The next item is a debate on motion S4M-15098, in the name of Jenny Marra, on health.
14:43
We come to the chamber this afternoon to discuss health and social care integration. While we make our speeches and debate today, thousands of people across Scotland will be in their homes having just had a visit from a carer at lunch time to give them their lunch. Many will have been helped by a carer this morning to get out of bed, wash, shower and dress and been given their breakfast. Many of the carers will then have done the washing up, put the bin out, perhaps dealt with any family issues, made sure that their charge has what he or she needs or wants for the day, ensured that they are warm enough, that the radio or television is on the right channel and that those lucky enough to receive visitors know what is happening throughout the day, that the key is in the right place and that there is enough tea in the caddy. All the while, they are watching the clock.
The myriad of seemingly small but important challenges is one of the reasons why health and social care integration is challenging on a daily basis. Medicines are to be taken—the prescription from the general practitioner says “three times a day”—but carers cannot administer medicines; that has to be done by someone else, but who? That is an example of the day-to-day challenges that make bringing health and social care together so complex and challenging. That is the reality on the ground—a window into many homes across Scotland this afternoon.
It is the right thing to do: we know that many old people—who make up the majority of recipients of home care—desperately want to stay in their own home.
Last week, Audit Scotland published its report, “Health and social care integration”. There are some very challenging messages for the Government in its pages. In the summary at the start, it notes that
“There is evidence to suggest that IAs”—
integration authorities—
“will not be in a position to make a major impact during 2016/17.”
Our motion today sets out clearly that Labour would spend the Barnett consequentials from the chancellor’s spending review on health and social care integration, channelling that money through our health boards into the integrated joint boards. It is plain for everyone to see that social care needs more investment if it is to be successful—that is clear in Scotland, across the United Kingdom and across most of western Europe. It is plain for everyone to see that that need becomes more urgent every day, as our population ages and more people require care. The Scottish Government has estimated that the need for health and social care services will increase by between 18 and 29 per cent by 2030.
It is also plain for everyone to see that investment in the area is about prevention. Ten years ago, Campbell Christie made some strong recommendations about preventative spending that the SNP signed up to when in opposition. We have still not seen the shift that is necessary. The Scottish Government estimates that £138 million to £157 million could be saved by doing integration properly. I personally think that that is a conservative estimate.
It is now nearly a year since the Cabinet Secretary for Health, Wellbeing and Sport, Shona Robison, announced that delayed discharge would be abolished by the end of the year. I cannot criticise her for her ambition, but she will have made that statement in the full knowledge that keeping people in hospital is exponentially more expensive than caring for them at home. As she will know, some estimates put the cost of a week’s stay in hospital at nearly £4,000. The Audit Scotland report states that, in 2014-15, the national health service in Scotland used
“almost 625,000 hospital bed days for patients ready to be discharged.”
That is roughly 89,000 weeks at £4,000 per week—an eye-watering sum of money. The cabinet secretary has the right ambition: to get rid of delayed discharge, and to have in place the care infrastructure in the community to enable that to happen. However, she needs to admit that that cannot be done without that further investment—it cannot be done without that preventative spending.
The member presents the challenge between preventative spending and reactive spending. One answer would be to cut the hospital budget and put more into the community. Would she support such an approach?
The case that I am making today is for spending the health consequentials that are coming to Scotland from the comprehensive spending review on health and social care integration. That is preventative spend, absolutely, and allocating Barnett consequentials—the health funds that are coming to Scotland from the chancellor’s statement—in that way is the only, and the right, thing to do with them. There is no reference at all in the Scottish National Party amendment to the Barnett consequentials. Will the cabinet secretary outline her plans for that substantial sum of money, or at least outline the priority areas where it will be spent?
At this point, I will address a topic that I hear regularly about from health boards, local authorities and social care providers: the thorny and complex issue of governance. The Audit Scotland report, which raises that issue, says that the Scottish Government should resolve tensions between the need for national reporting and the need for local reporting. Caroline Gardner, the Auditor General for Scotland, states:
“If these new bodies are to achieve the scale and pace of change that’s needed, there should be a clear understanding of who is accountable for delivering integrated services”.
The tension between national outcomes that integration authorities are required to meet and local autonomy is leading to confusion and problems with governance. I am sure that that is an issue on which the cabinet secretary has been working. Will she use this opportunity to update the chamber on progress?
The report identifies risks such as difficulties with agreeing budgets, complex governance arrangements and issues with workforce planning. We have been challenging the Government on workforce planning in the health service for many months. With the persistent problem of GP recruitment, it seems likely that the problem will continue. Will the cabinet secretary update us on that issue, too?
The tone of the SNP amendment does not quite chime with that of the Audit Scotland report and the many challenges that it identifies. There is no room for complacency, but the amendment suggests that that is the Government’s approach, which is of concern in and of itself. Labour will not support the SNP amendment not only for that reason, but for two other important, specific reasons.
First, the amendment says that the level of NHS funding is at a “record high”. The Scottish Government can take credit for inflation over the years if it wants to, but anyone who has read the Audit Scotland report will have learned—if they did not already know—that, under the SNP Government,
“The health budget decreased by 0.7 per cent in real terms between 2008/09 and 2014/15.”
For members’ reference, the citation for that quote is page 9 of the report. Therefore, while the SNP congratulates itself on inflation, we on the Labour benches are more concerned with real-terms spending on our NHS.
Secondly, being satisfied with “progressing the living wage” for care workers is not nearly good enough. Shona Robison’s amendment specifically says that the Government is making progress. We know—we hear the stories every day—about care workers’ jobs being viewed as the lowest rung in the employment market, with carers leaving caring jobs to take up jobs in supermarkets when they become available in order to get better wages and terms and conditions. Are we satisfied with a society in which caring roles are remunerated so badly, despite all the emotional and physical demands of the job and the value that should be placed on dignity in caring for our elderly in their own homes?
I know people—women especially—in my own community who would make marvellous carers, but who are being paid more in other jobs, such as cleaning and supermarket work, than they would be paid to look after our elderly citizens. Many would like to take on a caring role. They have told me that they would like to give back, to use the skills they gained in bringing up their families to care for people and to do that valuable job. However, our Government simply does not value the work highly enough to pay it well enough to allow them to take up those opportunities. Quite frankly, it is not good enough that the Scottish Government simply congratulates itself on making progress.
The First Minister is one of the most powerful politicians of our era. With all her power and support in the party and the country, her votes in the chamber and her rhetoric of equality and women’s rights, one would think that it would be her ambition to nail her leadership firmly to delivering a living wage for all care workers so that we can raise the value of caring roles and improve the living conditions of many women in Scotland who are on low pay. However, a year since the First Minister took power, I have still to hear her tell us specifically what she will boldly commit to do to change the face of our communities.
Labour contends that our care workers should have the SNP’s unstinting support for all the reasons that I have outlined. The SNP should commit to the living wage for care workers to raise the value of that crucial job in homes across the country, and it should commit to spending the health consequentials on social care to make that happen.
I move,
That the Parliament acknowledges the fine work being done by hard-working health and social care staff across Scotland to keep people safe and well; notes the Audit Scotland report that highlights important issues that need to be addressed for the successful integration of health and social care to be delivered; calls on the Scottish Government to allocate the majority of the health-related Barnett consequentials from the Comprehensive Spending Review to social care, and urges it to introduce a living wage for care workers.
14:56
I am very pleased to take part in today’s debate, which provides a timely opportunity to reflect on our progress towards the integration of health and social care in Scotland. I welcome, by and large, the constructive tone of Jenny Marra’s speech.
As has been said, last week Audit Scotland published its first report on integration. Douglas Sinclair, chair of the Accounts Commission, said:
“Integration has the potential to be a powerful instrument for change, and the Scottish Government, NHS boards and councils have done well to get management arrangements in place. However, there’s a real and pressing need for Integration Authorities to take the lead now and begin strategically shifting resources towards a different, more community-based approach to healthcare.”
I agree. This Government committed to legislating for integration back in 2011, because we recognised that we needed to ensure that our system of health and social care focused on the people who need it most—people with complex needs and multimorbidities, many of whom are older, for whom well-integrated care offers the best opportunities for better outcomes and better lives.
We have come a long way since 2011. By working exceptionally closely with a spectrum of stakeholders and partners, including the NHS, local government, the third and independent sectors, professional and staff bodies, and patient, carer and service user representatives, we have consulted on, legislated for and are now implementing the most significant changes to the way that the NHS operates since it was established in 1948. Those changes are just as significant for social care services and colleagues who work in local government.
As the Audit Scotland report sets out, success will depend on us continuing to work together, along with strong local leadership and commitment to improvement. The framework is in place. Health and social care partnerships are establishing their arrangements for integrated governance and are looking at improving pathways of care and bringing together different organisational cultures. Some have already gone live, and all will be up and running from April next year.
We and the partnerships are on time—that in itself is no small achievement—and we are ahead of where we need to be. At our NHS Scotland event in June this year, the King’s Fund noted:
“Scotland has made most progress on integrating health and social care in the UK”.
However, we are not complacent. I do not think that our amendment strikes a complacent tone; it simply recognises the positive things that have been said by not just us but others.
We recognise that much more is yet to be done. I agree that some partnerships need to show greater urgency as they delegate budgets for integration and develop their strategic commissioning plans. I have written to partnerships to reinforce the importance of showing strong leadership and making progress in the light of the Audit Scotland report. We have produced extensive statutory guidance on budgeting and commissioning, and this year we are investing £1.7 million in improved health and social care data to help partnerships to plan services more effectively.
Partnerships need to use the power of the £8 billion of health and social care resources that have been combined under integration but which were previously held separately to drive real improvements in community-based anticipatory and preventative care. Audit Scotland rightly draws attention to the need for robust indicators and measures of progress. We have legislated for outcomes and have published a first set of measures in statutory guidance, which we will, of course, keep under on-going review to ensure that they keep pace with health and social care changes. Every partnership will publish an annual report using those measures and outcomes, and that will allow us to monitor progress and offer support where it is needed.
I want every partnership to be bold and ambitious. Achieving our goals will be a challenge, and what happens in communities, within partnerships and in primary and social care settings with the involvement of pharmacists, social care teams, GPs and third sector support must be as important as what happens in hospitals. Our ambitions for health and social care integration are clearly set out; indeed, Audit Scotland has recognised the financial and practical support that this Government is providing to health and social care partnerships to implement these ambitious reforms.
When I talk about partnerships, I am really talking about our health and social care workforce. Around 350,000 people work in health and social care in Scotland across the statutory organisations and the third and independent sectors. If they are all to play their part, effective workforce planning will be key; as a result, we have legislated to require partnerships to develop an integrated approach to workforce planning, and we will support them in achieving that.
We know that we have a hard-working and dedicated workforce. For example, the recent survey of people working in social services in Scotland, called “The View from Here”, found that 75 per cent of respondents are driven by a desire to make a difference.
How many of those hard-working staff earn less than the living wage?
I am just coming on to the living wage, but I will say that, as the member will be aware, all those who work in the statutory sector already receive it. The Government fully supports the living wage, and Neil Findlay will recognise, as other members have—[Interruption.]
