Chamber and committees

Because of the work that we had done on adult social care, we were well aware that we had a huge amount of information. A huge amount of consultation has been carried out. We have undertaken to do similarly for children’s services and criminal justice social work. Work is on-going in looking at all of that. We will continue to consult and to listen to people on those fronts.

I reiterate that the Government has taken no decision on transferring children’s services or criminal justice social work to the national care service.

As you have just done, we recognise that caring roles vary in nature and intensity. We also recognise that some folk feel more able to access certain things than others do.

One of the key aspects, which comes up time and again, is the eligibility criteria. In removing some of the eligibility criteria for those unable to access sufficient breaks, the bill aims to shift the balance to enable more carers to access preventative short-break support. That might need to be different from what is currently on offer in particular places.

The key aspect is to understand better what a sufficient break is and to recognise what the differences are in terms of the nature and intensity of the care. The stakeholder group has been established to work our way through that, including on reaching a definition of “sufficient breaks”.

I think that we have a long way to go on data. I will have a look at the English, Welsh and Northern Irish situations. There is some data that I would like to get my hands on that is not easy to obtain, and we have to do better on that front. We must also do better in terms of individuals’ data. That is why the national health and care record is important. Depending on the data sharing agreements that are associated with that, we will be able to get much more accurate data about what is going on.

I get your point about the consistency and quality of data. You will know, having seen it at this committee, that, often, data is caveated, sometimes quite heavily, so it does not necessarily give us the true picture. Mr O’Kane talked about comparing apples to oranges; I often feel that that is what we are doing, when we look at comparative data. We absolutely need to get better at that. The national health and care record will go a long way in helping us on that front. Again, even before the NCS, we must continue to refine what data we collect, how we collect it and the impacts of that on people.

I will consider anything, but I again come back to the point that, if we put too much into primary legislation, we might end up in a situation in which it is difficult to change what is there. I do not really like the term “reablement”, so I am glad that you used the term “rehabilitation”. In that regard, we are seeing advances as we move forward. We do not want to set everything in stone, so secondary legislation is probably the right place for that.

Obviously, I want those very good folks, some of whom I know well—including Fanchea Kelly, whom I know from my previous role in housing—to be at the table helping us to shape what is required as we move forward. Blackwood Homes has made immense advances in the technology that it has put in play so that folk can live free and independent lives. Those include a washing machine that irons, which was something that took my eye—Ah hinna got een yet, but I certainly have been considering that over the piece.

We need those folks to be at the heart of the process. I will consider what they have to say. I do not think that that issue necessarily has to be in primary legislation, but their voices have to be heard, and we have to get that right as we move forward.

That is a key aspect. In recent weeks, the carers parliament has held events here and near here. Some folk are worried about leaving their loved ones and there are cases where some folk just canna leave their loved ones. How do we flex all this to ensure that we are putting some support in place?

The bill includes the right to have breaks from caring. However, the other week, one body argued with me that, although that right might be in place, a carer might not get that break because their loved one needs them all the time. It wanted to know what else we can put in place to enable somebody to have downtime. We have to work our way through that.

Some really good stuff has gone on in certain places to help folk who have been unable to go for short-term breaks. I am sweirt to give a specific example, as I might identify people, so I will just mention that other things have been put in place that are beneficial to them and to their loved ones. Those things might not be as good as a break, but they allow for some relaxation and downtime.

I should probably also say that we are setting up a stakeholder working group, which will include carers, statutory services and carer centres, to look at the issues that need to be addressed in that regard. Again, we will continue to listen to what folk have to say. Even in the past couple of weeks, I have heard some stories that are new to me.

I keep a very close eye on the issue, and I have already used powers of direction, as folk are aware. I get regular updates from the Care Inspectorate on any complaints that it receives to do with someone being denied access. The number of such complaints has decreased dramatically—there are very few now. I would not want to put a figure on that now, but we can provide you with that.

I also get—fortnightly, I think—a list of where there are outbreaks and information on what is going on in those places. It is rare to see a home closed for admission and it is rare for there to be no visits.

I can provide you with much more detailed information on that. However, I assure the committee that I keep a very close eye on the matter and that Scottish Government officials will challenge if they think that there is anything that is not working right for people.

I will look at what Mr Hazelwood said. He has engaged with us a fair amount. If I remember rightly, he was at the co-design process for the charter of rights and responsibilities the other week. Again, I come back to the point that not everything has to be in primary legislation. Although it is absolutely vital to get end-of-life care right, if we put too much into primary legislation, that does not allow us the flexibility to change.

I rule nothing in or out, but probably the best way of getting this right is by doing it in secondary legislation so that there is flexibility to change in the future as care in the area changes, as it has done to a huge degree in recent years.

