The Official Report is a written record of public meetings of the Parliament and committees.
All Official Reports of meetings in the Debating Chamber of the Scottish Parliament.
All Official Reports of public meetings of committees.
Displaying 593 contributions
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
You are absolutely right to raise the issue of Anne’s law. Everybody is passionately behind that and wants it to become a reality as soon as possible. Those are the tensions that we balance. We know that we need to pause and reflect before moving forward, but that cannot be for an infinite period, because there is urgency around issues such as making progress on Anne’s law.
Over the next few months, we need to reflect on the scope and phasing of the bill. I need to think about what I can do that does not require primary legislation—for example, how I can tackle some of the more immediate pressures in social care that do not need primary legislation to fix them. When we introduce primary legislation, we all know that it is not like a magic wand; it does not change things overnight and its implementation has to be phased. What, therefore, needs to be the highest priority? What do we need to do first? What can wait a little longer and how do we achieve that nationally? Do we need to pilot some aspects locally before we make the step to national delivery?
I hope to have a bit more clarity on all that, and a bit more consensus, as I have said, on what we expect to do and how far and how fast we expect to go over the next few months.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
Donna Bell might want to come in on that, because it was her baby.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
We will provide progress updates as those events take place. After each event, we will provide an update on what we think we have learned. I guess that, in co-design, there is a process of agreeing what everybody has learned, so we will absolutely be providing some detail on that as we go.
10:15I understand the concern about the lack of scrutiny of secondary powers, and I am mindful that the process that is laid out is a minimum standard. I am comfortable with making sure that we engage on the secondary powers as well and that there is a process of assuring that everybody understands what is required.
I get your analogy about buying a car, but it is not quite the same. We are designing and building the car; we are not going out to a showroom and buying one. That is kind of the point.
There has to be a process of checking in with stakeholders at regular points throughout the process to make sure that everybody is comfortable with the direction of travel. With the pause, we have demonstrated that we are willing to do that. In fact, we are keen to do it, because we want the change to work. We see the change as absolutely vital for Scotland. The only way in which we will manage to deliver it is by working closely with all the stakeholders and partners to deliver it together.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
There are three distinct phases to the national care service collaborative design. Understanding is about building a shared understanding of the current challenges. Sense making is about what and how we can deliver improvement. Agreement is about whether the proposed changes address the issues that people raise. Those are the standard clear phases to what we are proposing with the national care service.
In addition, once we have reached that consensus point at which we understand how things work and what needs to change, and we have an agreed way forward on changing, then there will be the drafting of regulations and more operational detail on how we will do things differently.
That has to be within a legal framework, which is a slightly tricky aspect of co-design. Things have to be developed within our legal competence. There is then a review: we come back to make sure that we have co-designed aligns with what our aims and intentions were.
Co-production cannot happen in all areas, because it requires collective decision making on changes that require the Parliament to decide. That is slightly tricky. Co-design is more about agreeing arrangements, whereas co-production is the collective development of the idea. Anna Kynaston, does that make sense? Do you want to say more?
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
I had not until you asked me. I am certainly willing to go away and reflect on that.
I think that it is really important that the committee is involved. It is quite a different way of doing things, and I want to be sure that the committee understands what is happening in those events and understands the power that participants have to shape a service that meets their needs.
I am happy to reflect on whether there are conflicts of interest and to listen to the committee’s thoughts on that if it has concerns about it. I think that it would be valuable for members of the committee to come and see what we are doing, but we can reflect on whether they should be participants or observers. Observing would take away any concern around conflicts of interest. I am more than happy to consider that.
I suppose that, as a committee, you will have a formal role to come back to us and say that you think that things should be done in a certain way or that you have concerns about a particular area. Being observers of the events rather than participants would take away any concern about that. We will have a think about that.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
Absolutely. As you said, I am a Highland MSP. I represent the northernmost constituency on the mainland of Scotland, and I live in the rural west Highlands. If anybody in the Parliament knows that one size will not fit all, it is me. I know how important it is for people to be able to remain in their own communities. That is a strong priority for me.
Even within Highland, things happen differently. Care looks different on the rural west coast from how it looks in Inverness. That is necessary, and it is dictated by geography and by the available workforce and estate.
We are keen to reduce unnecessary variation. Around Scotland, things are done very differently among the 32 local authority areas. For example, for the social work profession, there are often very different contracts, pay, conditions and offers of continuing professional development. There is no real need for such variation. Things could be standardised and supported nationally.
