Chamber and committees

Earlier this week, I had a meeting with Alison Bavidge about social work within the NCS bill, and she usefully described social workers as the GPs of social care. I am interested in hearing your thoughts on how we ensure through the bill that social work, rather than continuing to deliver small things, gets back to the holistic cross-wellbeing view that social workers would like to see—a restoration of the profession, if you like.

Obviously, social work is an area that is heavily based on legislation, and the bill is another piece of legislation to add to the spectrum. I would like to hear your thoughts on how we ensure that we get back to a cross-issue view, rather than delivering pieces of justice, and how we do investigative work and other things in looking at the whole wellbeing piece.

I thank Carol Mochan for securing this evening’s debate and all the allied health professionals in the gallery and across the country. The debate gives us an important space to discuss the valuable work of allied health professionals the length and breadth of Scotland.

As we have heard, allied health professionals are a wide and varied collection of professionals, including speech and language therapists, diagnostic radiographers, art therapists, podiatrists and many others. Those professionals play a vital role in supporting and improving patients’ wellbeing in health settings and across our communities.

I thank Movement for Health for its work in highlighting the great work that is done by allied health professionals on a range of issues. Among its policy asks, it highlights the importance of social prescribing, which is an issue that I have raised many times in the chamber and at the Health, Social Care and Sport Committee. Although we all recognise the importance of our physical health, the importance of wellbeing is becoming an increasingly familiar part of the dialogue during discussions on health.

AHPs have the potential to support a wider transition towards more preventative health interventions. For many, they provide vital support without which some people might have had their health issues deteriorate.

Social prescribing can allow for more individually orientated healthcare provision. Such an approach puts the individual at the heart of decision making and outcomes, rather than focusing on pre-prescribed or generic outcomes. Without such talented allied health professionals, who are trained across so many various sectors of healthcare, policy initiatives such as social prescribing would surely not be possible.

In Lanarkshire, in my Central Scotland region, there is a well-established social prescribing programme that has been shown to help people by improving self-confidence and self-esteem, reducing low mood and feelings of stress and helping people to develop positive ways of coping with the challenges of life, among its other benefits. We must view the relationship between health and wellbeing in that way, with both being necessary, and where helping one improves the other.

I thank Movement for Health for highlighting some of the issues that were raised in the Health, Social Care and Sport Committee’s “Tackling health inequalities in Scotland” report. As the report notes, community link workers are one of the services that link the wider array of allied health professionals with those in the community. One of the report’s recommendations was to further embed community link workers across GP practices in Scotland. Community link workers have the potential to further support health and wellbeing, and allied health professionals, to address poor health outcomes in areas of deprivation in particular by tying in the expertise of a wide range of social, mental health and physical health care providers, including AHPs, and being able to advise patients on financial and social security issues.

As we have heard, allied health professionals make up the third largest workforce in the NHS. Much like other sectors in the NHS, appropriate resourcing is essential to the delivery of good health and social care. Brexit has been a significant driver of recruitment issues in our NHS, and I am sure that many colleagues across the chamber will share my alarm at the announcement of £18 billion-worth of public sector spending cuts. The knock-on effect that those cuts would have on Scotland’s public sector could be really damaging.

As parliamentarians, we have to acknowledge those real and prevalent challenges, especially given the cost of living crisis and the impacts of the Covid pandemic. We must ensure that allied health professionals do not simply hear our warm thanks but get our support in their delivery of crucial health and social care benefits, and that they are not left behind in those circumstances.

I do not often tell personal stories in my speeches, but today I will repeat the story that I shared in my very first speech in the chamber.

My grandpa fell in his house shortly before the council elections in 2017. After that fall and his recovery, he required care in his home for the rest of his life. His carers were far more than help around the house—they enhanced and enriched his life. He loved to tell stories, and what his carers and, often, their families were up to became part of the stories that we were told. We knew that he was safe with them, and they often stayed to make us a cup of tea when we needed it, too. Words could never express how grateful I am to each and every one of them.

