Meeting date: Tuesday, February 16, 2021
Meeting of the Parliament (Hybrid)16 February 2021
Agenda: Time for Reflection, Point of Order, Business Motion, Topical Question Time, Covid-19, Budget Update, Adult Social Care (Independent Review), Decision Time
- Time for Reflection
- Point of Order
- Business Motion
- Topical Question Time
- Budget Update
- Adult Social Care (Independent Review)
- Decision Time
Adult Social Care (Independent Review)
The next item of business is a debate on motion S5M-24134, in the name of Jeane Freeman, on the independent review of adult social care. There is no time in hand. Accordingly, members must be very strict with themselves so that I do not have to be strict with them. That is a happy marriage.16:02
The independent review of social care gives us a clear road map for the future of care provision in Scotland. Central to its proposition is that we see—and deliver on—adult social care as an investment that we make collectively in ourselves and in each other. It is a shift in thinking that underpins future funding, commissioning, regulation and, critically, delivery. We believe in the recommendations in the report and, in the elections in May, we will ask the people of Scotland to back the creation of a national care service—a service on a par with our national health service.
The foundation for delivering on the recommendations is the adult social care workforce. They must be recognised, offered opportunities to develop skills and expertise and rewarded for the significant value that they bring every day to the important job that they do. I will come to the specifics of that shortly.
The backdrop to the review is clear, in the terrible loss of life from the Covid-19 pandemic. I know that I speak for everyone in the chamber when I offer my condolences to everyone who has lost a loved one to the virus—whether a care home resident, a staff member or someone who was in their own home.
Before I turn to the detail, I place on record my personal thanks to the chair of the independent review, Derek Feeley, and his advisory panel of experts, and to everyone who gave them evidence and feedback. It is a testament to everyone involved in the process that a thorough and comprehensive review was delivered swiftly, with strong engagement with those who have lived experience of adult social care, representative organisations, providers of social care in the public, private and third sectors, and trade unions.
The cabinet secretary said that the report produces a plan for a system that is equivalent to the NHS. Can she elaborate on that?
In essence, the report tells us that, in everything that we do in its delivery and how we treat its workforce, we need to accord adult social care the same value as we accord our NHS.
The review’s report has been widely welcomed. It recommends that we change the narrative of social care, put human rights at its heart and move from a competitive market to one of collaboration and ethical approaches to commissioning and procurement. It recommends that we put an end to charging for non-residential care, as well as a revised funding structure for free personal and nursing care.
Crucially, the report calls for the
“creation of a national care service”
to drive delivery of consistent, high-quality social care support and put adult social care on the same footing as our NHS. To support the introduction of those changes, the report suggests that we need “a new social covenant” for adult social care to ensure that it reflects our values and, as a society, our commitment to each other.
We need to build on the strong foundations that we currently have in the system. Legislation is in place to underpin self-directed support—the Carers (Scotland) Act 2016—and we have our commitment in legislation to integrate health and social care. Although many people already receive good-quality care and support, that experience needs to be consistent across the country, and that is not the case now.
We need to redesign parts of the system. That process will include legislating for a national care service with reformed integration joint boards focusing on prevention, early intervention, de-institutionalisation and, at its heart, the involvement of the people who use services, unpaid carers and the workforce. The central role of IJBs will help to ensure that local representation will be vital in the shaping of services.
The national care service would also introduce
“a national improvement programme for social care”,
which would initially address three key areas:
“the experience and implementation of self-directed support ... the safety and quality of care provided in care homes”
and the improvement of
“commissioning and procurement processes”,
to embed fair work principles and inform reformed regulation, inspection and improvement.
Although there is widespread support for the review’s recommendations, there are also concerns. Let me touch on two that are among the most important. The first is the understandable concern that the Convention of Scottish Local Authorities expressed on the issue of accountability. I understand that concern and I know that local government is a critical partner in taking forward the radical change for which the review rightly calls.
Yesterday, I had the first of what will be a number of meetings with COSLA to learn more about the concerns that it has and begin to work through how we might jointly work through them. Local government has experience and understanding of local communities and their needs, and it provides a range of vital services that are closely connected to social care—the report recognises that point—so we need to work together to find the best way to secure the review’s recommendations and the spirit of its intent.
What is abundantly clear is how much we and COSLA agree on. I hope that before Parliament rises for the elections in May, we will have reached areas of agreement with COSLA that form a firm foundation for the work of the next Scottish Government.
The second concern comes from those whose lived experience contributed so much to the review who think that this will be another report of fine words and laudable sentiments that, in the end, goes nowhere, because vested interests combine to make little real improvement to people’s lives, and because we spend all our energy and time arguing about structures that we fail to grasp the opportunity to deliver. I understand that concern too and take it seriously. For those people, there is no time left to waste and there are too many lives still to be fully lived.
We can take immediate action, however, to secure improvement. On the associated themes of individual autonomy and citizenship, I am pleased to announce a new community living change fund of £20 million to deliver a redesign of services for people with complex needs, including intellectual disabilities and autism, and those who have enduring mental health problems. The fund will focus on delivering a proper sense of home for people with complex needs, including those who have encountered lengthy hospital stays or who might have been placed outside of Scotland, and who could, and should, be more appropriately supported closer to home.
The report also highlights the fundamental role of unpaid carers in our society. The Carers (Scotland) Act 2016 is a building block for strengthening the rights and status of unpaid carers and must act as a springboard for major improvements. I have already prioritised support for the implementation of that act, and I have backed that with significant investment, which now stands at £39.5 million a year, with an additional £28.5 million uplift that is earmarked in the budget for 2021-22. That brings the total investment in local support for carers to £68 million.
The report recognises and highlights the critical and invaluable support that the social care workforce provides to people all over Scotland. A key recommendation from the Fair Work Convention’s report “Fair Work in Scotland’s Social Care Sector 2019” is to consider establishing a?new sector-level body with responsibility for ensuring that social care workers have effective voice and developing a collective bargaining role in that sector. I confirm our support for that work, which is being taken forward through the fair work in social care group, which is chaired by Andy Kerr. By the end of May, we will establish a minimum set of standards that reflect fair work, effective voice, what that will look like and how it will play out in terms and conditions, and how it will be applied across all our social care workforce.
Since 2016, we have provided funding to enable adult social care workers to be paid the real living wage for waking hours. During 2018-19, that commitment was extended to include those undertaking overnight social care support. We want to ensure that there is no delay in the annual uplift being received by the workforce. I confirm that, with the fair work in social care group, as a priority, we will seek to agree a national approach to implementing the real living wage for adult social care workers for 2021 and future years.
The report rightly highlights how commissioning for the public good can drive change and that ethical commissioning and procurement can support the standardisation and implementation of fair work requirements and practices. I have therefore asked that this year’s minute of variation requirement for the national care home contract should also embed changes that drive the fair work agenda, and that, for the first time, union representatives should be party to the discussions on the contract.
I want to work towards parity with the national health service, in which healthcare and social care are both free at the point of delivery, so we will work with local partners as quickly as is practicable to end all charges for non-residential care. I have already announced a significant uplift in the allowances for self-funders, and I want to move swiftly towards a position in which all care is fully funded in residential settings.
Finally, the report has recommended a number of important areas for substantial investment not in more of the same, but in supports that will propel our vital social care system forward and make it work consistently and to a high standard across the country for those who need it.
The report sets out how we need to invest in adult social care financially, and it highlights the wider economic benefits of investing in our social care system. Many may be tempted to ask how we can afford that, but—for me, for the report authors and for many members across the chamber—the answer has to be, how can Scotland now afford not to do it?
I believe, as the report sets out, that improving adult social care gives us a tremendous opportunity to improve people’s lives, build our economy and invest in high-quality, fair work. This is just the beginning of a process for improvement. It is now up to us, in the Parliament, to consider carefully the practical application of the recommendations and to build on good practice in order to ensure a social care system that consistently delivers high-quality services across Scotland, is founded in fairness, equality, and human rights, and puts lived experience at the heart of its redesign and delivery.
That the Parliament welcomes the Independent Review of Adult Social Care and supports its recommendations, which provide the foundation to enhance adult social care provision across Scotland; expresses thanks to the review’s chair, advisory panel and all the individuals and organisations who shared their views and experiences through the programme of engagement; believes that the incoming parliament should implement these recommendations as quickly as practicable, including scrapping non-residential social care charging; commits to establishing a human rights approach to social care that incorporates equality, individual autonomy and citizenship; recognises the fundamental role of unpaid carers in society and commits to providing them with improved recognition and support; agrees that increased and more effective investment in social care will benefit everyone in Scotland, in terms of economic growth, as well as wellbeing; recognises the critical support provided by the social care workforce on a daily basis and commits to providing improved pay and terms and conditions that reflect the Fair Work principles, and delivered through national bargaining, and commits to establishing a National Care Service in law, on an equal footing with NHS Scotland, to provide national accountability, reduce variability and facilitate improved outcomes for social care users across the nation.
