Seòmar agus comataidhean

Good morning, and thank you for inviting me to speak today on the financial information that I provided to the committee on 11 December 2023 in response to the committee’s stage 1 report on the National Care Service (Scotland) Bill. My officials updated you on Tuesday on the details of the finances and our thinking behind them, so I want to take the opportunity to update you on the work that we have been doing since I gave evidence to the committee in September last year.

Since summer 2023, we have worked with the Convention of Scottish Local Authorities and the national health service to agree on a statement of shared accountability. There has been weekly engagement between the Scottish Government, COSLA and the NHS. Those weekly talks have built on the shared accountability consensus that was reached on 30 June 2023, and have created a revised version of the national care service. I will set out the impact of that agreement on our plans for the bill in a moment. We have also been working hard in discussion with stakeholders, through numerous regional events and meetings during the second half of 2023.

I believe that the proposals for reform to the existing system are highly reasonable and balanced, and they accommodate as far as possible COSLA’s position, while ensuring that we can still effect the real change and improvements that people who are using the services today require and deserve. The proposals will also cost far less to implement than the initial plan. Indeed, our forecast over a 10-year period is for a drop in costs of between £249 million and £1.276 billion.

I note that, on Tuesday, my officials provided some comparative costs to clarify the scale of the changes for the bill as introduced, as well as for the proposed amendments at stage 2. Those have, unfortunately, been misreported to the media. The revised financial memorandum now contains the anticipated costs of the bill as introduced, and they are substantially less than the figures that were misquoted.

The case for change has been made unequivocally through the independent review of adult social care, through our on-going co-design discussions with people with lived experience, and through almost every exchange that I have had with people who work in and receive services from the social work and social care sector. We already spend more than £5.2 billion per year on social care, as per the 2021-22 local finance returns data, but that spend is not transparent and it is not clear to people who need social care who is accountable for the service that they receive.

We cannot just think about the financial costs in isolation. The establishment of the national care service will deliver many plausible benefits. For example, improving care and support services could help to reduce barriers to an individual’s ability or opportunity to work, to increase their working hours or even to take up a new job, thus enabling more people to contribute to the economy.

Looking ahead from the shared accountability discussions, the three main changes that we want to make to the NCS bill are that local authorities will retain responsibility for all current functions and delivery of social work and social care services, with no transfer of staff or assets; reform of integration authorities, rather than the creation of new care boards; and the establishment of a national care service board to oversee delivery across Scotland.

Subject to the will of the Scottish Parliament, the Scottish Government proposes to make amendments to the bill at stage 2 in response to evidence that was taken at stage 1 and on-going feedback from stakeholders. Although those are the main changes that I intend to make at stage 2, they and any others will, of course, be influenced by the consideration of this and other committees at stage 1.

My letter of 11 December 2023 set out the changes that will reduce the cost of the bill substantially by removing the need to set up care boards and to transfer staff and assets. It is a £249 million to £1.276 billion saving. There will be some new costs associated with reforming integration authorities and establishing a national board, but the overall costs are greatly reduced. Costs are also reduced because the new proposal phases in reforms over a much longer timeframe than was originally intended.

However, over the next 10 years, we must spend a certain amount on setting up the national care service in order to save in the long-term future. If we get the national care service right, we will, potentially, save a great deal by empowering people to live their best life, and to remain active in society and the economy. That is perhaps the best saving that any of us in Government can make, because it means having an economy of greater wellbeing as well as one of greater resources.

We have worked enormously hard to reach a consensus with stakeholders, and I am confident that we have reached the best position from which to go forward. We continue to discuss and co-design the NCS with stakeholders. In some ways, that process, in one form or other, will never stop, because the NCS will inevitably evolve to meet the needs of people who need it, and we will continue to involve the voice of lived experience in that evolution. Financially speaking, our revised proposals reflect the challenges of a new fiscal environment in which we must demonstrate value for money.

I hope that I have given you an overview of where we are with the NCS now, and I am very happy to take any questions that you might have.

The local delivery plan being overseen and scrutinised by the national care board will help to ensure that the outcomes that are outlined in the local delivery plan are achieved. At the moment, there is not that level of external scrutiny of whether what local areas say will happen happens, or that strategic thinking about commissioning—it works well in some areas and less well in other areas. The oversight from the national care board and its ability to step in and support if there is service delivery failure will improve the situation.

