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That is an extremely important question, which comes to the crunch around prevention, rather than crisis—which I talked about earlier with Ms Mackay. In some areas, freedom and autonomy are already being given to front-line staff, who are the folk who recognise whether Mrs Smith is becoming frailer or is improving.

In my home city of Aberdeen, the front-line staff at the Granite Care Consortium have the ability to step up and step down care. Obviously, that must be done in consultation with the person receiving care and support and their family, and there is of course more stepping up of care than stepping down, but the ability of the staff to do that puts the person front and centre.

Beyond that, the best way to stop delayed discharge, for instance, is to prevent folk from going in the front door of a hospital in the first place. By stepping up Mrs Smith’s care, are we saving a journey to accident and emergency and perhaps a lengthy stay in hospital? I reckon that we are doing that in a lot of cases.

We need to change that situation with autonomy, freedom and independence for front-line staff, which largely do not exist in many places, because of contracts. We are trying to change that in the here and now. I do not want to wait for the NCS if we can get some flexibility in that regard in the here and now, which would be brilliant. That would be good not only for health and social care partnerships and local authorities; it would be very good for people.

We will continue to try to persuade and give comfort to local authorities and health and social care partnerships on the matter of trying to change contracts at this point. That is clearly working in Aberdeen. Changes have been implemented in Fife, too, which I think are benefiting people there. We need to see more of that, and I want to see more of it before the NCS, although the NCS gives us that complete opportunity with ethical procurement.

I outlined some of the main areas that we need to consider in the co-design. I will repeat some of them, although I will not go into all the detail that I did earlier.

Structural change is important but it is not the be-all and end-all of what we aim to achieve here. We have to make sure that we have a service that works for people. There are quite a few arguments about structural change out there, but the focus of all that we do here has to be on people.

The committee will have heard some of the comments that I have made to the other committees that I have appeared in front of about the purpose of care boards, some of which I will go over again. I think that I spoke about some of that in an earlier answer to Emma Harper.

The national care service will balance the need for local flexibility by having the care boards plan and commission care while providing national consistency through ministers being ultimately accountable. Although local boards will have their own budgets and staff, they will be directly accountable to Scottish ministers. That will ensure that the standards that we have talked about are maintained across the country so that high quality services are in place that reflect local circumstances as they are delivered.

I have had lots of questions, and I am sure that Mr O’Kane will follow up on some on them, about the number and composition of care boards, and so on, so I will go through some of that just now.

Care board membership will be examined in detail as part of the co-design process, as will the number of care boards. Based on consultation responses, we are looking at how membership will include people with lived experience. The one point that I am adamant about, as I said earlier, is that lived experience is at the very heart of decision-making. For some folk, that has been controversial. Some people have suggested to me that folks with lived experience on care boards will have vested interests so they should not be there. The same argument is often used for local authority members and various other things, and we declare interests and sometimes leave if we have an interest. I do not see that as a problem.

Through the co-design, we will also consider how we might include carers, other professionals and service providers, and local authority elected members in local care boards. We are committed to ensuring that all who are on care boards will have full voting rights.

The other aspect might be the number of care boards. That is another matter for co-design. However, we need to be honest here. I have heard it suggested that there should be 250 local care boards. I do not think that that is possible, and we have to be honest about some of the parameters in the co-design.

I do not think that Ms White has necessarily been listening to some aspects of what I have said this morning about the financial memorandum and the fact that it covers a fair amount of costs in terms of staffing and terms and conditions.

What I would say is that we need to change. Folk recognise that change is required. We cannot continue with the same system. Derek Feeley highlighted that in the independent review of adult social care. We need to plan and invest for the future so that those of us who will require care and support in the future—that is probably the bulk of us—have the right care and support in the future.

As for the analogy of using a sledgehammer to crack a nut, there are many folks out there with lived experience who would have used sledgehammers long before now. I would be very naughty if I were to repeat what someone from the social covenant steering group said but, for many folk, the sledgehammer has not come out quickly enough.

I cannot remember seeing the letter from Lauren McNamara. We will have a look at that and respond accordingly.

I have a lot of comments on that. I know that some folk out there are not even getting 45p a mile. I declare an interest, convener, because I have two nieces who work in social care, one of whom works in rural Aberdeenshire, so I know how hard those mileage costs have hit.

That is why I have written to the UK Government, not once but on several occasions, to ask it to change the rates that it sets in order that we can do better for folk out there. I have also urged the UK Government to find additional resource to deal with increased fuel costs; the UK Government is taking in much more money in fuel duty and VAT because of the increased prices, so let us use some of that money to pay better mileage rates to social care and other vital workers across the UK. Unfortunately, I have yet to hear from the UK Government on that issue. I wish that it would take cognisance of the elements that I have laid out, for the good of social care workers and other vital workers, not only here in Scotland, but right across our islands.

Ethical procurement and fair pay and conditions are at the heart of the bill. Do we aspire to do better in all of that? Absolutely, we do. We need to do this for the simple reason that if we do not, we will be unable to grow the social care profession, which has taken a huge hit in recent times. We have lost lots of people because of Brexit, and we need to replenish that staffing core. In order to attract young people to the social care profession, we will have to do much better with regard to pay and conditions and in providing career pathways, so that they see the profession as being the right one for them. That is the only way that we will make the workforce sustainable for the future.

I have no desire to take folks’ electric cars off them, to be honest with you.

There are some myths about assets and staff transfer. The bill gives the Scottish ministers powers to transfer staff from local authorities to care boards or the Government as part of the NCS, but there is no desire for wholesale transfers of staff. Many local authorities are delivering good social care services and we see local authorities as being essential delivery partners, as we move forward. However, because care boards will be the providers of last resort, the bill has to include the ability to transfer staff if a care board becomes that provider of last resort.

It is by no means a foregone conclusion that local authority staff will have to transfer their employment. The Scottish Government’s position remains that the new local care boards will work collaboratively and in partnership with local authorities, NHS boards and the third and independent sectors locally and nationally. Our intention is that local staffing decisions will be taken by local care boards as they are established.

That is where we are. I have heard rumours about 74,000 staff being transferred. That is not on our agenda.

Let me take the example that Ms Callaghan gave in relation to drugs and mental health. At points, it seems as though Angela Constance and I are joined at the hip in respect of getting it right for folks who have more than one difficulty. I have to be honest and say that services in many parts of the country are not what they should be when it comes to dual diagnosis. That is why we are already changing standards and there are several pilot projects aimed at getting that right. Those things should become the norm. That is why we need national high quality standards in order to get it right for everyone. We cannot have a situation where we are pushing folk from pillar to post. That is one of many reasons why we need to have a completely joined-up approach.

Where folk have substance use and mental health difficulties, on many occasions, we have managed to overcome those barriers for those folks through housing first. We should—and need to—do that right across the board for everyone who has that kind of situation in their lives.

It can be achieved. We are seeing changes in certain areas now in the way in which we are dealing with folk, so it can be done.

Convener, Ms Kynaston has just pointed something out to me, and if I do not say it, she will give me trouble. Again, I refer the committee to the policy memorandum, where paragraph 38 has a commitment to

“Improve outcomes through prevention and early intervention”.

I think that that fits in here, and the issue is also referred to in part 1 of the bill.