I call Donald Cameron to speak to and move amendment S5M-24134.4.16:14
I welcome the opportunity to open for the Scottish Conservatives in this important debate, and I place on record my party’s thanks to the advisory panel and to all who contributed to the thorough and wide-ranging report.
I pay tribute to Derek Feeley, in particular, not just for leading on the report but for his regular engagement with health spokespeople from all political parties during the process. I can honestly say that, in all my time as an MSP, I have never felt more involved in such a review. Much of that comes down to the personal dedication shown by Mr Feeley and the genuine and sincere attempt to consult Opposition politicians. Such a radical and refreshing approach should be the way forward for future reviews and reports.
It is important that we reflect on why the review was commissioned in the first place and why it is critical that we make changes. One factor behind the review—it was not the only factor, of course, but it was an important one nonetheless—was the tragic loss of life in our care homes during the Covid-19 pandemic last year. That is still happening, although, thanks to life-saving vaccines and better practices, the mortality rate is declining.
The latest figures show that there have been 3,146 deaths in care homes in respect of which Covid-19 was mentioned on the death certificate. That accounts for 36 per cent—over a third—of Scotland’s total Covid-19 deaths. That is 3,146 lost mothers, fathers, grandparents, aunts, uncles, brothers, sisters and friends. It is 3,146 grieving families left behind and urgently looking for answers.
We know that more than 100 patients were sent to care homes earlier in the pandemic, despite their testing positive for Covid-19. We also know that, according to Public Health Scotland, some 3,000-odd patients were discharged into care homes between 1 March and 30 May without being tested. Those may have been clinical decisions, but they were clinical decisions that were overseen by the Government. That is why our amendment repeats our call for a public inquiry, which has already been agreed to twice in parliamentary votes.
The other key factor behind the review is the near universally agreed view that the way that we deliver social care is not working and that change is needed. The Royal College of Nursing has said:
“the current way that adult social care operates is not fit for purpose and needs radical overhaul”.
I agree with it.
There are many recommendations emerging from the report that the Scottish Conservatives agree with and welcome. We agree that
“Carers need better, more consistent support to carry out their caring role well”,
as the report states. We, as a party, have a strong record of supporting our carers, which includes the delivery of short breaks for unpaid carers as part of the Carers (Scotland) Act 2016 and our calls for an increase in the carers allowance.
We also agree with the need to remove the needlessly bureaucratic process of accessing social care. In the report, families described that as “notoriously difficult” and “over-complicated”.
There are strong and compelling arguments for applying national standards and for driving high-quality care on a Scotland-wide basis, as well as for approaching workforce issues at the national level and for a human rights-based approach to delivering care. We acknowledge that there is a need to improve training and career development opportunities for carers. The report argues that many felt that there was a
“need to improve the skillset of the workforce”
“the Scottish Social Services Council is not equipped or resourced to support effective training and development of staff.”
The RCN has said that its members feel that there is
“a barrier to nurses working in adult social care”
“a lack of opportunity to undergo training at work, as well as a perception, rightly or wrongly, about lack of career progression”.
As the cabinet secretary said, at the heart of the review is the call for a national care service to be placed on an equal statutory footing with NHS Scotland. We have long agreed that health and social care need to be seen as integral parts of the same system, and that implies parity between them.
The Scottish Conservatives believe that the creation of a national care service in Scotland could assist in achieving higher-quality care as well as improve the employment conditions of care workers. However, the Scottish National Party Government must provide details of how that will work in practice. Such a service must avoid becoming a centralised, monolithic structure, and it must ensure that individual people are at its heart. The Government has an unenviable record when it comes to centralisation, and there are patent dangers if that were to become another act of amassing power and control in central Government. It is imperative that any change to the delivery of social focuses on such care being person centred.
We know that a one-size-fits-all approach does not work. I note the comments of the Coalition of Care and Support Providers in Scotland, which has stated that
“any new system must also allow for local variation, flexibility and accountability”.
The Scottish Association for Mental Health notes that
“Social care providers ... also need to be involved in the design of social care services”,
“delivering a support service that has not been designed with a person-centred or recovery-based ethos in mind.”
We also acknowledge the views of local government, which is concerned that some of the recommendations in the review, especially around the national care service, could see local accountability diluted.
COSLA’s health and social care spokesperson, Councillor Stuart Currie, has argued that council leaders are opposed to
“the recommendations on governance and accountability which would see the removal of local democratic accountability and a degree of centralisation, which Leaders rightly felt would be detrimental to the local delivery of social care and its integration with other key community services.”
We must be highly mindful of those views. Any new service should involve local stakeholders, and local decision making should be enhanced rather than diminished.
The review also calls for the reform of integration joint boards as part of a national care service, and more detail is needed from the Government about what that would involve. As constituted, IJBs are far from perfect, and the current system of integration raises many issues around funding, organisation and delivery.
The Scottish Conservatives believe that a local approach remains crucial in designing a new service and that local government should receive the support that it needs. That is why the Scottish Conservatives have pledged to
“enshrine fair funding for councils into law, ensuring that local authorities receive a set fraction of the Scottish Government budget each year”.
I will draw my comments to a close. The review is detailed and provides many positive ways forward in improving the experience of social care for those receiving it and for the many people who are either working in care or providing care voluntarily. I reiterate my thanks to Derek Feeley and the advisory board for producing the review during the most difficult of circumstances.
It is clear that the Covid-19 pandemic has exposed many of the weaknesses in the existing care system and that reform is long overdue, but we must be cautious in how we achieve that change and ensure that the people who receive care are at the heart of any change. All relevant stakeholders, whether they be the public, the third sector, local government or others, must be consulted and kept apprised by the Scottish Government.
I move amendment S5M-24134.4, to leave out from “supports its recommendations” to end and insert:
“thanks the review’s chair, advisory panel and all those who shared their views and experiences; believes that the creation of a National Care Service in Scotland could assist in achieving higher quality care, as well as improving the employment conditions of care workers, but that the Scottish Government must provide details of how this will work in practice, and must address, in particular, concerns raised about undermining local decision-making; believes that any changes must ensure that care is person-centred; notes that, sadly, more than 3,000 residents have died in care homes during the COVID-19 pandemic, and calls again for an inquiry into this tragedy, as voted for by the Parliament in resolutions to previous debates.”16:22
Scottish Labour has campaigned for improvements to our chronically underfunded care services for a long time. We believe that social care support in Scotland should always be free at the point of use, based on need and not income, and rooted in a system that respects the dignity of people, service users and staff.
Although it breaks my heart that it has taken the effects of a global pandemic to shine a spotlight on the flaws in the current market-based system, I welcome the fact that we are finally seeing social care getting the attention that it deserves. I want to put on the record Scottish Labour’s thanks to those who have worked on the independent review of adult social care and contributed to its recommendations. There is much to be welcomed in it, and I am grateful to Derek Feeley for his willingness to engage with MSPs, to keep us updated and to engage widely with trade unions and service users.
Social care should be based on upholding human rights. The commissioning of services should be for the public good. The workforce should always be properly valued. Reform of social care and the creation of a national care service has been Scottish Labour Party policy for a long time. Sadly, it was rejected by Nicola Sturgeon when she was the health secretary.
My colleague Richard Leonard has used his time in Parliament to bring social care out of the shadows. During his time, he provided leadership, elevating social care and the need for a national care service before and during the pandemic. The issue has now come back to the top of the political agenda. Scottish Labour’s “It’s time to care about care” campaign last year reignited the debate on a national care service, and I am pleased that the Scottish ministers have finally paid heed to what has to be done.
Social care has borne the brunt of the pandemic, from what happened in our care homes to what happened in people’s own homes. All too often, it was left for staff to raise the alarm or for heartbroken families to speak out.
We know that the Scottish Government’s pandemic preparedness exercise, Silver Swan, identified social care as a weak link. At the beginning of the pandemic, we heard repeated warnings from front-line workers and trade unions including Unison, Unite the union and the GMB—I refer to my entry in the register of interests—who all spoke out about the inadequacy of personal protective equipment. Those calls went unheeded for too long. In April last year, Scottish Government guidance from the chief nursing officer was still in circulation that suggested that home carers did not need any PPE beyond the basic apron and gloves that they always use.
