Chamber and committees

The financial delivery unit in the Scottish Government supports all boards on their financial performance, and there is enhanced support available to those boards that are furthest from balance. The number of boards in that category has reduced over recent years, and we are undertaking work, which is being led by Fiona Bennett, to provide an increased level of support to those boards that are in that position in order that they can manage their balances down while maintaining service provision.

A good example of that in recent times has been the escalation of NHS Grampian. I believe that the new leadership of NHS Grampian has been getting a very strong grip on the financial perspective while also focusing on improvements in service delivery. The Government helps to provide the assurance board process at level 4 that allows boards to have additional areas of support and to de-escalate when they are in a better position.

Ms Mackay is correct in her assertion. In the Finance and Public Administration Committee debate last week, the Cabinet Secretary for Finance and Local Government set out our position that employers should be responsible for statutory employment costs. That takes us to the minimum wage. We then fund the difference from the statutory responsibility to the real living wage.

I have received correspondence from Rachel Cackett of the CCPS. I also met COSLA’s political representative in this space, Councillor Paul Kelly. Discussions on the matter continue. We recognise the challenges in the social care sector. That is why we have increased social care investment to more than £2.3 billion. We continue to fund increases to social care pay. That takes us to more than £1 billion of investment in it. However, we also recognise the pressure that the sector is under, so discussions continue.

Equality impact assessments are completed across portfolio areas. That is the normal course of budget setting.

Discussions with the sector are on-going. In a very tight financial envelope, we remain committed to supporting social care pay that takes us to the real living wage. I do not believe that that is matched in all other parts of the UK. We continue to do that in spite of the difficult financial circumstances of the budget settlement.

We will continue to meet, and discuss implications with, the CCPS and other social care employers to ensure that we do everything that we can to support these critical services, which touch the lives of many families throughout Scotland, including mine.

There are two areas in that. The first relates to the migration policies of the UK Government, which are causing significant harm to service delivery in Scotland. Donald Macaskill has said so, as you say, convener. Health and care visa approvals from the UK Government are down around 80 per cent compared with those under the previous Conservative Government, which, given the population demographics in Scotland as a whole and particularly in certain parts, such as rural and island communities, is devastating.

Resource challenges exist in many health and social care partnerships—I recognise that. However, the largest challenge that the sector is facing is access to staff. When one route for that is being cut off by the UK Government in the way that it is, it makes it incredibly difficult to sustain services. We have made significant representations, as has the sector, to have those migration policies changed and, if they are not, to allow us to have our own rules around migration so that we can have a service that meets the needs of the people of Scotland.

Convener, you correctly referenced the impact that increases to employer national insurance contributions are having. Last year, that impact was estimated to be more than £80 million for social care providers—I do not have the figure for this year. Given our support for care wages going up to the real living wage, which we have just spoken about, that highlights the detriment to the service. We have called for those increases to be reversed or fully funded, neither of which has happened.

The challenge to the sector in those two areas alone is profound. They are areas that we have no direct control over. However, on the migration point, the committee will have noticed that, in autumn last year, we committed to introducing a scheme to support displaced international workers in other parts of the UK. That has been incredibly successful, and the First Minister announced its extension earlier this year to allow those who have visas and are in the UK but currently have no employment to find their way to Scotland in order to be able to contribute to social care services in Scotland. I am proud of the fact that we are doing what we can within the rules to support migrant workers in Scotland.

As a former committee convener, I recognise and place incredible value on the role of our committees in scrutinising Government, and I welcome the opportunity to be here to be scrutinised on the decisions that we are making.

I will bring in Ms Bennett again on the detail but, in the correspondence that I sent to the committee on pre-budget scrutiny, I set out a number of steps that have been taken to improve transparency in budget setting in the social care space and the mental health space, on which there was significant attention last year. We want to support that transparency. I have already set that out in my answer to an earlier question, but I am happy to bring in Ms Bennett to provide any more detail on the question that Ms Mochan raises.

I will need to double-check with Ms Bennett, but I believe that the real living wage funding has been baselined into local government’s budget. I see that Ms Bennett is nodding, so some of that has been baselined.

Dr Gulhane has compared the autumn budget revision position with the opening budget position, but there is still opportunity for in-year movement in budgets to support demand-led services or reform and improvement services. In that sense, the work that has been done to reduce waiting times has expanded significantly in the year compared with the opening budget position last year.

Significant structural reform improvements are on-going to ensure efficiency, productivity and capacity optimisation across the service through measures such as subnational planning—planning for our planned care system on a larger population basis—that will mean that we get a similar or better outturn to our investment. We will get better bang for our buck when it comes to the investment that is being put into the system.

Forgive me—

No—the policy intent remains, as I have set out. The pipeline of new national treatment centres, as in physical buildings, is paused, but the policy intent has continued through the investments that have gone into Gartnavel, Perth Royal infirmary and Stracathro in order to protect planned care services in those facilities.

No—I have already set out the perspective with regard to the overall capital budget, which has not allowed us to progress Carrick Glen at this stage. The investment in human resources—in people to staff such a facility—will have been utilised in other parts of the system.

NHS Ayrshire and Arran has a very effective frailty at the front door service; I was able to see that at University hospital Ayr very recently. It is doing great work to support some of our frailer patients. Those patients tend to come in and out of hospital and stay for longer as a result, while their condition continues to deteriorate, which means that when they return home, they require increased social care intervention.

The frailty service will, I believe, have been staffed by some of the people who were employed to staff Carrick Glen, as Mr Whittle set out. As a result of that service, we have seen a reduction in admittance to hospital and a reduction in the length of stay for those with frailty, both of which are incredibly beneficial for those patients. That ensures a better flow within the wider system but, most importantly, a better service for those patients.