Seòmar agus comataidhean

I will write to the committee with indicative timelines. I do not want to be specific about any of this, because, as the committee will be well aware, this is an ever-moving feast. I am also, as are my officials, reliant on other partners in all this. However, we will give you indicative timelines.

There are a number of things to address in that. A rushed visit is not good, either for the person who works in care or for the person who is being supported. Although I have heard examples that are exactly the same as that one, I have also heard examples of things working well for the folks who work in the sector and those who are receiving support and care. We need to look at those good examples and export them across the board.

Let me give you what is probably the best example that I have come across. I recently met Aberdeen’s Granite Care Consortium, which is a group of third and independent sector organisations that came together to bid for a home-care contract in Aberdeen. During the pandemic, those organisations did something that I hope others will follow suit on—I have been encouraging others to do so. They gave their front-line staff the independence and autonomy to step up or step down care in order to meet the needs of the folk whom they support. As Dr Gulhane, the convener and the committee will understand, there is more stepping up of care than stepping down.

In my opinion, that person-centred approach, with independence being given to the person in the know—the person who goes in daily and can see the needs of the patient—is the right way forward. We should have more independence and autonomy among front-line staff.

Some people would ask us to provide evidence that that makes a difference. We know that we have difficulties with delayed discharge across the country and that rates in some areas are much higher than they are in others. Dr Gulhane will know from his medical experience that the best way of stopping delayed discharge is to keep people out of hospital in the first place, and instead to provide for their needs at home, if that is at all possible.

For example, delayed discharges in Aberdeen stood at 19 on 26 April. That is very low compared to many other parts of the country, and it is particularly low compared to the other cities. The work in Aberdeen by the Granite Care Consortium and others on flexibility and stepping up care where that is required has meant that fewer folk have had to go into hospital. Flexibility and autonomy for the front line and understanding about meeting folks’ needs make a real difference. That is what we need to be doing.

Yes, it can be achieved. That is the reason for doing all this. The postcode lottery has had a real impact on some folk. It is quite bizarre. I may have touched on this with the committee before. There can be differences in service delivery even within local authority health and social care partnership areas, which can be really frustrating for people. I may previously have given an example from the convener’s constituency. Someone who lived there was absolutely, completely and utterly annoyed that service delivery for them was so different to service delivery in Peterhead, which is not in the convener’s constituency but is within the same local authority area and the same health and social care partnership.

My confidence that service delivery will improve towards getting it right for all is down to the bringing in of national care quality standards. The folks who are delivering and supporting people will know what is expected of them; the folks who are being supported will know what they should expect. It is probably true that inconsistencies in service delivery have led to a fair amount of correspondence to the mailbags and inboxes of everyone around this table. Getting rid of those inconsistencies is one of the main reasons for doing this. I am confident that we will get the national care standards right and create a fairer situation for all.

Some people have argued that standards in their area are already the best. They feel that the NCS may pull those standards down. We will aspire to reach those highest standards.

Mr O’Kane talks about the complexity of the consultation; other folk said that it was not complex enough. I recognise that folks always want more detail but, at the same time, in the areas where there was more detail in the consultation, some folks said, “Oh well, you’ve already made up your mind on that issue.” Sometimes, ye canna win in these regards. However, folk recognise where the Government is going with all of this—most stakeholders recognise that the consultation is only one part of the process. We will continue to discuss where we need to go with stakeholders and listen to the voices of lived experience, and that will include discussion of the benefits.

I am absolutely convinced that the service will be beneficial for all. We need to grasp the opportunity to get it right and ensure that we are doing the right thing in shaping the future of social care in Scotland.

Crises cost a lot of money, and there is also the human cost of not dealing with things early. The move to the preventative approach will save a lot of money that can be reinvested as well as stop some of the human costs of not getting this right. We know, because we have heard it from people themselves, that, where the focus has been on prevention, it has been much better for people and over the piece is much less costly for the public purse. It is very difficult for me to relay these things, because there is always the danger of identifying people, but I have heard stories of folks moving from almost constant crisis to a situation in which self-directed support has worked for them and crisis is now very rare. That is what makes the odds for folks, and it is less costly.

As we move forward, we have to analyse what is happening, and we will carry out tests of change to see what the financial impacts of these changes are. However, having listened to the stories of people’s day-to-day lives, I think it is beyond doubt that the move to prevention lessens the difficulties that they face, stops some of the horror stories that we have all heard about happening and is much less costly than crisis intervention, which costs a lot.