Order, Dr Simpson.
I am sorry, Presiding Officer.
Continue, cabinet secretary.
The member will recognise, as will other members, the difference that the living wage can make to the lives of those who work in social care, which is why we have taken direct action to raise pay rates for the parts of the public sector that are under our direct responsibility. In doing so, we have set an example that we would, of course, encourage all employers to follow by committing to pay the living wage. In fact, this year alone, we have provided £12.5 million as part of a £25 million tripartite arrangement with local authorities and care providers to improve the quality of care in the care sector by jointly investing in improving fair work practices for care workers, including making progress towards the living wage.
Of course, that investment is very welcome but, with integration, those care workers will now move substantially under the new integration joint boards. Will they be counted as part of the statutory workforce and therefore be subject to the same very welcome measures that the Government has already put in place for the rest of the health service?
IJBs will be required to commission services from the third and independent sectors, whose voices will be heard around that table. We have also put in place statutory guidance that requires all public bodies to consider including a question on fair work practices in the procurement process. That is a very strong lever for the IJBs; the guidance makes it clear that the Scottish Government sees the payment of the living wage as a significant indicator of an employer’s commitment to fair work practices. It is one of the clearest ways in which an employer can demonstrate that it takes a positive approach to its workforce. Some local authorities are already doing that, and I encourage all partnerships to do the same through the new integrated arrangements.
That said, our work does not stop there, and I am committed to making even further progress on fair work practices by working with the Convention of Scottish Local Authorities, Scottish Care, the Coalition of Care and Support Providers in Scotland and others. To ensure that we reach a common understanding of the scale of the challenge, I am happy to put the information that we have on costings for delivering the living wage into the Scottish Parliament information centre, if that would be helpful. We need that common understanding, and by putting that information into SPICe, I think that we will all be able to look at the challenge that we need to face.
I want to talk about my visit to Oakbridge care home in Glasgow this week. There, I saw first hand very progressive work on integration and intermediate care in particular. What struck me most on the visit was the absolute commitment of all the staff and the strong leadership that was shown by the new health and social care partnership in Glasgow to improve people’s quality of life. I was told that staff felt motivated and empowered by the work that they were doing and that there was a strong belief that they were involved in something that was worth while: improving outcomes for older people.
Through the work that staff have done, the 106 delayed discharges of over three days’ duration that were recorded in Glasgow last November were reduced to 25 in October this year. That is a reduction of 76 per cent. In fact, staff were able to name the people who were delayed in the system in Glasgow because the number was so small. That is a great achievement, and we want other partnerships to deliver such achievements.
More than half of all partnerships now have their delayed discharges of over three days into single figures, of course. Five partnerships account for 60 per cent of the rest of the delays. I assure members that we are working very hard with those five partnerships to ensure that we get delayed—
Will the cabinet secretary take an intervention?
I am conscious of the time and will have to move on. I want to address the forthcoming budget.
It is worth remembering that the Government has passed on every penny of health resource consequentials since 2010-11. Page 9 of the Audit Scotland report that Jenny Marra referred to makes it very clear that there has been a real-terms increase in resource spending on health. The figure that Jenny Marra quoted includes capital.
Jenny Marra shakes her head, but I do not know why as page 9 of the Audit Scotland report makes it very clear that health resource spending has increased in real terms. Capital spending is a different matter. We know that capital spending has been a challenge because of the 25 per cent decrease from the Westminster Government to the Scottish Government. However, as per our commitment, resource spending has increased in real terms, and Audit Scotland has confirmed that.
Obviously, I cannot say much about the forthcoming budget, other than that I am sure that Parliament can be reassured that the direction of travel that I have laid out will be continued in the decisions that we make in it.
I am very happy to move amendment S4M-15098.3, to leave out from “notes” to end and insert:
“recognises that NHS staffing and funding are at record high levels; supports efforts locally and nationally to successfully implement health and care integration; shares Audit Scotland’s analysis that good progress has been made toward integration and that it has widespread support; welcomes the recognition that the Scottish Government has provided significant investment to improve integrated care, and endorses working with COSLA and the care sector in progressing the living wage, noting that additional funding has been provided toward its achievement and associated fair work measures.”
15:07
Throughout the country, front-line staff in healthcare and social care are working flat out to satisfy the needs of the people who are in their care. I am not quite as familiar with the social care sector, but I am sure that the staff in it are no different from those in the NHS, and in all the years that I have known the NHS, the vast majority of staff—at all levels and in all settings—have worked with commitment to ensure the best possible outcomes for their patients.
However, we know that many of those people are working under increasing pressure as the demands of an ageing population stretch resources to their limit. Many are nearing retirement age, while others are retiring early because of the pressures, and recruitment is not always easy. We see that in the large numbers of consultant vacancies, particularly in some specialties; in the difficulty in attracting new trainees into general practice and keeping them in primary care once they are qualified; in the real difficulty in recruiting home carers; and in the continuing use of agency and bank staff to cover an increasing level of nursing staff vacancies.
Health boards are doing their best to plug the gaps. My NHS board—NHS Grampian—has made wide-ranging and strenuous efforts to solve the problem. That has resulted in a number of consultant vacancies being filled, and an innovative scheme is in place to recruit and retrain nurses who have left the profession but are showing interest in returning to work in the NHS. However, overall, we know that demand for NHS services is outstripping available resources and that the system is unsustainable as it is.
It is generally accepted and has been made clear by the Auditor General for Scotland that the NHS will not be able to continue to provide services in the way that it does now and that it needs to develop a more strategic approach to support long-term change and the move to community care, which we all agree is required. Key to that is the achievement of the Scottish Government’s 2020 vision, which we are all signed up to, and top of that is integrated health and social care. The vision includes an ambition to keep people at home or in a community setting for as long as possible, and to get them back home as soon as appropriate, should hospital care be required.
All that requires long-term planning, which Audit Scotland has found is lacking. It says that that is putting the plans for an integrated health and social care system at risk. That is concerning, given that all 31 integration authorities are expected to be operational by the statutory deadline of 1 April next year.
As we approach that deadline, Audit Scotland’s recent report flags up a number of concerns, including workforce uncertainties, a lack of evidence of progression towards an integrated system and the need to involve the voluntary and private sectors in consultation. Integration authorities need strategic priorities for use in developing a workforce strategy that shows how they will redesign health and care services, and they need a risk management strategy to show that they are properly prioritising their work and their resources. Those concerns and others are about pretty fundamental issues in developing a system that must be up and running by April.
Two issues at locality level worry me greatly. The first is the suggestion that integration joint boards might be too large. That sets alarm bells ringing that we could see a repeat of the failed community health partnerships, which soon lost the support and interest of local GPs, largely because their size made it
“difficult to reach agreement, make decisions and ensure services improve.”
Those are exactly the words that Audit Scotland used in its report in referring to its fear that IJBs might be too big.
When we were discussing legislation, I emphasised heavily the importance of GP involvement at locality level. GPs should be lead players at that level, because they are at the centre of community provision for patients, and I do not see how the new system will work if they walk away. Given that localities are key to the success of integration, I hope that the joint boards will monitor the situation carefully, focus on how localities will lead the integration process and deal with any emerging problems promptly. I have heard anecdotally that some GPs might already be feeling disenfranchised, which I would not like to be the case.
My other concern is about the cultural change that is required if integration is to be effective. Audit Scotland thinks that joint boards might struggle to change how local services are provided. It says that, once difficult decisions are made, there are still complex relationships to be negotiated by the health boards and councils, and it is unsure whether IJBs will be able to exert the necessary independence and authority to change fundamentally the way in which local services are provided. Those relationships will be key to the success or failure of the new system.
It is no surprise that health boards and councils have been finding it very difficult to agree budgets for the new integration authorities. I do not have the latest figures but, as of October, only six integration authorities had informed the Government of their agreed budgets.
Undoubtedly there will be funding issues as the new system beds in, and there will be uncertainties until the Scottish Government’s financial plans are approved. That is why we have lodged an amendment that suggests a use of the consequentials following from the chancellor’s autumn statement and the UK Government’s proposed increases in health spending over the next five years. Jackson Carlaw will deal with that in his closing speech.
I will refer to a couple of briefings that we received before the debate. The first, from the Royal College of Nursing, says that
“The success of integration is dependent upon having, and supporting, a multidisciplinary workforce that can deliver the right care in the right place at the right time whilst recognising the unique contribution of different professions”
and stresses that integration needs to be fully resourced. The RCN also emphasises that health and social care workforce planning can no longer be done in isolation.
The second briefing, from Marie Curie, points out that palliative care is integrated health and social care and should be a priority for joint boards. It indicates that investment in palliative care has the potential to reduce acute care costs as well as to give people the care that they want while living with their terminal condition and at the end of life.
I still have high hopes for the integration of health and social care, but there is a great deal to be done before it becomes effective across Scotland. I commend all those who are working extremely hard to meet the April deadline for integration and I hope that their efforts will be successful.
I move amendment S4M-15098.2, to leave out from “calls on” to end and insert:
“notes that additional funding will arise in consequentials to health funding in Scotland following the Chancellor’s Autumn Statement; acknowledges that significant additional funding arises from consequentials following proposed increases in health spending by the UK Government between now and 2020, and calls on the Scottish Government to ensure that the immediate additional funds are used, in part, to ensure a successful integration of health and social care, as well as working to establish, achieve and deliver a sustainable strategic plan that secures the future of Scotland’s NHS.”
15:14
I am glad that we have the opportunity to debate the integration of health and social care and I thank Labour for bringing the subject to the chamber. We want support to be given at the right time and in the right place. However, Audit Scotland’s report “Health and social care integration” could not be much clearer. It states:
“there are significant risks which need to be addressed if integration is to fundamentally change the delivery of health and care services.”
Integration will place assets that are worth about £8 billion—or nearly two thirds of the entire health and social care spend—into the management of the integration authorities, so it is one of the biggest projects that the Scottish Government has co-ordinated. I appreciate that the task is not easy, and no one who is involved in it can afford to cut corners on it.
I welcome the Scottish Government’s investment of £500 million as well as the support and guidance on early integration plans. However, Audit Scotland gives a sobering account of the real state of the integration plans. As Nanette Milne noted, some integration authorities have not yet agreed budgets. As of October, just six of the 31 integration authorities had done that. As a result, strategic plans have been affected, there is uncertainty about long-term funding and there are significant challenges in recruiting and retaining crucial staff such as GPs and care staff.
Those findings are not really new to us. Such problems existed before the Public Bodies (Joint Working) (Scotland) Act 2014 yet, rather than address them at their core and ensure that they were not transferred into its flagship policy, the SNP Government let the problems grow to reach a point at which we are facing a danger to the NHS. We do not want to shift problems from the NHS into the integration process.
One of the main benefits of integration is that money will be saved. The widely welcomed integration principles called for a community-based, preventative approach to health whereby patients are treated in their community, closer to home, and there are more local resources. That would allow hospital stays and delayed discharges to be decreased. All those things would be welcome.
