly rate in Scotland is significantly higher than the national living wage rate that will apply to many social care workers in England and Northern Ireland, with workers there receiving £1 less an hour than in Scotland.

We have a long-standing commitment to the principles of fair work for the social care sector.? We are fully committed to improving the experience of the social care workforce as we recognise and value the work that they do.

From April this year, adult social care workers delivering direct care in commissioned services will see their pay increase to a minimum of £10.90 an hour. That is in line with the real living wage rate for the 2023-24 financial year. The minimum £10.90 an hour pay rate represents an increase of 3.8 per cent from the minimum £10.50 an hour rate that was introduced in April 2022 for adult social care workers delivering direct care in commissioned services. All the rises represent a 14.7 per cent increase for those workers in the past two years, with pay rising from at least £9.50 an hour in April 2021 to £10.90 in April 2023.

Will the minister take an intervention?

Very briefly.

Will the minister advise on the number of social care vacancies and whether that figure is rising or falling?

We keep a close eye on social care vacancies. There are vacancies around the country. That is why a recruitment process is going on at this moment, backed by the Scottish Government and our resources.

The principle of financial sustainability is set out in the bill. We need to ensure that we can deliver continuity and security of service for the people who access the services. The Government has already committed itself to increase spend in social care by 25 per cent by the end of this session of Parliament, to help to lay the groundwork for the establishment of the national care service.

Through plans for an ethical commissioning framework, we will ensure increased financial transparency, allowing us to prioritise quality of care and to better understand cost and profit across the mixed economy of providers.

The focus of the national care service is to meet people’s needs. In doing so, it must strike the right balance between local flexibility and national consistency. That is why the National Care Service (Scotland) Bill has provided for services to be planned and commissioned locally by care boards, with ministers being ultimately accountable.

Local delivery will be vitally important, and we will promote local responsibility for the design and delivery of health and care support with, and for, our communities through the establishment of new local community health and care boards. [Interruption.]

The minister must conclude at this very second. Thank you.

Those boards will be accountable not only to ministers—

At that very second, minister.

—but to the people who use and support our services.

I move amendment S6M-07813.3, to leave out from “but” to end and insert:

“and welcomes that increased funding is being delivered to ensure that all adult social care workers are paid at least the real Living Wage, and notes the desire to go further when possible; recognises that social care recruitment has faced the devastating impact of Brexit and an immovable visa system and immigration system from the UK Government; notes the impact that increased energy costs and high inflation are having on care service operators; supports the creation of the National Care Service to end the postcode lottery of care, help deliver fair work national pay bargaining for the adult social care sector, and ensure ethical commissioning of services as well as better support for unpaid carers; believes that the voices of people with lived experience must be central to the development of the National Care Service, and commends that the National Care Service will be built on local co-design and local delivery of services.”

I call Craig Hoy to speak to and move amendment S6M-07813.2.

16:49  

I thank Alex Cole-Hamilton for introducing the debate, which gives us an opportunity to rehearse the arguments that we will use against the Government’s ill-thought-out plan for the national care service when we debate it at the completion of stage 1.

The Scottish National Party Government has been repeatedly warned of the risks that those sweeping, centralising and anti-democratic reforms pose. The SNP consults but does not listen; it makes mistakes but never learns. Albert Einstein once said:

“Insanity is doing the same thing over and over and expecting different results.”

Will the member give way?

No, I will not.

If that is the case, the definition of ministerial arrogance is asking well-qualified professionals for their views over and over and ignoring the responses. I honestly do not know what should worry us more about the SNP Government—its policy insanity or its arrogance. Looking at Mr Stewart and Mr Yousaf, I cannot work out which one of them is Laurel and which is Hardy. Having made a huge mess in our NHS, they are about to make a massive mess of Scotland’s social care system, and the people who will pay the price are those who work in, and those who rely on, social care.

I pay tribute to those people who work in the sector. They are overstretched and undervalued, and they do essential work for vulnerable people in very difficult times. However, the pressures that they face are only set to grow as the Government allows itself to be distracted by the creation of a national care service. Just when the system needs urgent attention, Nicola Sturgeon’s Government proposes to waste £1.3 billion of essential resources on a massive structural reorganisation.

Let me nail two myths that the Government is happy to leave uncorrected as it seeks to shore up public support for this failed policy. First, unlike our national health service, a national care service will not be free at the point of delivery—many people will still lose their homes to pay for residential social care. Secondly, despite the impression that is given, the service will not be run at the front line by the Scottish Government. In fact, the private sector might have to take on more of a role as councils and third sector organisations hand back the keys to Scotland’s care homes. The SNP could be the party that further privatises social care in Scotland.

The SNP-Green coalition is, once again, trying to rush through its ill-conceived legislation against the will of the third sector.

Will the member take an intervention?

Yes. Mr Stewart could perhaps tell us whether there is one third sector organisation that agrees with his plans.

Many third sector organisations agree with our plans, and some third sector organisations think that other parts should be added to the national care service.

Mr Hoy has said that nobody backs the national care service, but I point out to the chamber that 72 per cent of people who responded to the consultation backed it.

