Chamber and committees

Sandesh Gulhane appears to be making an argument against physician associates and AAs, but we have heard that they have been practising for 20 years. The instrument is about regulation of those professionals. Is Dr Gulhane making an argument against having those professionals in the system?

Okay. It can be challenging to get clarity on the social care budget because of the way that the money flows between the Government, health services and local government. The Scottish Government committed to increasing spending on social care by 25 per cent over this parliamentary session. Can you remind the committee of the progress that has been made on that?

You have touched on the importance of social care for the whole system. We talk about health and social care separately, but the services are intrinsically linked, particularly from the perspective of patients. Good-quality services in the community often prevent hospital admissions, particularly those that are unscheduled. How does the Scottish Government make decisions about the appropriate balance between money going to social care and money going to other areas of health?

We are thinking about the budget. Will that service reform make it easier to move budgets and move resource into the community?

Are you able to tell the committee how that increase compares with the Barnett consequentials that the Scottish Government has received?

Jackson Carlaw’s remarks have been interesting—although I was not going to ask any of those things. I was wondering whether, more generally, the dialogue that we have in politics and in the media prohibits that kind of honest reflection on the part of leaders. I think that our discourse sometimes contributes to that. Does he agree?

I welcome the opportunity to contribute to this debate on the importance of continued investment in delivering and reforming public services for Scotland’s people and communities.

Although things have undoubtedly been challenging for quite some time—since the beginning of Tory austerity more than a decade ago, in fact—it is clear that the economic damage of Brexit, which means that up to £3.7 billion of potential funding for our public services has been lost, has piled on additional pressure. Much like the austerity agenda, it is the result of a political choice, which the majority of Scottish citizens voted against.

In speaking to the Scottish Government’s motion and legacy of successful public service reform in recent years, including the creation of health and social care partnerships and Social Security Scotland, I make it clear that, although outcomes have improved for many people and communities, in particular as a result of Social Security Scotland’s absolute focus on treating people with dignity and respect—which has been transformational and to which all parties in the Parliament have contributed—one person in this country not having their rights realised is one too many. We—all of us—need to focus on the policy implementation gap that is clear in several areas.

The slightly hyperbolic rhetoric from some Opposition colleagues might have us thinking that our country is in absolute tatters. That is both untrue and unhelpful when we are seeking to reform services, but it would be equally unhelpful for us to close our eyes to the very real challenges that our public services face and the impact that that has on many of our vulnerable citizens.

Colleagues on the Education, Children and Young People Committee saw a stark illustration of that with regard to our disabled children and young people. Of course, as with everything, there are pockets of excellent practice, but it is not good enough if the rights of any children and young people are not being realised.

Colleagues on all sides of the chamber will be aware of the numbers of people in their constituencies who are not receiving their full entitlement to social care—care that is crucial to sustain them in a dignified manner in their own homes. Health and social care integration was absolutely the right thing to do. Again, there are pockets of excellent practice, and there is a skilled and committed workforce of people who do their very best to make the lives of citizens better. However, there is much to learn from what has not worked so well.

For the proposed national care service to succeed, there must be clarity on what its structure will mean from the perspective not of organisations or professionals but of those who are entitled to the services. For example, there must be clarity on how a disabled citizen who is assessed as requiring additional support in their home in order to be healthy and thrive will actually get it. When a citizen returns to their home after a serious operation and a professional assesses that they need adaptations to ensure that they are safe, there must be clarity on how those adaptations will be completed in a timely manner. It is no exaggeration to say that those are matters of life and death.

My constituents also want to be clear on whether key local services such as mental health support for vulnerable young people should be delivered on a project basis. Should boards be able to withdraw services with no consultation, no equality impact assessment and no transitional arrangements being in place? World-leading human rights-based approaches to policy and legislation are a wonderful thing to talk about, and we should be aspiring to them, but they must be backed up by delivery and access to redress when rights are not realised.

Further reform to public services will be necessary to ensure that they remain fiscally sustainable and to improve outcomes for all of Scotland’s people and communities. Public sector workers are key to the success. As I acknowledged earlier, they are doing an excellent job in some challenging circumstances. Showing how much we value them will mean continuing with fair pay and conditions.

The Government’s motion states that further reform will require a focus on

“prevention and early intervention, involving people and communities in the design of public services and embracing the power of digital technologies”.

As my colleague John Mason laid out, we all know intuitively that focusing on prevention and early intervention is the right thing to do, but we also have screeds of evidence that it will improve outcomes for people and be the most cost-effective way to operate. However, bravery will be required to deliver that, because investing additional resource in prevention and early intervention will often involve shifting resource from elsewhere. That is difficult in times of abundance, but it is even more challenging in the fiscal environment that we find ourselves in now.

I noted at the beginning of my remarks that the political choices of austerity and Brexit that were made elsewhere put our public services at risk. Those were choices that our citizens in Scotland did not vote for. Whatever constitutional arrangement Scotland has, there is a lot of work to do. However, it is crystal clear to me that, until Scotland’s independence is restored, we will always be at risk from political decisions that are made elsewhere. With the number of challenges that our communities face, that is frankly heartbreaking. I agree that independence is urgent.

Will the member take an intervention?

Minister, I seek your reassurance because, although those pathways to college and employment are important, community learning and development is also important for people’s health and for tackling social isolation and loneliness. That aspect of it will not be lost, will it?

That is an encouraging response. I certainly endorse that skill sets can lead people on various paths, and it is good to not be too narrow with our young people. Also, learning is lifelong and, if young people wish to pursue academic routes later in life, that is an option for them. It is not that they have to pick something and then that is it for them.

That leads on to my next question. What do you hope to achieve through the review of community learning and development?