We welcome the recommendations in the report, but we also want to hear when the country will get a public inquiry into the pandemic response and, in particular, what has happened in social care. There were comments in the chamber earlier today about the exclusion of essential care givers. I pay tribute to my colleague Neil Findlay—I am sad that he is leaving the Parliament at the end of this session—who has worked tirelessly throughout the pandemic to make the case that family care givers are an essential part of the care team. They are not an extra—not just a visitor—and they, too, should have access to PPE and testing to be part of the safe provision of care in our care homes. I hope that we get to a place where the Parliament can unite and support Anne’s law, which would ensure that people never again have to spend a year in isolation without access to their loved ones.
The creation of a national care service offers the opportunity to create jobs and improve pay for social care workers. The Scottish Labour amendment reflects our support for a wage of £15 an hour for social care workers. That workforce is made up primarily of women. It is not unskilled and it deserves to be properly recognised for its labour. Fair work has far from met its potential. Fair work in social care has been a positive coalition well navigated by Andrew Kerr, but ambitions have been too low. Until we politicians take action, it is all just talk. Fair work has to be a floor, not a ceiling.
On a positive note, there are recommendations that we welcome, and, if the Government’s motion is turned into action, that would be a huge step forward for the workforce and for women in Scotland. We know that 83 per cent of carers are women, so seeing a dramatic wage rise for those workers would not only end the recruitment and retention crisis; the economic multipliers in wider society would be huge. Unpaid carers should also get equal payment and formal recognition for their labour. A properly funded care sector that creates decent, well-paid jobs will help us to meet our ambitions for the caring economy.
As things stand, too much money has leaked out of care to offshore tax havens. Care should always be about people, not profits. The report criticises the market-based system but then recommends largely leaving it in place with a bit more regulation. That is not Scottish Labour’s vision for a national care service. The amendment in my name makes it clear that a national care service has to be about delivering parity, with national standards that are delivered locally. We cannot have a system of centralisation that does not work for care visitor staff.
At the moment, the report holds only promise and requires further action. Nonetheless, it is a positive start and it is evidence of what the Parliament can achieve when there is the will to do so. I look forward to taking the matter forward, not just in the years come but through immediate action that must be taken now, including getting that pay rise to workers through the budget. If we can work together to achieve bold and radical change, we can have a national care service that is not just a title—not just words on a page—but that brings those to life and delivers better outcomes for service users and the workforce.
I move amendment S5M-24134.3, to leave out from “provide national accountability” to end and insert:
“deliver national funding and consistent standards for care services which offer equal access, based on need not income, and facilitate improved outcomes for social care users across the nation; acknowledges the grave concern expressed by COSLA that the report’s recommendations could undermine local delivery of social care; agrees with local authority leaders that local democratic accountability for care services must be maintained; believes that the Scottish Government should demonstrate its commitment to support the social care workforce, and calls for a minimum £15 an hour social care pay package in the 2021-22 Scottish Budget.”
I call Alex Cole-Hamilton to speak to and move amendment S5M-24134.2.16:29
It gives me great pleasure to rise for the Liberal Democrats. I welcome the publication of the report of the independent review of adult social care, which examines the future delivery of care for older people and disabled people in Scotland. The review’s recommendations focus, rightly, on a better service for care users and fairer pay and conditions for care workers, all of whom we have come to rely on so much—that is, we have come to understand how much we rely on them—in the course of the pandemic.
The review also sought to address disabled people’s concerns that previous pieces of legislation, such as the Carers (Scotland) Act 2016, the Public Bodies (Joint Working) (Scotland) Act 2014 and the Social Care (Self-directed Support) (Scotland) Act 2013, have not worked sufficiently well or lived up to the aspirations that were set for them. They have not created a system that is based on human rights, which would allow each individual to achieve their goals.
The review’s aims are laudable, and the Liberal Democrats will always support efforts to stretch ever higher in the quality of support that we offer. We support moves such as the establishment of national entitlements and paying our workforce so as to make social care a profession of choice and recognise the tremendous contribution that those workers make to the fabric of our society.
We have tried and failed to reform social care through policy before, so this root-and-branch review is both timely and necessary. However, the suggested move to a national governance structure causes us significant concern. To our minds, the delivery of health and social care is not suited to central control. That is why we—rightly—have 14 territorial health boards, and even more integration joint boards. Subsidiarity must apply here, because Scotland is too diverse for a one-size-fits-all approach to the delivery of care that is governed from the centre. We need only look at the problems that came with the amalgamation of Scotland’s regional police forces to form Police Scotland to see the difficulties that can arise from a central-belt-knows-best approach.
As Liberals, we believe that there should be a step change in social care so that it is provided on a human rights basis and is built around the individual and the realities of their geography. Care should be considered a normal part of human life that merits investment in order to allow people to achieve their goals and secure their own wellbeing. As with all aspects of intervention in health and social care, we should embrace prevention first and foremost to offset the need for that care. Where care is needed, as it will be more often than not, people should have the security of nationally prescribed entitlements and the expectation of a gold standard of provision. We need a step change in how we do that, and that change will be key to improving quality of life for social care users. Implementation should begin now, through existing systems, and should not be delayed by the need to create a cumbersome, overarching organisation to deliver it.
Above all, those in the social care workforce should be respected for the work that they do. As a result of the pandemic, they have finally received—perhaps for the first time—some of the recognition that they deserve. They should be afforded a nationally agreed and mandatory fair work package that will make social care a profession of choice and allow us to retain those vital high-quality individuals in the profession.
The answer in social care is never centralisation. Centralisation has not delivered the benefits that were promised for other public services, and the loss of local democratic accountability is a risk, not a benefit, to care users and staff. As Liberal Democrats, we will work with other parties in the chamber, and with the architects of the report, to reform social care in our communities, embracing much of what those communities ask of us.
We need changes in the experience of care users and care workers, as described by the independent review, built around a new national consensus that social care should be provided on the basis of human rights first and foremost. We need the setting of national care service standards and entitlements, with the funding put in place to meet those standards. Effective complaint resolution procedures for those for whom services do not come up to scratch should be at the heart of the system. We need local commissioning to involve disabled people and other care users in service design, and to be informed by local experience of unmet needs, as highlighted by the independent review.
Changes to value the social care workforce better should include a requirement that any care service, whether it is delivered by public, private or charitable providers, must comply with fair work requirements that are set nationally, and all staff should have nationally agreed pay, terms of employment and career progression.
Does Alex Cole-Hamilton agree with Scottish Labour that the fight for 15 campaign is a fair ask, and does he support a rate of £15 an hour for social care workers?
Monica Lennon made a compelling argument for that, and I do not see a reason why we would not support it, in particular given that, as she rightly said, 83 per cent of the social care workforce are female, so there is gender pay inequality as well.
As well as involving service users, we must harness the creativity and passion of our dedicated care workers. That means affording them the opportunity of effective collective bargaining and giving them a chance to help to shape the service that they provide. That must be built around the essential principle of allowing care services to operate in a way that allows carers to build relationships and trust with care users, moving away from narrow task-based contracts in which individual carers change with alarming and unsettling regularity.
Part of the offer must begin with the scrapping of charges for care services that are delivered at home. By so doing, we can enable more people to stay in their homes if they choose and experience the better outcomes that that can mean.
It is important to recognise that reform of social care should not just cover the profession itself. The measure of our efforts to bring reform will lie in how we recognise the tireless contribution of unpaid carers, giving them better support, respite and the ability to continue to work.
I will draw my opening remarks to a close, but I have more points to make in my summation.
I move amendment S5M-24134.2, to leave out from “welcomes” to end and insert:
“notes the recommendations of the Independent Review of Adult Social Care; agrees with the ambition to enhance adult social care provision across Scotland; believes that centralisation has not delivered the benefits promised for other public services, and the loss of local democratic accountability is a risk to care service users, and calls for the new resources and new human rights approach to social care to be provided through integrated local services, governed locally, involving care users, to national care service standards and entitlements; believes that there should be a new national consensus that social care should be provided on a human rights basis, and that a preventative approach should be championed; notes the concerns of disabled people that previous legislation has not worked sufficiently well to give them a system based on their human rights which allows each individual to achieve their goals; recognises the critical support provided by the social care workforce on a daily basis and believes they must be afforded a nationally agreed and mandatory fair work package on pay, terms of employment and career progression, shaped by care workers and collective bargaining; considers that there should be national care service standards, with the funding put in place to meet those standards, and effective complaint resolution for when they are not met; calls for national standards and local commissioning to involve disabled people and other care users, and be informed by local experience of unmet needs, as highlighted by the independent review; believes that charges for care services delivered at home should be scrapped; calls for unpaid carers to receive better support and respite in recognition that their role is critically important, and considers that these step changes, described by the independent review, are key to improving the quality of life for social care users, and that implementation should begin now and not be delayed by a need to create new organisations to deliver it.”
