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The next item of business is a statement by Maree Todd on the impact of UK Government decisions on Scotland’s social care sector. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.
14:51
First, I thank the dedicated and hard-working staff who work in social care. I am incredibly grateful for the work that they do.
My statement will focus on the far-reaching impacts of recent decisions by the UK Labour Government. However, before that, I would like to take a moment to reflect on how far we have come. Under this Scottish National Party Government, we have introduced free personal nursing care for every person over the age of 65; we are making strides towards effective sectoral bargaining with our trade union partners; and, rather than kicking the can down the road on social care reform, as we have seen from successive UK Governments, we are implementing changes through our Care Reform (Scotland) Bill, which will improve the life of every person who is in receipt of care. We have also continued to invest in social care, having increased spending on adult social care by 69 per cent between 2011 and 2024.
However, that progress is under threat from the decisions of a UK Government that is intent on delivering blow after blow to social care. The latest of those falls from the devastating and needless proposal to end new visas for those working in social care. For workers, for the many vital social care services and for the people in receipt of care, there is no other way to describe that than as catastrophic.
Scottish Care has said that the policy
“would not only be irresponsible, but it would also be reckless. It would put lives, services, and whole communities at risk.”
Providers in the independent and third sectors, who are grappling with the last round of visa changes, have now had the rug pulled from under them. A number of providers are reliant on international workers to fill critical vacancies. Already, Home Office statistics show that, since March 2024, when the callous and cruel ban on visas for dependants of care workers was brought in, there have been 81 per cent fewer applicants for health and care visas. Now, shockingly, Labour wants to reduce the number even further.
We are clear that migration is vital for supporting sustainable communities, our economy and public services in Scotland. Scotland needs talented and committed people from across the world to work here without excessive barriers.
I echo the views of the Coalition of Care and Support Providers in Scotland and reject the notion that social care staff are “lower skilled workers”. They are staff who provide critical and complex care to the most vulnerable people in our country, and for them to be labelled “lower skilled” is demeaning and disrespectful.
The immigration white paper represented a clear opportunity to redress the imbalances in the current system, and, through meaningful engagement, create a system that is flexible, forward thinking and well placed to promote economic growth across the UK.
We have consistently made the case for tailored migration routes within a single UK immigration system, and in March, we provided a set of policy proposals to the Home Office to feed into the white paper’s development. Shamefully, to date there has been no substantive engagement from the Home Office on any of the policy proposals that we contributed. The UK Government’s complete failure to engage with the Scottish Government underlines, once again, that Scotland is barely an afterthought for Labour. Now, more than ever, it is clear that Scotland needs full powers over immigration in order to properly support our public services.
However, we know that this is not the only challenge facing the sector. Over recent years, the social care sector has been hit by a whole host of issues: Brexit, Covid, increasing demand, the cost of living crisis and workforce challenges. Those have increased the risk to the continuity and quality of care and support for people across all communities in Scotland.
Despite that, in its autumn statement, the UK Labour Government took the decision to increase employer national insurance contributions and lower the threshold at which employers start to pay them. That reckless decision has placed a heavy and entirely avoidable financial pressure on our social care sector. My officials have estimated that Labour’s decision will cost adult social care alone more than £84 million. When you factor in the costs for directly employed, contracted and commissioned services across health and social care, the figure increases to over £300 million.
At every opportunity, the Scottish Government has vehemently opposed that disastrous decision. We have made our view very clear to the UK Government and called for additional support to fund those costs. That, sadly, has fallen on deaf ears.
In an extremely difficult financial environment, the Scottish Government has responded as best it can by increasing investment into both health and social care. This year’s budget sees a record £21.7 billion going into health and social care, which exceeds front-line Barnett consequentials. The investment will deliver reform and improvement across our services, driving efficiency and delivering the quality and access to services that people have a right to expect.