There are always challenges in retaining some folk. The Government places great importance on its relationship with senior health and social care leaders. My officials regularly meet integration joint boards’ chief officers, and I have been meeting chief officers almost monthly since I took office. Those meetings cover a wide range of topics, including leadership development and barriers to integration.

Officials recently met the executive group of chief officers to discuss what more support might be required—whether that is more capacity to provide peer support in learning, coaching and mentoring for individuals, or more structured programmes of support. We have also discussed engagement with wider staff groups to encourage participation in local and national strategic activity, with succession planning in mind.

The meetings that we have with chief officers also give them the ability to articulate what they are doing well and where they are having difficulties. There is also peer support, which is extremely important. At some points in the pandemic, folk felt that there was not enough time for that. All those things will be important as we move forward.

My role in all that is to listen to what is being said by chief officers about what barriers exist for them, and to see whether we can get rid of them. It is also to provide a forum to bring folk together for the support that is required.

There is absolutely no doubt that resilience is a part of that. However, much of the focus in discussions has been on how we have all supported one another during what have been very difficult and stressful times for many of us. There have been lots of discussions around the mental wellbeing hub support that we have put in place, for example. Local examples of good practice in mental wellbeing support have been talked about in the national group and folk have implemented them in their areas.

Coming together to talk about such things can be not only good for learning but can be quite cathartic, because at points during the past period, many of us have felt a little bit alone. When we talk to others about what is happening to us, we find that people have been in similar positions. How do we help one another through all that?

As the committee well knows, I do not commit myself or promise anything unless I know that it can be delivered. Timelines are difficult, because we do not know what the coronavirus will do next and trying to second guess all this is not an easy thing to do. As always, I am more than happy to continue to brief the committee on where we are at in all aspects of our workstreams as we move forward.

On the timeline for the bill, we said that we would introduce it by the end of this parliamentary year. That is June, and we are on track to do that. However, I emphasise that it is not all about the bill or the formation of the national care service. We have a lot of work to do to ensure that we get back to some kind of normality—the remobilisation of social care.

The committee will be well aware of the actions that we have already taken. For example, on pay, we have introduced the minimum rate of £10.50 an hour. We are in discussions with the Convention of Scottish Local Authorities about conditions, and I hope that the newly elected members in our local authorities and whoever the new COSLA health spokesperson is will continue to engage with us on that.

I put on record that the previous spokesperson, Stuart Currie, who stood down at the recent election, was extremely co-operative. I think that we are in a good place with our local authority partners, because we all want to achieve the same thing. On that front, we also have to recognise that, at the moment, one of the big difficulties for me and the folks in local authorities is that we are dealing with 1,200 employers, but we will continue to try to make gains in that regard.

As I mentioned in my opening speech, another thing that I would like to see is the demise of eligibility criteria for non-residential services. I know that COSLA shares that ambition, but we have to work our way through that. As we have those discussions and negotiations and, I hope, make progress, we will keep the committee informed. At the heart of all that change are people, of course, and getting it right for people—not only the workforce, but the folks who are being supported and receiving care.

I hope that, with the comfort that we have provided through the procurement policy note that I talked about earlier, we can move to a type of ethical commissioning that has fair work at its heart.

We have drafted procurement rules in Scotland in a way that enables collaboration and discourages competition based on price. The rules enable preliminary market engagement with providers before starting a tender process and prevent a public contract being awarded on the basis of price alone. We want to see high standards; we want fair work to be at the very heart of all that we do. That is vital as we move forward. There are some folks who say that it is difficult to do that under the current procurement rules. Those folks are more than welcome to have conversations with my team or with the procurement team to give them comfort on how they should move forward on that front towards ethical procurement.

We have given a really good outline of what we want to do. You ask about defining benefits. Whose benefits are we defining? There are benefits for the public service itself, and for people using it—the list goes on. We must continue to work on defining what the benefits are. We will continue analysing all of that.

I go back to the report by the Christie commission: the key thing is to look at a joined-up approach and to get rid of the silos that still, unfortunately, exist. No matter what is in, or out, of the national care service, making the transition phases much better for people will be a major benefit. Without doubt, there will be a huge amount that will benefit people and the public sector as a whole. We will continue to work on all of that, and I am sure that Mr O’Kane will continue to scrutinise whether those benefits become a reality. I am hopeful that we will make real change, particularly for the good of folks.