Seòmar agus comataidhean

You are absolutely correct. During the bill process, I have personally spoken to hundreds of people who access social care, and the team has heard from thousands. People are telling us loudly and clearly that the system is not working. We have increased investment and, as I said, we have set ourselves a target of increasing investment. Many would say that the fundamental challenge is a lack of investment, and I would not disagree that social care needs more money. However, we have invested an extra £1 billion over the past few years, and we have not seen the systemic improvement that we would have expected from that investment. The Feeley review looked closely at the system, and Derek Feeley said that the system very clearly needs reform and that it is not simply a case of pumping additional money into a system that needs reform.

We have a suite of work. A lot of work is being done to improve conditions for social care workers. We have worked closely on, and are close to delivering, a collective bargaining system. A lot of work is being done to attract people into social care careers and to support them with continuous professional development.

As I described in the chamber last week, we have a weekly collaborative response and assurance group meeting at which Government and local systems come together to look at delayed discharges in particular in order to work out how to tackle them and how to tackle unmet need. It also looks at what can be done to improve efficiency in the system and pick up areas of best practice. It is difficult for local systems to pick up best practice in other parts of the country and translate that into their area. It is not a case of one size fits all, so people have to adapt best practice and apply the methodology that has been used in parts of the country where it is working well to their area. As I have said before, I live in the rural west Highlands, and it is clear to me that it is not a case of one size fits all. However, a national care service would enable us to better pick up best practice, share it around the country and ensure that our entire system works as well as it possibly can, despite the strains.

As you will be aware, I am a junior minister with responsibility for those things in my portfolio. I work as part of a team of health ministers, and we work as part of a Cabinet structure within Government.

That statement is incorrect. The forecast cost of the national care service, as refined, is £345 million over 10 years.

I work closely with the trade unions. Many of the comments that they have made do not actually relate to the legislation; they are comments on social care in general, and their view is absolutely valid. To be clear, they are raising concerns about the social care system, not about the legislation.

It is important that I listen to all of the parties in Parliament and work out what there is support for. What I am hearing at the moment is that there is strong support for a number of aspects of the bill. In fact, I am not even hearing much concern being raised about amendments that might be needed. There is clear consensus around elements such as complex care commissioning, Anne’s law, information sharing and support for unpaid carers. There is strong support for those aspects.

The things that the trade unions are asking for are outside legislation—so they are not part of the bill—and concern issues such as sectoral bargaining. We are making good progress on that and are close to the point of that being a reality. In fact, the legislation that Stephen Kinnock has introduced in the United Kingdom Parliament is probably more relevant in that regard, and I am in negotiation at the moment with the UK Government about how that legislation can apply in some way to Scotland, particularly given the work that we have already done to put fair work principles into social care in Scotland—we are well ahead of the United Kingdom Government in that regard. I am keen to collaborate with the UK Government on that piece of work, but that would be a separate piece of legislation from the NCS bill.

Given the complexity of social care and the number of stakeholders involved, it was very likely that no single stakeholder view would be reflected by the bill. However, each of them was heard and the bill was developed with their collaboration. We worked hard to bring to life what people were telling us.

Do you want to say more, Donna?

Anne’s law will be implemented as soon as is practically possible. I think that the care home relatives know and understand the challenges that we are facing. Anne’s law will engage the European convention on human rights, and when we are balancing human rights, it is always tricky to get the legislation correct. They understand the complexity, the sensitivity and the challenges that are involved, and we are working very closely with them to get the balance right on those rights. I assure them that we will deliver Anne’s law. We need to take time to get it correct. As I said in my letter to the committee, I will come back with a new timetable for the new year, so I do not think that they are going to be waiting terribly long. I do not think that there will be a long delay.

There has been lots of discussion about how long it will take for the national care service to come into being once the legislation has been passed. There have been quite a lot of headlines in the newspapers about how many years it will take for that to happen. Anne’s law could be implemented immediately, as soon as the bill is given royal assent. As soon as the bill becomes an act, we could see rapid implementation from that point on, and we would be working to deliver it as soon as was reasonably practicable. I am remembering my Government jargon: as soon as is reasonably practicable and as soon as the bill becomes an act, we will be working hard to deliver it for them. There is no reason to wait.