We have provided almost £2.2 billion for social care and integration, which is almost £350 million more than was set out in our previous commitment to increase social care funding by 25 per cent over the parliamentary session. We are uplifting pay to a minimum of £12.60 per hour for adult social care workers, reflecting the real living wage. We are providing an additional £125 million in order to make that happen, and we have invested an extra £5.9 million in the Care Inspectorate and an extra £13.4 million in our independent living fund. I am also pleased that the partners that are involved in the national care home contract were able to reach an agreement that delivers an additional 5.8 per cent for nursing care and 6.8 per cent for residential care, incorporating some of the increase in employer national insurance contributions, pay rises and inflation.
However, despite substantial funding increases, we know that the national insurance increase remains a significant concern for the sector. While we will continue to demand that the UK Government changes course on national insurance, it is becoming more and more apparent that Labour is perfectly content to balance the books on the backs of the most vulnerable. That is why we have wasted no time in working with local government and the sector to understand the impact of these changes, and explore what might be possible to help address the pressures.
We have provided targeted support through our collaborative response and assurance group, and the cabinet secretary has hosted monthly round-table sessions with the Convention of Scottish Local Authorities, provider representatives and local leaders. We have established a joint financial viability response group with COSLA to engage with key partners. The group has been meeting weekly since February and working at pace to identify the proactive steps that can be taken to mitigate the impact of increasing financial pressures, to protect services and to support people who are in receipt of care. That work is on-going, but we remain committed to exploring options and solutions in a collaborative way.
The new national care service advisory board will also work openly and collaboratively with integration joint boards, local authorities, health boards and organisations across community health, social work and social care in Scotland. It will have a vital role in strengthening transparency around spend and considering how effective spending on integrated health and social care has been.
Once again, I urge the UK Government to rethink, to fully fund the cost of the national insurance changes to social care and to work with us to deliver an immigration system that works for Scotland. To quote Scottish Care again:
“It’s like the UK government decided to make social care provision as hard as possible. National insurance is a nightmare, immigration changes are awful, disability changes will increase demand.”
These decisions cannot wait. In just the past month, we have been notified of five adult social care services that are closing, where the increases in national insurance were a major contributing factor. Those closures alone will result in the loss of more than 80 care home beds. Quite simply, we cannot stand by and allow the social care sector to be sacrificed. We will always work collaboratively, constructively and proactively to support the social care sector in the face of substantial risk. There is only so much that we can do. Without swift action from the UK Government, I fully anticipate that more care services will close and that there will be areas of Scotland that do not have access to social care. That might mean that some have difficulty in securing a care home placement or individuals being cared for many miles from their friends, family and community. That is not a future that I want to see, and that is why I find it heartbreaking that the UK Labour Government is prepared to accept that.
Thank you. I remind members that we are tight for time across the afternoon. It is unfortunate that the statement has slightly overrun. I still intend to allow around 20 minutes for questions, after which we will need to move to the next item of business. I invite members who have not pressed their request-to-speak buttons but who want to ask a question to do so now.
I declare an interest as a practising national health service general practitioner.
This is yet another SNP statement that passes the buck, never accepting any responsibility. Labour’s national insurance hike has financially devastated charities such as Scottish Action for Mental Health and Scottish Huntington’s Association, which support the care sector, and has directly plunged GPs, pharmacies and care homes into chaos. However, the SNP has failed the care sector for almost two decades, with a lack of workforce planning, a lack of proper investment and a failure to end delayed discharge. In fact, compared with a decade ago, we have fewer adult care homes, as 250 have closed under this SNP Government. It has also wasted £30 million—equivalent to the salaries of 1,200 care workers—on its failed national care service, and it has the brass neck to exalt its cobbled-together Care Reform (Scotland) Bill.
Social care staff are caring and compassionate; Scots are caring and compassionate. Why can the SNP not use some of the 125,000 unemployed Scots who are desperate for jobs to plug the gap, instead of relying on immigration?
I will respond to Dr Gulhane’s last point. Our social care staff are highly skilled, are regulated and have qualifications. It is somewhat insulting to suggest that people can come off unemployment benefit and straight into a social care job—
Train them, then.
That underestimates our social care workers, and the member’s suggestion does him, as a doctor in our NHS, a disservice—[Interruption.]