His experience, and the fact that not everyone has that experience, is what drives my approach to the national care service. We must ensure that people receive person-centred care. I acknowledge the anxiety about the lack of detail in the bill. Framework bills do not give the immediate certainty that is needed, but the bill provides people who receive care, their families and their care workers with the ability to offer input to how the service runs. Let us not pretend that our current system is one in which their voices are always heard. The bill gives us the chance to get things right.

Fair work must be at the heart of that. I was hugely frustrated to hear from my grandpa’s carers about the lack of holiday pay, sick pay and maternity pay, and even lack of consideration for something as basic as local knowledge.

I am really sorry, but I have a lot to get through.

I heard about carers being sent from one end of the local authority area to the other because a manager who did not know the area thought that the trip from Bo’ness to Larbert could be done in 10 minutes, only for the carers to come back to Grangemouth after that. Caring for care workers must be at the heart of the bill. That is why I will lodge amendments to further embed, at the heart of the bill, fair work as part of ethical procurement. I will work with the minister and unions to address concerns.

We know that there is a mixed picture across the country, but social care workers in Falkirk should have the same terms, conditions and working culture as those in Argyll and Bute. For people who receive the care, how they receive it and what they are entitled to should also be the same everywhere. That is a fundamental principle of the national care service and one of the main reasons why we want to see the bill progress.

Culture change must be a key part of any social care reform, and as I said in the Health, Social Care and Sport Committee meeting on Tuesday, culture change does not often come without huge costs attached. I agree with Mr O’Kane—as, I am sure, the minister does—that any of those issues could be tackled now. In the joint working group involving COSLA and the Scottish Government, I would like to see discussion and agreement on ways to do that and to advance it now.

In yesterday’s HSCS Committee meeting, we heard COSLA’s concerns about appointments to care boards being the minister’s decision. Might the minister address that in his closing remarks?

I am really sorry, but I need to keep going.

We can agree that there are some good things in the bill. We all recognise the importance of Anne’s law. I met campaigners outside Parliament, as did others from across the chamber. The pandemic robbed many people of their last precious hours and days. I want better and consistently offered bereavement support for unpaid carers, as well as support with manual handling and, crucially, the right to short breaks. We need to ensure that that is implemented consistently to ensure that breaks are available, in a way that is useful to them, for people who have multiple caring responsibilities.

In reality, there is too much to cover in four minutes. There are real opportunities through co-design and secondary legislation to be flexible, to listen, to take account and to change things that do not work as anticipated. I recognise the anxiety around the lack of detail, but I look forward to working with carers’ organisations, with people with lived experience and with care workers in order to ensure that the bill delivers on its core aim, which is to make things better and more consistent for people who use the social care system and people who work in it.

Thanks, convener. I apologise to everyone; I have to go to the Parliamentary Bureau in a couple of minutes.

My question is particularly for Councillor Kelly. You referenced geographical variation around delivery, but there is also geographical variation around terms and conditions and working conditions for staff. How would you like that to be strengthened in the bill?

If there is anything specific going on in councils, it would be really useful for the committee to hear about that.

I appreciate that. Some of this is absolutely about resource but, as you referenced earlier, it is also about culture, which does not always need pounds behind it. What is being done by COSLA to improve the culture in which people work?

I appreciate the work that is being done at joint ministerial working group level and all that sort of thing, but what work is being done at COSLA level to make sure that good terms and conditions exist? One thing that is being looked at in the creation of the national care service is making terms and conditions consistent across the country. What is being done in relation to the services that are delivered by local authorities to ensure that terms and conditions and working conditions are consistent across the country? Also, what is being done where services are contracted out by councils? The variations are wild, in some places.

In its written submission, the Faculty of Advocates raises concerns about use of the word “sufficient” in relation to carers’ breaks. How can that wording be strengthened? Does the faculty have a view on what mechanism would be most appropriate to determine what qualifies as “sufficient”?