Seòmar agus comataidhean

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.

I am fine.

I do not see this as centralisation, at all. Some folk around the table will already be aware of this, but I will just point out to the committee that I was the first minister to island proof a bill—the Fuel Poverty (Targets, Definition and Strategy) (Scotland) Bill—before the Islands (Scotland) Bill had been passed. In all the work that we are doing, we are taking cognisance of the different airts and pairts of our country and of how we need to get this right for everyone.

As a result, we have a separate workstream that is looking at islands and what can be done there, and we are looking at some of the suggestions that authorities have made about how they can deliver on the bill in a different way. A few months back, I was in Shetland to listen to people’s views, and I am due to go to Orkney at the beginning of the year. There have been suggestions from some island leaders—although not all, I hasten to add for the record—with regard to single-island authorities. The Government will look at that.

As for our more rural areas, particularly our remote rural areas, there is, as I have said, an opportunity to use ethical procurement to change the way in which we do things, and I hope that that opportunity will be grasped. We have to look at how we deliver across the board. I will do so, and my officials know what needs to be done in that regard.

Again, I note that we have, so that we can get this right for everyone, gone out of our way to find voices of lived experience from our remote rural and island areas, given that the difficulties that they face are often very different to those that are faced by folks in my community in Aberdeen, for example.

I have already given an assurance this morning that we are moving on many of those fronts. That is why we have the statement of intent with COSLA. There are things that I want to have been done yesterday. We will continue to try to advance on all those things. I say to Ms Mochan and others on the committee that, sometimes, such things are not so easy. I would, for example, like to see national sectoral bargaining, as is envisioned in our NCS proposals.

Whatever we invest in the national care service is for the good of people, but we know that there is work to do in the here and now. It is not all about the formulation of the national care service. That is why we are also acting in the here and now, which will also be for the good of the establishment of the NCS.

I am very pleased that the Convention of Scottish Local Authorities has now agreed, through our joint statement of intent, to support additional actions that we will jointly take over the next 12 to 18 months to bring about improvements in delivery of social care.

We have heard repeatedly from people with lived experience that the current adult social care system must change in order to drive up standards to a consistent level across our country. We need to tackle the postcode lottery of care, so a different approach is needed. We must have a system in which high-quality community health and social care support helps to create thriving communities across Scotland. That is why we have introduced the National Care Service (Scotland) Bill, which is a framework bill to support collaborative design and address the historical implementation gap that has been mentioned. The implementation gap between policy, legislative intent and service delivery must be closed. That is top of the agenda for people.

The NCS is important, but the work that is being done here and now is absolutely important, too. That is why we will work with the Convention of Scottish Local Authorities to ensure that we cover the additional actions in our newly published statement of intent.

I said at the finance committee that there also would have been detractors if we had done it the other way round. The approach that we are taking allows for the scrutiny of the principles of the bill before the co-design starts, which provides reassurance for people in the co-design process that their contributions matter.

That is a good question. I will not dodge Ms Mackay’s question, but I will start off with something that I should perhaps have said in my response to Ms Harper. Some folks have asked what co-design is. One key element is that we have a job of work to do on the introduction to co-design sessions, many of which are now complete. Those sessions demystify the process for people, and more than 200 folk have taken part in them so far. That has given them a fair grounding in the task that they are going to embark on.

Ms Mackay is right that we want to ensure that we have all the voices that we can possibly have at the co-design table, and we have gone out of our way to attract folk with various conditions from various parts of the country. We also have to take cognisance of the fact that some folks require help and support, which may mean financial support, in order to take part in the process. We will continue to listen to people and provide what support we can.

We have to ensure that we continue that listening process along the way and continue to encourage people to come forward. We also have to look at the activities around co-design, which will vary. A number of activities will be suitable to meet the needs of individuals, including one-to-one sessions, surveys and group sessions. Recruitment for the lived experience panels, for which we now have more than 400 folk, will continue throughout the development of the national care service. I said “more than 400 folk”, but I should probably say 450, because that is the latest number.

That is a very good question. Sometimes there is confusion. Co-design means working with people in an equal and reciprocal partnership on design of services, policies, frameworks and interventions. Involvement starts from understanding the present to decide what the future should look like and how we will all get there.

There are three clear phases to the national care service collaborative design. The first is understanding; that is, building on the shared understanding of the current challenges that I mentioned. The second phase is sense making—what we can deliver and how in order to make the improvements that we all want. The third phase is agreement. Do the proposed changes address the issues that have been raised by people?

The initial co-design themes were launched at the national care service forum in October, and they focus specifically on the information that will be needed to develop policy that is directly associated with the passage of the bill. They are:

“information sharing to improve health and social care support”,

which includes measures such as data sharing;

“realising rights and recognising responsibilities”,

which is the human rights work and the charter development;

“keeping health and social care support local”,

which will consider care boards, geography and board representation, for example;

“making ... my voice ... heard”,

which will consider advocacy and complaints; and

“valuing the workforce”,

which will consider issues such as ethical commissioning.

I hope that that helps Ms Harper and the committee.

Absolutely. Although we need everyone to adhere to the national high-quality delivery standards, we must also have the ability and flexibility to create the right services for places. That will also allow for innovation.

I will give an example. I have had discussions with folk from our island communities; it might be the case that we need to do things differently there. We will listen and we will act and react accordingly. Ms Harper is right that delivery might be somewhat different in rural Galloway from what it is in Glasgow. We have to allow for flexibilities.

I will give an example of what I see as an opportunity. During the Covid period, many community organisations stepped up to the plate and provided help, care and support for some of our most vulnerable folk, when others were unable to do so. That work has continued in some places. Ethical procurement provides an opportunity for community wealth building. It might be that some rural communities—and some urban ones—choose to deliver care in their own locales. Often, the current procurement practices have been a barrier to such approaches, but ethical procurement can open the door. Therefore, others might come forward to provide care and support in rural Galloway, Orkney or maybe even Glasgow and be able to do so through ethical procurement methods.