Thank you for keeping to your time, Mr Cole-Hamilton.16:35
The Scottish Green Party thanks everyone for their involvement in the review process and in what the cabinet secretary referred to as the “road map”. The Scottish Green Party supports a national care service.
The 53 recommendations set out how adult social care can be improved, but that should not be taken as a suggestion that the delivery of care is not already of the very highest standard, by and large. Overall improvement is needed, however, and it is important that we look forward, rather than backward.
Families feel a range of emotions about care. They welcome the support, but they worry about changes in care, and about continuity of care. They worry about transitions and about their loved ones being institutionalised if care is not available at home—which is ideally where we want care to be delivered.
There is a role for self-directed support, but I issue a slight caution about that: in the wrong hands, it can be seen as a way for those who are responsible not to meet their obligations.
The report discusses a more “collaborative approach” to adult social care. I can identify with that, reflecting on my days with Highland Council. The council and NHS Highland were the first to come together in what remains a unique model. The assessment of the effectiveness of the delivery of care at home found, strangely enough, that the teams that were co-located had the best results. That will surprise no one—the more collaboration, the better.
Integration joint boards have been mentioned. They are not universally welcomed, and their status relative to that of some local authorities is an issue.
There is talk of a step change in capability to address the implementation gap. That should not be at the behest of the profit motive, with private companies cherry picking high-density areas, leaving behind the remote, less densely populated areas, such as the one that I represent. Then there is the local authority, which has the statutory obligation and extols how much cheaper it can do things. There are many fine examples of good work being done by commercial care deliverers, but the statutory obligation of the limited company is to deliver profits for its owners, and I and my party are certainly of the view that care and profit need to be separated. I recall mentioning that in my first speech in the Parliament two sessions ago.
It has been said that the voice of lived experience needs to be amplified when it comes to proposed service design, and I absolutely get that. There is a suggestion of consultation fatigue. Of course we seek input from individuals, but their experience is not the whole story. We all experience things differently and the way ahead is to take a patient-centred approach.
Local authorities are concerned about accountability. I had representations from one authority last night. I have been a bit critical of the relationships in some of the joint boards, but I find that a bit ironic, particularly as—in my experience—they have sometimes sought to sidestep their own accountability and to blame central Government.
That said, it is important that we listen to COSLA. I am delighted that the cabinet secretary has indicated that there has been engagement there. I do not think that we are clear about the shape of the system. Is it entirely new and innovative? I certainly want it to be innovative, but I do not think that we want to discard some of the good practice that has been set out.
The need to set out a clear vision is covered in the review. Vision is good and passion is good; empathy is much better. I am not sure that that has ever featured as a qualification in any procurement process. The new system must be consistent, and the statutory responsibilities must be very clear.
I do not think that private companies have a role here at all, but it is important that we discuss the recommendations in a positive, constructive manner. We must recognise that posturing sometimes puts people off, and we want public support for what goes ahead, which must be evidenced by the information that we have at hand.
I like the suggestion that a national care service should be “on an equal footing” with the NHS, and I hope that, over time, we will see the warmth and affection for a national care service that we have seen for the NHS and what it delivers.
It is very important that we take a human rights approach. The Highland Senior Citizens Network was involved in ensuring that Scotland’s national action plan took a human rights approach. I remember speaking to someone who was very cynical and thought that human rights related to prisoners. However, there were many issues at that time, such as hydration for people in care homes. Making human rights relevant to people is important, and they certainly cannot be more relevant than for people who require—[Inaudible.]
The recommendation on a national improvement programme is good, and so is the one on shifting from markets and competition to collaboration in commissioning and procurement practices. I do not think that there is a role for the profit motive; it is about delivering fair work.
In the very short time that I have left, I will turn to the rural dimension. There must be subsidiarity in all aspects of this, because we want a care system that delivers across Scotland.
We will not support the Conservative and Lib Dem amendments, but we will support the Labour amendment. We share Labour’s aspiration of improved conditions, but there are many other areas that we care about, and we will address those through the budget process. “Care after Covid: A UNISON vision for social care” does not contain the £15 per week figure that Labour’s amendment mentions. Sectoral bargaining arrangements would be far more important than any figure, and it is important that Labour, like everyone else, explains where the money would come from and meaningfully engages with the budget process.
It is important that we all get behind the creation of a national care service.
I call Lewis Macdonald to speak on behalf of the Health and Sport Committee.16:41
I am glad to have the opportunity to speak in the debate and to highlight the Health and Sport Committee’s two-year inquiry into the future of social care, which was interrupted but not derailed by the Covid pandemic. I know that all committee members would want me to express our collective thanks to all paid and unpaid carers, particularly for all that they have delivered under the most difficult circumstances in the past 12 months.
I particularly thank the carers and people receiving care who shared their views and experiences with our inquiry. Our report is driven by their views and our inquiry has been guided by their experiences. Crucially, they told us that the voices of carers and care users were not being heard or even listened for. Users and carers were equally clear that they did not feel that they were being listened to or valued. However, throughout our inquiry, we learned that care-experienced individuals and front-line staff have valuable insights from which decision makers could learn a great deal.
We believe that there must be a national conversation about the future of social care and support in Scotland, with the voices of people who give and receive care at its heart. Everyone who is involved in developing and delivering social care in Scotland must work with and alongside those who are most impacted. The views of users and carers should drive the reform process. That might seem self-evident, but we are clear that that has not been happening.
We therefore welcome the independent review and its call to put a human rights-based approach at the centre of the social care system. We are pleased that the review puts people at the centre of policy development and decision making, and that many of its recommendations seek to achieve the same aims that we have, with a focus on involving people who use services, their families and their carers.
Throughout our inquiry, we heard that the current model of care is crisis driven, reactive and ultimately unsustainable. The provision of care is considered only after a crisis has struck, generally after a person has been admitted to hospital. A fundamentally different approach to social care is required—a proactive approach, with prevention at its core. We must move away from the current crisis-driven system. A key aim should be supporting people to live longer, healthier lives in their own homes.
Throughout the past five years, the committee has been alert to the benefits of shifting the balance of care from the acute sector to the community. Our budget report of 2019 showed that a preventive approach to providing care was more cost effective in many cases, and that it improved the quality of life of users at the same time.
Looking ahead, better use of technology, increased public and community involvement and improved data collection must be embedded in any changes in the way that social care is planned and delivered.
Will the member take an intervention?
As he is convener of the Health and Sport Committee, could the member tell me what evidence the committee took from stakeholders about integration and its success or otherwise? We were told that integration would release huge amounts of money by eradicating delayed discharges, yet we have record levels of delayed discharge. Could the member address that?
The committee took a great deal of evidence on that. We have done so not only in this context but in the context of a number of inquiries over the years. Neil Findlay’s point is reinforced by the evidence that we heard that the opportunities for greater effectiveness, efficiency and better care through integration are yet to be realised.
We need to create a fair and equitable system. To achieve that, local partnerships must be supported to work with communities to deliver creative, innovative solutions and not be hindered by over-complicated processes and bureaucracy. As we have heard, social care is underpinned by a strong legislative and policy base, but that is being undermined by poor implementation.
Commissioning and procurement came through strongly as areas with overly complex processes resulting in confusion, risk aversion and an over-focus on the system, instead of on outcomes, wellbeing and care planning for individuals. We are therefore pleased that the independent review recommends commissioning for the public good and seeks to reframe commissioning and procurement as collaborative, rights-based and participative. Our own recommendations take the same approach.
We are particularly pleased to note the review’s recommendations on unpaid carers. We, too, are calling for unpaid carers to receive increased support and recognition and to be valued for the significant contribution that they make. Indeed, we believe that the status and value of all carers, paid and unpaid, must be addressed. The lack of value placed on social care staff has been amplified by the pandemic, with social care staff witnessing their NHS colleagues being celebrated and praised, rightly, but in a way that social care staff are not. We are therefore pleased to see recommendations in the review relating to that.
We also believe that action must be taken to improve public understanding of social care in Scotland. More must be done to educate and inform the public, to encourage people to have their own conversations about care and support and to think about the type of care that they might need in the future. That will help to move away from a crisis-driven system to more flexible and prevention-focused care.
The committee’s report does not pretend to answer every significant question, but is driven by the thoughts, needs and aspirations of the public. As such, we believe that it adds significant value to the debate. Our recommendations are intended to encourage the change and action that are urgently needed for the future of social care and support in Scotland, and I commend them to the Parliament.