Given that the committees of the Parliament, including the Delegated Powers and Law Reform Committee, do not know what the bill means, how can people in the country know what the minister is actually proposing? His response is based on a survey in which the questions were, no doubt, drafted to give the answers that he wanted.

I do not want to be party political about this. Before the minister accuses me of that, let me consider some of the people on his side who are against the SNP’s plans: the SNP-led Aberdeen City Council administration; the SNP-led Dundee City Council administration; the SNP-led East Ayrshire Council administration; the SNP council groups in Renfrewshire and East Renfrewshire; Michelle Thomson MSP; and Kenneth Gibson MSP. Senior members of the SNP can see sense on that legislation, so why can these ministers not see it? Ms Thomson has admitted to having “no confidence whatsoever” in the financial planning behind the proposed legislation. Audit Scotland has concerns, too.

Only last week, the DPLR Committee warned that the legislation sets a “dangerous precedent” by allowing Scottish ministers to use delegated powers to introduce as-yet-unknown core provisions to social care. What the DPLR Committee sees is a power grab—an SNP power grab that removes parliamentary scrutiny of the biggest shake-up of the public sector in the history of devolution.

Will the member give way?

No, I will not.

However, the criticism goes way beyond Parliament. Johanna Baxter, who is the regional organiser and head of local government for Unison Scotland, said:

“We cannot and should not break up the local government workforce, particularly at this critical time in our recovery from the pandemic.”

Mr Hoy, I have to ask you to conclude and to move the amendment in your name.

Fine.

Unite the Union, responsible for co-designing the workforce, has also walked out on ministers. This Government must listen. It must scrap the plans for its disastrous national care service.

Thank you, Mr Hoy. You are out of time.

I move amendment S6M-07813.2, to leave out from “, backed” to end and insert:

“; further calls on the Scottish Government to explain why it took back £331 million from the struggling social care sector, at a time when the sector is urgently calling for more investment; urges the Scottish Government to scrap its plans for a National Care Service, which has been derided by a variety of stakeholders, including unions, local government and Scottish Parliament committees, and calls on the Scottish Government to establish a Local Care Service underpinned by a Local Care Guarantee, which will ensure that people in Scotland are able to access social care in their local area.”

I call Paul O’Kane to speak to and move amendment S6M-07813.1.

16:55  

I thank the Liberal Democrats for bringing this debate to the chamber. I am pleased to open on behalf of the Scottish Labour Party.

The proposed national care service is one of this Government’s self-proclaimed flagship policies in this parliamentary session. It is, of course, a concept that this party first suggested more than a decade ago, but our vision was not the shambles that the Government is currently presiding over. The SNP has presented a hollowed-out, unfunded mess of a bill that is not worthy of the name “national care service”.

As each week passes, the voices raising concerns about the bill continue to multiply. The Coalition of Care and Support Providers in Scotland has called for the bill to be paused because of the “considerable work” needed to make the legislation workable. The Convention of Scottish Local Authorities, the umbrella body for Scotland’s councils, has called for a pause due to insufficient funding and lack of clarity around key aspects of the bill, including the viability of local authorities. Unite the Union has withdrawn from the co-design process due to its losing confidence in the Government’s approach. Unison has described the bill as “unfit for purpose” and stated that it “would be better withdrawn”.

This Parliament’s own committees—including the Finance and Public Administration Committee, the Education, Children and Young People Committee and the Local Government, Housing and Planning Committee—have raised significant concerns about the scope and structure of the proposed bill. Only last week, the Delegated Powers and Law Reform Committee joined the chorus of voices calling for the bill to be paused.

The minister said that he will listen to Parliament. I think that his message on the national care service bill is becoming clearer by the day.

I will listen to all. We will reflect on what the committees of the Parliament and others have said. Without doubt, I will also continue to listen to people—to those 72 per cent who are in favour of a national care service and to those people who are currently dealing with the postcode lottery. This is all about people, and they are the folk that we should be listening to.

I will come back to the minister’s point, but he has some gall to stand there when he has presided over a postcode lottery for 15 years.

The message is clear—pause the bill now and get back round the table. Our social care sector needs Government action to deal with the immediate problems. Care workers cannot wait another three or four years on the promise of a national care service that is not worth the paper that it is written on.

That is why Scottish Labour has called for an immediate uplift in the wage of social care workers to £12 per hour, rising to £15 per hour, and for the Government to deliver on the recommendations of the independent review into adult social care by scrapping non-residential care charges for those who are supported to live in their own home by social care workers. That was a manifesto pledge of this Government that it does not seem too keen on fulfilling any time soon.

It is time that the minister and the cabinet secretary removed their heads from the sand and addressed the significant and growing concerns of front-line workers, trade unions, professional bodies, local government, their own back benchers and—before the minister gets to his feet to intervene again—people with lived experience, who are speaking to me and sharing their concerns about this shambles of a bill.

The Government needs to get serious about addressing the crisis in social care, and it has to act now to give social care workers a meaningful pay rise and scrap those non-residential care charges. Addressing that crisis in social care will have a huge impact on the problems in our national health service, because it is clear that having meaningful and real action on dealing with delayed discharge can change the game in relation to what is happening in our NHS. This Government needs to get serious about it.

