Chamber and committees

Thank you, Presiding Officer. I will try to use my outside voice, just in case the sound is still quiet.

Care workers perform an extremely challenging, complex and skilled role. They look after our loved ones, often when they are unwell, vulnerable or coming to the end of their lives. I offer my heartfelt thanks to care workers for all that they do.

For too long, the enormous contribution of care workers to our society has gone unrecognised. They were classed as low skilled by the United Kingdom Government, and we all know that that is simply not true.

It was international women’s day on Tuesday, and the theme was “break the bias”. In light of that, it is worth noting, as many other members have done, that with women making up approximately 85 per cent of the workforce, the failure to properly appreciate social care workers is linked to how we value caring roles, which are traditionally performed by women. I was struck by the words of Fiona Collie from Carers UK, who said in evidence to the Health, Social Care and Sport Committee:

“We often talked about the important role that the national health service plays, but we talked less about the significant role that social care plays in maintaining people’s independence and enabling them to live good and positive lives ... The role of social care has been very hidden.”—[Official Report, Health, Social Care and Sport Committee, 22 February 2022; c 2.]

It is right that social care has now become a national focus—that is long overdue. The pandemic may have highlighted the undervaluation of care workers, but that has been a problem since long before any of us had heard of Covid 19. Care staff were often working in difficult conditions before the pandemic, contending with low pay, long hours and insecure work, but for the past two years, they have also had to deal with a dangerous virus that has devastated care homes.

The interim findings of a workforce survey conducted by Scottish Care were published in September. One finding was that the number of hours that staff were working was markedly high, with increasing pressure on them to maintain the same quality of care while working longer hours. Almost 50 per cent of organisations relayed that their staff were working more than 35 hours a week. I am extremely concerned about the physical and mental wellbeing of care workers who have been under such sustained pressure. As we seek to help social care recover from the pandemic, we must prioritise workplace wellbeing. Some care workers may have been traumatised by their experiences and they must be able to access mental health support when they need it.

As we enter the recovery period, we are also creating a new national care service, the cornerstone of which will be improved terms and conditions for staff, with the Greens and the Scottish Government committing to deliver ethical commissioning that promotes fair work. That is vital. The report “Independent Review of Adult Social Care in Scotland” highlighted that

“The current approach to commissioning and procurement is characterised by mistrust, conflict and market forces.”

At the moment, commissioning and procurement processes are largely focused on cost, which can squeeze pay and conditions. Ethical commissioning would shift the emphasis from cost and cover a range of factors, including workforce terms and conditions, investment by providers in training and support for staff, and the quality of care. We must ensure that staff can access the training that they need, as well as opportunities for career development and progression. That will be key to improving both recruitment and retention. That is why we have also committed to a system of national collective bargaining, through which we will deliver improved pay, terms and conditions.

The increase in the minimum wage for adult social care staff to £10.50 is an initial step in improving pay for care workers, but we recognise that the work is far from over, and we will continue towards delivering pay that recognises the incredible work that care staff do.

Once again, I extend my thanks to everyone working in the social care sector. We recognise that care workers’ pay, terms and conditions must continue to improve. We will continue to work towards that, and we will create a national care service in which staff are properly valued and respected.

I thank Jackie Baillie for securing the debate, and I pay tribute to Anne Duke’s family for their campaigning on this issue.

Social care has experienced some of the worst impacts of the pandemic. Covid-19 infections have devastated many care homes, and residents and their loved ones were cruelly separated by restrictions on visiting that were introduced for their safety. The pain of being separated from a loved one when residents may be feeling scared, isolated and lonely is terrible. Having loved ones in hospital over the pandemic who sadly passed away and who we could not get in to see was devastating. We do not know what we missed—what we might have picked up from their behaviour or what comfort we could have offered them. I am sure that many people listening to the debate know all too well the feeling of helplessness at not being able to get to their loved ones.

When I met some Anne’s law campaigners outside Parliament, they spoke very movingly about the impact that such separation has had on them and their family.

I thank them for their incredible campaigning efforts, which have resulted in the Government committing to make those changes, as we heard earlier from the minister.

