Official Report 1201KB pdf
We move to the next item of business.
Craig Hoy has a point of order.
On a point of order, Presiding Officer. Not for the first time, details of a statement that is to be made in the Parliament have been leaked to the Scottish press. For years, we have been saying that the Scottish National Party’s ill-conceived plan for a national care service should be scrapped. Today, thanks to the Daily Record, we found out that that is the Government’s intention. That shows complete and utter contempt, not just for the Presiding Officer and the Parliament but for the many stakeholders who have invested a huge amount of time, energy and money in working with the Government on the botched plan.
I seek your guidance, Deputy Presiding Officer. Have you had any discussions with the Government about the latest breach of protocol? Are you aware of how the information may have come to be in the public domain, and what will you and the Parliament do to prevent such egregious breaches of the rules and disrespect of the Parliament and its members?
I thank Mr Hoy for his point of order. I am not cognisant of the full detail of the newspaper article to which he refers. I would not expect to see any detail being made available to others before the Parliament is made aware of it. That is the expectation to which we all work. Therefore, I will look into the matter to which the member has referred.
We will now proceed with a statement by Maree Todd on the future of the national care service. The minister will take questions at the end of her statement, so there should be no interventions or interruptions.
15:07
I will start with a quote from Sara Redmond, chief officer of the Health and Social Care Alliance Scotland, from November last year. She said that
“people with lived experience have invested huge amounts of time, energy and emotion in trying to make the NCS work. We cannot afford to let that effort go to waste by leaving social care in its current state.”
Her view has been on my mind since I announced a pause to stage 2 of the National Care Service (Scotland) Bill last year. I have reflected on the evidence that has been taken by the Health, Social Care and Sport Committee, and views from stakeholders, people with lived experience, members of the public and political parties. I am grateful to everyone whom I have spoken to, particularly those with lived experience, for their continued commitment. Throughout my conversations with people, the case for reform has remained clear. Despite the best efforts of many, our social care system is not delivering the care and support that people require to live and thrive. There is an overwhelming need for change now. I also note that in England and Wales, similar discussions are under way and that there is rising momentum for national approaches.
We have spent three years developing plans, and significant commitment and resources from a wide range of people have brought us to this point. I will set out revised proposals for the bill and other urgent actions to deliver improvements in the social care system. We remain committed to creating a national care service, as recommended in the Feeley review and, ultimately, to improving the individual experience of everyone in Scotland who relies on social care.
Part 1 of the bill, and the draft amendments lodged in June, proposed reform of integrated social care and community health. We made considerable efforts to find a compromise and a way forward, but it is clear that those proposals are not supported by the chamber.
I have concluded that we must deliver our Scottish national care service without legislating for structural reform, securing a different means to deliver our goals. It is therefore my intention to remove part 1 from the bill at stage 2 and to proceed with parts 2 and 3 only. I realise that that will be a source of disappointment to many, particularly those with lived experience, who have been clear that greater transparency and scrutiny is necessary to drive the improvement that we all agree is needed. I want to reassure those people that I remain committed to the ambitions of the national care service. We have already made significant improvements to social care during this parliamentary session. Later in my statement, I will explain how I intend to continue that progress.
First, I want to set out what will remain in the bill. Core elements of Anne’s law are already in place through strengthened health and social care standards on visiting rights in relation to care homes, but more is needed. The First Minister and I have been profoundly impacted by conversations with families on Anne’s law. We are committed to enshrining Anne’s law in primary legislation and to working together to ensure that the bill gets that right.
We know that sharing your story repeatedly can be frustrating and traumatic. The bill enables information sharing across health and social care services with consistent information standards. That will lay the foundation for an integrated digital approach, making it easier for people to access and manage their own information and care. Digital approaches offer a great opportunity to improve people’s experience of care and treatment. Unpaid carers make an incredible contribution to Scotland’s communities and to our health and social care system. Through the bill, we will introduce a right to breaks for unpaid carers. That builds on the £88 million that we invest, through local government, in support under the Carers (Scotland) Act 2016 and the £8 million a year that is already provided for voluntary sector short breaks, as well as the roll-out of the carer support payment across Scotland.
Across the chamber, as well as across the sector itself, there is agreement that change is needed to support the vital role of social workers. We are committed to driving forward those improvements in partnership to bring sustainable reform that future proofs the social work service in Scotland for generations to come. From the Feeley review, engagement with thousands of people with lived experience and a wide range of stakeholders, and the recommendations of this Parliament following its post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013, it remains clear that enhanced national support and oversight are necessary.
