Chamber and committees

I am keen to start with the sustainability of management of finances within NHS boards. Audit Scotland previously highlighted a lack of stable senior leadership, with high turnover and short-term tenure. When we went through this session last year, we discussed some similar issues. Therefore, it would be good to know what progress the cabinet secretary feels has been made on financial stewardship within boards and whether he feels that more has to be done to tackle those issues.

Given the acute situation that we find ourselves in and the announcements that the cabinet secretary will make later this afternoon, that detailed piece of analysis on the benefit of increasing pay should stand alone and be done by the Government. I am sure that the cabinet secretary intends to make an announcement containing further detail about the beds that he will purchase in care homes. That will require a staffing element, and we know about the staffing challenges. It is not just that, because, obviously, there are care at home staffing issues, and I agree with him about terms and conditions. My sense from his previous answers is that we are being told that, four years down the line, the national care service will deliver all of this and we can move the dial. Does he not accept that we need to do more now and look at the issues right now, instead of wishing them away to the national care service?

I will ask about something else that Audit Scotland has consistently raised, which is the impact that multiyear budgeting would have and the adverse impact that a lack of multiyear budgeting has on longer-term financial planning, ensuring that innovation can be planned for and other things that we are keen to see. What is your view on how multiyear budgets might assist in achieving financial stability, and what do you perceive as being the barriers to offering those multiyear settlements?

Good morning. I will return to the point about the potential transfer of staff and the figure of 74,000, which I think that you described as “rumours”, minister. I think that trade unions, local authorities and front-line staff would contend that the concern about the possibility of 74,000 staff being transferred is legitimately held; however, I appreciate that you said that your view is that wholesale transfer is not envisaged, and you gave the example of a care board being the provider of last resort.

My understanding is that, currently, a council would be a provider of last resort anyway—it currently fulfils that function. If we are in the business of trying to clear up and dispel rumours, are there any other reasons why staff might transfer to a care board?

I want to go back so that I understand the point about ministerial control as opposed to local control. The minister said that people have told him that they want ministerial control and accountability, and I appreciate that in previous answers he has said that he will communicate to the committee where that evidence came from.

Okay, but, as the minister knows, people have raised issues around the consultation and how consulted they felt. I am happy to go through the detail of that; I speak to people who have lived experience as well, and some people have raised concerns.

However, I want to get to the heart of this issue. What interests will local authorities have in the delivery of social care if they are not accountable for it? If local authorities do not hold a statutory responsibility for it, then what is their role?

I want to turn to some of the financial implications and the financial memorandum. Last week, we heard from Cathie Russell from Care Home Relatives Scotland and the social covenant steering group, who said:

“What worries me, to some extent, is that we hear figures such as the £500 million cost of the new structure—Audit Scotland thinks that it could be more than £1 billion—but we will not get one extra hour of care for that. None of that will be spent on the front line.”—[Official Report, Health, Social Care and Sport Committee, 13 December 2022; c 38.]

Can the minister explain why existing Government commitments on the reform of social care as listed in the financial memorandum were not included in the bill? Can you give an update on any progress that there has been on fulfilling those commitments?

What was your rationale for giving a promise of co-design after the bill is passed rather than doing that during the preparation of the bill? Is it your view that co-design after the fact is better than co-design before legislation, and who decided that the bill should proceed in that manner?

What will happen to health and social care partnerships, given the process of integration that has happened in various local authorities?

I begin by asking more broadly about structures. I hear what the minister says about the need for national standards, and there is a large degree of consensus around that. However, whatever way we look at it, the national care service involves big structural change. Does the minister feel that there is a risk of that structural change becoming an end in itself rather than being a means to a greater end?