Minister, could you please resume your seat for a second? We will get through the questions only if the questioners ask the question and allow the minister to respond.
Yes, we are offering training for our social care service. To be fair, the member’s comment revealed a somewhat central belt focus. Some parts of our country—I represent one of them—absolutely do not have enough people. Immigration is relied on for more than 80 per cent of the workforce. To suggest that there are in the villages and communities that I represent young people who are fit, healthy and able to train in the skilled jobs that social care requires is a very challenging point to make.
On our support for social care, the member will be well aware that, in Scotland, our offer to individuals who seek social care is more generous than that in the rest of the UK. We provide more financial support through personal and nursing care payments, and we also pay our social care staff more. In fact, in Scotland, social care is a regulated profession, unlike in England. We have been investing in social care for a great deal of time.
I am saying to the Parliament today that there has been a sequence of appalling blows. I said to the Parliament very clearly at the tail end of last year that the ENICs proposal was likely an existential challenge for the social care sector; we now face the blow on immigration.
What the minister will not tell the Parliament is that Audit Scotland said that there is a £560 million black hole in the finances for social care this year, which is down to the SNP; nor will she tell the chamber about the £30 million that was wasted on a national care service bill that had to be renamed because it did not deliver a single hour of extra care, which is down to the SNP.
The minister will choose to ignore the fact that Scottish Labour has for four years demanded an increase in wages to £15 an hour to stop care workers leaving the profession to work in Aldi and Lidl, which pay more. That is down to the SNP. She will not talk about training some of the 119,000 unemployed Scots to fill the estimated 9,000 vacancies across all social care settings. That is down to the SNP.
Instead of addressing any of those issues and improving the terms and conditions of social care staff, the SNP simply blames someone else for its failures. After 20 years, Scotland needs a change.
The fact that Nigel Farage is praising Keir Starmer for copying his policies should shame the Labour Party, which is an increasingly unrecognisable party of austerity cuts, Brexit and hostile migration policies. The Labour Party’s damaging migration plans will leave communities across Scotland worse off by making it more difficult to recruit vital care workers, by squeezing economic growth and by harming Scotland’s valued international workforce.
Would one of the few Labour Party members who are in the chamber today like to tell me whether the £300 million that will be going directly from health and social care in Scotland this year and every year from now on will support social care in our communities or worsen the £500 million gap? [Interruption.]
I encourage members to ask questions and listen to the responses, rather than provide a running commentary.
In 2023, more than 58,000 overseas care workers came to the UK on skilled worker visas, representing nearly half of all new entrants to the social care workforce. Following the UK Government’s announcement of its proposed immigration reforms, Unison’s general secretary said:
“The NHS and the care sector would have collapsed long ago without the thousands of workers who’ve come to the UK from overseas.”
Does the minister share my concern that the UK Government’s decision to restrict recruitment from abroad will leave many providers with staff shortages?
I absolutely share that concern. It is not a question of whether those changes will leave providers with staff shortages; that is inevitable. In recent days, Scottish Care, CCPS, Care England, Renaissance Care, Unison and the Home Care Association have all been on record telling the UK Government that. Providers have been clear that international recruitment is critical and that the impacts of not having it will be felt by the most vulnerable.
It is simply outrageous that the UK Labour Government does not recognise the immense contribution that care professionals from all over the world have played in caring for our communities over many years. Those vital workers have cared for the most vulnerable in society and, with the Covid pandemic, in the hardest of times. Rather than thanking them, Labour has chosen to devalue and disrespect them.
We spoke to a group of chief executive officers of organisations that provide social care. They told us that they need to reduce their staff numbers just to keep their heads above water, yet the minister comes into the chamber and complains that recruitment is the biggest challenge that the sector faces, while it is having to shed jobs to stay afloat. Will she explain how she proposes to support care providers to retain existing staff in the face of the SNP’s cuts and Labour’s NI increase?
Let me be clear that the Scottish Government is increasing the funding to social care. We have provided record funding to the NHS and local authorities. That is how social care is funded in Scotland.