Therefore, I will move quickly to establish a national care service advisory board on a non-statutory basis. It is my intention that the advisory board will include people with lived experience of accessing care services, unpaid carers, those who work in the sector, care providers, the third sector, trade unions, the national health service and local government. I expect the board to meet for the first time in March this year. I want the chair of the board to be independent—ideally someone with lived experience of accessing care or of caring themselves or someone who represents those with lived experience and who can hold the Scottish Government and all our partners to account for the improvement that is needed.
Where it is indicated that agreed standards are not being met, progressive and targeted support will be offered to those areas to help them to improve. I will ask the board for advice on the best way to do that. The current system for integrated health and social care is not delivering for people. There is no shared understanding of what good looks like and no systematic approach to tackling problems in local areas quickly when problems first emerge. That results in performance issues in some local areas reaching crisis point.
We will review our health and social care standards, agree local monitoring and reporting frameworks and improve access to information. That will enable a systematic approach to providing progressive and targeted support for local areas, where necessary using our powers of direction and guidance when standards are not being met.
The advisory board will have a wide remit. It will provide advice on national programmes that are intended to support improvement. Those include the existing implementation of the carers and dementia strategies, work to embed a person-led approach through getting it right for everyone—GIRFE—and our work to reduce the number of people in delayed discharge in the drugs mission.
We will explore with partners how we can plan and deliver more effectively for people with high levels of need across current organisational and geographical boundaries. We will empower people to understand their rights by publishing our co-designed charter of rights. We will develop national standards and guidance for commissioning and procurement to deliver on our commitment to ethical commissioning. We will continue to overhaul eligibility criteria in social care, and I will consider how we will achieve our ambition to remove non-residential charging.
It is essential that we continue to support our workforce. We are delivering on our commitments to fund the real living wage for adult and social care workers. We have a clear focus on national and local workforce planning and high-quality learning, development and leadership support for social care staff. We will build a well-deserved sense of professionalism in the sector and improve parity with the NHS workforce.
At local level, integration joint boards will continue to plan and oversee social care and community health. I will consider what changes can be made to secondary legislation, guidance and the approval of integration schemes to ensure that the voice of lived experience is heard and to increase accountability and financial transparency. I will also support Highland partners, who have decided to end their unique model of integration to align with the rest of Scotland’s IJB model.
I welcomed the news on the United Kingdom Government’s plans for an independent commission on social care, which was announced a few weeks ago. There are significant issues in relation to employment, the relationship with taxation, immigration and pensions that can be resolved only through powers that are held by the UK Government. Those include the impact that increasing employer national insurance contributions will have on the social care sector in Scotland. We are already engaging with UK ministers, and I will continue to urge the UK Government to reconsider.
I note the comments made by the UK Government’s social care minister, Stephen Kinnock, on previous UK Government attempts to reform adult social care failing due to a destructive combination of party-political point scoring and short-term thinking. I want us in Scotland to move forward collaboratively, focusing on the importance of social care reform and the vital purpose of a national care service to improve people’s lives.
Throughout the bill process, I have said that my door is always open to discussion. That is the case today. We are all agreed that social care outcomes must improve, and I urge members from across the chamber to engage constructively with us as we move forward. Together, we can bring about the sustainable change to social care that people urgently need.
The minister will take questions on the issues raised in her statement. I intend to allow around 20 minutes for questions, after which we will move to the next item of business. I invite those members who wish to ask a question to press their request-to-speak button.
I declare an interest: I am a practising NHS general practitioner.
The national care service was the Scottish National Party’s flagship healthcare policy, as promised at the 2021 election, to fix the care crisis. However, four years later, almost £30 million has been wasted, which could have paid for the salaries of 1,200 social care workers.
From day 1, the Scottish Conservatives were against the bill and repeatedly called for investment in front-line care. The SNP has failed to listen, just as it has failed to listen to experts, trade unions and councils, which agree that the bill is fatally flawed. However, the SNP stubbornly ploughed on, throwing good money after bad.
Following today’s hapless and tone-deaf statement by Maree Todd, which has shown the NCS proposal collapsing after a humiliating display of arrogance, failure and sheer waste, the SNP Government could not be trusted to run a bath, let alone be trusted with our health and social care service. We have a shower of charlatans before us, who have failed people who need social care, failed social care workers and failed Scotland. Today’s statement amounts to the failure of a flagship policy. Party has been put before people. In any other organisation across Scotland, such failure would lead to sackings and resignations.
Dr Gulhane, I need a question from you, please.