However, Labour wants to spend £200 million of the £400 million of health consequentials on social care. The Audit Scotland report makes no mention of the need for more money to be spent in that area. NHS spending is £12 billion. If we assumed inflation at 1 per cent, that would mean £120 million to account for pay rises, which would leave only £80 million of the consequentials for mental health services, GPs, accident and emergency services and everything else.
Is Mr Hume saying that we should not pay social care staff more? Is that what he meant when he said that we should not put any more money into this?
No—I did not say that. Mr Findlay has been clear, and I will be clear. Labour is walking away from mental health services, from the GP crisis, from health inequalities and from the problems in A and E.
In this case, the Scottish Government has a duty—as recommended by Audit Scotland—to work with the integration authorities and help them to develop performance monitoring to clearly demonstrate their impact.
We were clear in our press statement this week that Labour would spend the mental health consequentials, which we estimate at £59 million, on mental health, and the rest would be allocated to health and social care integration.
I do not read press releases from Labour, but I read its motion for the debate, which makes no mention of mental health.
Public monitoring and reporting of the integration authorities’ progress must be supported. There is no clarity about what they should measure changes and their success against. They need more information and an assurance that they will be able to report into a network of clear outcomes.
Any investment in social care must meet the needs that we have and those that we anticipate having. Our population is changing and the demographics are shifting. More people are living longer lives, but I repeat my call that we must also ensure that they live healthier lives. It is essential to create a consistent, sustainable and person-centred model of care. If we are to treat people in a holistic way, we cannot separate their physical needs from their mental needs.
Marie Curie is urging the Government to improve the provision of care to people with terminal illnesses. Anyone who is nearing the end of their life must have as much psychological support as they have physical help, so a combination of healthcare and social care is necessary. We have not only the ability but the duty to put resources in place for every person who requires care and support.
As we know, care does not start or end with physical support. It is time that the facts were faced through investing in our mental health services—investing in psychological support for people and delivering personalised, all-round care.
By committing at least £200 million of the £400 million of health cash consequentials from the spending review solely to social care, we would risk leaving mental health in the same situation as it is in now, where some young people travel hundreds of miles for treatment, while others have to wait for up to a year to see a specialist. Staff are under pressure to deal with increasing demand, while there is a non-increasing supply.
Will the member give way?
I am sorry, but I am finishing—I have only a few seconds left.
People in the most deprived areas have five times more risk of having poorer mental health than those in the least deprived areas have. Integration of services must mean that people who have higher chances of reaching a mental health crisis will have those chances reduced and a crisis point averted. A big component of that solution is prevention.
I am sceptical of Labour’s calls for more spending at a time when integration authorities need more information. I am wary that, by leaving mental health behind, we would let down thousands of people who could benefit from more mental health support in their community.
I move amendment S4M-15098.1, to leave out from “calls on” to “introduce” and insert:
“believes that committing at least £200 million of the £400 million of health cash consequentials from the Spending Review solely to social care puts at risk the ability of the Parliament to agree a step-change in mental health provision in Scotland; notes that the recent Audit Scotland report on the integration of social care did not recommend specific additional financial resources but did make clear that resources should be moved to a preventative approach; notes that one in four people in Scotland will have a mental ill-health issue at some time in their life and that this includes staff working in health and social care; calls for a Scottish Budget Bill for 2016-17 that takes a step-change to improve mental health services, as well as meeting other priorities in the NHS, such as ensuring that there are sufficient staff, the provision of GP services and dealing with health inequalities in Glasgow, and supports”.
15:21
From the outset I have been very supportive of the integration agenda. Having served on the social care, wellbeing and safety committee of Aberdeen City Council prior to becoming a member of the Parliament, I saw for myself some of the challenges that were faced in the delivery of social care.
While I was a member of Aberdeen City Council, we managed to get the delayed discharge figure down to zero. Unfortunately, since we left the administration, that figure has slowly crept back up to a higher level. One of the reasons why that has occurred is the difficulty of ensuring that appropriate care packages are put in place for individuals coming out of an acute setting. I have seen that in a number of constituency cases, with individuals often being taken from an acute setting and placed into a care home setting, rather than being allowed to return home, as the care package that would allow them to return home cannot be put in place. That has persisted even with the decision by Aberdeen City Council—a decision that I did not agree with—to outsource its social care to an arm’s-length organisation, Bon Accord Care, rather than having it delivered on an in-house basis.
The reason why I supported health and social care integration was to do with tackling and removing the silo mentality from health and from social care, as well as the gaps that can arise and into which individuals find themselves falling. I felt that we should pursue the opportunity to create a more joined-up approach. I still think that integration will benefit all our constituents when the work of the integration joint boards takes effect.
There are other areas that we need to consider tackling, beyond the silos that exist in health and in social care. I refer to the silos in areas such as primary and acute services, within the health service. Those still need to be addressed. Those services need to be brought much closer together in terms of the way in which they work. That would help with some of the issues that were raised earlier about individuals finding themselves in an acute setting, which is obviously more expensive compared with being dealt with through the primary care sector.
We must ensure that, even within the primary sector, all the different professions work together in a much more rounded and holistic manner. As we will be discussing in the debate on primary care redesign that has been scheduled for next week, we must ensure that, when an individual presents in a primary care setting, they do so to the most appropriate profession at that time. That would relieve workload pressures and would create a system that allows people to be seen and dealt with in the most appropriate setting.
I have a huge amount of respect for, and place great value in, the work that is done by carers, not least as my mother worked as a carer. She was employed as a carer and, latterly, she was also an unpaid carer. I entirely recognise and understand—
Will the member take an intervention?
I want to develop this point first. I entirely recognise the strain that is often placed on individuals in that environment.
With regard to the call for care workers to be paid the living wage, the cabinet secretary pointed out that those who are paid through the public sector already receive the living wage. However, beyond that, the ability to effect a living wage for those who are employed outwith the public sector environment would have been immeasurably increased had the opportunity been given through the Scotland Bill—as the Scottish Trades Union Congress called for—for powers over employment legislation and employment rights to come to this Parliament.
The other thing that would help—and something that we should perhaps be encouraging the integration joint boards to look at more closely—is a move away from unit cost purchasing when it comes to social care services. Instead, they should look more widely at an outcomes-based approach rather than at a simple unit cost-based approach. That might allow for greater flexibility around the pay and conditions that are afforded to care workers.
I realise that I said to Jenny Marra that I would take an intervention from her. She is indicating that she no longer wishes to come in.
It is clear that the care sector is facing difficulties in certain areas. In my area of Aberdeen, there is a real difficulty around recruitment and retention. That difficulty was highlighted to me when I held a care sector jobs fair in my constituency that was aimed at promoting opportunities within the care sector.
I know from feedback that I have had from organisations that individuals were able to secure positions as a result of that jobs fair. However, compared with a previous jobs fair that I hosted, which was much more wide ranging, there was a noticeable drop in footfall because individuals do not necessarily see the care sector as an area that they wish to work in. Part of that will undoubtedly be because of the pay element, but part of it is also down to a perception of what the role entails.
To help tackle some of those issues, we need to ensure that we present a much more positive image of the work that is done in the care sector and have more people speaking up for the valuable role that is performed by those who work in the care sector. That would be helpful in attracting more people into that role.
One thing that seems quite clear this afternoon is that a conflicting message is coming from opposition parties on where the health consequentials should be allocated. I have no understanding or knowledge of where the health consequentials will go—that is above my pay grade. What I do know is that the cabinet secretary and the Deputy First Minister will be entirely focused on making sure that the health consequentials are spent in a way that benefits the people of Scotland. For me, that is the most important element in all this.
15:27
Our motion rightly starts by paying tribute to health and social care staff, who often work way above their contracted hours to make sure that those in their care are well looked after.
Within the social care sector, people are often paid only the minimum wage, are on zero-hours contracts and are expected to deliver high-quality care in fifteen minutes or less. On top of that, many carers are not paid for the hours that they spend travelling between clients.
I spoke to someone recently whose wife worked as a home carer and that was the situation that she was in. She was out at work for nine hours a day but was paid for only five of them. The rest of the hours were unpaid travelling time between clients. Although that travel was seen as a commute for pay purposes, she was still required by her employer to insure her car for business usage, despite not being paid while driving it. That meant that she had to pay much more expensive insurance premiums.
We need to value all health and social care staff. That means paying them a living wage and making sure that their contracted hours allow them to plan ahead to meet their own financial commitments.
Payment for time that is spent travelling is essential. In the Highlands and Islands, we can have care workers travelling twenty or thirty miles between clients as part of their normal day and it is unacceptable that that travel time might not be paid.
We need to give carers a career structure. Care is often described as the new retail but, frankly, retail provides a better career structure and better pay.
We often see social care workers building up expertise on the job looking after complex cases. They need to be properly trained. I was speaking to a couple of carers who had had a caring career for a number of years. They told me that it was only on joining their current employer that they were given any training at all. They told me that if they had received that training at the start of their careers, it would have made a huge difference to them and to the clients that they were looking after.
Others have developed expertise in specific areas. One growing area is home care for people with dementia. With the right knowledge of the condition, a carer can organise the home to be safe while allowing the client to live independently for many more years. Perhaps Jim Hume will acknowledge that mental health care can happen in the community with the right workforce and skills.
When I meet such dedicated people, I cannot but be impressed by their compassion and their love for their career. They get great job satisfaction from working with people, seeing their work lead to health improvement and maintaining their clients’ independence. However, too often, they are moved between clients, which means that they cannot build relationships with the people they care for or grow a knowledge of their conditions. That is difficult for the client and the carer.
The integration of health and community care has been devised to remove some of the pressure from acute health services and enhance community care. We are all signed up to that concept, but there are real concerns. As other members stated, Audit Scotland highlighted some of those concerns in its recent report. It points to funding as an issue. That was raised time and again during the passage of the 2014 act. The policy is right but the transition needs to be funded. We also heard from Audit Scotland that the staffing profile is wrong and is structured to fit past priorities rather than the situation in which we now find ourselves. Putting that right needs investment as well as workforce planning.
Audit Scotland’s warning about funding is timely as we consider the Carers (Scotland) Bill. The bill is widely welcomed but the funding is woeful. It will not meet existing demand, far less the demand that the bill will create. Many unpaid carers are close to collapse and need more support, but that costs money.
Rhoda Grant identifies something that Barnett consequentials in health and social care integration could be spent on. It would be a worthy cause, but the Labour motion says that the money should all be spent on one thing, not the cause that she brings to the chamber. At some point, the Labour Party has to make a decision, not ask for money for everything and spend money on nothing.
I am slightly confused by that intervention. I believe that unpaid carers provide social care in the home. If Bob Doris does not recognise that, I fear for the Government.
Will Rhoda Grant give way? She is misleading Parliament.
No, I do not have time. Unpaid carers save us £10.8 billion a year, so I do not recognise the point that Bob Doris was trying to drive at. The least that we can do is support them and enable them to continue their caring role while having the freedom to live their lives. They also need training and information and to be treated as partners in the care team. Nor should we expect them to do anything that we would not allow paid staff to do because we think that it is dangerous.