As we have heard, visiting restrictions can affect care home residents’ physical and mental health. Many people in care homes have dementia and it might be difficult for them to understand why they cannot see their family members. Interruption to routine and lack of social contact may also cause their health to deteriorate.

A survey of 128 care homes published by the Alzheimer’s Society in June 2020 showed that nearly 80 per cent had seen a deterioration in the health of their residents with dementia due to lack of social contact. The Alzheimer Scotland report, “Covid-19: the hidden impact”, revealed that

“The disruption to daily routines, social interactions, and health and social care support has had a negative impact on the physical and mental health of people with dementia and carers”.

Restrictions can also cause particular distress to people who may be in the last years or months of their lives. For those people, the past two years may have robbed them of their last opportunities to spend time with the people they love; our thoughts and condolences go out to all of them.

When visiting was stopped, many people had to turn to remote communication methods just to stay in touch with residents. However, as we have all learned over the past two years, that is a poor substitute for being able to talk to our family and friends face to face, to hug them, and to see their body language and their facial expressions.

As a minimum, we must ensure that people in care homes have the right to receive visits from their loved ones. That recognises that friends and family play a vital role in supporting the health and wellbeing of residents and that a care home is a person’s home and their right to family and private life should be respected.

Social contact must be prioritised in any social care recovery plans. As I and others have said, visiting restrictions were introduced to keep people safe from Covid, but we must also consider the wider risk to wellbeing posed by limited social contact. It is a delicate balance, which we must get right in any forthcoming legislation.

Although the focus should be on upholding the rights of the resident, it is vital that we consult staff and the sector as we move forward, so that any changes are implemented safely. Legislation alone will not be enough. We need to ensure that it is accompanied by robust safety and infection control procedures, as well as access to PPE and training for staff.

Organisations such as the Coalition of Care and Support Providers in Scotland and Scottish Care have raised concerns about the wording used in the programme for government and the Anne’s law consultation document—specifically,

“giving nominated relatives or friends the same access rights to care homes as staff”.

They have pointed out that that is a greater level of access than is proposed in the consultation questions and that staff have legal duties of care to all residents, which visitors do not have. I would be grateful if the minister could comment on that in his closing speech.

I again pay tribute to Anne Duke’s family by welcoming the action announced by the minister to help visitors be involved in the care of their loved ones, and by reaffirming the Scottish Green Party’s full support for Anne’s law.

My thoughts are with all those whose care has fallen short of the high standards that we hold for our public services. Fighting to have your voice heard can be exhausting, so I also thank those who have tirelessly campaigned to bring injustices or failure to light, especially Milly’s family, and I thank Anas Sarwar for securing the debate.

Our public services are invaluable and we should all be able to rely on them, particularly during a global pandemic. Unfortunately, sometimes those services fall short of the standards that have been set for them. When that happens, it is right and proper that there is honesty and transparency about what has gone wrong and how those failings can be addressed. However, as the motion and the Government amendment note, individuals and their families are too often left seeking answers or justice.

We must not underestimate the pain and hurt caused to individuals who know that something is not right with either their or their loved ones’ care, but who are ignored or dismissed when they try to raise concerns. Too often, I know that people feel shut out of the process when investigations are taking place. It is important that any investigations and their findings are communicated on an on-going basis to patients and their families. It is essential that whenever public bodies have failed in their duty of care towards members of the public, they are held accountable.

Transparency and candour are fundamental to ensuring that people can trust the services that are available to help them. The public has a right to know when there have been failings, as well as what action will be taken to prevent such failures in future. Without that, relationships can be damaged. Understandably, that can lead to fear, hurt and anger on behalf of those who have been failed and their families. As we recover from one of the greatest challenges that our NHS has ever faced, we must prioritise rebuilding and repairing the relationships between patients and health services, which have been severely tested by the strain that Covid has placed on them.

As the Cumberlege report notes, the system is not good enough at spotting trends in practice and outcomes that give rise to safety concerns. The report found that people from all over the UK who have been affected have been dismissed, overlooked and ignored for far too long, and that the issue was not one of a single or a few rogue medical practitioners or differences in regional practice, but that it was system wide.