It is clear to me that we must put people at the heart of this national care service if it is going to work at all. Social care workers do not need warm words and platitudes from this Government, or ministers who were happy to stand and clap for them during the pandemic, but a real pay rise.

I move amendment S6M-07813.1, to insert at end:

“, and further calls on the Scottish Government to immediately uplift social care pay to £12 per hour with a plan to raise it to £15 per hour and, as recommended in the Feeley Review, remove non-residential care charges.”

16:59  

It is fair to say that centralisation is never done with the interests of rural and island communities at its heart. Rarely is it possible to retrofit some provisions, which may mitigate the impact on rural and island communities; broadly speaking, they are part of the collateral damage.

The Scottish Government has a track record of bringing forward many proposals in this area, most recently the plans to centralise air traffic control services across the Highlands and Islands. Before that, it attempted to abolish the board of Highlands and Islands Enterprise and merge the island health boards. In all three cases, thankfully, U-turns were performed. Unfortunately, we were not so fortunate in relation to police centralisation.

It is against that backdrop that the current plans are viewed in island communities, and I think that it could credibly be argued that the implications of the centralisation that is proposed with the setting up of a national care service go much, much further than those of any of the proposals that I have just mentioned. We have already heard about the opposition and the concerns that have been raised by staff, unions, charities, third sector organisations, local authorities, auditors and legal experts. We have also heard about the concerns that have been raised by the Finance and Public Administration Committee, the DPLR Committee and the Local Government, Housing and Planning Committee.

We have a process for scrutinising legislation, and I am confident that that is what Parliament will do. In the limited time that is available to me, I want to put on record some of the specific concerns that have been raised by key stakeholders, which will be on the front line in trying to deliver whatever emerges at the end of the current process.

Voluntary Action Orkney, for example, talks about its concern about a system that involves a one-size-fits-all approach, which it says

“is of particular concern to a small geographically scattered island population like Orkney which has very specific needs and challenges.”

That theme is picked up by NHS Orkney in its consultation response, in which it says:

“There is a risk of the loss of local accountability if the planning of services and commissioning of outcomes is done centrally. There are excellent examples of innovation, flexibility and integrated working taking place in remote and rural communities and creating a third structure in those areas that are already struggling to manage two risks duplication of bureaucracy and erosion of progress made throughout Covid.”

NHS Orkney goes on to say:

“There is a risk of disengagement and disintegration of joined up working between primary and secondary care, there is a further risk of disengagement of a fragile workforce in remote and rural communities.”

It concludes by highlighting the

“Risk of implementing large scale solutions in small scale systems which creates unnecessary bureaucracy that diverts resources from front line care.”

The Orkney integration joint board says:

“As a remote and rural island community, we believe that the solutions to addressing the cultural and governance challenges of multi-agency working are most effectively found at a local level. As a small system, serving a population of circa 22,500, we fear that the creation of a new national body has the potential to further clutter the governance landscape.”

It concludes by saying:

“We believe that the majority of the proposals contained within the consultation could be achieved without structural change, and by engaging with local services and addressing the funding deficit that has been recognised.”

None of that is new—much of it reflects what we are hearing in other parts of the world—but my concern is that the damage that the NCS proposals could do in an island community such as Orkney will go beyond what we see across the country as a whole. I make the plea that others have made: that the Government pause its proposals, give further consideration to the proposals that have been put forward by stakeholders in Orkney and elsewhere, and stop what appears to be a slow-moving car crash.

17:03  

I begin by agreeing whole-heartedly with the Liberal Democrat motion, right down to the words

“shortage is impacting the waiting times of those who require care packages”,

but no further.

As we clapped during the weeks and months and, indeed, years of Covid, recognition grew among all of us of the valuable dedication of the people who work in the care sector as well as those who work in the NHS. Covid threw the spotlight not only on the nature of care work, whether through home visits or in care homes, but on the personal and selfless commitment of carers to the people in their care.

The Liberal Democrat motion highlights the various levels of pay and conditions. Of course, employment law is reserved to Westminster—would that that responsibility lay here. However, the Scottish Government is aiming to deliver work and fair pay bargaining in the social care sector. Although employment law is reserved, it might be able to do that by including fair pay conditions in a contract or in funding dished out to the sector.

I note what the minister has said about pay, but have Alex Cole-Hamilton and Paul O’Kane entered into discussions with the finance secretary regarding even more funding for the sector? I, too, would like the sector to get more funding, but they have to say how much and where it is to come from.

Regarding loss of staff, which has a ripple effect through the care and health sector, it is well documented that that has been attributed in no inconsiderable manner to Brexit, and now it has been exacerbated by UK criteria for immigration, which is not helpful. Indeed, Donald Macaskill, the chief executive officer of Scottish Care, called the UK system “unusable”.

The Lib Dems, of course, do not reference Brexit in their motion, as they have now thrown in the towel and support it. That loss of staff means delays in accessing care packages and hospital discharges, which in turns leads to delays in people having access to hospital beds and treatments. The Liberal Democrats refer to those delays but do not attribute them in the least to Brexit or, indeed, Covid. I would hope that, in summing up, the Liberal Democrats will at least recognise that.