One initiative that was taken to put control in the hands of social care clients and their unpaid carers is self-directed support. It was meant to empower people, but sometimes it does the opposite. Constituents tell me that they are offered fund holding only for the provision of their care. They need to find people with the skills to manage their conditions. They have no cover for sickness or, indeed, emergencies and might not have the skills to employ people. Often, the people who are employed as personal assistants do not have the skills for the job. We need to examine the situation to ensure that self-directed support is used for the purpose for which it is designed.
We need to recognise the importance of social care and the workforce that delivers it. Investment and training in social care will remove pressure from our hospitals, which are much more expensive to run. That will allow the hospitals to concentrate on those who need acute physical and mental care. People who are supported in their communities will enjoy more independence and will not be at risk of the disabling effect of hospital.
15:34
I am also glad to take part in the debate on health and social care integration. We are all committed to the aims of integration—less duplication, a more joined-up approach, the better use of human and financial resources, a more preventative approach and the third sector being full partners, to name but a few.
An attempt at integration was made some years ago in Glasgow, which at that time had community health and care partnerships. I was a councillor and a member of the east CHCP, and I felt that there were opportunities that had not existed before. For example, elected councillors were involved in health discussions, which was a new thing for me, and priorities could be set for the east end of Glasgow that might be different from those in other parts of the city. From memory, children’s dental care and breastfeeding were two of the priorities for our part of Glasgow.
Does the member share my concern about the recent report that exposed the fact that communities in deprived areas get poorer services and that GPs in those areas are under pressure? Will he join me in asking the Cabinet Secretary for Health, Wellbeing and Sport to look at the formula, which disproportionately affects communities such as those that he and I represent in Glasgow?
I have also been doing a lot of work and speaking to the deep end practices, and I would certainly like to see more resources going into GP practices and other community care at a local level in the neediest areas.
There are challenges—as I highlighted when I intervened on Jenny Marra earlier—with regard to whether we can move resources out of hospitals and into communities, but that is something that we should at least consider.
As I said, integration did not work out in Glasgow, apparently because of clashes of personality or style among some of those in senior positions. It seems to be better that all of that is now on a statutory basis. However, I still have some concerns about Glasgow. The fact that NHS Greater Glasgow and Clyde and Glasgow City Council are very large organisations makes the danger of huge bureaucracies all the greater. We shall see whether the joint board for health and social care will simply mean the creation of a third bureaucracy.
Will the member take an intervention?
I had better make some progress, if the member does not mind.
Glasgow City Council’s executive committee is due to consider a report on integration tomorrow. I was a bit uneasy at reading, under the heading “Procurement”, that
“The Integration Joint Board will in future commission the Council to deliver social care services and the Health Board to deliver health services.”
The tone of that language suggests to me that the two silos are likely to carry on under the integrated board, with the veneer of integration but not the reality. On the other hand, I know that the staff on the ground often work well together, and any problems are more likely to arise at management level.
Another issue in Glasgow has been that the council has tended to be very much against devolving power down from the city chambers to communities or at least to sectors of the city. The council wants more power in George square, but it does not want to pass it downwards.
I wonder whether Jenny Marra can assure us that, while Glasgow is Labour led, we will see more decentralisation and not the continuation of that centralist approach.
The Audit Scotland report touches on a number of those issues. It recommends that integration authorities should
“develop financial plans that clearly show how IAs will use resources such as money and staff to provide more community-based and preventative services. This includes: developing financial plans for each locality, showing how resources will be matched to local priorities”.
The report goes on to highlight the need to
“shift resources, including the workforce, towards a more preventative and community-based approach”.
The use of the phrase “each locality” suggests something much further down than a Glasgow-wide level. The term “shift resources” suggests that money will need to be spent in a different way from how it has been spent in the past. We shall see.
Does Mr Mason think that the Government that he supports is a model of how to devolve power down from the centre? Is it a good example?
When I was a councillor in Glasgow, one of the big problems that we faced was ring fencing. I seem to remember that that happened under the Labour Administration, and I am very glad to say that it no longer occurs. I would like to see more devolution to local government, but Glasgow City Council is far too centralist and we need a much more devolved approach in Glasgow.
Am I okay for time, Presiding Officer?
Yes, Mr Mason—I can give you just over six minutes.
Thank you.
I am glad to see that the living wage is mentioned in the motion. However, I must stress once again that a voluntary living wage is always second best in comparison with a statutory minimum wage that sets out the compulsory living wage level.
Clearly, the budget is the time to allocate expenditure, rather than in this debate. The reality is that we need to choose priorities and I am sure that we will come back to that in the budget debates. On that point, I commend the Lib Dems for realising in their amendment that there have to be priorities and that we must choose between competing needs. Obviously, Jim Hume’s amendment focuses on mental health—I support that, although it must be considered in the round—and I found this wording refreshing:
“committing ... solely to social care puts at risk the ability of the Parliament to agree a step-change”,
because it acknowledges that we have to make choices and that we cannot do absolutely everything, although another party here sometimes seems to suggest otherwise.
Speaking personally, I wonder whether we need to disinvest first in order to put more resources elsewhere. For example, should we be cutting hospital budgets to put more into GP practices and community solutions? That would not be easy and it would require acceptance and willingness across parties to take that approach and re-emphasise preventative spend.
Mr Mason, if you could close now, I would be grateful.
There is no point agreeing on preventative spend in committee, then, if it actually happens, attacking it in the chamber.
15:40
I always welcome the opportunity to debate the NHS in the chamber—never more so than at this time of year, when the challenges that face the service are at their most acute, due to winter pressures. Many staff tell me that they now have winter pressures all year round.
I want to turn first to the staff. I say to the doctors, nurses, paramedics and allied health professionals—the whole NHS family in primary and secondary care—that I think that the Scottish Parliament owes you our gratitude for all that you do to take care of us all year round. I also thank the staff who work in social care. I know from constituents who care for loved ones what a vital lifeline service our social care staff provide in helping and enabling people to stay in their own homes. With the demographic changes that we face, and with an ever-increasing elderly population, that service, too, is now under extreme pressure.
Public sector staff are constantly being asked to do ever more with fewer and fewer resources. It is on that basis that I am genuinely disappointed with the SNP amendment. It is self-congratulatory and fails to recognise the very real challenges that our health and social care systems are facing. It is all very well to engage in assertion and rhetoric, and to offer warm words about the staff. That is easy to do—much harder is giving them the resources to do that job. However, that is absolutely the territory that the Labour Party will occupy. We need to get beyond the warm words and the rhetoric and instead to take practical action that will make a difference in communities such as mine and communities across Scotland.
The SNP’s track record is not really very good: let us just look at some of the facts. Local government, with its partners in the voluntary and private sectors, is responsible for providing the overwhelming bulk of social care, alongside primary care in health. However, local government’s share of the Scottish budget has been cut from 29 per cent in 2011-12 to 25 per cent in 2014-15, and I suspect that it will fall further—I hope not, though—in the forthcoming budget. What level of cut will be inflicted on local government this coming year? The SNP Government has cut NHS spending in real terms. Audit Scotland, the Government’s very own auditor, has said that the health budget decreased by 0.7 per cent, which amounts to hundreds of millions of pounds.
As Jackie Baillie will know well, page 10 of the same Audit Scotland report shows that the real-terms resource increase was 2.2 per cent. She has asked for more money for local government and more money for the NHS. Is there not a sense that she is undermining her own argument today if she says that everything is a priority? Can she clarify what she thinks more money should be spent on?
I do not regard “everything” as a priority. I make it very clear that I think that the money should go into social care because that is where the greatest challenge that we face is. I will describe that to the cabinet secretary in a minute.
Let me point out to the cabinet secretary, who is fond of occasionally engaging in use of smoke and mirrors, one example of a line in her budget. There is £50 million for nursing and midwifery education that is counted in the health budget line, but is immediately transferred to be spent in education. There are other, similar lines that are shown in health but are spent in other areas, but the budget line remains in health to give an inflated level of expenditure. That is not transparency and honesty in accounting for spending.
Let me remind the cabinet secretary that in the period from 2007 to 2010, a Labour United Kingdom Government raised spending in the NHS by much more than inflation. The SNP Government failed to pass that on in full to the NHS in Scotland.
Will Jackie Baillie give way?
I will give way if the cabinet secretary can answer this question. Why do we see month-on-month overspends growing steadily in health boards across the country? Structural deficits, where savings arising from non-recurring spending are building up, are creating a black hole in NHS finances. Explain that, cabinet secretary.
As I said earlier, there has been a real-terms resource increase in every single year from 2008-09 to 2014-15, as has been confirmed by Audit Scotland.
Jackie Baillie has just called for more money to be spent on nursing in a debate on a motion that calls for more money to be spent on social care. She needs to be clear and consistent in her arguments. What it is that she wants the money to be spent on?
The cabinet secretary should listen carefully. I am accusing her of not being transparent and honest in respect of budget lines that are counted under health but which are actually spent under education. That is smoke and mirrors; it is an attempt to hide—if you like—the spending that is not happening in health.
Let me go back. Local government and the NHS are both under enormous financial strain. The SNP’s sticking-plaster approach is, to be frank, not sustainable. The pressure means that we do not focus on prevention but instead focus on crisis. We fund acute presentations at the front door of accident and emergency departments instead of treating people at home where they know they can be treated effectively. There has been no shift in the pattern of spending. We all say that we want spending in primary care and in communities in order to prevent hospital admissions, but we do not do it.
Labour would spend the consequentials from the UK Government arising from its decisions on health, which amount to about £400 million. We would set aside the mental health funding allocation, which we believe is in the order of £59 million. We urge the SNP Government to allocate the rest to social care. Let me tell members why.
Needs in our communities could rise by almost 30 per cent. Elderly age groups will increase hugely: the 75 years and older age group will increase by a staggering 82 per cent in the next 25 years. We have 820 centenarians: that is fantastic, but in 20 years we will have 7,600. That is where the public policy pressure is, and we need to do something about it.
I believe that we need to fund prevention work. We need to fund social care staff and give them a living wage, because doing so raises quality and standards and values them appropriately. This is the SNP Government’s opportunity to make a difference. If it does not seize it, shame on it.
15:48
I start by commending the work of the health and social care staff in my constituency and across Scotland. Only last week I met the chief executive of the Golden Jubilee national hospital to discuss the expansion of services there, which is a true testament and recognition of the work by the medical and support staff at the Golden Jubilee.
Presiding Officer, I welcome the Audit Scotland report that is highlighted by the motion. It recognises that the aim of integrating health and social care is to ensure that
“people receive the care they need at the right time in the right setting, with a focus on community-based and preventative care.”
Audit Scotland found widespread support for the principles of integration among those on the ground who are implementing the changes.
Although the report highlights a range of positives related to integration of health and social care, it also highlights a number of issues that Audit Scotland considers should be addressed in order for integration to fundamentally change delivery of health and social care services.
I am pleased, however, that Audit Scotland recognises that the framework that was set out by the Scottish Government allows for significant local flexibility. The report further recognises that the Scottish Government is providing resources to support integration. That includes £300 million in the integrated care fund, which will be distributed among the 32 local NHS and social care partnerships that have been set up as part of the move towards integrated services. The fund will support implementation of partnerships’ plans that detail how they will bring together health and local authority care services in order to implement the report fully.