There is no intention to blame individual members of staff, the vast majority of whom work extremely hard to deliver excellent care for the people of Scotland. However, there is clearly a culture where patients are not always listened to when things go wrong. A “clinician knows best” approach fails to take into account that patients are often the first to know when something is not right with their own bodies or the care that they are receiving. That is why the creation of an independent patient safety commissioner will be so important and will ensure, when patients do have concerns and complaints, that they are listened to and that those complaints are considered alongside other similar concerns and complaints so that patterns can be detected at an early stage. The commissioner will be able to advocate for patients in a system that is not always willing to take their concerns seriously, or capable of doing so.

Services should be held accountable when failings are discovered but, when genuine mistakes have been made, we need to support staff to come forward, and to establish an opportunity for learning, training and development. Creating a hostile culture that discourages people from coming forward will not serve patients or staff well. The Sturrock review laid bare the cultural problems that exist within our NHS and the terrible toll that they have taken on staff, who are afraid to speak out about issues. We need to foster a culture in which people feel comfortable and safe in coming forward when mistakes have been made.

I close by expressing my thanks to all those working in the NHS and wider public services, many of whom have been dealing with extremely difficult conditions since the beginning of the pandemic. Improved transparency and accountability will serve patients and staff better, and we owe it to all who are affected to make sure that that happens.

I thank all the panel members for giving us their thoughts. Some respondents to the committee’s survey expressed a pretty negative view of social prescribing. Some said that it was not the type of care that they wanted or expected to be offered when seeking help from their GP. One respondent said that they would be “insulted” if they were directed to those services. Another said that it represented an “easy way out” for the GP.

The benefits of social prescribing are well documented. Does the panel think that the negative attitudes towards social prescribing stem from a lack of awareness of it or explanation of the benefits? Does there need to be a greater culture shift with regard to what care people can expect in accessing their GP?

I will go to Hannah Tweed first, as she is nodding lots.

I have heard GPs raise another concern about social prescribing, which is that it takes less time to explain a drug prescription than it does to explain a method of social prescribing, such as a nature prescription. Is lack of GP time a barrier to patients understanding and engaging with social prescribing? Are the rationale behind and benefits of social prescribing being properly explained to patients? How can we raise awareness of social prescribing if GPs have limited time to explain it properly?

Dr Williams mentioned links workers, but, with their limited capacity and the financial strain that people are facing as a result of the cost of living situation, there is concern that much of their time is being taken up with helping people to apply for benefits, as a result of which they do not have as much time to engage with social prescribing. What are the panel’s thoughts on that? Do we simply need more links workers, or should that part of their role be separated out and allocated to, for example, welfare rights advisers in GP practices? Perhaps Wendy Panton can respond first.

Good morning, panel. What do you see as the main barriers to GPs engaging with social prescribing? That question is perhaps for Dr Williams in the first instance.

This has already been touched on, but I am concerned about the inverse care law. As services come under increasing strain and become more difficult to access because of waiting lists and practitioners having to see more people with more complex issues, and as the system becomes more complicated to navigate, with people expected to self-refer to different services, is there a risk of the inverse care law becoming more entrenched and those with lower levels of health literacy becoming less likely to engage with health services? If so, how can we mitigate that risk? Perhaps Hannah Tweed can answer that question first.

Thank you, convener. As we have already touched on various issues to do with marketing and sponsorship, I will squish some of my questions together so that we can try to cover everything.

The SHAAP report on alcohol marketing during the six nations championship has been referenced. Do you believe that there should be a full ban on alcohol sponsorship of sport? Given that it can be lucrative and many sports clubs are facing challenging financial circumstances, do you have views on how we can encourage clubs to move away from such sponsorship? Would it be best to achieve a full ban through legislation? If not, what mechanism should be used?

What are your views on other preventative measures, such as a social responsibility levy on retailers? The Scottish Government has stated that it will take action to improve alcohol labelling. What impact could mandatory alcohol labelling have on alcohol harm? What changes would you like to see in that regard?