However, on the points that Mr Hazelwood has made and others have made elsewhere, we have to do all that we can to try to meet the needs of folks at the end of life. I myself have had loved ones and friends who have passed at home and who had much better experiences because of that. We recognise that there is work to be done, but the issue is whether that needs to be in primary or secondary legislation.

Thank you very much, convener, and good morning to the committee. Thank you for having me along today to give evidence.

You will be aware that I have given evidence on the bill to several committees already, so it is good to come to the lead committee, although I have another two to come. It is fair to say that the national care service is one of the most ambitious reforms of public services. It will end the postcode lottery of care provision in Scotland and it will ensure that people who need it have access to consistent and high-quality care and support to enable them to live a full life, wherever they are.

The NCS bill sets out a framework for the changes that we want to make and allows scope for further decisions to be made. That flexibility will enable the national care service to develop and adapt, and to respond to specific circumstances over time.

I will take time this morning to reflect on why a change of such scale is necessary. Scotland’s community health and social care system has seen significant incremental change over the past 20 years. Despite that, people with experience of receiving care support and of providing it have been clear that some significant issues remain.

We are not changing just to address the challenges of today; we must ensure that we build a public service that is fit for tomorrow. Today, about one in 25 people receives social care, social work and occupational health support in Scotland, and demand is forecast to grow. The NCS must be developed to take account of our future needs, so we will build a system that is sustainable and future proofed to take account of the changing needs of our population.

The principles of the new system will be person centred, with human rights being at the very heart of social care. That means that the NCS will be delivered in a way that respects, protects and fulfils the human rights of people who are accessing care support, and those of their carers.

Improved carer support is one of the core objectives of establishing the NCS. As part of the human rights based and outcomes-focused approach, carers and people with care needs will be able to access support that is preventative and is consistent across Scotland.

Nationally and locally, the NCS will work with specialist charity and third sector providers of social care as well as other third sector organisations in the field of social care to meet people’s needs.

The NCS will bring changes that will benefit the workforce, too. The importance of staff in the social care sector has never been clearer, so we are fully committed to improving their experience through recognising and valuing the work that they do. The NCS will ensure enhanced pay and conditions for workers and will act as an exemplar in its approach to fair work. Our co-design process will ensure that the NCS is built with the people whom it serves and those who deliver the service. They have to be at the very heart of all this.

I have noticed that the committee has been out and about, hearing from people with lived experience of social care across Scotland. You have also heard from organisations that represent them. I was delighted to see that, because it is vital that we listen to those people as we establish the national care service. We are committed to working with people who have first-hand experience of accessing and delivering community health and social care to ensure that we have a person-centred national care service that best fits the needs of the people who will use and work in its services, with human rights being at the very centre.

Thank you very much, convener.

Community health is a foundation of the national care service that we need to get right. Through early engagement with stakeholders, we have learned that it is imperative that we continue to engage people who have experience in that.

As things currently stand, community health—those services that are based in the community and provide the first point of contact, diagnosis and treatment—comprises more than 90 per cent of all interactions in health, and many problems are identified, managed or resolved within the community. That makes it one of the largest and most crucial areas of healthcare.

Community health, community social work and social care services are the front line. They are accessed in a variety of ways: through many of our health and care sites; in people’s homes; or remotely, supported by technology. Again, we need to look at best practice in that when it comes to getting it right for the NCS.

For clarity, community health staff will remain in the NHS. The commissioning and planning of community health will be the responsibility of the national care service. That will build on the current integration arrangements that are in place under integration joint boards.

The National Care Service (Scotland) Bill will allow the Scottish ministers to exercise powers, under section 78 of the Public Services Reform (Scotland) Act 2010, to require care home service providers to comply with any directions that are issued by ministers.

The key issues that you have talked about as having been raised by stakeholders are that our proposed approach to delivering Anne’s law through such directions does not go far enough and that Anne’s law should be extended beyond adult care homes to cover additional settings. We have talked to others about that, and there is dubiety about it.

Stakeholders have also talked about the importance that is placed on local decision making and, understandably, the importance of human rights and a person-centred approach. In the recent parliamentary consultation, some respondents indicated concern about whether our approach of using directions is the right one. It is absolutely the right approach.

The most challenging issue has been in how to balance the use of the directions with the views of some—in the main, Public Health Scotland—who endorse the occasional need for restrictions on health grounds. Although the directions envisage continuous visiting during outbreaks, we expect that formal advice from Public Health Scotland will highlight that that is a risk to outbreak management. At the moment, therefore, a piece of additional work is looking at every aspect of that. However, as a minister, I want to ensure that people have access to their loved ones. There will have to be a balance, but that is my expectation.

Rightly, people will always be concerned. At the back of their minds, they will be thinking about what went on during that Covid period. We do not want that to happen again. That is why we are doing all the work that we can to ensure that we get this right for relatives, families and loved ones.