Seòmar agus comataidhean

Foxgrove will be working to the secure care standards, so in its consideration of how it will operate once the regulations are in place, it is looking carefully at the secure care standards. It is a slightly different environment, but there is a lot of learning to be had from looking at how the secure care environment operates. It also looked at national standards that apply in England to pick up on good practice points. Therefore, to reassure you, Foxgrove will operate to the secure care standards.

The opening is now scheduled to be in mid-March 2024. There have been some building challenges, as is often the case, in the completion of the construction projects, which have meant that there is a slight delay. The building is now expected to be completed and operational in mid-March next year.

The committee can have confidence that the health board—as in all the sites that it operates—is capable of identifying the staffing requirements for, and the training needs of, the people who are going to work in the unit.

As we have said, the recruitment process has already begun. As the service is completely new, we would expect that that process would need to begin early to enable the opportunity for any shadowing or networking that might be required on other sites. We do not have anything like that in Scotland yet, so we would expect that the process would begin early and that there would be a slightly longer lead-in time than there would be if we were just building a hospital like what we already have in Scotland.

As far as I know, that commitment still stands.

How we improve access will be crucial to the success of the delivery. We all pore over the delayed discharge figures, particularly coming into winter. We are less good at capturing the level of unmet need that we know is in the community for people who seek care packages and have been assessed, but are not able to get them, which is equally important. We know that accessibility at every step is a challenge.

One challenge that we face is that there are different levels of integration around the country. As I have said, that makes it difficult to know where services are falling between cracks. We think that services sometimes fall between cracks because of the accountability in different models of design.

I see the national care service as the natural next step in integration. This is about further integration. We see different models of integration around the country. In some parts of the country, mental health is included; in other parts, it is not. As I have said, that gives rise to some of the postcode lottery and some of the challenge in taking steps to improve accessibility. We will look at whether that serves the nation well. The issue is probably improving integration in every part of the country.

The national social work agency will produce national standards. That will be an important part of improving delivery and ensuring that everywhere operates to the same national standard. I think that that will give protection to individual social workers, who will know what they need to do at each step of the way in their jobs. That is really important.

As I have said, I am determined that the national board will have teeth, so it will not be there just for decoration. It will absolutely be there to take an overview and to take action if there is service delivery failure in any part of the country. Where problems arise, the national care board will be able to take action to correct them.

One thing that will be really important—I think that we spoke about this when I was last at the committee—is the review of independent inspection and scrutiny that has just reported. We as a Government still have to reflect on and respond to that, but I think that that will provide us with another lever to pull to improve the situation and the standards nationally. Getting the inspection and scrutiny process right is a really important part of the process. One of the aims is to shift from what is perceived to be a punitive system in which there is reputational damage if things fall short to a more supportive system in which there is an ethos of continuous improvement and support is easily available to try to improve standards where they are found to fall short.

That is a tricky thing to fix. If it were easy to fix, we would certainly have done it by now. Lots of work was being done across the system all last winter, and as soon as the winter was over, we began to reflect on how to rise and face the challenges that we expect to be faced with again this winter.

Scotland’s situation is not unique; it is similar all over the United Kingdom and in many developed countries. There are a number of challenges. As your question implies, there is no doubt that we were not rising to the challenge of delayed discharges prior to the pandemic, but we are now in a really difficult situation because of the pandemic. The whole of our health and social care system has been under sustained pressure for a number of years, and that is one the reasons why we are in such a difficult situation on this issue.

Of course, we have to cope with a new condition and several hundred people will be in hospital today with Covid and Covid-related complications. There is, therefore, a whole extra condition to be coped with as well as the fact that the staff and systems have been under sustained pressure for the past three years during the pandemic.

What are we going to do to improve the situation? That is the crux of the issue: how are we going to move forward from where we are now? A lot of work is being done across the system, including a lot of collaboration with local governance systems. We are producing dashboards of data, so during the past few months, we have spent some time on improving the data that we can provide to ministers and to local governance structures to try to ensure that quick action is taken where problems are brewing.

There is a suite of things that we know work, such as discharge before 12. Programmes such as home first are in place. That is an interesting programme and early results are impressive, so we probably need to ensure that that programme increases at pace and is delivered at a high level right across the country. In that programme, instead of an in-patient waiting for an assessment in a hospital environment, they are discharged to their home and assessed there. The clear finding is that a smaller package of care, with immediate support, is required to support people at home if they are discharged quickly. We are striving to spread that practice all over the country.

There is a lot of work to be done, but there is no magic pill. If there was, we would do it, and everyone else in every other country in the UK would be doing it, too.

There are a couple of important things to draw out about shared accountability. It is shared, rather than joint, accountability, which is a significant distinction because we have different groups to which we are accountable.

As ministers we are accountable to the country; local authorities are accountable only to the local authority area that they represent; and the national health service is accountable to the NHS boards. We all have different groups to which we are accountable, but if we share that accountability we get really good coverage and oversight of the country. The three of us together will definitely have an impact in terms of delivery of better standards and qualities.

We are still working out the detail around the national care board, but I do not think that it will be just the three of us. There will be more people around that table. I expect that there will probably be an independent chair. I think that the voice of lived experience will be absolutely vital on that board, and I think that it should include representation of the workforce and the national social work agency. Those are the things that will give that board teeth and make sure that it delivers an impact.

I have heard criticism from many people that the board is just the status quo, but it will be different. At the moment, I have no control over the social care system; I am held to account day in and day out for things over which I have no control. In the future, Scottish Government ministers will have some control, which they will share with a national body. That will absolutely ensure that we deliver improved standards.

Do you want to say anything more, Rachael?

During the past number of years, we have effectively introduced a floor level of payment of social care staff. We have introduced that nationally, and we did so by providing funding to ensure that that pay can be passed on to staff. I think that we will manage to do so again using the mechanisms that we have used for a number of years. I am absolutely delighted that we are delivering on that commitment.

I know that people are, as ever, pushing for more and would like even better pay in social care, but I am absolutely delighted, given the financial constraints that we face as a nation, that we are delivering on that, and that we are setting a path of year-on-year significant improvement in pay for social care staff, because that is one of the very important things that we need to do to strengthen the system as a whole.

Generally, when we go out to consultation there is a set of proposals on the table. When we have gone out to speak to people, one of their criticisms has been that there is not enough meat on the bones. We would usually have a set of proposals and we would ask people whether they liked them. We have taken a step back from that approach and adopted a co-design process, spending a great deal of time understanding the current situation and trying to imagine a different way of doing things that would deliver better.

That is a step back, I think, from consultation. It delivers the voice of lived experience right at the heart of the design of the national care service, which is really important. I do not envisage that process having a hard stop at the end, when the bill is delivered. I envisage the voice of lived experience continuing to be a strong part of how the national care service evolves. It will help us to get the policy right in the first place and to deliver it according to our ambition.

Is that sufficiently clear for you or should I bring in my officials to give a little more detail?

I will bring in Donna Bell in a second.

As well as all of the regional events during summer, we have since added another three regional events, because of popular demand. We have a national event at the end of October, and we also held online events for people who could not attend in person. We have commissioned some specific work, with specific partners, to go out and reach the groups that, when we looked at the information that was coming in, we felt we did not have 100 per cent coverage.