The report also acknowledges that there is, due to the needs of the ageing population and increased demands on services, widespread recognition that health and social care services need to be provided in a fundamentally different way. Therefore, the Audit Scotland report recognises the need for integration of health and social care, and the Scottish Government is taking action to support that.
The motion highlights health consequentials from the spending review. It is worth pointing out that the SNP has met its pledge to pass on every penny of health resources consequentials from the UK Government since 2010-11, and that in 2015-16 the Scottish Government invested an additional £54 million, which brings the increase in the resource budget to 5.8 per cent in real terms since 2010-11.
However, on the specific issue of integration, in June, following discussions with the British Medical Association and the Royal College of General Practitioners, £60 million of additional funding for the primary care development fund was announced to help to ensure continuing good quality care in general practice. That funding will further help to support integration of health and social care.
It is becoming a bit of a habit of the Labour Party to say that the Scottish Government and Parliament have powers beyond what is in the Scotland acts, including in respect of the living wage. I welcome that the Scottish Government encourages care providers to pay the full living wage and fully recognises the real difference that it can make to the lives of the people in Scotland.
However the Scottish Government cannot force employers to pay the living wage—employment law is reserved, and the European Commission has also confirmed that any requirement on contractors, as part of a public procurement process or public contract, to pay their employees a living wage that is set at a higher rate than the UK’s national minimum wage, is unlikely to be compatible with European Union law.
Would Gil Paterson like to explain why Boris Johnson has made it a condition of all procurement contracts that are let in London that the workers have to be paid a living wage? The condition is not that the employers should pay all their workers a living wage; just that the workers who are employed as part of that contract should be. We should surely go at least that far.
That is news to me. I am entirely unaware of that. I will need to check; it does not sound right to me at all.
Through legal and financial means, the Scottish Government is doing sterling work to use the resources at its disposal to improve the health and social care sectors. It has introduced the Carers (Scotland) Bill, which will enshrine carers’ rights in law for the first time. The SNP Government has invested around £114 million in programmes to support carers—more than ever before. Some £28.9 million has been provided so that health boards can give direct support to carers.
The Scottish Government has also significantly increased funding for short breaks, with £13.7 million being invested through the voluntary sector short breaks fund, which will allow more than 15,000 carers and cared-for people to take a break, which gives them an opportunity to relax without feeling stress or guilt. The short breaks fund is attracting international attention, and it is one reason why the International Short Break Association will hold its biennial conference in Edinburgh in 2016. That will provide an opportunity to exchange knowledge and experience with organisations from all round the world.
The Scottish Government also funds the equal partners in care initiative. Through that, the Scottish Government has worked with the NHS and social care professionals to improve how they work with carers and young carers.
Draw to a close, please.
Let us not forget the distinctive Scottish policy of free personal and nursing care, which benefits about 78,000 people.
I commend to Parliament the cabinet secretary’s amendment.
15:55
If there is anything that we can actually agree on in the chamber this afternoon, it is that we can all congratulate the workforce of the health and social care sectors. We can also agree that there are challenges in all sectors. Nanette Milne said that her knowledge and experience lie in the NHS; to an extent, my knowledge and experience are more in the care sector, having worked in it for more than 30 years.
Some of the challenges that we have today are no different from the challenges that we had in the early 1980s, when I first started out in social work. They are about how we identify, through assessment, a person’s need and how we then resource that need, so it is absolutely right that we have the agenda of integration. Back in the early 1980s, I was looking at an integrated approach to some of the work that we were doing.
Jackie Baillie talked about preventative spend. I believe that we are making real progress on some of the preventative spend areas, and I want to focus on those areas. Community optometry, for instance, prevents people having to go to acute sector ophthalmology for tests, and that is work that we should commend. We should look at what we can do to encourage allied professionals to have a greater and more proactive role in the community. That may be a shift that the cabinet secretary could, in line with integration, look at in more depth. We could move some of our allied professionals from the acute sector into the community sector to ensure that people who require appropriate occupational therapy or physiotherapy are getting what they need, perhaps in their home, rather than having to go to an acute hospital or community hospital.
I was interested in what Jenny Marra said at the start of her speech. It reminded me of my early days in social work, when I was visiting people who were adjusting to old age or sensory impairment. At that time, they were thinking, “I can no longer do X, Y or Z”, but with an enabling approach it is amazing how much people can do to adjust, if they are given the right encouragement and support from people who have the skills and knowledge—that is the important thing—to provide that enablement, so that they can stay safely in their own homes for longer. If we are encouraging people to stay in the community, we must ensure that the right approach is taken to ensure that they are safe in that environment.
We need to look at new technology that was not around in my early days in social work but is now, because that new technology can enable people to stay at home. There are so many things that we can do now. In the health service, digital technology is being used to prevent patients from having to go on long journeys. That is commendable for people on the islands, as we can see from some of the progress that has taken place in Orkney and Shetland in using telecommunications to talk with consultants in Aberdeen.
I commend the work of Aberdeen royal infirmary and of Malcolm Wright at NHS Grampian. As Nanette Milne said, staffing levels for consultants and in nursing have increased to a record high in NHS Grampian, where there has been a co-ordinated approach. My colleague Mark McDonald referred to people working in silos; there was a silo mentality in NHS Grampian, but a lot of that is being dismantled and an integrated approach is now being taken to work in the acute and primary sectors there, which is to be commended.
I think that NHS Grampian works with three councils: Aberdeen City Council, Aberdeenshire Council and Moray Council. That is sometimes the problem—but is it a problem or is it just a challenge? The challenge provides the opportunity, and the opportunity is for the councils and the health board to work together to look at the best possible outcomes. It is outcomes that we are looking at for the patients and people living in the community.
Recently the Health and Sport Committee was looking at palliative care. It was encouraging to learn that we have so many people with such skills and knowledge in the community. However, sometimes they are not being directed to the most appropriate patients. Palliative care is not just about end-of-life care; it is also about ensuring that people who have long-term conditions can have the best possible quality of life in the community.
I commend Jim Hume for raising the issue of mental health. As he knows, we all have mental health—sometimes it is good and sometimes it is bad. We have seen an increase in the number of older people with dementia and Alzheimer’s. We need to acknowledge that and to recognise their specific needs and the needs of their carers. Quite often, the carers are family members who have to adjust what they do and their lifestyle, whether at work or in other caring roles for children, which is difficult.
We have to realise that there are limited resources, but how do we use them best? It is not just a question of money; it is about taking the best possible approach to trying to ensure—I repeat—the best possible outcomes for our patients in the community. That is about recognising that we now need to take that challenge and that opportunity, and to say that acute cases should go to primary care, but other people should stay at home, safely, in their own community.
16:02
The background to the debate has already been set out by Labour colleagues and others, but the report of the independent care commission that was set up by Neil Findlay, whom I had the pleasure of serving under as a shadow minister, is not the only report on the subject.
Labour proposed a far more extensive and inclusive approach, with a cross-party independent commission to review health and social care in its widest sense. That was our intended equivalent of what has now been announced as a national conversation. That proposal in our manifesto in 2011 was rejected by the SNP Government on the ground that it would take too long, but four years later we are having a national conversation—interesting.
The NHS is having great difficulty in meeting its targets. The recent Audit Scotland report says that there has been a consistent failure and a trend downwards in many of the nine targets—seven have not been met since 2012. We also have admissions of difficulties, with high levels of consultant and nurse vacancies, massive pressure and shortages in other areas.
The acute services are under such pressure, partly driven by targets, that they will have great difficulty in shifting the balance of care. That is something that we can surely all agree we want to achieve, Mr Robertson. In fact, there are many things that we can agree on, and one of them is integrated health and social care.
The main thing is to achieve prevention, which comes in a number of categories. Primary prevention is achieved by addressing issues that are outwith the field of health. For example, a majority of health inequalities are related to things outwith the health sector. As a first step, the commission on health inequalities said that it supported the Scottish public health observatory’s finding that paying the living wage to everyone would achieve the greatest health outcome. That is a salutary comment for a health observatory to make. Labour has made the modest demand that we should start by at least paying a living wage to our social care workers. They are about to be part of the statutory sector to which the Government is committed to giving a living wage. We are going to have two categories of statutory workers: those inside and those outside. That cannot be right.
The evidence from places such as East Renfrewshire Council is that the consequences of bringing in a living wage for care workers are improved recruitment and retention, a reduction in sickness rates and progression into higher standards and sectors. The workers see it as a job with a worthwhile career path, rather than a temporary occupation while they wait to get a better job.
The Scottish Government’s commitment through the cabinet secretary today is a good first step. It is not a complete commitment, and I understand the difficulties, but the agreement to put the full costs into the Scottish Parliament information centre is helpful. I think that we estimated that it would cost about £60 million, so the £25 million to which the cabinet secretary referred will not do the job. Nevertheless, it is a practical step in a direction on which we are all agreed. However, we must move quickly if we are to achieve that shift in the balance of care. Of course, I am talking about a real living wage, Mr Carlaw—not Osborne’s Tory living wage, which is in fact a new minimum wage.
Audit Scotland predicted in 2011 or 2012 that if we failed to shift to prevention, the resulting requirement in the acute sector would be an additional 6,000 beds. We clearly could not afford to do that, so the integration of health and social care is vital. We must have new models of secondary prevention, which is the care that many members have been talking about.
The royal colleges indicate that as many as 35 per cent of hospital beds are occupied by patients who do not need to be there. I am not talking just about delayed discharges but about the many patients who should not be in hospital in the first place. Our challenge is to achieve that with the new integrated joint boards.
I understand that, since 2008, we have had the integrated resources framework—IRF—as a method to determine the budgets on which the IJBs base their plans. I further understand from the Audit Scotland report and also answers that I have received that, through the Information Services Division, we have the health and social care data integration and intelligence project—HSCDIIP—which is an extension of the IRF dataset. Will the cabinet secretary agree to publish the HSCDIIP data? We need to see what the budgets are that make up the £8 billion to which she referred.
As the Labour commission said,
“Integration in itself will not bring about the desired shift in the balance of care. The pressures on the acute hospital sector will not be resolved without greater investment in the social care.”
That is the basis of our motion.
Will the member take an intervention?
I do not have time. I am sorry.
The member is in his last minute.
We need to have some quick hits. I would suggest that IJBs should be told to commission in two areas fairly rapidly. One is building on the very welcome programme started by Labour and developed much more fully by the SNP Government: falls prevention. If we could assess every frail person and give them the tools to deal with falls, we could prevent a lot of problems developing.
We will be debating primary care next week, so I do not propose to go into that subject matter—
I have to ask you to come to a close, Dr Simpson.
I am coming to a close, Presiding Officer. We must have early front-line hits, because unless the front-line staff buy into the integration, no matter how many integrated frameworks there are, they will not deliver. We know from the English experience that we need to deliver good hits quickly on the front line. Part of that is to get the living wage for our social care staff as a matter of priority.
I am afraid that I will have to ask our next three speakers to keep to their six minutes, please.
16:09
This SNP Government has a strong record on supporting health and I am sure that it will continue to do everything in its power to make sure that the people of Scotland have access to the best healthcare available and that no group of people are overlooked. The First Minister has confirmed that health is a priority of her Government, which I welcome.