I beg to differ on whether the greatest challenge in our social care sector is finance or people; the answer varies in different parts of the country. I refer members to the SAMH briefing that was provided to us for a grasp of the scale of the challenge that the social care sector faces. The ENICs increase this year will cost SAMH £500,000, which it has to find from a relatively fixed budget. It cannot increase its charges to the public in the way that all other employers can. I have been saying for months that the ENICs challenge—the tax on jobs—will lead to redundancies.
I will need responses to be briefer.
The Coalition of Care and Support Providers in Scotland has warned that the UK Government’s national insurance hike is “a massive threat” and has said:
“We have absolutely no idea how we’re going to cover that bill.”
Will the minister update us on the Scottish Government’s latest engagement with social care providers about the impact that the hike will have on services?
As I set out in my statement, the ENICs increase is disastrous for social care, with care providers warning that significant numbers of providers could close their doors as a result of the changes from Labour. The situation has been described as an “existential threat” for the sector.
We have regular engagement on the issue with social care providers and stakeholders, such as CCPS and Scottish Care, through our financial viability response group. The Cabinet Secretary for Health and Social Care has hosted monthly round-table meetings with that group and with COSLA. The group is continuing to work at pace, and its next meeting is scheduled for tomorrow.
The message that we hear loudly and consistently from providers and stakeholders is that the UK Labour Government must reconsider this harmful decision and fully fund the cost to social care of the national insurance changes. I echo that call today.
It is ironic to hear the Government praise its work on the botched National Care Service (Scotland) Bill, which is now unrecognisable from what was first envisioned, with £30 million wasted in the process. Despite the Scottish Government’s warm words today, in reality, the social care sector has been ignored, underfunded and let down for 18 years by this SNP Government.
The UK Government provided funding to the Scottish Government to assist with national insurance contributions. However, we believe that local government has not received all its funding to date. Will the minister tell the Parliament whether all the moneys that were provided by the UK Government have actually been allocated?
As I understand it, that is absolutely the case. I can confirm that in writing if that would be of comfort to Carol Mochan.
On the £30 million—[Interruption.] I ask Jackie Baillie to allow me to make my point. I think that members in the chamber are just not understanding the scale of the threat that faces our social care sector. Carol Mochan raised the issue of the £30 million—£10 million per year over three years—that was spent on understanding and making improvements to the social care sector. Let us look at the scale of the national insurance bill for the health and social care sector in Scotland. This year and every year as we go forward, the bill is £300 million. That £300 million is going not directly to our health and social care sector but to HM Treasury.
Sadly, it seems that, once again, Scotland is an afterthought to the UK Government. Can the minister provide an update on any engagement that took place between the UK Government and the Scottish Government ahead of the announcement of the migration proposals?
I question whether we were thought of at all. Renaissance Care has said that the UK Government
“are shooting themselves in both feet”
with its policy. More care homes will close, delays and waiting lists will increase and it will directly harm the lives of vulnerable adults across the UK. However, for the already fragile systems in areas such as the Highlands and Islands, including the area that I represent, the policy is nothing short of calamitous.
The UK Government cannot say that it was unaware of impacts. We issued a comprehensive, evidence-based proposal document outlining Scotland’s needs to the Home Office during its development of the immigration white paper. There was no substantive engagement on any of the policy proposals that we submitted. Very clearly, the needs of Scotland’s communities have been ignored. The brutal truth is that the UK Government knows the damage that that policy will do, and it is doing it anyway.
We have six minutes and five colleagues who want to ask questions. We will need to get through the responses a little more quickly.
As well as preventing more migrant workers from coming here, the announcement this week will undoubtedly make those who are already here worry about the anti-migrant rhetoric that is rising across the UK. What work is the Government undertaking to prevent those staff from moving away from Scotland and to support them at a time when the toxic narrative around migration appears to be growing?
Gillian Mackay is absolutely correct to highlight the impact of the toxic narrative around migration on people who are already here—in fact, on people who have been here for generations. It is being felt very painfully. This morning, I had a meeting with NHS chairs, each of whom talked about the impact on the workforce. I worked in the NHS for 20 years, and I have to say that I welcomed the support, skill and talent of the many people with whom I worked who came from other parts of the world.