We come to the open debate.16:48
I welcome the opportunity to speak in this extremely important debate and thank the organisations that have provided briefings, including the Scottish Association for Mental Health, Marie Curie, Inclusion Scotland, Age Concern and the Health and Social Care Alliance Scotland.
The independent review of adult social care is an important step towards the creation of a national care service for Scotland, which can enable us to improve the experiences of everybody who uses social care support, their carers, their families and the workforce, especially in this Covid pandemic world and recognising the lives lost to the virus.
The review is comprehensive and has found many aspects of our adult social care system that are worthy of celebration, such as the introduction of self-directed support, the Carers (Scotland) Act 2016 and the Scottish Government’s commitment in legislation to integrate health and social care.
However, it has also found room for improvement, including through ensuring that the Scottish Government’s commitment to the principles of fair work is embedded in social care, to achieve better terms and conditions and more rewarding roles for our skilled social care workforce. It is important that that extends to unpaid carers and that unpaid carers receive equal rights and recognition for the invaluable work that they do.
The review found that adult social care support in Scotland is an area of unrealised potential. There is sometimes a gap between the intention behind groundbreaking legislation, such as that introducing self-directed support, and the lived experience of people who need support. The report highlights the need to move from old to new ways of thinking about adult social care and for a more collaborative approach. That could bring about a step change in our capacity to address the implementation gap. The voice of lived experience could be amplified in all aspects of the proposed redesign of adult social care. To that end, the report sets out a clear vision for a new system to ensure delivery of consistent, high-quality social care support.
The report found that
“human rights, equity and equality must be placed at the very heart of social care”
and that those qualities should be “mainstreamed and embedded”. The report also found that
“delivering a rights based system in practice must become consistent, intentional and evident in the everyday experience of everyone using social care support.”
John Finnie gave good examples of human rights for all, not only for prisoners. That includes unpaid carers, families and those who work in the social care support and social work sectors.
The report says:
“People must be able to access support at the point they feel they need it, including for advice and signposting to local community-based resources and help, and for barriers to this, such as the current eligibility criteria and charging regime, to be fundamentally reformed and removed, to allow a greater emphasis on prevention and early intervention.”
It goes on to recommend:
“People should understand better what their rights are to social care and supports, and ‘duty bearers’, primarily social workers, should be focused on realising those rights rather than being hampered in the first instance by considerations of eligibility and cost.”
There are many other recommendations, but those highlight the importance of a person-centred, human rights-based approach for those who rely on our social care system. That is eloquently highlighted in the report by a service user who said:
“Start listening to disabled people. We are the solution, we’re not the problem.”
That is an important approach. I urge the cabinet secretary to ensure that all are involved and engaged with future changes so that all voices, from those of service users to those delivering the service, are heard. We must ensure that the social care system delivers for everyone in Scotland.16:52
I welcome the publication of the independent review of adult social care. There have been calls for an independent review from the third sector and social care providers for many years. In 2019, when I held a round-table event to discuss self-directed support, concerns were raised about gender assumptions, training, development, funding, local authority guidance, the complaints process and many more issues that appear in the review.
However, Covid-19 has done most to reveal the cracks in adult social care. The SNP’s failure to protect care homes, with more than 3,000 deaths in them in the past year, has prompted the review and moved the situation on. We know the effect that decisions have had on care homes: residents have been put under pressure and staff have faced pressure on their mental health and wellbeing, and have seen the deaths of residents who were also friends and family.
The review identifies familiar themes that will resonate with members across the chamber. The report outlines a guddle of a system that reflects experiences that many constituents and groups have presented to me, in my role as an MSP. The need to fight for support and services causes stress and anxiety. Disabled people are frustrated when they discover that no personal assistant with the right skills to help them to lead an active and independent life is available in their home town.
On self-directed support, when people are told the options that exist, social workers too often do not tell them that they can employ someone themselves—they are not given all the options. When I was putting together my care package, there was no mention of that option during my several meetings with the social worker. The meetings were all about the state or other people providing my care package. That might be appropriate for many people, but if we are truly to revolutionise care for older people and people with disabilities, they must be given all the options, and the funding must follow what is best for the individual, not what a social worker thinks is best for them.
We have too many people still caught up in bedblocking because their package of care has been cancelled, is not available or has been delayed. For many relatives, the challenges of securing appropriate social care for a loved one are just too difficult and overwhelming. That can require them to take on the role of unpaid carer, which sometimes leads to financial insecurity when they cannot hold down employment alongside their caring responsibilities. As we heard from Monica Lennon and others, the responsibility often falls on women relatives and mothers, among others, to provide that care. That is why we need to look at the issue as one that affects women particularly, in our society.
We must not kick the recommended improvements into the long grass. We must start moving on them and not wait for yet more discussions, regardless of whether the improvements are about developing people’s personal capacity, looking at how we direct self-directed support in a more positive way or empowering people in their communities. We should be united on the issue, so I am pleased that we have a lot of cross-party support on it. I hope that whoever forms the next Government will get the support of the whole Parliament to take the issue forward.16:56
I congratulate the convener of the Health and Sport Committee and the committee clerks on the pragmatic way in which they managed to ensure that we debated the work that led to our report, which is helpful for us in this debate.
This is an important debate for all of us in the chamber. How we progress from here could make this one of the landmark points in the on-going story of the Scottish Parliament. It goes without saying that anything that we say and do regarding social care comes on the back of a difficult year for everyone, but it has been an especially difficult year for people who have lost a loved one, and for those who work in a sector that has had to deal with difficult and challenging circumstances.
However, there is much in our adult social care system that warrants celebration. Key legislation has been created to support the sector, examples of which are the introduction of self-directed support, the Carers (Scotland) Act 2016 and the Scottish Government’s integrated health and social care agenda, all of which are part of the way forward. We have had challenges along the way in meeting expectations, but nothing worth while is easy. If it was, we would have done it previously.
In September 2020, the Scottish Government announced in its programme for government the review of social care, the report on which we are discussing today. If we have learned anything over the past year, it is that there is a need for change in our social care settings and that there are better ways of working.
I have continually pursued that with health boards when they have come to committee. Recently, they have said that they have found better ways to work with other services over the past year because they have had to do it and it was important that they did so. Those who manage our health boards are correct to say that they have, during this difficult year, found ways to make what appeared to be impossible last year happen this year. The solution tends to be around how they interact with integration joint boards, but they should have been working previously as they work now.
Everyone in Scotland’s NHS and care sector is to be congratulated for the work that they have done. However, whenever board members come to committee and explain what they have achieved this year, I cannot help but ask why it took a worldwide pandemic to make all that work. I know that a crisis can focus people on delivery, but I still find it bizarre that many health boards took so long to understand what was needed.
The independent review of adult social care could not have been published at a more important time. It is a substantial piece of work, and its many recommendations show us a different way forward for providing care. The creation of a national care service has been spoken about by many colleagues in the debate. In my opinion, probably the most important part of the report is on how we take forward the recommendations. Our challenge is to create a robust and deliverable national care service of the type that we all want.
That the establishment of human rights in the approach to social care should incorporate equality should go without saying. However, there should be better support and representation for unpaid carers. I am sure that I am not the only MSP who has had unpaid carers approach them, and who has guided them through the process and tried to get them the support that they need. The report is extremely important in that it provides a road map for making that process better.
Most important is that we are talking about delivering fair work for the workforce, with increasing and more effective investment. For far too long, many women who work in the care sector have been subjected to financial and work-related conditions that are different from those that are afforded to women who work in our national health service. Anything that can balance that anomaly is to be welcomed. Obviously, that will be helped by the proposed shifting of the adult social care model from markets and competition to collaboration, commissioning and procurement practices.
The report also highlights the need to move from old thinking to new thinking. That seems to me to be something that should have been obvious to us all.
However, this is day 1, so we all need, as the debate progresses, to work together to ensure that we create the service that we want, so that we are not having the same debate in future years.17:00
I, too, very much welcome the opportunity to speak in the debate. I will begin by being positive—it is a positive review—so who better to quote than the chair of the review, Derek Feeley. He said:
“there is much about adult social care support in Scotland that is ground-breaking and worthy of celebration. The introduction of self-directed support, the integration of health and social care, and the promise of the Carers Act form the scaffolding upon which to build.”
That is exactly what we need to do. We need to build on the foundation blocks that the Scottish Government has put in place so far. I welcome the cabinet secretary’s earlier announcement about the improvements and moneys for carers.