The integration of health and social care services is one of the most ambitious programmes of work that the Scottish Government has undertaken. As has been said, the Government will provide more than £500 million over the next three years to help partnerships. Integration will deliver sustainable health and social care services for the future that are centred around the needs of patients.
The Scottish Government is taking action to develop social care and to provide support for all who require it. Although the UK Government’s spending review falls far short of the ambitions of the Scottish Government and the SNP, spending on health and social care in Scotland has increased over the years for which the SNP has been in government, and it is now around £12 billion. The fact that just over a third of our total budget is spent on health shows the Government’s commitment to health.
However, I agree that we must have a desire to invest more in health. The population of Scotland is expected to rise to a record level of around 5.7 million by 2039. The average age of the population is also expected to rise, and older people are expected to live longer than ever before, which I welcome. In fact, the number of people in Scotland who are 75 or over is due to increase by 85 per cent by 2039.
As people are living longer, they are more likely to have more complex needs and to develop long-term and multiple conditions. That means that demands and pressures on health and social care services will increase. According to the Marie Curie briefing—for which I thank the organisation—an analysis by NHS Forth Valley of the impact of an ageing population on demand for hospital beds shows a projected increase in demand for bed days for those aged 65 or over from around 2,500 in 2014 to more than 4,600 by 2035. That is an increase of 84 per cent. Therefore, we must do more to provide integrated social care to meet demand.
That is why I believe that, whenever possible, we should increase investment in social care to help to ensure that people who are living with a terminal illness have the best possible quality of life. Ninety per cent of palliative care in the final year of life is delivered in the community. It can be provided in different places, including the home, a care home or a hospice. The provision of palliative care can involve many social care staff, including home-care workers, social workers and nursing and care home staff, as well as family members and informal carers. They all play a vital part in ensuring that people can be cared for at home for as long as possible, and can die there if that is their preferred place of death.
A review by the London School of Economics and Political Science estimates that providing palliative care to those who need it could generate net savings of more than £4 million in Scotland. We could use that money to ensure that more people in Scotland are healthy and receive the best possible care.
As we adapt to an ageing population, the role of carers and care workers will become even more important, so there is an overwhelming economic, social and moral case for continuing to improve the services that are offered to all carers. The Carers (Scotland) Bill will, for the first time in Scotland, enshrine the rights of carers in law. It proposes a range of measures to improve and expand support for carers. The Government has shown its commitment to ensuring that we look after our carers and care workers and appreciate their tireless efforts. In all aspects of what they do, all carers are true heroes, and I commend all of them for the work that they do each and every day.
Health is a vital issue that cannot be caught up in the political process. It annoys many people that parties play political football with health; it certainly annoys me. People are always going to get sick, so it is our job as a Parliament to ensure that patients and providers of care receive all the help that they can get.
Will the member give way?
I am sorry—I have no time.
We all want to invest more in all aspects of health and to ensure that people who are living with a terminal illness have the best possible quality of life. We must not sit idly by and wait for a problem to arise; we must take the lead and make sure that the people of Scotland and the workers who care for them receive nothing less than the best healthcare and—most important of all—our support.
Mr Doris, if you still wish to speak after Mr Chisholm, could you press your button, please?
16:14
I do not like health to be a political football, either, but in that regard I think that it is useful to look at what Audit Scotland has to say, as it is very much above party politics. In one of its recent reports, “NHS in Scotland 2015”, it says that
“There is limited evidence of progress towards achieving the 2020 vision”,
but it goes on to say that what it has in mind is the failure to shift significantly to
“preventative and community-based services.”
Another Audit Scotland report, “Health and social care integration”, which came out earlier this month, has been referred to quite a lot this afternoon. The cabinet secretary is right to point out in her amendment that some progress has been made, but what alarmed me about that report was what it had to say about budgets, which are key to successful integration. It said that councils and health boards were
“having great difficulty in agreeing budgets”
and that there was “a risk” of health boards and councils seeking
“to protect services that remain fully under their control”.
That set alarm bells ringing for me.
The member has said that budgets are very important, but is having a culture change that works alongside those budgets not just as important?
The two are inextricably interlinked, because I take it that the reason for the budget difficulties is that health boards and councils are trying to hang on to their own budgets.
The Audit Scotland report on health and social care integration also makes specific comments about set-aside budgets. I do not have the time to go into that issue, but I hope that the cabinet secretary will look at all such matters, because that, for me, is the main problem highlighted in the report.
Audit Scotland also highlights two other issues that are relevant to the commission for provision of quality care, whose report for the Scottish Labour Party is just hot off the press. The first is the difficulty in recruiting social care staff and, in that respect, the Audit Scotland report makes particular reference to “high living costs” in Edinburgh. Of course, the answer to that—or, at least, a significant part of it—is the living wage and the development of a well-paid, well-trained, professional workforce, as highlighted in the commission’s report.
The other interesting comment in the Audit Scotland report is that
“the arrangements for localities are relatively underdeveloped.”
The section on decentralisation in the commission’s report for the Labour Party is perhaps the most radical of all its proposals, because it talks not just about locality budgeting but about building incentives into that budgeting. That report, which has been published today, contains some interesting and original ideas and I think that it will repay study by all parties, notwithstanding the fact that it was produced by a commission for the Scottish Labour Party.
How the budget is devolved is very important, but clearly the key issue in the debate is the overall budget, and Labour’s proposal in that respect is for the health consequentials—or, at least, the majority of them—to go to social care. That will happen not at the expense of hospitals but, crucially, to help them, among other things.
What is happening in my home city of Edinburgh illustrates that better than anywhere else in Scotland. I do not want to look at the overall figures for delayed discharge or the bed days occupied by delayed discharges, but I have noticed that Edinburgh has far more such bed days than any other local authority in Scotland. For example, from July to September this year, Edinburgh had 24,466 bed days occupied by delayed discharge patients; on that occasion, the next on the list was Fife, with just over half that figure. From July to September last year, the number of bed days occupied by delayed discharge patients in Edinburgh was 23,965, which was way ahead of the second authority, which—interestingly—was Glasgow. The cabinet secretary was therefore perhaps right to commend Glasgow for its progress over the year.
I would argue that those figures highlight the fact that Edinburgh is a special case, and I hope that special support will be given to it. After all, there are special factors such as the difficulty of recruiting social care staff, the absence of care home beds and the cost of living.
I can reassure Malcolm Chisholm that, as I understand it, considerable progress has been made in the latest discussions between the City of Edinburgh Council and NHS Lothian on a plan to significantly reduce those delayed discharges. I hope that the member will welcome that.
I am glad to hear that. I had been told that the figures went down in November, and I am looking forward to hearing more about that at the meeting with the health board on Friday.
I was going to highlight a good example from Glasgow, but I do not think that I have the time to do so. I will say that, at the cross-party group on health inequalities, we had a very interesting presentation on the community connections project in Glasgow, which seemed to be a very good example of preventative spend in the community that involved the voluntary sector. Clearly, we need more of that sort of approach, but I think that that will be difficult for Edinburgh without additional financial support.
I turn to Jim Hume’s amendment. I have already pointed out that our motion talks about the “majority” of the consequentials going to social care. Jenny Marra specifically said that a considerable amount of money would go to mental health. All of that will go through the integration joint boards, of course, because mental health, particularly community mental health, is the responsibility of those joint boards. Jim Hume and others might be interested to look at Labour’s radical motion on mental health in the UK Parliament today, because it is very interesting. It includes a reference to a right to psychological therapies.
Will the member give way?
I have no time to give way, as I am in my last minute.
I have certainly had a lot of concern about the availability of psychological therapies recently. I think that one of my constituents waited almost a year for cognitive behavioural therapy. She told me last week that, after all that, all that she was offered was an occupational therapist. She is so disgusted that she is not going to access mental health services from the NHS again.
I think that my time is up. There are very reasonable and sensible proposals in the Labour motion, and I hope that the Scottish Government will adopt them, if not this week then next week.
16:21
I want to spend much of my contribution addressing the matter of care workers.
In recent months, I have had direct experience of the wonderful job that care workers do for the frail and the vulnerable in their own homes and in the residential care sector. Care staff have provided a vital and compassionate service for me and my family, and I place the highest possible value on that care.
As a Glasgow MSP, I apologise for wanting to comment on the living wage in relation to West Dunbartonshire Council, as it provided the care for my family. It pays its care staff the living wage, but it also acknowledges that other services that it contracts out to other providers do not necessarily do so.
I want to put on record in Parliament a quote from the West Dunbartonshire Council Labour group’s website:
“COSLA has been working with the Scottish Government and the private sector employers to come up with a funding package that would allow for an expansion of the Living Wage.”
A variety of other things are said, and I picked out another one:
“In January 2015, COSLA”—
which obviously includes West Dunbartonshire Council—
“agreed in principle to a £40m investment package to address low pay in the social care sector.”
A potential sum of £20 million from Scottish Government funds, as well as £10 million from employers and £10 million from local authorities, was mentioned.
I mention that because although we all use the living wage as a political football from time to time, we all agree that we want to deliver the same thing. I put on record the Scottish Government’s firm belief that it cannot force employers to pay the living wage. Employment law is reserved, and the European Commission has confirmed that any requirement on contractors as part of a public procurement process or public contract to pay their employees a living wage that is set at a higher rate than the UK’s national minimum wage is unlikely to be compliant with EU law.
I put that on the record to say that there is not a contest. The Scottish Government seeks to work in partnership with local authorities and the third sector to deliver the living wage, so when we have a debate about that, it is sometimes a little bit of a phoney war. Again, I put on record my firm belief that there should be a living wage for the care sector.
The member talked about West Dunbartonshire, which is my constituency area. The local authority wants to implement the living wage and sees its benefit. Surely we should use the social care money to do that and also to do much more on prevention. I do not see us as being apart on that. I just hope that the cabinet secretary is listening to the unanimous view across the chamber—between Bob Doris and me—on what the money should be spent on.
I hope that we can keep a unanimous view when I come to talk about Barnett consequentials in health and social care expenditure and consistency on that. However, Ms Baillie has put her point on the record.
I want to talk about health and social care integration. The £8 billion fund is being managed jointly by the NHS and councils. There will, we hope, be better-planned services, opportunities for service redesign and a focus on community healthcare prevention and early intervention. There will be £500 million over three years to support that process, including £300 million for an integrated care fund.
It is often said that, with health and social care integration, money will lose its identity. Maybe it should also lose its political identity. It is not Labour’s money or the SNP’s money; it is money that we spend on behalf of the people of Scotland. However we spend it, we can only spend it once.
The plea to pay all care staff a living wage is absolutely valid. I have outlined the barriers to making that compulsory and I also put on record the fact that there are genuine cross-Government discussions to deliver and support the living wage. I hope and expect that those discussions will continue in integration boards when they take forward their pay policies. When we deliver the living wage for care staff, it will not be a Labour or an SNP victory; it will be a victory for the public sector in Scotland and the contracts that it commissions.