In any other organisation across Scotland, such failure—
Dr Gulhane, could you please just ask your question?
—would lead to sackings and resignations.
Dr Gulhane, please resume your seat.
Will Neil Gray and Maree Todd do the right thing and accept responsibility for their monumental failure and resign? [Interruption.]
Excuse me. I say to members that we need to get through this item of business, and that we need to get in as many members as possible to ask questions. If I have to keep interrupting to keep order, fewer members will get to ask their question, and I do not think that that is what members want.
I thank the member for his question—I think.
We have listened carefully to what people have told us. We have listened carefully to the voices of lived experience. We have listened carefully to the recommendations of the Feeley review. We have listened carefully to our institutional stakeholders and the members of the different political parties in the chamber. Everyone agrees that change is needed in social care. No one is accepting of the status quo. I have listened extremely carefully, and I am trying—very carefully—to navigate a way forward.
We all agree that there are problems in social care. What we do not agree on is a way forward. Dr Gulhane is absolutely correct. The Tories have been opposed to our proposed legislation from its very conception, yet they have not come forward with a single alternative idea on how to improve social care. [Interruption.]
Excuse me. Please resume your seat, minister. When one person has the floor, no other member has the floor. [Interruption.] Dr Gulhane, please do not take on the authority of the chair.
Please resume, minister.
Today, I have set out a plan that I believe that all of us can get behind. We will remove part 1 of the bill, which is the most contentious part of the bill, and we will continue with parts 2 and 3, which contain work that we cannot proceed with without primary legislation, and which are parts of the bill that the majority of members of this Parliament are on the record as supporting. I will continue to work until I have delivered the change that people who access social care want to see.
We are three years on and three cabinet secretaries and two ministers later. Almost 200 civil servants have been involved, £2 million has been spent on private consultants and it has cost nearly £30 million of taxpayers’ money—just on this bill. Although I welcome the remaining provisions, the national care service is no more. Not a single penny of the £30 million has been spent on care packages. That money would have delivered a million extra hours of care and would have stopped care packages being cut and care homes being closed, yet the minister knows that the bill will do little to improve social care.
What a waste of time and money. The centrepiece of the SNP’s legislative programme has been sidelined—a bit like the health secretary. In 2021, Humza Yousaf said:
“The creation of a national care service will be the most significant public sector reform since the creation of the NHS in 1948, and the service will be operational within the five-year lifetime of this Parliament.”—[Official Report, 1 June 2021; c 29.]
Well, that has aged well. There is no national care service, and little difference has been made for those who receive social care. It has been yet another failure.
I need a question, Ms Baillie.
Is it not time for Neil Gray to follow Humza Yousaf’s lead and resign?
Is that it?
Excuse me. Cabinet secretary, please don’t.
I will pick up on a number of issues in Jackie Baillie’s question.
The Government committed to a 25 per cent increase in funding for social care during this session of Parliament and we have delivered on that two years early.
For context, the £30 million that we spent developing the national care service was £30 million over three years in a system that we collectively spend £5 billion on every year. Jackie Baillie might think that that is unreasonable, but I do not think that it is unreasonable to spend 0.2 per cent of the annual budget to achieve change in a system that we all agree is not currently working. The time and money that we have spent will help us to lay a strong foundation for the future of social care and, as always, we are guided by the outputs of the co-design work that we have done in the past three years.
We have seen progress. We have enhanced scrutiny and assurance in local areas and have made progress in reducing delayed discharge, with a focus on supporting the local areas experiencing the most challenges. We set up a collaborative response and assurance group to give us a far better understanding of the issues that are being faced, including the national and local challenges, and that has led to a whole system of national and local interventions.
The Scottish Government, the Convention of Scottish Local Authorities and Public Health Scotland have established a rapid peer review and support team to provide direct support to a small number of local systems to help them to reduce delayed discharge.
The 2024-25 budget provided a £2 billion investment for social care and integration, which means that funding for social care has increased by more than £1 billion since 2021-22.
I will go on. We have invested to ensure that social care workers are paid at least the real living wage. [Interruption.] It is interesting that people do not want to hear that. Social care workers in Scotland are paid at least the real living wage, which is why the minimum wage paid for adult social care staff—
Minister, please resume your seat.
First, again, I remind members to listen to the member who has the floor. Secondly, minister, we have only limited time for questions. I would appreciate succinct questions, with answers to match.
I will finish on this point, although I could point to many more improvements. Adult social care workers in Scotland are paid around £1,000 more than their English counterparts because of the investment that this Government has made to ensure that social care workers are paid at least the real living wage.
