Chamber and committees

Yes.

It is a step forward for the care of children with complex problems. These regulations will help us to uphold and protect children’s human rights in those situations. It is generally regarded as a positive step. Children who find themselves requiring secure care are currently usually transferred to England for medium-secure care. Being able to care for them in Scotland and therefore provide continuity of education—different education systems operate in the two countries—will help us to uphold the Promise rather than cause any challenge to those principles.

The Scottish Government is absolutely committed to delivering on the Promise. We made the Promise and we intend to uphold it.

As we stated earlier, officials have met each of the stakeholders who contributed to the consultation. They have had detailed discussions and have reassured the stakeholders that the processes are appropriate. We are comfortable that we have the support of stakeholders, that we have been able to adequately explain how the service will operate with regard to children’s rights, and that the service is an important step forward in upholding children’s rights.

I do not know whether Ruth Christie wants to say a little more about those meetings with stakeholders, which took place subsequent to the consultation.

That is a tricky thing to fix. If it were easy to fix, we would certainly have done it by now. Lots of work was being done across the system all last winter, and as soon as the winter was over, we began to reflect on how to rise and face the challenges that we expect to be faced with again this winter.

Scotland’s situation is not unique; it is similar all over the United Kingdom and in many developed countries. There are a number of challenges. As your question implies, there is no doubt that we were not rising to the challenge of delayed discharges prior to the pandemic, but we are now in a really difficult situation because of the pandemic. The whole of our health and social care system has been under sustained pressure for a number of years, and that is one the reasons why we are in such a difficult situation on this issue.

Of course, we have to cope with a new condition and several hundred people will be in hospital today with Covid and Covid-related complications. There is, therefore, a whole extra condition to be coped with as well as the fact that the staff and systems have been under sustained pressure for the past three years during the pandemic.

What are we going to do to improve the situation? That is the crux of the issue: how are we going to move forward from where we are now? A lot of work is being done across the system, including a lot of collaboration with local governance systems. We are producing dashboards of data, so during the past few months, we have spent some time on improving the data that we can provide to ministers and to local governance structures to try to ensure that quick action is taken where problems are brewing.

There is a suite of things that we know work, such as discharge before 12. Programmes such as home first are in place. That is an interesting programme and early results are impressive, so we probably need to ensure that that programme increases at pace and is delivered at a high level right across the country. In that programme, instead of an in-patient waiting for an assessment in a hospital environment, they are discharged to their home and assessed there. The clear finding is that a smaller package of care, with immediate support, is required to support people at home if they are discharged quickly. We are striving to spread that practice all over the country.

There is a lot of work to be done, but there is no magic pill. If there was, we would do it, and everyone else in every other country in the UK would be doing it, too.

There are a couple of important things to draw out about shared accountability. It is shared, rather than joint, accountability, which is a significant distinction because we have different groups to which we are accountable.

As ministers we are accountable to the country; local authorities are accountable only to the local authority area that they represent; and the national health service is accountable to the NHS boards. We all have different groups to which we are accountable, but if we share that accountability we get really good coverage and oversight of the country. The three of us together will definitely have an impact in terms of delivery of better standards and qualities.

We are still working out the detail around the national care board, but I do not think that it will be just the three of us. There will be more people around that table. I expect that there will probably be an independent chair. I think that the voice of lived experience will be absolutely vital on that board, and I think that it should include representation of the workforce and the national social work agency. Those are the things that will give that board teeth and make sure that it delivers an impact.

I have heard criticism from many people that the board is just the status quo, but it will be different. At the moment, I have no control over the social care system; I am held to account day in and day out for things over which I have no control. In the future, Scottish Government ministers will have some control, which they will share with a national body. That will absolutely ensure that we deliver improved standards.

Do you want to say anything more, Rachael?

During the past number of years, we have effectively introduced a floor level of payment of social care staff. We have introduced that nationally, and we did so by providing funding to ensure that that pay can be passed on to staff. I think that we will manage to do so again using the mechanisms that we have used for a number of years. I am absolutely delighted that we are delivering on that commitment.

I know that people are, as ever, pushing for more and would like even better pay in social care, but I am absolutely delighted, given the financial constraints that we face as a nation, that we are delivering on that, and that we are setting a path of year-on-year significant improvement in pay for social care staff, because that is one of the very important things that we need to do to strengthen the system as a whole.

Generally, when we go out to consultation there is a set of proposals on the table. When we have gone out to speak to people, one of their criticisms has been that there is not enough meat on the bones. We would usually have a set of proposals and we would ask people whether they liked them. We have taken a step back from that approach and adopted a co-design process, spending a great deal of time understanding the current situation and trying to imagine a different way of doing things that would deliver better.

That is a step back, I think, from consultation. It delivers the voice of lived experience right at the heart of the design of the national care service, which is really important. I do not envisage that process having a hard stop at the end, when the bill is delivered. I envisage the voice of lived experience continuing to be a strong part of how the national care service evolves. It will help us to get the policy right in the first place and to deliver it according to our ambition.

Is that sufficiently clear for you or should I bring in my officials to give a little more detail?

I will bring in Donna Bell in a second.

As well as all of the regional events during summer, we have since added another three regional events, because of popular demand. We have a national event at the end of October, and we also held online events for people who could not attend in person. We have commissioned some specific work, with specific partners, to go out and reach the groups that, when we looked at the information that was coming in, we felt we did not have 100 per cent coverage.

I think that we sent a letter with those figures.