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The issue of a shortage of psychiatrists is a global one. In Scotland, we have done a lot of work to ensure that we are recruiting in mental health and are developing the multidisciplinary workforce team that we need. For example, if we look at the related area of the child and adolescent mental health services workforce—the provision of such services is not specific to people with learning disabilities or neurodivergence—we see that staffing has increased by 59.1 per cent in the past decade. In those areas on which we have focused attention and tried to bring about improvement, we have been able to achieve that.

Work has been done to develop neurodevelopmental pathways. We work with the national autism implementation team, which works with local teams to build a neurodevelopmentally informed workforce in Scotland. The people on the implementation team also listen to and work in partnership with neurodivergent people. They host the adult neurodevelopmental pathways professional network to support clinical teams and national learning-from-the-pathfinders events. A whole suite of work is being done to improve the situation.

In relation to the standard data set, I have said before that there are gaps in our data. The only data sets and treatment time targets that we have in mental health are those that relate to access to psychological therapies and access to child and adolescent mental health services. We do not have a data set for the number of people who are waiting for attention deficit hyperactivity disorder assessments, for example. I am happy to consider whether it would be helpful to have such a data set.

As I said, at the moment, the level of demand is increasing hugely, and local health boards are unable to meet that demand, so the Government is looking at what we can do and what we can put in place to try to improve efficiency. For example, we are looking to develop waiting list initiatives. There are no simple strategies that we can lift off a shelf and put in place, but I assure you that we are working on the issue. I would be happy to come back and provide an update.

Absolutely, we can probably update you in writing. Jacqueline Campbell might want to say more about it. The LEAP is just the most amazing group of people. They really are outstanding, and it is a pleasure to work with them. In my role as a minister, I find that working with people with lived experience helps us to get things right in the first place, because we come from their perspective, and to develop policy and legislation that hits the spot. It also helps to hold our feet to the fire on delivery, which is really powerful.

One of the real challenges that I face as a minister, which I have talked about a number of times, is closing that gap between developing the aims of our ambition and policy, and the reality of the legislation—which sometimes is world leading—on the ground. That delivery gap is the real challenge for a minister and the Government, and those guys really help to support us on that. Using their lived experience, they challenge us on where we are meeting our ambition and where we are not. That is helpful to understand. They are a phenomenal bunch of folk, and I am looking forward to meeting them. When we meet, we will be looking to put together a programme of work. I hear this from many groups in our society, but this population is particularly weary of being consulted, and they want to see some action. We will be working on a programme of tangible outcomes that we would hope to deliver over a shortish period of time, so that they know that their voices are making a difference.

Absolutely. Part of the reason for having this discussion is that we make sure that members of the committee understand that there are things that we can do by different means. There are subtle differences in how we can achieve things.

Take Anne’s law, for example. Relatives of care home residents were initially very keen on the idea of that being achieved through primary legislation. One reason for wishing to use primary legislation is that it cannot be changed so easily. Were we to face another pandemic, changing primary legislation would require a level of scrutiny from Parliament that changing secondary regulations would not require: the latter do not attract the same level of scrutiny.

There are definitely different ways to achieve the same thing. I need to spend time listening to stakeholders and to political parties in Parliament, then I will need to navigate a way forward. It is really important that I work closely with stakeholders. I am content to come back to you with a clearer idea and a proposal. In my letter, when I asked for a pause, I said that I would like to set out in the new year what I think the next steps are likely to be.

You are absolutely correct—there are real challenges. There are some structural reasons why the social care workforce is disempowered compared to other workforces. First, caring is not generally valued in society. That is not my view, but care is regarded as a drain on society rather than as an investment in society globally. We need to shift that narrative.

It is a largely female workforce; I think that more than 80 per cent of the workforce is female, and we know that, even 50 years or so after the equal pay legislation came in, women are not paid equally in society.

The workforce is also largely non-unionised. Less than 20 per cent of the workforce is unionised—I think that the figure is just about 19 per cent .The workers who are unionised are largely those who work for local authorities. Social care workers in the private sector tend not to be unionised. I think that many of us around the table would have concerns about that and would recognise that unionisation would be a way of strengthening the workforce’s hand and ensuring that they were empowered and recognised within the system.

I regularly talk to unions about that—I say, “I’m not sure if you think I’m an unusual sort of Government minister, but I would be far more comfortable if this workforce were more unionised”. I cannot introduce unionisation to the workforce; in lieu of that, I can work with the unions to take away some of the barriers. We are working carefully on sectoral bargaining. We think that that is very close to being ready and that it will deliver an improvement in pay and conditions for the sector. Sectoral bargaining has been really challenging to deliver, and the unions were very helpful to us in recommending academics who could help us to unlock some of the barriers. The challenge is that there are more than 1,000 different employers and we in Government are not part of the negotiations, but I think that we have managed to make really substantial progress, so I am pleased about that.

We need to try and give effective voice to the workers in the sector. I should make it clear that when I talk about lived experience, I am talking about the lived experience of people who access social care—people who use social care, their carers, the people whose loved ones use social care, and the people who work in social care. To me, those are the voices of lived experience, and they need to have representation. My idea for the national care service board was that people working in social care would have representation on the board as well.