I fully support the report’s recommendations, and I thank everyone who has been involved in shaping and feeding into the review. I am pleased that extensive engagement with service users was undertaken as part of the review. As we all know, their lived experience is crucial to informing changes to the system.
I have, as a member of the Health and Sport Committee, been looking at the subject. We hope that our work will also feed into the review and help to shape the future of adult social care across the country.
The committee also engaged with service users and those who deliver social care services. I was struck by their personal experiences. There is so much that those of us who do not need to access social care services take for granted. Service users have spoken of systemic barriers in accessing services, with their choices about, and control over, their lives and needs not being taken into consideration or even being taken away completely.
For almost a year, we have all been firmly focused on the pandemic. Our collective actions have been—quite rightly—to protect lives and our NHS. It has been a year like no other, with our front-line workers facing incredible challenges. People who are dependent on the social care sector and those who work in it—paid and unpaid—have also been feeling the enormous impact of the pandemic.
The evidence that the committee received from one service user should resonate with all of us. They were reflecting on how the pandemic took away much of their control and choice over how they live their life. They said:
“this gives people a small insight into what it’s like for people with support needs and their carers because that’s our everyday lives, controlled by rules and regulations about what we can and cannot do.”
Another service user said:
“I don’t think the general public realise if you are dependent on this kind of support how precarious it can be. I don’t think they realise we’re talking about the most fundamental needs and rights, and to have that taken away from you by somebody who very often doesn’t know you, or hasn’t really taken the time to understand your situation, is such a violation.”
Those are only a couple of examples, but they are certainly not lone voices; others share their experiences.
We must recognise and learn from the effects of the pandemic, but as George Adam said, we also need to look beyond it at how we can use the foundations to create a sector that, as one service user said,
“is not a safety net but a springboard for those that need support”—
a system that enables people to reach their potential and provides independence through a rights-based people-power approach.
A national care service that is shaped and informed by service users would have enormous potential. I hope very much that it will be delivered in the next parliamentary session. There is much work to be done, but the review clearly sets out what we need to put in place, where support is needed and how such support should be provided, if we are to ensure equality and equity.
In his remarks, Alex Cole-Hamilton mentioned that people should be able to expect a gold standard. Indeed, they should. However, I believe that they should be able to expect that of elected members, in particular. I ask Mr Cole-Hamilton to reflect on that point.17:05
I will begin by setting out where we find common ground on this subject. In his foreword to the review’s report, Derek Feeley said:
“If we want a different set of results, we need a different system.”
I agree with him. Our system should be built on the values of human rights, equity and equality. We need to have co-production by service users in the design and delivery of social care. We must demand, at last, a decisive shift in public policy, and a shift of public spending towards prevention, which was recommended a decade ago by Campbell Christie. Instead of that, over the past 10 years we have witnessed cuts of up to 20 per cent to social care services in Scotland, as the SNP central Government has decimated local government budgets year after year.
As the report says, public spending on social care represents
“an investment in the Scottish economy”
and the principle of
“social care free at the point of need”
should be adopted right across Scotland. In addition, the long-standing—and outstanding—question of the undervaluation of the sector’s predominantly female workforce must be addressed with renewed urgency and unwavering ambition.
But let me turn to the report’s main conclusion, which is that we need to create a national care service. I agree. The Government’s motion speaks of establishing
“a National Care Service in law, on an equal footing with NHS Scotland”.
I agree with that, too. However, that is not what the review recommends. In fact, it goes out of its way on that point by devoting a whole section to an attack on the case for public ownership. It points to the example of Home Farm care home on Skye. However, that care home does not make the case for continued private ownership of social care; it makes the case against it.
We know—because it is in the report—that 84 per cent of the current annual funding of social care in Scotland comes directly from the public purse, through the public sector. However, instead of recommending the creation of a national care service that is publicly funded, and so publicly owned—which would place it on an equal footing with the NHS—the Feeley review recommends that local councils, and the tens of thousands of social care workers whom they employ, be reduced to competing as just another provider in a procurement exercise run by unelected integration joint boards. I ask the cabinet secretary to reflect on whether that is an equal footing.
I accept that the review calls for a “new deal” with private providers. However, its silence is deafening on the ethics of the biggest providers of residential care in Scotland being run by private companies whose ultimate ownership is in offshore tax havens. It is also silent on how public ownership keeps all funding in the local economy and all money reinvested in the care service and its workforce.
If the Parliament is serious—as I believe it must be—about establishing a national care service with the same values as our national health service, and on an equal footing with it, it must be based on public service, not private markets, collaborative or otherwise; human dignity, not corporate profit; and public interest, not the money interest. The means by which it is delivered should be local, it must be democratically accountable and it must be owned and run publicly and not privately.
That matters because, as the cabinet secretary knows, it is about the kind of society that we want to live in, and the relationships of power within it. She must also know that now is the time for boldness, courage and conviction, and that the change that we need to make is not simply for this generation but for future generations. It demands vision from the Government and resolve from the Parliament; above all else, it demands the active consent of the people. That is what we need if we are to create a national care service that is truly worthy of the name.17:10
The independent review is an important step towards the creation of a national care service for Scotland. In creating that service, there must be a laser-like focus on improving the experiences of everybody who uses social care support, their carers, their families and the workforce.
There is no doubt that over this past, difficult year, the pandemic has brought existing inequalities sharply into focus and laid bare the fragility in our systems. Policy intention in terms of equality and human rights does not always match the experience of far too many of our citizens—a point that Age Scotland highlights when it says that the review identifies the
“significant gaps between what should be happening in social care and what happens in reality.”
I agree with Age Scotland that ensuring that those gaps are addressed as a priority would be a major step forward.
Improving adult social care gives us a tremendous opportunity to improve people’s lives, to build our economy and to invest in high-quality, fair work. The report’s recommendations on establishing a human rights and equality approach to social care services and support are rooted in the work to consider the incorporation of international treaties into domestic legislation and the recent experiences during the pandemic that exposed structural inequalities and pre-existing inadequacies in the current social care support system.
Of course, I agree that placing human rights, equity and equality at the very heart of social care and mainstreaming and embedding that approach is essential. However, even as I use those words, I am acutely aware that it is phrasing that I hear a lot and—to be blunt—those words mean nothing unless that is what is delivered in practice.
In practice, a rights-based system has value only when it is consistent, intentional and, most important, evident in the everyday experience of people using social care support, evident in the experience of unpaid carers, evident in the experience of families and evident to people working in the social care support and social work sector.
The report recommends that
“People must be able to access support at the point they feel they need it, including for advice and signposting to local community-based resources and help, and for barriers to this, such as the current eligibility criteria and charging regime, to be fundamentally reformed and removed, to allow a greater emphasis on prevention and early intervention.”
The report also recommends that
“People should understand better what their rights are to social care and supports”.
It highlights the role of “duty bearers”, primarily social workers. We must take a serious look at what barriers are in their way when it comes to realising the rights of their clients. Social work as a profession takes a rights-based, person-centred approach. If considerations of eligibility and cost are hampering workers in that practice, we must address that.
Good provision of care is an investment in our whole country and a mark of a good society. Social care exists to help people enjoy their human rights equally, including the right to live with dignity, the right to independent living and the right to meaningful and active participation in Scottish society, work and education. There have been some fine speeches this afternoon showing that that is understood across the chamber. Social care must have parity with our NHS, be free at the point of delivery and have human rights and fair work truly at its heart. Let us make sure that, collectively, we take on the challenges and opportunities presented in the report and deliver just that for the people of Scotland.17:14
The independent review is an important step towards the creation of a national care service for Scotland, which will ultimately enable us to improve the experiences of everybody who uses social care support, their carers, their families and the workforce.
Covid-19 has changed the way that we think about many aspects of our lives and has made us think about the sort of country that we want to live in. I am pleased that the Government set up the review, which in time really could be a positive legacy of what has been a most difficult and tragic period in our history.
I am pleased that, as George Adam said, the review found many aspects of our adult social care system that should be commended, including the introduction of self-directed support, which has been particularly useful to many of my constituents. In addition, the Carers (Scotland) Act 2016 and the Scottish Government’s commitment in legislation to integrate health and social care should be celebrated. However, it is recognised that there is room for improvement and, once the 53 recommendations that have been made are implemented, they will result in even more support being provided. The recommendations are robust and will allow us to move to a new way of thinking in which collaboration is the key to ensuring that those with lived experience are listened to when we are designing and implementing a social care system that delivers for everyone.