I turn to national standards in the sector. During Covid and before Covid, I was certainly aware, not only from searching Care Inspectorate reports but from constituency cases, that there were huge variations, and not always for the better. Thank goodness for the Care Inspectorate, which was set up in 2011 to take over from the Care Commission. It beefed up, and it is still much needed.

We need a national standard of delivery in order to consign the well-worn expression “postcode lottery” to the bin. To me, that is exactly the purpose of a national care service. It is not a duplicate of the national health service, nor is it centralisation of delivery. It will have criteria that are set at the national level but delivery at the local level. I say that to Liam McArthur as well as to people in the Borders. Of course, things are different depending on where you are in Scotland, but the standard must be at a certain level and not variable. I repeat: criteria and standards at the national level; and delivery at the local level, with local input from people on the needs of their area.

As for career progression, I fully support that, but, of course, it is already available if transition is desired between the care sector and nursing. Indeed, Borders College in Galashiels has full-time higher health and social care courses and health and social care national 5, which can deliver that. I am happy to give Alex Cole-Hamilton contact details if he needs them.

Let me repeat my recognition of the dedication of all workers across the care sector, paid and unpaid. Wherever members are in this chamber, let us get it right for them and for those they care for.

17:07  

I thank the Liberal Democrats for bringing the debate to the chamber.

Scotland’s social care system is being held together by the blood, sweat and tears of carers who are working for people who cannot survive without them, and I applaud them.

When I was first approached about the care that my husband would need when he came home, no one could give me the slightest idea just what that would mean, but questions needed answers. Discussion topics ranged from bathing him, to feeding him and clothing him. Possible changes to the house included altering the sitting room to a bedroom and ripping out the shower for a sitting bath. Phone calls from therapists involved trying to find out what the next steps would be.

What struck me from the get-go were the questions on my current situation. What did I do for a living? Could I work from home? What experience did I have? Did I have any health issues that would make it harder for me to care for my husband? Those questions were nervously asked, and nothing could mask the change of tone, sound of relief, and shift to positivity when I explained that I was already working from home and that council elections were on the horizon and I did not intend to stand again.

My husband finally coming home was entirely down to his hard work and family flexibility for care. I fully believe that his on-going progress has benefited from a comforting environment, familiar surroundings and the mental security that comes from his known space. Again, I stand here highlighting how lucky we are, but many are not so fortunate.

As of 30 January, there were 473 patients in interim care placements in care homes—473 people not experiencing that mental boost of confidence from being at home, dealing with life-altering health conditions and a change to their everyday routine, facing the unknown in an unfamiliar place filled with strangers. Imagine the fear.

I wonder how many people are in interim care placements in the minister’s constituency—people who are affected by the SNP-Green Government’s decisions, such as the decision to snatch back £331 million of Covid reserve funding, which was set aside for social care and could have made a massive difference. How can the minister look the people of Fife in the face when £21.5 million was removed from the Fife integration joint board? In the Fife Council area, three residents have waited more than 1,000 days for a care package to be implemented. One resident had to wait for 1,385 days—three months short of four years. Another waited for 1,370 days—wow! a whole 15 days less—and another waited for 1,067 days. Should that person be grateful that getting a care package took almost three years rather than four?

The care system needs urgent reform. Recently, we heard Dr Macaskill of Scottish Care press the argument that social care is community care and should be the primary source of healthcare in Scotland, because good social care stops people going to hospital. It is essential that community-based social care is driven at local level, because only in that way will the needs of patients be met.

The Government’s plans for a national care service simply cannot provide that crucial local element. The Parliament will be having this debate again in years to come, because the fundamental point has not been understood. Let us stop the folly of the national care service and focus on a local care service that has been reworked and redesigned, with local care workers at the heart of the change and invested in shaping a programme that works for them, so that they can keep working for the people who would not survive without them.

I call Carol Mochan, who joins us remotely.

17:11  

Social care is one of the most pressing issues that the country faces, and I am confronted with the consequences of the failure to deal with it every time I visit a hospital or speak to local community groups in my region.

I think that the number of times that I have spoken on this topic during this parliamentary session might be getting close to double figures, but we are no closer to a resolution. Like many people who work in the sector, I am frustrated by the Government’s lack of meaningful action to address the problem. The Government fails to recognise—as it so often does—that it cannot begin to solve the crisis in the NHS without addressing the vast lack of care capacity. At the heart of that is the need to treat the care workforce better. Care staff are treated as though they were an afterthought, and it does not help that the Government refuses to pay them enough to live on.

If that is not the number 1 priority for the Government, we are very far apart in our assessments of what is going wrong. Scottish Labour has said repeatedly that we must immediately uplift social care pay to £12 per hour, with a plan to increase it to £15. That will bring people into the role and encourage people who left the sector to return, which is important.

Equally, removing non-residential care charges will begin to make care affordable for everyone in Scotland, during and after a burdensome cost of living crisis. The Feeley review recommended that reform, which was in the cabinet secretary’s party manifesto. The Government made promises to the public on which it has not delivered—and it looks like it will never deliver on them. Surely it must do better.