We are here to represent people, and the people who rely on care services and carers—the voices of lived experience—wanted to see structural change, so I am disappointed that that element is being removed from the bill.
The minister said that she will establish an NCS advisory board with an independent chair, ideally one with lived experience. I believe that it is essential for that chair to have lived experience, so can the minister assure me that the chair will be someone who has lived experience and who can hold to account those who have vested interests and who are against change?
I absolutely agree with the member that it is really important for the chair to be independent of local and central Government and of the strong institutional voices that we hear most loudly in this debate.
I personally believe that the chair should be someone who either has or represents lived experience because I think that they would be more able to hold everyone in the system, including Government, to account. It would also be a clear statement of our intent to take steps towards the human rights-based approach that we all want to see within social care if we absolutely enshrine the voice of lived experience at the heart of the advisory board.
I say again that we need succinct questions and answers to match.
Time and again, the Scottish Government ignored the social care sector when it said that the national care service plan was fatally flawed. That arrogance comes with a human cost—the rising waits for hospital admissions and discharges, the countless numbers of vulnerable people who are waiting in desperate need of a package and, all the while, care homes across the country being forced to close their doors. Given the disdain with which the Scottish Government has treated the sector, how can the sector trust that the Scottish Government will ever listen to its expert opinions again?
I work really closely with the sector in all its glory and diversity, and it is clear that there are differences of opinion. We all agree that change is needed, and we can all agree on the problems that our social care system faces. The challenge has been in agreeing on what the solutions are. As I said, I believe that I have set out today a path towards improvement that everyone can agree on. The onus is on all of us to make it work. That is what the public want, it is what the people whose lives depend on social care want and it is what their families want. Let us get on and do it.
Will the minister outline how the Scottish Government is working with stakeholder partners to design and implement improvements to social care support as quickly and effectively as possible? Will she again outline the timescales that can be anticipated for the resumption of the NCS bill’s progress through this Parliament?
We have an on-going programme of policy-level stakeholder engagement and opportunities for stakeholder partners to engage directly in co-design activities. We have 286 stakeholder organisations on our stakeholder register, all of which receive a monthly update on co-design activities that are being undertaken and opportunities to engage. We will continue to work closely with stakeholder partners to shape the future of social care support and improvement in line with priorities that are identified by the advisory board, once it has been established. On the anticipated timescales, we hope to resume the bill process in Parliament soon, subject to Parliament’s agreement on timescales.
In November, the minister told the Health, Social Care and Sport Committee that trade union calls for sectoral bargaining were not covered by the National Care Service (Scotland) Bill and that the matter would need to be covered in a separate piece of legislation. Given that there was scant detail on fair work in the minister’s statement today, I presume that that is still the Government’s view. Does the minister not agree that collective bargaining arrangements for social care staff must be included in the bill, given that the changes that she has set out today can be implemented only with the support and confidence of those key workers?
I will probably need to get into detailed discussion with the member on that issue, but I cautiously suggest that, if the bill included collective bargaining, it would not be within this Parliament’s legislative competence. I am working very closely with the UK Government on its Employment Rights Bill, which will, I think, deliver us a legislative underpinning for collective bargaining. In Scotland, we are many years ahead of our UK counterparts in developing a system of sectoral bargaining that will work. Given the complexity of the system, with more than 1,000 employers, it is very challenging to deliver that, but we are very close to delivering it. I will continue my engagement with the unions, and I am very confident that we will make progress on that front, but we will probably do so hand in hand with the UK Parliament.
It is important that the Scottish Government continues to unequivocally support social care users and the services that are in place. I note the minister’s comments about the 25 per cent increase in investment so far this session. Will she outline how the Scottish Government will continue to adequately invest in high-quality services and staff in our social care sector, particularly in the Scottish budget for 2025-26?
Our proposed budget for 2025-26 provides record funding of £21.7 billion for health and social care, with an uplift that exceeds consequentials and takes funding to an all-time high. Resource funding for health and social care has more than doubled since 2006-07, increasing by more than 41 per cent in real terms. Our £2.2 billion investment in health and social care integration delivers on our programme for government commitment, as the member has said, two years ahead of the original target. We have provided an additional £125 million to support delivery of the pay uplift to a minimum of £12.60 an hour for adult social care workers, as well as £5.9 million of investment in the Care Inspectorate and £13.4 million in the independent living fund.