By establishing a human rights approach to social care that incorporates equality and gives better support to unpaid carers, we will start to address the gaps that have been identified. We must also deliver fair work for the social care workforce, through increased and more effective investment. Our social care staff have shown just how much they deserve more recognition and higher pay, in working throughout the pandemic and putting themselves and their families at risk, often on low pay and with little recognition. Every one of them deserves our thanks and praise and our commitment to better their working conditions.
I recently spoke to a care home worker in my constituency who had been off work for a period after testing positive for Covid-19. Unfortunately, and to her surprise, she was not eligible for the self-isolation grant, which meant that she lost out on pay, and that made her feel really undervalued. I know that the self-isolation grant criteria have now been updated and that there is integration and overlap between various parts of the system, but even small things like that can make a big difference to people such as that care worker.
As other members have done, I will speak briefly about the important role that unpaid carers play. Supporting unpaid carers has been a priority for the SNP Government, both before and during the pandemic, which is why, in the Carers (Scotland) Act 2016, we established rights for all carers to support and advice. The Scottish Government continues to support local implementation of those rights, backed by additional investment that now stands at £39.5 million per year. That is particularly important now, when many carers are under additional pressure. The actual number of unpaid carers in Scotland could be as high as 800,000. We all know someone who is a carer, and we might even be one, either now or some time in the future.
I will take this opportunity to mention my gran. I was thinking about her this morning, as she always loved pancake Tuesday—I am not sure why, but she really went out of her way each year—and I was telling my kids about those memories. In the context of the debate, as I have said in the Parliament before, looking back to the late 1990s and early 2000s, I would probably have been classified as a young carer, because I and the rest of my family helped to care for my gran in her latter years. That is just what we chose to do; we did not think of ourselves as carers, and that is the point. It is likely that there are many people in that position today, which is why it is so important that support is made available through the Government.
At the heart of the review and our decisions is the opportunity to improve the lives of adults who receive care and those who give it. There are of course added financial benefits to the economy and we have an opportunity to invest in high-quality fair work but, first and foremost, we must ensure that the people of Scotland can equally enjoy their human rights, including the right to live with dignity, as well as rights to independent living, meaningful and active participation in Scottish society and opportunities for work and education.
I will conclude by talking about care homes, as others have done. MSPs of all parties and in all positions in Government—every one of us—will have been struck by the almost impossible dilemma and heartbreaking situation facing residents over the past year.
Mr MacGregor, you are slightly over time already. Please bring your remarks to a conclusion.
On the one hand, we have been dealing with a horrible virus that disproportionately affects our older generations and those in care homes, and on the other hand we have the most extreme restrictions, which are necessary to prevent the virus but which impact on isolation, loneliness and the dignity of residents. That is an impossible choice. It is important that the creation of any national care service delivers for care homes and honours the legacy of those residents who have sacrificed so much in so many ways during the past year.
I support the Government motion.17:19
It has been an excellent debate, with real passion having been displayed in some of the speeches. I will touch on that passion as I summate the Liberal Democrats’ amendment.
The Parliament has attempted the reform of the social care ecosystem several times before. We heard something of that in the integration of health and social care agenda—a great idea, but poorly executed and not given the resources or accountability that it required. Self-directed support was mentioned eloquently by Emma Harper and Fulton MacGregor. I worked in the social care sector when self-directed support was first introduced. An example of how the idea was great but the execution was poor could be seen when I helped a local authority to anticipate how it was going to build in self-directed support for its community. The local authority had a respite care unit that served 107 children who required respite support. It did so, and it met every single one of the children’s needs. There was no market for another provider to produce a rival service so that parents could choose how to direct their support. Nothing changed for them as a result of that agenda. We need to recognise the importance of putting individuals at the heart of this but understand the market conditions around which it is built.
Donald Cameron shares my party’s concern about centralisation. He rightly mentioned the briefing that has been provided by the CCPS, which pointed to the need for any national care provision to have local variation, flexibility and accountability built into its core. I do not believe that we can do that with a monolith at the centre, controlling things.
Monica Lennon pressed me on the £15 an hour, which she referred to as a floor, not a ceiling. I have a lot of sympathy for that. As I said in my reply to her, 83 per cent of women are affected by that. However, John Finnie captured our party’s position and said that sectoral bargaining is more important than a baseline figure. I have a lot of sympathy with the baseline being £15 an hour, but I think that we would go for—
Will the member take an intervention?
I will not take an intervention at this point—I am sorry that I do not have time. However, the member’s point was compelling.
John Finnie also made an important point about rebalancing the priorities among private sector providers away from profit and towards continuity of care and the importance of giving dignity in old age. He acknowledged the difficulties of rurality that I referred to in my opening speech, with 25-minute journeys for 15-minute visits, which, again, are stripping relationships out of care.
Lewis Macdonald referred to the social care inquiry, which should remind us that deliberation in this place on reform of social care is almost perennial. Jeremy Balfour, in an excellent speech, talked about the cracks in adult social care—from problems that can be found in publicly funded care homes in my community, which are now rectified, to the Covid disaster that we have seen in our care homes.
George Adam talked about
“the type of national care service that we all want.”
If this debate has done anything, it has helpfully shown that there are at least four different views about what a national care service might look like. We see that in the amendments that we have debated this afternoon.
Richard Leonard made a barnstorming speech. I acknowledge his qualities as a speaker and his loss as a speaker as the leader of Scottish Labour. However, although I agreed with a lot of what he said, I do not think that he recognised that, although private homes fail, so do public homes. Public provision is not a guarantee of quality. I am not saying that that is wrong, but it is important to recognise the reality of the situation. Richard Leonard also talked as if the NHS was entirely free from privatisation, when in fact there is a significant element of private provision in the NHS.
Ruth Maguire talked about unshackling social work, which is important, too.
We need to build a cathedral of trust in social care that is built around the individual but acknowledges the shortcomings of the current system. In our view, those shortcomings will not be resolved from the centre. Local accountability, flexibility and autonomy are at the very heart of the vision that we would all aspire to.17:23
I declare an interest as a member of Unite the union. Also, my mum is a resident in a care home.
I have probably spoken about social care more than any other issue in my 10 years in Parliament. We could fill the chamber with the reports that have been written on social care over those years. The system that we know is broken. It was broken before Covid, but the crisis has exposed it like never before. Everyone accepts that there must be change and that the good work that is going on in social care is despite the system, not because of it. Nowhere is that more evident than in the workforce. Currently, as we have heard across the piece, the sector is riven with low pay, poor conditions and, in some cases, outright profiteering.
Consider HC-One, which has more than 300 care homes in the UK and more than 50 in Scotland. In 2019, that company, which let us not forget is registered in the Cayman Islands, paid £48 million in dividends in one year to its shareholders and paid zero corporation tax—none—and it has posted a loss every single year it has been in operation. Today, it advertises care assistant jobs—I checked this morning—at £9.30 an hour and a laundry assistant job at £8.72. HC-One owned the Skye care home and currently owns the Redmill care home and many others that have been at the centre of scandalous neglect at times and multiple deaths during the pandemic. The Feeley report says nothing on getting rid of HC-One from the sector.
The report mentions good stuff on fair work—absolutely. I do not know how many times I have tried to amend legislation in here to give social care staff fair work and decent conditions. I have attempted it several times with amendments, all of which were rejected by ministers and voted down by George Adam, Sandra White and all the other back benchers who spoke in the debate, who are now falling over themselves to give care workers good terms and conditions. What happened? We could have done it in the past.
It is two years since the fair work convention’s report on social care recommended establishing collective bargaining. Why has it not happened by now? We will, I hope, vaccinate the entire population in six months, but we cannot set up collective bargaining in two years—why not?
On workforce issues, we are taking a big step in the right direction. The recommendations are welcome and need to be implemented now. However, one of the great frustrations of the report is the lack of genuine analysis of the past 14 years of cut after cut to social care and of whether integration has been a success or failure.
The report also fails to consider delayed discharge prior to Covid, and its magical eradication in April and May. Where is the condemnation of policy decisions that contributed to the current human rights catastrophe that goes on in our care homes—the PPE issue, the failure to test, the “Do not resuscitate” issue and denial of hospital treatment? There is silence on the fundamental issues that are at the heart of the human rights agenda.
Although Feeley’s report is good in parts, what it does not recommend is the creation of a national care service on a par with the NHS, because like so many of the Government’s initiatives, the rhetoric is not met with reality. We know that we have had 14 years of cuts and an overreliance on the private sector; that the standards in many care homes are not good enough; that we have a pay and conditions and recruitment crisis. However, the report says that the problem lies with councils—the very councils that have been stripped of cash to deliver the service in the first place—and that the answer is to remove their local role, centralise decision making and pass it back to ministers and senior civil servants who know best. I don’t think so—I reject that approach.