I reiterate that, if we refuse to act on those recommendations, we are not treating the problem with the seriousness that it deserves. I am not here to make repeated political points about the SNP-Green Government—points that I have made time and again in the past, because this Government does not listen. I simply want to recognise that there is general agreement in the Parliament that the NHS is in crisis and we want to do something about it, by implementing recommendations that alleviate the problems, so that the impact can be felt immediately.

Let us pause the National Care Service (Scotland) Bill. It is clear that the plans are for a national care service that is not worthy of the name. We need a complete review of the intended goals, because the bill is not working for people who need care and will certainly not work for the social care workforce.

The public are beginning to see that this Government needs to look at the national care service and act now. Sometimes, it feels to people that Holyrood is not making decisions. The approach that is set out in Scottish Labour’s amendment would provide immediate help by starting to bring back to the caring profession people who had given up on getting a fair pay deal. I implore the Government to take those people seriously before it is too late to do so.

17:15  

Having listened to the debate so far, and in the interest of introducing some consensus, I say that I believe that we all want to achieve the same things: better outcomes for people who receive social care, better terms and conditions for those who work in social care and better support for carers.

Sometimes in this policy area, we rightly discuss who should deliver social care and how, but we do not amplify stories about why it is important. There are parts of NCS work that I think we have no argument with each other about. We all know about the issues that relate to the ban on care home visiting during the pandemic. That practice was in place before the pandemic in relation to outbreaks of various viral infections, but such bans’ negative impact became more apparent as Covid dragged on. We should thank the families who campaigned on that issue for using their stories so powerfully. They often had to relive trauma for the betterment of other people’s experience. I know that some of the issues are on-going, so I encourage anyone in that situation to contact their MSPs.

We have discussed the National Care Service (Scotland) Bill, and issues related to the bill, many times in the chamber, but I want to cover one that we have not heard so much about through the process—young carers. The Carers Trust reflected that the size and technicality of the bill and their engaging in such a vast process could have an impact on those who have a caring role. We need to reflect on that when we talk about co-design, and we need to make sure that input from young carers is targeted and sustainable.

As part of its response to the bill, the Carers Trust has undertaken work with young carers to highlight why the bill is so important to them. The majority of young people whom the Carers Trust spoke to are in favour of a national care service. The issue of breaks is hugely important to them, so I want to offer two quotes from young carers. In the Carers Trust report, one young carer said:

“I want to spend more time 1:1 with my mum and dad … I don’t feel confident enough to go with people I don’t know. I want my breaks to be with my own friends and family and with people I choose … If my mum and dad got more help with my sister this would help me too.”

Another said:

“For a lot of young carers—a break away is not just physical but a mental break—don’t need to worry in the back of their mind about the person they care for. Even if attending a hub ... there is not necessarily a mental break. Helps for them to know the cared for person is safe and being looked after by someone.”

We have heard from carers that the mental break that is described in those quotes is one of the most difficult things to provide. Carers are often so focused on how to get everything done and what the next thing to do is that they find it difficult to switch off when they have time for a break. Due to their caring roles, some carers—we know this, because we heard it from them—became more socially isolated during the pandemic because the number of hours of care that they provided or the complexity of care increased. That resulted in them losing touch with friends or not having time for hobbies that they once loved. The cost of living crisis and what it means for being able to survive—let alone to have expendable income for a hobby—has also had an impact.

We need to work to ensure that the breaks that we bring in fit and support carers. We need to make sure that there is support for carers to find comfort and enjoyment from breaks.

Support, particularly for young adult carers, also needs to be better defined. We hear that many carers feel that their support just stops after they move on from school. For some young carers I have spoken to, that does not feel right; many go on to college or university but find that their day-to-day lives do not change other than in that they are getting their education somewhere else, often further from home.

We can address through the NCS bill some of the issues that affect young carers, but, for many young carers, there are many other issues to address. As the bill progresses, we need to keep that in mind for all carers.

You must conclude.

I call John Mason, who will be the last speaker in the open debate.

17:19  

I think that most people would agree that having more consistency and more resources in our care services is highly desirable, and that any disagreement is more about how we put that into practice.

However, I think that there is a certain inconsistency in the Lib Dem motion. On the one hand, it calls for “powerful national bargaining”, and, on the other hand, for

“abolition of ... plans for a National Care Service”.

Well, something there does not add up. Either we continue with the current localised—some would say fragmented—system, or we move to a more national system with consistent pay. I fully accept that a national system—

Will the member take an intervention?

Jackie Baillie rose—

I will take Mr Cole-Hamilton’s intervention very quickly.

Mr Mason will have heard speeches all afternoon from members of the Government party talking about the panoply of things that a national care service will do, but saying nothing relating just to pay bargaining. Does he recognise that those two aspects can be disaggregated—that they can, and should, be done in isolation?

No—I do not think that they can be done in complete isolation.

I fully accept that a national system could be done in different ways; for example, schools are run by local authorities, but pay and conditions are determined at the national level. On the other hand, the NHS has regional boards, whereas police and fire services are national organisations. Therefore, there are different models that can be used.

Will the member take an intervention?

I will not take any more interventions. I am sorry.