That would help us with some of the challenges in local authority areas. In one local authority area, a starting social worker is paid £5,000 a year less than they would be in the neighbouring area—and, of course, that local authority has real problems with recruitment and retention. Taking a more national approach, standardising what is required and expected from that profession and what rewards and values will be placed around it would be a very sensible way forward.
It is important to understand that. I will never advocate for everything to be dictated from Edinburgh, but everybody could acknowledge that there are advantages to doing things nationally as well as times at which we really have to make sure that the operational detail is down to local authorities.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
Yes, we absolutely need to improve pay and conditions urgently. That is a really high priority. However, that is not the only challenge for the workforce. In my part of the country, Brexit has devastated our rural communities. Far fewer people are coming to live in the rural Highlands, and I suppose that we have lost a tranche of that workforce. People have moved from social care into other roles or have left the country.
We are short of labour across the board, and it is particularly difficult to attract people into social care. We are asking people to do a really tough skilled job, and we want them to deliver care with compassion. The job needs to be competitive against jobs in retail and in hospitality, which is a big competitor up my way. Furthermore, there needs to be security and a chance of career development. We need to do more than just pay.
As I said, the issue is a high priority, and things will only deteriorate further if we do not stabilise the situation now.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
Certainly. The officials might want to say a little more about that.
People were undoubtedly keen for us to put a little more meat on the bones, but we have committed to co-design. We are keen for the people who access the services and work in the services to be part of the process. That is why we went for a framework bill in the first place.
The pause offers us an opportunity to put a little more meat on the bones so that people can better understand the ambition of the bill, what the detail around that ambition will be, and how the service will look. This is such a different way of doing things that it has been a little hard for everybody to get their heads around it—I will admit that it has been a little hard for me to get my head around it in my new portfolio. The pause offers an opportunity to give a bit more detail, clarity and understanding.
One thing that I am very clear about is that the national care service has to deliver the ambition, and we must be able to articulate that well to the country. There are many times when I think, “The national care service would enable us to do that,” or “The national care service is the answer to the problem that you’re raising,” but that understanding is not out there among our citizens and partners. I need to do a better job of articulating the case and explaining that the national care service is the answer to many of the social care concerns that are raised and articulated. I hope that the next few months will give us an opportunity to be clearer about the benefits that the national care service will bring.
I do not think that my officials have anything to add.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
I am certainly more than happy to speak about that. I had some brief discussions with representatives from Unison at the parliamentary event that happened a couple of weeks ago. I am very keen to hear from it and other unions that operate in the sector and represent staff who work in the sector about their concerns, and I want us to understand each other’s perspectives on what advantages or disadvantages a national care service and the approach that we propose could bring.
Most of the concern on pensions appears to be around the possibility that people who are employed by local authorities would have their employment transferred to the national care service. There is no plan for that to happen wholesale or automatically or anything like that. Those will be individual decisions for local care boards to make, if they feel that employment needs to transfer. There would then be a process of ensuring that pay and conditions are transferred over.
The landscape is complex. The biggest employers in social care in Scotland, by quite a long chalk, are private care companies; then we have the local authorities and direct employees, and the third sector is the smallest. Is that the order? Yes. Less than 20 per cent of the staff are unionised, and it is largely local authority employees who are unionised.
In general, there is a concern that the social care workforce is disempowered and does not have a clear voice in negotiations on pay and conditions. There is definitely agreement across the board—even across the board politically—that pay and conditions need to be better. There is a real opportunity for us all, including the unions, to work together to try to improve that situation.
I do not have strong feelings about the ideology of who should be allowed to be contracted to deliver care. I want that contract to deliver a high quality and high standard of care to the individual who is receiving it. I know that there are private businesses out there who are delivering excellent quality care, and I want to make sure that everyone who is delivering social care that has been contracted with public money is providing a high standard and that their staff have reasonable pay and conditions.
That built-in standardisation of the contract, the procurement and the ethical commissioning is part of the advantage of a national care service. There is an opportunity to talk about profiteering. There is an opportunity to build into those contracts constraints around how businesses operate, to ensure that they operate to a financial standard and with financial ethics that we would want to put public money into.
Health, Social Care and Sport Committee
Meeting date: 9 May 2023
Maree Todd
Many key stakeholders expressed concerns. I think that you missed my opening statement, but—