The greatest, central weakness of the report is the refusal to do anything at all about removing the profit motive from the care system. Feeley proposes reforms of commissioning and identifies delayed discharge as—once again—the magic elixir that will release millions of pounds into the system and drive up care. The reality is that we all know the magic elixir—pounds, shillings and pence. That is what eradicated delayed discharge in April and May this past year when all those elderly people were fired out of hospital untested into care homes almost overnight, because money was made available that was not there before.
I reject Mr Feeley’s faith in what he calls “an actively managed market”. I believe that that is complete hokum. When the cabinet secretary was a socialist, she probably believed that too. The report rejects the nationalisation of the sector, which means that the likes of HC-One will continue to extract their 10 per cent profit every year. Why do we not consider buying back care homes, saving money for the system in the long run to put back into care?
We have to now be at the start of a campaign for a genuine national care service. That is our goal, with decent care for our older people and dignity for everyone who needs social care. That is what I will be campaigning on.17:30
I am very pleased to be closing this hugely important debate on behalf of the Scottish Conservatives.
As others have, I place on record my party’s thanks to Derek Feeley, to the panel and to all those involved in what is a very comprehensive report. In general, the debate has been quite consensual, because, I think, we are all working for the same outcome.
As my colleague Donald Cameron reminded us, the report has been delivered against the backdrop of a Covid-19 pandemic that, to date, has claimed the lives of 3,146 care home residents—more than a third of Covid deaths—in Scotland. Furthermore, it cannot be overlooked that patients were sent to care homes early in the pandemic despite being Covid-19 positive and that, between 1 March and 30 May 2020, more than 3,000 patients were discharged into care homes without being tested. That is why our amendment repeats our call for a public inquiry into that scandal, which has already been agreed twice through votes in the Parliament. Relatives and friends will need answers.
As for the report, I think that the way in which the issues pertaining to adult social care have been framed captures much of the challenge that social care faces. My committee colleague George Adam, in his speech and in his continuing questioning of IJBs and health boards, has asked why it took a global pandemic to make the change and to start IJBs and NHS boards collaborating with each other. He has a point. However, change is what we have, and we need to maintain the rate of that change. As Donald Cameron highlighted, the RCN has stated that the way in which adult social care currently operates is not fit for purpose and needs a radical overhaul. That change is needed.
There is much in the report’s aims and objectives that we agree with, including the removal of needlessly bureaucratic processes in addressing our social care. We cannot have families describing it, as they did in the report, as “notoriously difficult” and “over-complicated”. Applying national standards to drive up the quality of care across Scotland is obviously a good aim, as is delivering better working conditions nationally, including by improving training and career opportunities for carers. That speaks to recruiting and retaining staff as well as delivering a healthy workplace environment for all staff.
As its convener, Lewis Macdonald, has said, the Health and Sport Committee considered the report and the responses that were required. Part of our report said that health and social care partnerships should be required to deliver a
“To prevent crisis situations”,
there has to be
“a focus on a neighbourhood approach to the planning of health and social care services. Better collaboration and relationship building across sectors and policy areas is required. Locality planning must be required and measured against its success in achieving this shift.”
One of the committee’s key recommendations was on the need to develop
“a strategy for widespread use of technology to improve ... delivery of social care ... support.”
I have long called for significant investment in communication and collaboration technology that can follow the patient as they transition between social, primary and secondary care. Future policy must be driven by the collection and analysis of quality data. That allows for the setting of measurements of success, for monitoring against those measurements and for evaluating outcomes. Audit Scotland’s briefing “Planning for outcomes” asked that public bodies be supported to deliver measured outcomes. However, the committee found it difficult to follow the money, and that needs to change.
The role of the third sector was also investigated by the Health and Sport Committee, and we recommended that its advocacy role be strengthened. For me, one of the key takes from the report is the wider view of what adult social care should include. The integration of statutory and third sector services has to improve.
As I think I said earlier, the report frames adult social care issues very well. However, it will be in the delivery of solutions that we will determine levels of success. In that regard, will we get to hear how the Scottish Government will implement any of the recommendations?
The Scottish Government must avoid the continuing centralisation of statutory services, which are much better delivered as close as possible to the point of need. That will require fair funding for councils, which the Conservatives have called for. The outcomes must be controlled around the needs of the individual and allow for variation, flexibility and accountability, as the Coalition of Care and Support Providers in Scotland has suggested. There is no one size that fits all. As SAMH has suggested, social care providers need to be included in the design of social care services.
As Jeremy Balfour said, Covid-19 has put incredible pressure on our social care and the NHS. Under that pressure, weaknesses have been exposed. Healthcare workers and carers who deliver in the system have been nothing short of remarkable. I agree with Neil Findlay that fantastic work is being done despite the system. That cannot be stated too many times, but the systems have been problematic. The communication in the NHS—especially between secondary care and social care—has been highlighted as falling short too often. The Scottish Government should not try to hide from that. We need to accept it and look at how the system can be made more robust and deliver solutions that are accessible to those in need.
This is the start of a national conversation about adult social care in Scotland, its future, and how a more prevention-focused approach to adult social care needs to be delivered, as the convener of the Health and Sport Committee has highlighted. Adult social care needs a complete overhaul, and Covid has laid bare the need for a national discussion about how it will be funded, organised and delivered. I look forward to hearing from the Scottish Government what a national care service would look like in its eyes.17:36
I thank members for their contributions to the debate. Although there are undoubtedly disagreements and we shall support none of the amendments to our motion, there are clear areas of agreement. That bodes exceptionally well for the work in the next parliamentary session, which will have to get into much more of the detail than we will be able to in the weeks that remain to us.
It is really important to be clear at the outset that the Feeley report is very clear that there is a great deal to build on in the existing provision of social care by many of those who provide it and in the legislation that exists, which has the right intent and the right legislative underpinning. However, it is also clear that that is not enough and that it is not consistent enough.
Jeremy Balfour put it particularly well in describing, from his personal experience, what it is like for a person to be told what they are going to get as opposed to being asked what they need. We see that across the country. The quality of delivery is not consistent enough—that is what we, as MSPs, have heard. I have heard that, as the cabinet secretary in this role and previously as a minister, and that is what the Feeley review heard.
That takes us to a central dilemma: how do we ensure that national standards and national consistency are delivered so that there is not one level of social care support in one part of the country and a different level of social care support in another part of the country? How do we create a national care service but manage to retain local knowledge, expertise and input?
It is really noticeable that the removal of variation is specifically argued for in the report. MND Scotland, Marie Curie, Inclusion Scotland, the Coalition of Care and Support Providers in Scotland and the Health and Social Care Alliance Scotland all support the creation of a national care service because of the standards that it can bring, the ethical commissioning that it can put in place, the fair work principles that it can embed, and the removal of variation.
We need to work our way through what should not be an either/or or a black-and-white situation. The service certainly does not need to be the monolith that Mr Cole-Hamilton fears. How do we create a national care service that retains a level of local input and, most important, has at its heart those who use the service and are part and parcel of making decisions about its delivery?
Much of that is for the next parliamentary session and the next Scottish Government. As I hope I have set out today, I am not waiting for that. I am moving now to provide the additional resource that I set out today—and that is in the budget—for the active work with Andy Kerr, which has a clear timeline, and the fair work group that he leads so that it can begin to flesh out and put in place early on in the next parliamentary session the opportunities that exist for collective bargaining for improved terms and conditions, as well as what it means to have ethical commissioning.
I am also moving now to use the national care home contract to make some important changes, not the least of which are bringing trade unions to the table for the first time ever and working with COSLA to see how far we can go towards addressing its concerns and setting out the significant areas on which national and local government agree.
The next bit is critically important and very close to my heart. I will put in place the steps necessary to put users and their voices at the heart of policy and delivery. We have done it before and we do it elsewhere in Government. I have to say—and, yes, I have a vested interest—that we did it very successfully in social security, and it continues. There is no reason why we cannot do it again in this most critical of areas.
The next Scottish parliamentary elections loom, and it will be for all parties to set out their own plans. However, I and the Government are clear that, in May, we will ask the people of Scotland to back the creation of a national care service that is intentional in its human rights and in the delivery of dignity and fairness, that is person centred at its heart, and that comes with a significant additional financial investment. Those are political choices, and every party has to decide how it wants to make them. The Government is clear that, if it forms the future Government, it will make those political choices, make that investment, ensure that variation is removed and, significantly, put those who use the services and who will use them in the future at the heart of its design, delivery, regulation and control.
At the end of the day, it is an investment that we will make in ourselves, in each other and in our country’s future.