It is not a secret that the Finance and Public Administration Committee would have liked more detail on all that before we were asked to comment on the financial memorandum for the NCS bill. However, the positive side to the current plan is that all options are still on the table. Councils could still be the main players in the care service. After all, the NHS consists of quite a mixture—hospitals and secondary care are fully in the public sector, whereas general practitioners, dentists and opticians are usually independent organisations. The new NCS could be such a mixture.

From a personal perspective, I note that I used to work for a private company that ran nursing homes and other care facilities. On the other hand, my mother spent the last two years of her life in an excellent third sector care home that was run by Abbeyfield. Therefore, I can see advantages in continuing to have a mixed model with a wide variety of care providers.

One of the criticisms by private and third sector providers has long been that councils provide hidden subsidies to their own care facilities, such as in how they treat capital costs. Therefore, there are advantages in having a level playing field with charges being consistent across the country. Only if charges are set at a realistic level can providers actually afford to pay better wages. My view is that we cannot afford to make all care completely free, given the state of the country’s finances. If people are well enough off to do so, I see no reason why they should not pay part of the accommodation or other costs, as they do at present.

Another key factor is occupancy. Whoever the care home provider is, they cannot make the figures stack up when there are empty beds. Overheads are huge, so a commitment is needed to use care home beds rather than leave potential residents either blocking beds in hospitals or lonely and isolated at home.

As far as council involvement and provision is concerned, Glasgow City Council for one has invested heavily in modern, good-quality facilities. I think that there are five across the city. In my Glasgow Shettleston constituency, we have the Riverside care home, which was part of the Commonwealth games village that was built for 2014. It is a highly regarded good-quality facility, and it is certainly like comparing night and day when we compare it with care homes of the past, which were often converted but unsuitable old mansion houses. Glasgow City Council appears to be running the facility very well, so I see no need to change that. I certainly hope that councils will have a central role in a new NCS.

I will just mention the Conservative amendment and its proposal for a local care guarantee. What would that actually mean in practice? It seems to me that there would have to be limitless money, limitless staff numbers and limitless care home places, which I do not see as being possible in practice.

Mr Mason, please conclude.

I will conclude there.

17:23  

Members across the chamber have described the crisis in social care. I, too, thank the Lib Dems for using their debating time to give us the opportunity to do so.

What is increasingly clear is that, until we fix the crisis in social care pay, we will not address the problems in the sector. Vacancies are spiralling as social care workers move to jobs in retail and hospitality, where they are paid more and have less responsibility. The minister failed to answer my question: vacancies are increasing, serious concerns are being raised about whether services are sustainable and the safety of those who receive care is at risk.

That is why Scottish Labour is committed to immediately paying care workers a fair wage of an £12 per hour, rising to £15 per hour through discussion with employers and trade unions. We have already set out where the money—

Will Jackie Baillie give way?

No.

We have already set out where the money to pay £12 per hour could be found. That would provide almost double the £150 million that it would cost to implement the NCS policy, so there is no barrier to the SNP’s doing so. It is a matter of political will—

Will Jackie Baillie give way?

I suggest that the minister listen.

Scottish Labour would also remove non-residential care charges, as the Feeley review recommended, in order to provide financial relief during the cost of living crisis for those who need it most. That was in the SNP’s election manifesto, but the SNP has ignored it since then.

The SNP’s record on social care is, to be frank, abysmal. It has presided over cuts in care packages, insufficient respite and support for unpaid carers and a recruitment crisis that threatens the safety of residents. That needs to be tackled now, and not left to the SNP’s proposed national care service. The proposal lacks vision and detail, and it is about simply changing structure rather than changing culture.

For more than a decade, Scottish Labour has campaigned for the creation of a national care service that prioritises raising quality standards, delivering national funding and retaining local delivery to ensure that local expertise, accountability and community input are retained. That is all, largely, absent from the current bill. Trade unions and organisations across the social care sector have come together to ask the SNP to pause, or even to scrap, the National Care Service (Scotland) Bill. They join the four parliamentary committees that have expressed serious concerns.

I say to John Mason that there is nothing at all in the bill about national collective bargaining. Last week, Unite the union pulled out of the co-design process for the national care service, with concerns that 70,000 workers could be transferred without any protection of their pensions. The GMB has said that, although the bill contains “plenty” of information around

“new executive boards ... and their pay and pensions ... there is no mention”

of the same for care workers, and no mention of whether the body will need to pay 20 per cent VAT.

I ask members to imagine the centralising tendencies of the SNP resulting in millions of pounds being taken away from care. There will be no financial memorandum for the bill until after stage 3 of the budget process, which is a wholly unsatisfactory state of affairs. In any case, a national care service will not be in place until at least 2026, but the crisis is happening now.

Last month, Scottish Labour held a round-table meeting for people in the social care sector in order to hear about their concerns and priorities. People around the table were unanimous that they want parity of esteem between healthcare and social care. Their message was clear: until we fix the crisis in pay, we cannot deal with the crisis in healthcare and social care.

The Government must listen before it is too late and it must stop pushing the blame on to others. It is the Government’s responsibility—it should give social care workers the pay uplift that they deserve, end non-residential care charges, as it pledged in its manifesto, and pause the National Care Service (Scotland) Bill.