We talked about anti-racism work at this morning’s meeting. NHS Grampian has a great piece of anti-racism work, and I would be more than happy to meet Gillian Mackay to talk more about what our health and social care system is doing to make sure that those staff know that they are welcome here and that we value them.
On a note of consensus, I absolutely agree that some of the best care in our country is provided by care workers who have chosen to settle here from overseas. I also agree with the Government that not excluding social care providers from the national insurance contribution increase is a hammer blow. However, does the minister recognise that the actions that have been taken by her own Government, especially in relation to the failure to supply affordable housing to care workers and the massive gap in funding for social care, fall squarely at her feet and are causing the closure of homes, particularly in the Highlands, in communities such as those that she represents?
I absolutely recognise that the latest threats are not the only challenges that the sector faces. I acknowledge that. Alex Cole-Hamilton is absolutely correct to point to the sustainability of housing in rural areas as also being an issue. Again, we are working in a collaborative way to ensure that our health and social care sector is working closely with our local authorities in order to rise to the challenge, where it occurs locally.
On the gap in funding, I am proud to be part of a Government that has increased the amount of funding to social care. We have also increased funding to our national health service. We have given record amounts of funding to our NHS and to local authorities, which also means record funding to social care.
In Scotland, we pay our staff more. We value our social care staff. Of course I would like to go further, but the real living wage—to which the Government has been committed since 2016—is a substantial improvement on what is paid in England.
The minister and many colleagues have mentioned the UK Government’s employer national insurance contribution hike. That hike could cost the social care sector in Scotland £84 million a year. I think that the minister mentioned that the cost could even be £300 million. That is a huge cost for the sector, including in Dumfries and Galloway.
Can the minister reiterate how the Scottish Government is engaging with the UK Government on the issue and provide reassurance that the Scottish Government will continue to press it on the costs?
It is important that people grasp the scale of the issue. We estimate a cost of £300 million across health and social care, including GP contractors. The direct cost to adult social care is £84 million—it could be up to £100 million—and we estimate a cost of £30 million for the not-for-profit sector in Scotland. It is unbelievable. Those costs are for each and every year, and they need to be met only to stand still. There are 100 better ways in which I could spend that money.
At every opportunity, my ministerial colleagues and I have stridently opposed the issue. We have tried to engage with the UK Government. Our budget and funding will be spent on mitigating UK policies.
Almost 6,500 people across Scotland are waiting for a social care assessment—a number that represents real lives and real families. The Scottish Government says that it is investing money in care services, but what does that mean for people who are waiting for those assessments? When will people receive the care that they desperately need?
As I understand it, the number of people waiting for a care assessment has gone down year on year. I am more than happy to provide information on that. The situation is different, of course, if we pick certain months—particularly if we pick months in which we have faced a challenge. However, when we look at statistics because we want to learn about what is happening, we tend to look at the same point in each year and compare. Doing that shows us that, year on year, the number of people waiting for assessments is going down. However, I know that that is of no comfort to the people who are waiting for assessments, and I am determined to improve that performance.
The Labour Government’s plan to limit the number of international social care workers is only the latest measure from successive UK Governments that have damaged recruitment in the sector. Can the minister set out what assessment the Scottish Government has made of the impact of Brexit on Scotland’s social care workforce?
As members know, Brexit had a devastating impact on the Highlands and on Scotland as a whole. Scottish employers were more reliant on European Union workers than employers in many other parts of the UK, so the ending of free movement as a result of Brexit, which Scotland did not vote for, had a hugely negative impact on our public services and the Scottish economy. That is one of the fundamental reasons why there are so many labour shortages across every sector at the moment.
Brexit left the social care sector with less flexibility to respond to on-going labour supply challenges. Research by the Nuffield Trust highlights the broader negative impact on the UK health and social care sectors.
That concludes the statement on the impact of UK Government decisions on the care sector. There will be a brief pause before we move to the next item of business to allow members on the front benches to change over.
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