You asked about the money getting to where it should be. Everybody agrees with this: the local authorities and the NHS have agreed to share accountability, much of which is, at the moment, entirely in local authorities’ hands. They have agreed to shared accountability in order to improve the situation and that will go some way towards doing so.

The evidence for early intervention and prevention is relatively strong. More than 10 years ago, the Christie commission made a strong case for early spend—in other words, for preventing people from falling into the river rather than having to pick them out of the river.

There is robust detail about the economic benefit of early intervention and prevention—we have fairly robust calculations on that. I am not sure where the 1 per cent assumption that you have talked about came from, but the fact is that we are running a very costly system. Social care costs Scotland enormous sums of money every year, and everyone accepts that what we are delivering is not of the standard that we want.

The national care service provides an opportunity for us to improve social care delivery. I absolutely agree that there might well be costs. Feeley calculated that, as the business case says, social care would be beneficial for 36,000 people in Scotland who do not currently have access to it. I agree that there might be costs that we are uncertain about, but I am certain that, if we can deliver better care—which we will do through the national care service—we will save money and bring money back into the public purse.

We can calculate the wellbeing impact on the 36,000 people. If just 10 per cent of them—3,600 people—experienced a 0.1 point improvement in their wellbeing on the life satisfaction scale, the annual benefit could be worth about £5 million.

We are still working hard to establish the costs of carers’ breaks. As you will see in the revised financial information, there remains quite a level of variance on that. We are seeing improvements in carers’ rights to have a break: we are putting funding into that, without the legislation having to make that change. We will consider very carefully the costs and how quickly we can implement carers’ breaks after the bill is passed.

I would need to read the letter and get back to Social Work Scotland on the detail of it. Unfortunately, I have not seen the letter. Lee Flannigan saw it last night, but it was not addressed to us.

Donna Bell wants to come in on that. I suppose that the thing to emphasise is the cost of the national care service relative to the cost of social care spend. The cost of the national care service, from 2031-32, would represent between 0.54 and 0.82 per cent—less than 1 per cent—of spend on social care. It represents between 0.2 and 0.31 per cent of the entire spend on health and social care, so the cost of the bill is relatively small compared with the enormous amount that is being spent on social care. It is important that everyone understands that.

There will be some costs earlier than the first three years. The three years is to do with setting up the local care boards. We will begin to set up the national care board as soon as possible after the bill is passed. We are working to deliver things such as the national social work agency now, so some of those things will start sooner.

The implementation costs of Anne’s law are likely to be small. Much of that work has been done, but there will be an education piece that is associated with that. Some costs will start from day 1, and some will come a little further down the line compared with the bill as introduced.

I think that we have already given full information. Not every bill that comes through this Parliament has an accompanying business case. Members do not get that level of detail about economic impact or the value of the investment with every bill that comes through Parliament.

I am happy to furnish the committee with more detail. I want to have robust, quantifiable figures, but the reality is that much care work is female work and is unseen and unaccounted for in our society. That is one of the challenges that we are facing and one of the reasons why we are determined to improve the delivery of social care. There are no accurate numbers about how many unpaid carers are out there. From looking at that population, we have some idea of how many there are and we know that care is a gender issue and that far more women than men are impacted by unpaid care. We also know that, for working age carers, that impacts their ability to work. Unfortunately, we live in a society in which women’s work is unaccounted for and invisible, so it is tricky to get robust evidence. I am determined to work to improve the quality of the evidence that you have.

The powers of the national care board are clear. We have agreed what the board will do, but the detail about its composition, and about who will sit on it and will have voting rights is still being negotiated and designed.

The national care board will be interested in service delivery, and it will certainly have powers to intervene, particularly where there is service delivery failure. That is somewhat similar to what happens in the NHS at the moment, where there is an escalation framework of support to ensure that local NHS boards are helped to deliver as required. On the ability to direct budgeting and so on, I think that the system that we are introducing will enable far better financial scrutiny. Local authorities and the NHS are signed up to that. They are inviting that level of scrutiny and shared accountability so that we can do a better job together.