We are looking over a precipice. Unless the SNP gets a grip quickly, social care will be diminished and will struggle to continue to provide the quality of care that our older people and disabled people rightly deserve. I ask members to support the Labour amendment and to reject the SNP’s complacency.

17:28  

I thank every member who has taken part in the debate, whatever their views. It has highlighted the value of care and carers, as well as the diversity of the sector and the options within it.

People in need do not fit a formula, and in care we cannot have one size fits all. We have heard some excellent speeches today, but the one that really struck me was from Roz McCall. I say that not just because she is sitting next to me, but because she told us powerfully about her own experiences and the questions that she was asked while dealing with the care system.

I will focus on the National Care Service (Scotland) Bill, which many members have spoken about. The bill was dissected powerfully by Alex Cole-Hamilton initially and then by Craig Hoy. I cannot think of a bill that has been so derided and that has received the criticism that it has from committees in a Parliament where the Government wins every vote. That is good: it shows that the committees have been doing their job, but it should make the minister think again. So far, he has not—or he has not been told to do so.

I will go through what some committees have said, starting with the Education, Children and Young People Committee. It concluded that improvements must be made to the bill. The committee’s report says:

“At present there is insufficient information and a lack of detail in the Financial Memorandum to reassure the Committee that the implications of the Bill for children’s services, regardless of whether they are in or out of the National Care Service, have been properly costed.”

The report goes on to say that the committee

“shares concerns over the robustness of the overall costs of the Bill as outlined in the Financial Memorandum and would not be content to wait until any secondary legislation was laid for further detail.”

It concludes:

“The Committee ... cannot form a clear view on whether children and young people’s services should be included under any future National Care Service.”

Indeed, even Kevin Stewart could not tell us whether those services would be included. That is just not acceptable.

I turn to the Delegated Powers and Law Reform Committee, which is a technical committee. Former members, including myself and Mr Hoy, do not normally get too exercised about things. However, that committee’s report said that it

“does not believe the Bill should progress in its current form ... The Committee is concerned there is insufficient detail on the face of the Bill and within the Bill documents to allow for meaningful parliamentary scrutiny.”

What a disgrace.

The report goes on:

“Given the far-reaching nature of the proposed reforms the Committee is mindful there is a real risk of letting down those the Bill is intended to help by allowing Scottish Government ministers to use delegated powers instead of primary legislation to introduce core and as yet unknown provisions.”

That is shocking.

We have also heard about the Finance and Public Administration Committee’s significant concerns. Three committees are all attacking the bill; the minister needs to take heed of those concerns. He should listen, but he is not listening—it is about time that he did and scrapped the bill immediately.

17:32  

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

We know that a new national care service could not exist without the dedication and commitment of people who deliver care and support services, and a key objective will be to support and value our unique workforce. We will not wait until the national care service is established to do that. However, we have to have a little bit of honesty in the debate. Christine Grahame pointed out that we should ask how much a national care service will cost and where the money will come from, which is the key question.

We have heard about increases in pay—

Alex Rowley (Mid Scotland and Fife) (Lab) rose—

I will give way to Mr Rowley in a little while.

We have heard today about increases in pay. The Liberal Democrats’ motion talks about increases in pay, but their colleagues south of the border have called for £10.42 per hour from April 2023, which is less than we are paying social care workers in Scotland at the moment.

We heard from Ms Baillie and other Labour members that to increase pay to £12 per hour would cost £150 million. However, as Scottish Labour is aware, the £150 million figure is based on estimates using UK-wide data from the annual survey of hours and earnings. It is not based on how policy is delivered to workers who practise in Scotland, which includes funding to support differentials and all relevant on-costs. The true cost of delivering a £12 per hour pay rate is £300 million. If Ms Baillie wants to talk to Mr Swinney, the finance secretary, about how we can move money and find that sum now, I am sure that he would be willing to listen. I think that, if we come to the chamber to discuss these matters, we should follow the principle set out by Christine Grahame and say how much a proposal will cost and where the money will come from, and we should give the true figures involved.

We cannot continue to deliver social care support services through the current system. The extent of the pressures that we are currently experiencing is evidence of that. We have repeatedly heard from people that change is needed and that, given that context, it is no longer good enough for people in this chamber to simply say, “Stop”. There is a responsibility on all of us to bring forward viable, affordable models that will deliver better public services for people.

One of the main criticisms from the committees is that there is a complete lack of detail in the bill. How does the minister respond to that?

We have been open, honest and transparent about how we would deal with the situation in terms of co-designing with people the way in which we will move forward. That will rid us of the implementation gaps. People should be at the heart of all that we are doing. We have folk on lived experience panels and in stakeholder groups who are helping us to design a system that is fit for the future.

I will turn to some of the other questions raised and comments made in the debate. Roz McCall talked about the situation in my constituency. I have to say that, in Aberdeen, the delayed discharge rate is much lower than it is elsewhere, and that is because the contract that the Granite Care Consortium got from the health and social care partnership gives it flexibility that enables front-line staff to step up and step down care as they see fit, which helps to reduce delayed discharge. I want to see that happening across the country. That is why ethical procurement is the way forward—it allows others to follow the example of the likes of Aberdeen and Fife.