There are things that we can do. We will work with the UK legislation that is being introduced. Many of the barriers to progressing fair work in Scotland are because employment law is reserved, so we do not have the power to tackle many of the issues. We try to get around that through procurement and commissioning.

We now have a different Government in the UK and the legislation that it has introduced is interesting. We are significantly further ahead in Scotland in delivering fair work in social care, and I am keen to work with the UK Government on the issue. Of course, I want it to devolve powers to the Scottish Government because we are much further on, and the social care situation in Scotland is sufficiently different from that of England to warrant it. We will work together however we can to ensure that we make a difference to the people who work in social care.

The other thing that we do regularly is talk up social care. I am not sure how much difference that makes, but I do that because I see social care as a massive investment in society. I think that I have spoken to the committee previously about attending a national forum at the Glasgow Science Centre and seeing on the wall there a quote from Stephen Hawking, who made an incredible global contribution to our understanding of the world and the universe that we live in. He would not have been able to make that contribution if he did not have social care. Social care is absolutely vital to the individuals who access it and their families, and it is vital to our communities and our society. It makes a profound difference to our society, and we must all say that loudly and clearly as often as possible.

You are absolutely correct; we are still committed to establishing a national social work agency. There is consensus that it would be a good thing, and it stemmed from a recommendation in the original Feeley report. We think that it is required for the social work profession, which does not have the same level of professional oversight and representation as do some of our other health and social care professions. An agency will help to drive change and continuous improvement and will provide support.

Committee members will all be aware of the number of newly qualified social workers who leave the profession. We want to provide a good and supportive environment so that people are supported to become effective professionals and to progress, through the course of their working life, into specialist areas, if that is required.

I think that Feeley picked out the social work profession particularly because it has a particular role in legislation. I always describe the social work profession as absolutely crucial to upholding human rights in the system. If we want to achieve a rights-based approach to social care in Scotland, it is vital that the social work profession is supported and enabled to fulfil its duties according to law in terms of upholding human rights in the system. That is why there is a particular focus on social workers.

That is not to say that there is no focus whatsoever on social care workers; everyone in the system is really important. The scale of the challenge that the social care system faces because of the change in employer national insurance contributions and how many people no longer working in the system that might translate into is really concerning. Everyone who works in social care is really important.

I am well aware that professionals such as occupational therapists work in the same sort of areas as social workers. We are working with their professional body to make sure that they are well represented in the decisions that we are making. However, it is important that social workers have their own professional body and that we, as parliamentarians, recognise how crucial that profession is to the delivery of human rights-based social care in Scotland.

My main focus is on outcomes and on what we need to achieve for the people of Scotland. I have heard loud and clear that the system that we are currently overseeing to deliver social care is broken and that we need to fundamentally change the way in which we deliver.

I ensure that the voice of lived experience is heard loud and clear, which I think is part of my role as minister. I have been dismayed at how that voice has not always been heard in the discussion about social care. Some very strong institutions are involved in delivering local and social care, and the people who access social care are often not heard within that. I consider my relationship with those people to be very precious and, when I make representations to Cabinet, I absolutely talk about how the decisions that we make will impact on them, as well as what their wishes are and what outcomes they want to see in the system.

Those people tell me clearly that they want a human rights-based approach, to tackle the variation around the country, and a system of social care that protects their dignity, supports them and has in place early intervention and prevention before they reach crisis. They also tell me that, when things are not going well, they want a clear system through which to put in complaints or concerns and to have those concerns investigated and upheld.

I am a junior minister, and I am very happy to take the guidance and wisdom of all my senior colleagues. That is what happens with collective responsibility. We have a great deal of experience around the Cabinet table and in our Government. I listen carefully to how my colleagues think that we can deliver the improvement that we need to see, in the same way as I listen to all of you as parliamentarians.

The Government thought that the legislative proposals that we brought forward would deliver the change that is needed.

On how integration joint boards operate, there are clearly challenges with regard to the different cohorts that are represented on the IJBs. We need to provide support and training to ensure that IJBs are able to act as a whole as well as representing their individual constituency. For example, when a local councillor sits on an IJB, they are not simply representing the council’s view; they are also representing citizens. We could provide more support to enable that representation.

I am absolutely determined that an equal seat at the table for people with lived experience would bring better focus, grip, assurance and scrutiny to the local system. People with lived experience need representation at local and national levels, and the Feeley review was clear that one of the main ways in which we would deliver a human rights-based approach to social care would be by ensuring that people with lived experience had a seat and a voice at the table at local and national levels.

There are challenges. I hear clearly from carers’ and service users’ representatives that there is a power imbalance round the table, but there are things that we could do to support people to ensure that they are able to represent users and lived experience effectively. We could put supports in place to ensure that that process works really well, which would deliver a level of grip and assurance that is not there at the moment.

No—those costs will come every year. It is a permanent change to employer national insurance contributions. Social care will be hit particularly hard because of the number of part-time employees in it; there are lots of low-paid and part-time employees, so the change will hit the sector particularly hard.

The group is not meeting at the moment, but we could revive it. I regularly meet a number of stakeholder groups. I meet very regularly with the social covenant steering group and the key stakeholder reference group, and have done so throughout the development of the bill. In fact, I am meeting them today, after my committee appearance. The expert legislative advisory group is a much broader group that focused particularly on the drafting of the bill. We could bring it back together in the future if we or Parliament feel that it would be useful.