The motion calls for Barnett consequentials for health and social care and the prioritisation of the living wage for care staff. That plea is valid only if those things can be delivered in an honest, frank, consistent and budgeted way.
I will talk about two things that have cross-party support in the Health and Sport Committee that the proposals in the motion could take money away from. First, palliative care in Scotland, which we had an inquiry into, is the best in the world, but it falls short of anything that we would want to see in a humane society. Money needs to be spent on that, and other politicians will make pleas for that to happen.
Secondly, the Health and Sport Committee is looking again at access to new medicines. That has dramatically improved, but there are still medicines that are not being approved and whenever that happens, there will be cat calls from members and calls for more funding.
With regard to the Carers (Scotland) Bill, we heard calls for additional financial support for carers, and we heard the same calls regarding self-directed support and the recruitment and retention of GPs in our deprived areas. To that list, I could add money for allied health professionals, nurse specialists—again and again, more and more.
There will be an investment of £200 million for five new specialist surgical centres for frail older people to have hip replacements and cataract operations to enable them to stay in their homes. That money will be spent.
Draw to a close, please.
We all want the living wage for those in the social care sector, but when we come to this chamber, let us not spend the same money five, 10, 15 or 20 times. Care staff in Scotland will see right through that.
You must close, please.
Let us work in partnership to deliver it and have consensus on doing that.
Thank you. We come to the winding-up speeches.
16:27
I have heard what members have said about the challenges of integration. There are less than five months to go until health and social care integration goes live, and the state of the planning concerns not just me but members across the chamber. Eight billion pounds will be jointly managed by integration authorities, yet, as of October, only six of the 31 were able to provide their budgets. I do not know whether there is any update on that figure today. Much information, co-operation and co-ordination is still missing, and existing problems, such as staff shortages, persist.
There was no mention of mental health in either of the other parties’ amendments or the Labour motion. I welcome John Mason’s support for my amendment and I hope that he will vote for it at decision time. I also welcome Dennis Robertson’s comment that mental health is a complex issue. It is a complex issue. We often talk about it as if it is just one thing, but it is far more complex than that, so I welcome those comments.
Jackie Baillie mentioned £59 million and Jenny Marra said that I should have read Labour’s press release. I am quite busy at the moment, as members can imagine, so I do not get to read all of Labour’s press releases, but the figures there do not quite add up. Of the £400 million, £200 million is going to social care; inflation takes up £120 million; and £59 million is going to mental health. In the Scottish Government’s draft budget, there is a real-terms reduction of £11.2 million, which leaves about £9 million to tackle the problems regarding GPs and accident and emergency that Glasgow university described. Perhaps Labour members will get calculators for Christmas.
Not only those with the most severe conditions are affected. Mental health issues affect veterans, people in rural areas, NHS staff and schoolteachers. We have teenagers with eating disorders and middle-aged men and women who are suffering from depression, and those are just two of the mental health problems that people live with. We are only beginning to tackle the stigma for some groups, and others remain largely unable to seek help.
At last night’s meeting of the cross-party group on rural policy, it was highlighted that those in rural communities are less likely to refer themselves when they have mental health problems. Sickness absence rates for NHS staff are at their highest since 2008, with more than 5 per cent of staff absent from their post this year for health reasons. Mental health is part of that rising problem, as pressure and stress take their toll on overworked staff.
It is only right that we put mental health conditions on a par with other conditions. In turn, that will decrease staff absence rates, increase preventative support for patients—that is mentioned in the Audit Scotland report and our amendment—and play a significant role in decreasing inequalities across Scotland.
The Royal College of Nursing notes that demand for NHS services is outstripping the available resources, putting staff and patients under huge pressure. Just last week, we saw the vacancy rate for nurses rise, and the RCN says that it is “at unsustainable levels”. The 2,400 nursing and midwifery vacancies will not help with integration. Audit Scotland points out that one of the biggest challenges for integration boards remains the recruitment and retention of GPs and care staff.
Real-terms spending on the NHS is falling. A look at GP spending shows a reduction of £11.2 million on last year. The Royal College of General Practitioners warns that 20 per cent of GPs could retire during the next session of Parliament, while the BMA found that one in three GPs in Scotland is hoping to retire in the next 5 years. The recommendation for the Government is to support integration authorities by sharing lessons that are learned from GP clusters, but that cannot be put into practice if there are not enough GPs to take that guidance forward. GPs must be at the heart of integration plans, but they are in short supply. Localities and clusters offer many benefits, but I fear that the Scottish Government is putting the cart before the horse, with limited GPs to staff the changes.
The NHS is at risk of becoming unsustainable. If we allowed more resources to be used proactively and preventatively in the community, that would ease the tensions in A and E and acute psychological services and the financial stretch that some NHS boards have been experiencing. At present, the care that is being provided is fragmented. Doctors cannot allow themselves the luxury of time to consider the wellbeing of their patients holistically; they can only really address parts of their health.
The Mental Health Foundation notes that up to 30 per cent of GP consultations contain an element of mental health, and the integrated care network points out that
“Coordination ... is especially important for people with mental health”
issues,
“who often require support from a variety of organisations”.
Yesterday, we read that there continue to be
“considerable variations”
in healthy life expectancy
“at birth ... among different geographical and socio-economic groupings.”
I do not see how we can reduce inequalities if we leave mental health on the back burner and do not structure our services in such a way that the unconcerned unwell are also taken care of.
We have an opportunity to take health and social care to a level of fully inclusive and preventative support. Despite that, however, Audit Scotland notes that there is only limited evidence of a shift to more community-based and preventative services. There are now 61,500 people requiring more than 700,000 hours of care in Scotland, and that excludes 24/7 care. In the meantime, more than 500 people have waited for more than two weeks to be discharged because care was not available to them.
You must draw to a close, please.
I call today for more attention to be paid to mental health. Labour’s call is not a wise one as it risks going against mental health, GPs, A and E and everything else. We must ensure that mental health services stop being Cinderella services, and the Scottish Government can start by recognising the need to increase investment in mental health.
16:34
About 15 to 20 years ago, I took my young sons, as they were at that stage, to a duck farm in Berkshire. There was a quite magnificent species down there called a Fifi duck. It had a terrific, magnificent crown on its head, and I watched it in the water. It was very proud, and it had a clear sense of where it wanted to go. As I watched it over time, however, it just went round in circles. Actually, it got nowhere at all.
I am increasingly of the view that we have a Fifi duck Administration here in Scotland. That is not to disagree about the strategic objectives or where the Government wants to go on health. Unfortunately, this is not a disagreement about strategic objectives; it is a concern about the Government’s ability to follow through and deliver on the objectives that it sets. That is where there is increasing concern and criticism in the Parliament.
I note that Mr Carlaw said that he had to go somewhere else to see the ducks. Is he one of the few Tories who does not have his own duck house?
I have a river that runs through the bottom of the property—although it is not mine.
I am increasingly concerned about delivery. If we are to achieve the strategic objectives, it is the follow-through, the management and the leadership in directing the process to a conclusion that is important.
It is not all bad news. I thought that the cabinet secretary set out, quite fairly, a number of ways in which progress is being made. However, she denied that there was any complacency on the part of the Government. I will read out the cabinet secretary’s amendment. It proposes that the Parliament
“recognises that NHS staffing and funding are at record high levels; supports efforts locally and nationally to successfully implement health and care integration; shares Audit Scotland’s analysis that good progress has been made toward integration and that it has widespread support; welcomes the Scottish Government’s commitment to enhance health and care; notes Audit Scotland’s recognition that the Scottish Government has provided significant investment to improve integrated care, and endorses working with the care sector in progressing the living wage, noting that additional funding has been provided toward its achievement and associated fair work measures.”
Where in that amendment is there any reflection of Audit Scotland saying that there are significant risks? Where in it is there any recognition that there are issues of any sort whatsoever? Irrespective of how the cabinet secretary would like to present it, the Government amendment evinces that complacency that we always have when it comes to being able to demonstrate the real progress that is being made on the issues.
When we heard from witnesses at the Health and Sport Committee’s first evidence session on the move towards social care integration, that was apparent. There were about a dozen people round the table representing all the different parts that have to be brought together and made to work effectively if the measures are going to operate. As Nanette Milne mentioned, we spoke about the problems with the CHCPs and about how, if the process is not properly managed and led, various parties might effectively end up walking away. We recognised that there is a window of opportunity, while we create the new arrangements, to get them right. If we do not do that—if the process freezes at some point midstream—what we have will not be what we intend to have.
I do not have time to quote from our RCN briefing extensively, but it concluded:
“Our health and care services are creaking at the seams. The need to shift care from our hospitals to the community is widely acknowledged, but on the ground there has been little or no action to make this a reality.
We must look at different ways of delivering services to ensure that people get the care and support they need. Investment in nursing and other staff to enable this to happen is key. This will ensure that the NHS is put on a sustainable footing for the future while also meeting the Government’s 2020 vision for care at home.”
We agreed that 2020 vision in 2011. We are nearly into 2016 and, in the next parliamentary session, we will obviously be considering major service change in primary care. If we are going to have confidence that we can make meaningful progress on that, we have to be convinced that we are making meaningful progress on the delivery of what is a very important change.
I will touch on some of the other things that have been said. It would be ungracious not to applaud the Liberal Democrats’ focus on mental health, but Mr Hume cannot abrogate to himself concern for mental health in the Parliament. Throughout all the years that the Parliament has sat, members on all sides of the chamber have been passionate about bringing an additional focus to mental health.
Will the member take an intervention?
Frankly, it is a false accusation to suggest that there is a lack of interest from others. It is not enough to say that the Labour Party has abandoned mental health—that does not help the argument at all.
Will the member take an intervention?
I will not give way. Mr Hume has spoken twice already.
On a point of order—
For him to say that he is too busy to read the Labour motion is extraordinary.
Will the member give way? Point of order, Presiding Officer.
This is the first Christmas in 16 years that there are no Liberal Governments in power anywhere across the United Kingdom.
Point of order.
Mr Carlaw.
Mr Hume has all the time in the world to—
Mr Carlaw, Mr Hume is making a point of order. I have to ask you to take your seat.
What is your point of order, Mr Hume?
Thank you for taking the point of order, Presiding Officer. Twice in the last 10 seconds, Mr Carlaw has misrepresented my words in this Parliament. [Interruption.] At no point did I say that other parties took no interest in mental health; I stated only that none of the amendments—or the motion—stated anything about mental health, aside from our amendment.
Mr Hume, could you hurry up, please? If you have a point, could you please make it?
The other point was that Mr Carlaw said that I did not have time to read the motion. I said that I had not had time to read Labour’s press releases.
Mr Hume, as you know, that is not a point of order. Also, I do not appreciate points of order in the middle of speeches, as members will know. [Interruption.] Order, please. I did not have any choice about taking it because, as members also know, if a member makes a point of order it has to be heard.
I will nonetheless, Presiding Officer, help you by coming to a conclusion and leaving one or two of the other points that I was going to make for another day.
A constituent wrote to me and, in a rather Freudian slip, he said that “Nicola Surgeon” is the highest paid politician in the United Kingdom and, for that pay cheque, we need her to deliver. What we need if we are going to achieve delivery is a surgeon to cut through the complacency that exists and ensure that we move to the delivery of health and social care integration and delivery on all the other areas of health that we know we need to make progress on.