This year’s budget also underlines our continued commitment to support Scotland’s unpaid carers. It includes an increase in funding for voluntary sector short breaks to £13 million. We have delivered record funding of £15 billion for local government this year, with the freedom to set council tax that local government requested. Parliament now needs to work together to pass the budget, to enable us to get on with delivering the services that the people of Scotland expect and deserve.
I remind members that we are pressed for time. I need succinct questions and answers to match.
I hope that the announcement by the Government will allow us to make small but positive changes to social care, even if we know that much more needs to be done. The minister rightly highlighted how traumatic it can be for people to repeat their stories. Will she outline how the work of lived experience groups will be retained, how it will contribute to the on-going reform of social care and whether the right to information and advocacy that was originally contained in part 1 of the bill will be put elsewhere?
I recognise that the voice of those with lived experience is vital. Gillian Mackay and all Green Party members are committed to listening to those with lived experience. The various stakeholder groups that I interact with are extremely important in helping me to find a way forward in a complex and contested area.
I am happy to speak with Gillian Mackay about independent advocacy as the bill progresses. She is correct in saying that the changes that we are making to the bill will change where that links into it.
Care in our country is broken, but Scottish National Party ministers have spent four years and £30 million on the wrong solutions. That is enough to pay the salaries of 1,200 care workers for an entire year. What a waste. Every year wasted is a year that the minister could have been getting on with fixing our broken care system. Will she apologise to everyone who is stuck in hospital because community care is not available to receive them home, to the care workers who cannot offer the care and support that they signed up for and want to offer because there simply is not enough time, and to the legions of unpaid family carers who do not have the wraparound support that they need?
Thousands of people who use social care and community health services across Scotland have told us that things need to change. The independent review of adult social care, which was carried out by Professor Derek Feeley, recommended that we establish a national care service that is underpinned by a human rights-based approach and gives a voice to people with lived experience at every level.
A national care service is not opposed by those with lived experience; it is the opposite. They pressed the Scottish Government to push forward. I hope that the pause and further clarity on what we are trying to achieve through primary legislation will enable those parties that have been opposed to change from the conception to come round the table and contribute to shaping the change that we need in Scotland.
Ultimately, at the heart of this discussion are social care users across the country who require our support and reassurance while the NCS bill is paused. Can the minister outline how the Scottish Government will engage with service users and carers directly on the next steps of the process?
We recognise the value of engaging with people with lived experience of receiving and delivering social care. That has been at the heart of our approach to date, and it will continue to be. Today, a letter will be issued to all our stakeholders. I have arranged to speak with several groups of users, carers and stakeholders during the next couple of weeks. It is absolutely vital that we continue to engage with and listen to people throughout the next phase of the national care service. I will also hold smaller, more focused group discussions with disabled people’s organisations, the workforce, social care and carers organisations and other stakeholders. Alongside those discussions, we have a number of co-design engagements planned. All of that will be made clear in the letters to stakeholders.
From day 1, the Scottish Government was warned that the bill would not work, and it did not listen to anyone. Four years on, nothing has changed. Will the minister take the opportunity to apologise to all those she has let down?
It is somewhat incorrect to state that, four years on, nothing has changed. In fact, the bill was introduced, it was changed extensively and then we paused. It was then changed extensively again, and again now. I have listened to stakeholders who have raised concerns and I am changing direction again. As I have said multiple times, I hope that the whole of Parliament can get behind what I have put forward today. I look forward to working with all members to deliver the improvements that the people of Scotland need.
The Health, Social Care and Sport Committee has heard from numerous third sector organisations, stakeholders and, importantly, people who access care services about the need for radical reform of the care system. Can the minister advise how the amendments that she is proposing to the bill will ensure that their concerns are addressed?
The changes that I am outlining today will improve the lives of people who have been calling for reform for far too long. Putting Anne’s law into primary legislation gives it the status and protection that it deserves and that the families of care home residents have been calling for for so long. We have listened to those who have told us that sharing their story repeatedly can be frustrating and traumatic. That is why the bill improves information-sharing standards. It also includes a right to short breaks for unpaid carers, ensuring that we are not only providing support for carers but that their rights are protected by law. We have heard, loud and clear, that people want improvements in the management of the complaints system, as well as governance at a national level, and the outputs of that work have had a direct impact on the plans that I have outlined for the advisory board.
It remains clear from the Feeley review and from engagement with thousands of people with lived experience as well as a wide range of stakeholders that enhanced national support and oversight of the way that care is delivered in Scotland is vital. That is why the advisory board will play a vital part in ensuring that people across the country get the quality of service that they deserve, driven by the real experts—the voice of lived experience.
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