Chamber and committees

We have heard about what sporting organisations and community organisations are doing. Surely, one of the biggest barriers to participation must be time. Have you seen any good practice from employers and workplaces to encourage physical activity? How might we support that at policy level?

Thank you all for coming this morning. I will zoom back out a bit to look at the bigger picture. Cabinet Secretary, you alluded to the fact that this might be our first meeting of many during the parliamentary session. We have heard a bold plan for reform, and there is a clear direction of travel on prevention, which there is cross-party consensus around. What are the measures for success on which this committee and others should hold you to account in the coming parliamentary session?

I make my now-customary note of my entry in the members’ register of interests showing that I was employed as the director of Scottish Autism until May.

Thank you for that answer, minister. I recognise exactly the picture that you have painted, but none of it is news. Neurodevelopmental assessment and support pathways were trialled as part of the strategy for autism, which ended in 2021. There were promises regarding post-diagnostic support as part of the Covid mental health transition and recovery plan, and we were also promised action within 100 days of the Scottish National Party returning to power.

What concrete resource can we expect to see in the coming months for all of the people who have been waiting years for assessment and support? That resource is urgent, because people have been waiting a long time and there have been years of discussions about neurodevelopmental assessment and support.

A consultation on social care was pledged and then there was a five-year consultation on the national care service, which did not end up in there being a national care service. People also gave months and years of their lives to supporting the LDAN bill. You will recognise, in a context in which there is waning faith in the ability of politics to deliver for people, that there is some consternation in the community at the abandonment of the bill and scepticism about whether the Government will deliver, particularly for groups that were not explicitly mentioned in the programme for government.

I am sure that we will have a few discussions in the coming months about social care governance and structures—as we have been having for several years.

I want to flag up something that has come up in evidence and discussion with local care providers in my region, which is the collaborative and ethical commissioning that was envisaged by the Feeley review, back in 2021. Care providers are still in a market system in which there is sometimes a race to the bottom on price and providers are pushed to lower their prices. At times, not-for-profit providers have to wait on payment for services for months or years on end. We do not have the ethical and collaborative commissioning that we need in social care. Whatever structure we arrive at, how do we change that culture to ensure that we get a collaborative commissioning process?

The population health framework is mentioned in your plans but we have not heard much lately about the national performance framework, which has more of a focus on wellbeing outcomes for the people of Scotland and is not just about the remediation of difficulty. Where will the revised national performance framework sit within the plans that you are setting out for us?

I absolutely recognise the flow-of-care aspiration and the need to address the needs of people coming out of hospital. Do you also recognise that there is some concern in the social care community about the idea that commissioning from the NHS, as was hinted at, might result in the overmedicalisation of people’s needs, and that there are people with lifelong support needs whose aspirations are not about delayed discharge from hospital or medical treatment, but about having a meaningful life in the community, and that the role of social care is not only to serve the NHS or facilitate that flow of care for the people who need it?

On the point about the workforce and sectoral bargaining, you mentioned the real living wage. Something that has been flagged up in evidence in the past few weeks—I have talked about it previously—is the differential between, for example, the pay of someone at band 3 in the NHS and that of someone working in a commissioned social care service. That can be as much as £3,500, not to mention the different pension arrangements, the unsocial hours and so on. Does the Scottish Government have an ambition to create parity between the NHS and social care in that regard?

My question is for Gareth Adam-Hammond of the Care Inspectorate. Your submission gives an overview of what the Care Inspectorate does and who you are. You have specific criteria to use when you carry out inspections, but I am interested in the big picture that you see when you inspect care services. What makes a good service? I am thinking about not just the criteria but the culture and leadership. What patterns do you see across the system? Are there particular areas or sectors where you see good practice? How does provision compare in the third, private and local authority sectors? I am interested in those big-picture trends.

I note again that my register of interests shows that I was the director of a social care organisation in the third sector until 18 May.

I will ask Rachel Cackett and Donald Macaskill about commissioning. You both mentioned that in your submissions and in your opening statements. The Feeley review, which was carried out in 2021, led to a lot of discussion about structure and governance, but one of the key elements of the review was collaborative and ethical commissioning. That might be about culture and process as much as it is about structures of governance, so I would like to tease out what you think good, ethical and collaborative commissioning would look like. How does it differ from the status quo? Let us start there.