Seòmar agus comataidhean

Thank you for inviting me to discuss spending on the national care service programme. The Government remains committed to delivering a national care service to improve the quality and consistency of community health and social care support across Scotland. Through our summer co-design activities, we have heard from hundreds of people with experience of accessing support or delivering it, and it is clearer than ever that the system needs to change if we are to deliver the services that people need.

That said, we are in a different situation from the one that we were in when the National Care Service (Scotland) Bill was introduced in June 2022. The timings for the bill have changed. We originally expected the bill’s passage to be completed by now. The delay has given us additional time to have deeper discussions with key partners and stakeholders, and to advance the co-design activities. However, it has obviously affected the profiling of expenditure, with development activities taking place over a longer time rather than our moving to implementation.

The fiscal circumstances are also different from those in June 2022. There is increased pressure to find different ways of working to make the best use of the available public funds. During its initial stages, the NCS programme involved a small number of consultancy projects that provided research and advice, but that work has significantly reduced in the current year, and we are focusing on providing the skills that are required through our own staff.

In addition to the internal spend on developing the national care service, the Government is increasing spend on front-line social care. More than £1.7 billion has been provided for social care and integration in 2023-24, and we are committed to increasing spend on social care by at least 25 per cent by the end of this parliamentary session—an increase of more than £840 million. So far, spend has increased by £800 million since 2021-22, so we are well ahead of that target.

However, simply spending more will not deliver. In order to make the improvements that people are calling for in relation to the quality of social care support and giving people choice and control over the support that they receive, we need to change the system. I believe that the new approach that we are developing, with greater national oversight and strengthened integration at the local level, is how we will achieve that.

A lot of the staff costs that are attributed to the programme relate to training and travel, and there will have been more training at the start of the transition than there will be as we progress. Fiona Bennett may want to give a bit more detail on that. Another factor probably relates to outturn and reconciliation.

Co-design is a new method of developing legislation. We have used it before in the Scottish Parliament and the Scottish Government, but some of the training costs will have been on co-design methods to ensure that people were aware of how to engage with lived experience and how to make sure that that lived experience made its way to the heart of the legislation.

Donna Bell can give you a bit more detail on that.

With the exception of a very small dedicated bill management team, the majority of officials working on the national care service are involved in teams that combine policy development, co-design and implementation across a range of areas. Those activities will inform the development of the bill and the more detailed development of the national care service, which will be set out in secondary legislation, guidance and practice. They will also inform many areas that feed into improvements of the current service.

You have heard me say many times that we do not need to wait for the bill or primary legislation but that we can make improvements in the area now, and we seek the areas that we can improve without legislation on a regular basis. Officials continue to review priorities at all times in line with the current fiscal position in order to focus on improving services for people who access social care support. I am more than happy to furnish you with as much detail as we possibly can. I want you to be able to scrutinise the bill. We are not trying to hide anything from you, and we are keen to use your scrutiny to improve what we do.

We are always looking for opportunities to improve the system, and I point to the increase of the minimum wage to £12 per hour, which did not require us to wait for legislation. The decision was made by the Scottish Government to deliver that from the next financial year, and I am so delighted that we are able to deliver that without the need to wait for primary legislation. There will be other areas that we can improve on, and some will require primary legislation, but we are always looking for opportunities to improve.

This week—tomorrow, perhaps—we will get a review of scrutiny and inspection. We will consider that publication keenly to see what we can do and how we can take its recommendations on board. The regime of scrutiny and inspection is a tool that we can use to improve quality and consistency. If we think about the outcomes from the bill that we are aiming for, we can see that the review will be a crucial piece of work. I cannot pre-empt the report, which I think will be published tomorrow, but I imagine that not every recommendation will require primary legislation to effect change. We will look for changes that can occur without the legislation, because we are keen to set ourselves on a trajectory of improvement of delivery from day 1—from now.

That might be an easier way of doing it, but we can deliver both. We can have co-design at the heart of our development of legislation and ensure that this committee and others are comfortable with the financial scrutiny.

Co-design is a core part of the national care service. I do not expect it to finish by Christmas; indeed, I expect it to continue throughout the bill’s development and to be a fundamental part of the national care service in future.

Donna Bell can give you a little bit more information.

What I have been trying to describe is a dynamic process in which we take on board the co-design and then come back to the committee with more information. The business case is iterative, so we will have lots of opportunities for you to scrutinise and examine what is going on. The use of co-design in developing the legislation is fundamental to the type of change that we are delivering. As I say very regularly to people, if we have lived experience at the heart of our policy and legislation, we are much more likely to get them right. The challenge, though, always lies in implementation, so we also have a built-in mechanism for holding our feet to the fire in that respect to ensure that we not only deliver our ambitious policy and legislation but implement them appropriately on the ground.

What I am trying to say is that co-design is a core part of the national care service. I would expect that, once we have delivered it, it will continue to evolve, much like the NHS has. It will not be fixed in stone, just as the NHS was not fixed in stone when it was introduced in 1948. Having co-design at the heart of the development and at the heart of the service itself means that the voice of lived experience will continue to be involved in its evolution, even after we deliver the legislation. However, I agree that the approach makes it more difficult for you to scrutinise costs.

Yes.

I will ask Fiona Bennett to answer that question.