I have met many care-at-home companies across Mid-Scotland and Fife, and they all say to me that the contracts that they currently have do not allow them to pay better wages or improve poor pay and conditions. Does the minister accept that the major issue in terms of the recruitment and retention of staff in that sector is poor pay and poor terms and conditions?

We have already recognised that the pay that those workers receive must improve. That is why there have been three pay rises in the past two years. We know that we have to go further, which is why we are co-operating with the Convention of Scottish Local Authorities on improving conditions. As Alex Rowley knows, because we have spoken about this before, I think that it is absolutely wrong that, in some cases, folk do not have access to maternity pay or sick pay. We will change that in the near future, before the establishment of the national care service. Alex Rowley is right about some of the contracts—

You must conclude now, minister.

—and that is why ethical procurement is at the heart of all that we are doing in this area.

17:38  

The national care service will not be free at the point of use—care homes will still charge millions of pounds to users. The national care service will not be run by the state—many of the providers will be private. The national care service is uncosted, ill defined and half-baked. Therefore, equating the proposed national care service with the national health service is an insult to all those nurses, doctors and staff who have worked in the NHS since its inception. The project is a charade dressed up as a revolution.

The SNP is no founder of a great new future. It is nothing like the people who built the NHS following the second world war. Kevin Stewart is no William Beveridge and he is certainly no Nye Bevan—Kevin Bevan, perhaps, but not Nye.

We should be able to agree that the social care service is in crisis—Jackie Baillie is right: it is in crisis now and it cannot wait until 2026 for an answer from this Government. Thousands of people are stuck in hospital every day, in interim beds, or are waiting at home for a care package.

There is an exodus of staff from the sector for jobs in places such as Aldi supermarkets, which pay staff more for stacking shelves than the Government pays staff in care homes and the social care sector. Staff vacancies are sky high—Alex Cole-Hamilton referred to a 47 per cent vacancy rate—and the effect backs up into hospital wards, A and E units and ambulances, because patients have nowhere to go.

The SNP grasps on to Brexit, as Christine Grahame did. Yes, of course, Brexit has contributed, but to point only to Brexit is to ignore the failings of this Government for years on end, because the situation has been building for years. Staff have been taken for granted and underpaid by this Government for years. The minister said that his Government pays care staff more than the Conservatives do in England, but he set a low bar on the ambition for the care service in Scotland when he compared it against the dizzy heights of the Conservatives.

The minister also said that the proposals to increase pay for social care staff would cost £300 million or so, or perhaps the equivalent of one ferry—you never know. However, the staff, who did their bit during the pandemic, are now scunnered, knackered and exhausted.

Gillian Mackay rightly talked about young carers, but absolutely nothing of what she said is guaranteed with the national care service. It is the ambition, but it is not guaranteed. What she mentioned is as possible under the current system as it would be under the future system.

The national care service abandons any notion of integration. At present, integration joint boards and health and social care partnerships attempt to combine the work of health and social care into one organisation at a local level, but the plan abandons all of that. It rips up those local partnerships and creates a new national care service silo. [Interruption.]

Mr Rennie, please stop for a moment.

I am aware of numerous conversations taking place in the chamber. Can members please give Mr Rennie the respect of listening to his contribution?

The minister could not tell me earlier whether children’s services will be in or out of the national care service. The Government is driving the bill through Parliament but is still dithering as to whether children’s services will be in or out. [Interruption.] No, I will not take an intervention just now.

The Government commissioned the Feeley report without even asking for children’s services to be considered. The Government is making it up as it goes along. Worse than that is the fact that children are an afterthought. While the Government is ripping adult services from where they are and putting them into a national care service, children’s services will have to make a decision. Will they stay local and integrate with education and other local services or will they go with adult services on a national basis? They will have to make a choice to go with education or adult services. Either way, children’s services will lose out. The First Minister has repeatedly said that she wants Scotland to be the best place for children to grow up in, but, with the national care service, that is no longer the case.

Paul O’Kane rightly identified that trade unions and charities are pulling out of co-operation with the bill, which has few friends. Despite numerous witnesses appearing before the Education, Children and Young People Committee, we could not find anybody who was enthusiastic about the bill, and the committee could not bring itself to endorse the proposal.

The Delegated Powers and Law Reform Committee condemned the plans, and the Finance and Public Administration Committee, led by its highly respected convener, Kenny MacAskill, unanimously criticised the bill for poor—[Laughter.] We can only dream of Kenny MacAskill and wish that he was back. I meant to say Kenny Gibson.

Kevin Stewart still ploughs on, but he has not learned the lessons from the centralisation of the police. Kenny MacAskill was fondly regarded in this Parliament for driving through those changes. However, the Parliament ignored the fact that centralisation led to the loss of all local accountability and, devastatingly, cost lives. That is what we are dealing with here. We need to consider the impact on ordinary people.

I must ask you to conclude, Mr Rennie.

Roz McCall was quite right when she highlighted the personal circumstances that she has endured. That is what we should all remember. We need to create a care service that is fit for people who need those services and not for some national political ambition.

That concludes the debate on investing in the future of social care.