I am concerned that, although the strategic objective is there and there is agreement across the chamber on it, the delivery is weak.
16:41
I have never been compared with a Fifi duck. I would not even know what one looks like. However, I think that that comparison is a bit rich coming from a lame duck opposition.
Members: Oh!
I promise not to make any more duck references. However, I will say to Jackson Carlaw that he is right that we have to deliver and I can assure him that, as Cabinet Secretary for Health, Wellbeing and Sport, I am very much focused on delivery, whether that is making sure that our A and E departments improve their performance—I have been very focused on that over the past few months and on getting the winter plans that we need—or tackling delayed discharge and making sure that integration joint boards work effectively.
I am absolutely focused on delivery because, as other members have said, it is crucial that we get integration right. A lot of time, energy and resources have been invested in what is one of the biggest reforms of our health service, so it is important that we deliver progress and that we get it right.
I will come back on as many comments as I can within the time available. As regards Jim Hume’s comments on mental health, I am sure that he will recognise that we are already committed to investing an additional £100 million over the next five years to help achieve some of the improvements that he outlined, whether that be investment in child and adolescent mental health services, in access to psychological therapies or in mental health services in the primary care setting. It would be wrong to suggest that there has not already been a significant investment in mental health, but there is always more to do. I accept that, and that will work its way through as we discuss the budget.
Mark McDonald mentioned the removal of silos. He made a valid point that it is not just about the silos between health and social care but about silos within health itself. We have to make sure that primary and secondary care are working in a way that produces the required outcomes. He rightly referred to some of the particular challenges within Aberdeen city on tackling delayed discharge. Despite some of the recruitment and retention issues around capacity that are due to the market conditions there, Aberdeen is continuing to make progress in reducing delays. However, we need to see more progress.
Rhoda Grant mentioned the role of unpaid carers and the need to support them. Of course we all agree with that. That is why the Carers (Scotland) Bill, which Jamie Hepburn is taking through Parliament, is so important. The bill comes with significant resource attached—by 2021, up to £88 million of additional investment will be made in supporting the aims of the bill. It is important that we recognise that.
John Mason talked about the need to ensure that we give priority to primary care and GP services that operate in deprived areas. I am sure that we will talk more about that next week. I have said in the chamber on a number of occasions that I agree with that. As we progress with the negotiations, we need to ensure that the funding reflects more fully the challenges in those areas.
Jackie Baillie talked about the need for investment in social care and prevention. However, it is important that there be consistency in relation to that. Here comes the rub: she does not write asking me to invest more in social care and prevention; she writes demanding that I spend more in acute services. She wants a new A and E department in her area.
We cannot have members coming to the Parliament demanding that we spend the budget in one way while demanding in their own areas that we spend the budget in a different way. The two things are not compatible. If a decision is made to invest in social care, we cannot spend the same money on building new A and E departments.
The cabinet secretary might need to be reminded that her budget is £12 billion. We are talking today about allocating up to £400 million, less mental health consequentials, on doing something that will prevent people from going to hospital. The separate demand for a new A and E department is a long-standing one from my community, and she is wrong to dismiss it—it is about how services are provided near where people are. To be frank, the cabinet secretary makes a mistake if she positions one against the other. That is simply wrong.
No, Jackie Baillie is wrong in that I am not dismissing the claim. I am merely stating that we cannot—[Interruption.]
Order. Let us hear the cabinet secretary.
We cannot spend the money twice and, if the money is to be prioritised for social care—[Interruption.]
Order!
—Jackie Baillie cannot come to the Parliament demanding that money is also spent on acute services. There are choices to be made, so Jackie Baillie has to be consistent in what she calls for. [Interruption.]
Ms Baillie!
There is not a money tree at the bottom of the garden for any of those things. Priorities have to be set and, if there is agreement that health and social care integration is the priority, it means that the money cannot be spent on other things. That is just a fact.
Dennis Robertson spoke about using digital technology to make improvements in health and social care. I agree with that. We have to ensure that we have to use digital technology to make the systems work more effectively.
Richard Simpson asked whether the data in the HSCDIIP would be published. The answer is yes. It is already in the public domain, but I am happy to write to him giving him the information in more detail.
Bob Doris talked about competing priorities and the need to ensure that areas such as palliative care are resourced. We have already announced that we will support the palliative care framework, and we have allocated additional resources to that.
You need to wind up, minister.
This has been a consensual debate. It has been helpful, but members need to follow through on their rhetoric. [Interruption.]
Order.
If decisions are made to allocate resources in a particular way, members cannot come back and demand that the same money be spent in 100 other ways. That is a fact and that is how budgets work. I hope that Labour will continue in a spirit of consensus as we take the matter forward.
16:49
I am wondering whether I have been in the same chamber as the cabinet secretary for the past couple of hours. She came to the conclusion that we should have substance over rhetoric with no sense of irony whatsoever. My word, the cabinet secretary needs to reflect on that.
It was a pleasure to listen to Dr Simpson’s commentary today; he has a complete grasp of the issues. I forgive him for calling me Dr Findlay earlier. I know that he is stepping down at the election, and the Scottish Parliament will be poorer for the fact that he will not be here to comment on such vital matters as the integration of health and social care. We will not write his political obituary quite yet, but his contribution today was very powerful.
I will come to the challenges in the health and social care system, which Jackie Baillie set out, in a minute, but I must start by saying that high-quality social care for our elderly and vulnerable citizens is one of the most important and pressing issues affecting our society.
Jenny Marra, Nanette Milne and the cabinet secretary all mentioned the Audit Scotland report. Of course, reports can be, and are, spun by politicians in many ways. We can all do that, and we can all talk about structures and management issues. However, the reality is that, as a society, we are failing to provide decent care for our older and most vulnerable people, and the Government is failing to deal with a crisis that is going on here and now.
Last year, the Scottish Government claimed in its discredited white paper on independence, “Scotland’s Future: Your Guide to an Independent Scotland”, that it would
“continue to provide ... world-leading ... social care”.
I ask the cabinet secretary to reflect on that statement, because that is not the lived reality for so many people and their families; for social care staff who are trying valiantly to do the work that they love; or for councils that are bled dry of funds with yet more pressures heaped on them.
Today, more than 61,000 people receive more than 700,000 hours of part-time care a week, which equates to an average of 11.5 hours per person. On top of that, there are others in long-term residential care. There are 141,000 care workers who provide that care. Care is a big employer, and the sector is only going to grow and grow.
Those numbers prove what we already know: that social care is an area that impacts on all of us. We all know or are related to someone who is either receiving care or who works in the sector. Indeed, many of us will depend on the care sector to look after and care for us at some point in the future—for some of us possibly sooner than for others, but I will not go into that too much. We have a growing elderly population, and many people are living longer with multiple conditions. That is all happening at a time of social care integration, running alongside huge cuts to public services—a perfect storm indeed. All the time, our hospitals are backed up with people who could and should be looked after at home in familiar surroundings.
As budgets have been cut, care has been privatised and standards have fallen. Care visits of 15 minutes, which were originally designed as a management tool, have become the default allocation of care time. Contracting has driven down costs to the extent that the sector is now typified by low pay, job insecurity and poor conditions. Many staff who love their job and go well beyond the call of duty to provide care are at breaking point or have left the sector altogether. They feel undervalued, and they have little job security. They do not get paid for travel, some do not get paid for their uniform and some have to pay for their own mobile phone calls. That is the type of system that we have created. Time and time again, we hear of care staff leaving to work in supermarkets or shops, or in other types of employment—anywhere else, because they cannot live and bring up their families under such conditions.
Mark McDonald said that he wanted care staff to speak out positively about their jobs, and Richard Lyle said that care workers were “heroes”. Let us listen to what some of those heroes are saying. This information comes from a staff survey by Unison 18 months ago, and the situation will have got worse since that survey was published. The survey reported that the majority of workers believed that the service that they provided was not sufficient to meet the needs of the people whom they cared for, in relation to both the time that they can spend with clients and the quality of care that they can provide, with 44 per cent saying that they had very limited time for doing their work so there was a limit to how much time they could spend with their clients. One carer said:
“I have to just rush from one house to the next. It’s very, very stressful. I have told my manager but nothing is done.”
Another said:
“We are not able to deliver the care we are trained to do and want to give/should be delivering to our service users.”
Another said:
“Rush rush rush, I think they forget we are dealing with human beings, old ones at that.”
Another said:
“I’ve been a carer for 16 and a half years ... I am old school, I spend time with my clients, and therefore if I am over my time”—
so be it. The carer continued:
“These are people who rely on you”,
so the carer cannot just go “in and out” and has to have
“a couple of minutes for a wee chat”
because
“it makes their day”,
and they do not want
“rushed about in the morning or evening.”
If we speak to care staff, we find that such stories are repeated time and again.
We know that 39,000 care workers out of the 141,000 working in Scotland receive less than the living wage. That is no way to treat staff in this vital sector. All of that impacts on the care provided.
We hear all the time about people not knowing which carer or how many carers they will see in a week, or even sometimes in a day. They do not know whether the carer who starts one week will be there the next week. That is not good for the continuity or the quality of the care provided. How can we build relationships between the carer and the client in such circumstances? It simply cannot be done. One carer recently told me:
“Staff are not receiving the training they need to carry out their roles, we only get low cost basic training.”
I appeal to everyone to agree that that situation cannot go on. We cannot treat social care staff as if they were second-class or third-class citizens and then be surprised when the service that they provide is substandard, but that is what we are doing to our elderly and vulnerable friends and neighbours.
That is why we published today the report of our commission for the provision of quality care in Scotland, which was an independent commission chaired by David Kelly, the former director of West Lothian community health and care partnership. I thank Mr Kelly and the commissioners who sat on the commission and produced such a good report. The report is a challenge to us all. I am happy to provide any member with a copy of it.
In the report, the commission identifies the need to set out a new social contract of rights and responsibilities that are understood by our citizens; the need for greater devolution of budgets to local teams to develop local solutions with GPs, care staff, social workers and allied health professionals working together; and the need to elevate the status of social care to make it a valued career that people want to go into and remain in—rather than one that they want to get out of—with training and a proper structure. The commission sees the workforce as central to the future of the sector.
Of course, the biggest issue is cash. Some of this is as simple as money. We must put more cash into the care system, and Scottish Labour is committed to doing that. We recognise the vitally important work that carers do, so today we commit to a national care workers guarantee. Under that guarantee, we will ensure that 39,000 care workers gain from a living wage for all care staff, that all staff are paid for their travel, that zero-hours contracts are ended for care staff, and that the staff are well trained to do their job. All of that will improve morale and productivity; most important, it will improve the care that our mums and dads, neighbours and grandparents deserve. We need a service that is fit to address the problems and issues of the 2030s and 40s, not the 1930s and 40s. We commit today to provide extra money to the health and social care sector.
You need to bring your remarks to a close.
I will do, Presiding Officer.
It will be telling today if the Government uses its majority to vote down additional funding for the army of care staff who do so much good work.
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