I will bring in Donna Bell, who was very close to the ELAG. The ELAG was brought into being largely because Parliament suggested, during stage 1, that we needed to put together such a group. We were already in the process of hearing and listening to stakeholders a great deal. I will check with Donna, but I think that more than 70 organisations were involved in the group.

When we paused negotiations with COSLA, there were three areas of disagreement—direct funding, removal of people from boards and the issue of children and justice, which had been contentious throughout the process. I have been clear that it would be best for children’s and justice services to be within the national care service. That is important to give an individual who is accessing care the most cohesive and joined-up experience. Children who are taken into care are often vulnerable, and they are taken into care because of issues that make their parents vulnerable. Their parents often have adult social care support or justice social care support.

It is important that we look at how integration of the whole system can mean that it works better for vulnerable citizens. That is about recognising that children live in families and in communities and that the child usually requires care not because of their own situation but because of the family situation.

The social work profession has been clear to us that it would like the profession to stay together under one umbrella, so that is something to bear in mind. However, the issue has been contentious with local authority partners, who believe that the decision whether to delegate services should be a local decision.

I do not know whether any of my officials wants to add more or whether I have explained the position adequately.

Donna Bell will take that question.

You are absolutely correct that there is an unacceptable level of variation. We often use Ayrshire as an illustration of that. As you said, the area has one health board and three local authorities. East Ayrshire has a fairly low level of delayed discharges. As I said, delayed discharge is not the be-all and end-all, but it is the tip of the iceberg. North Ayrshire has more than double the level of East Ayrshire, and South Ayrshire has more than three times the level of East Ayrshire.

There are different levels of priority, spend, grip and assurance in each of those systems, and there are challenges. Demographic differences might contribute somewhat to the differences; indeed, we probably will not get uniformity across the country, even if there is a national system.

We are hearing loudly and clearly that there is some support for recognising the situation as it stands and improving and picking up learning nationally. For example, South Ayrshire Council, which I spoke to recently, has started a frailty service in its hospital that is having a huge impact on the efficiency of its system. That is a really effective piece of work. We need to learn about that quickly and translate it throughout the country, because it is having an almost immediate impact, but we have very little in the way of mechanisms for doing that.

I think that it was Henry McLeish who said to me—he does a lot of work for Alzheimer Scotland—that if he visits an area of Scotland where there is absolutely amazing work going on and asks, “How do we get this happening in the other 31 local authority areas?” he is told that the charity or third sector organisation that is delivering that amazing work has to go and persuade the other 31 local authorities to do the same thing. A mechanism is needed to pick up great work nationally and to make sure that it works.

When we first made the shared accountability agreement, we agreed that operational responsibility and statutory responsibility delivery would absolutely remain with local authorities. I have reiterated many times that I believe that that is really important. I come from the rural west Highlands, and what works in my part of the country will not work in Edinburgh or in Fife. It is important that delivery of social care can take into account the local challenges and the local assets that are available in every community.

However, there is undoubtedly unnecessary variation. The bill, as it was originally introduced, meant that ministers would have had sole responsibility for social care in Scotland. At the moment, it sits with local authorities. We said that local authorities, NHS and ministers would share accountability and that together we would make sure that there is top-notch local delivery and national oversight. When the committee looked at self-directed support, one of the things that it was very clear was required was national oversight. That is what we agreed on, and we have been working on that. We have been meeting weekly with local authority colleagues and the Convention of Scottish Local Authorities since June last year in order to deliver that. We had agreed, I would say, 90 to 95 per cent of what was required to deliver that.

As I set out in the chamber last week, around June this year, local authorities came to Government and said that they had capacity challenges in facing the delayed discharge crisis and continuing negotiation over the National Care Service (Scotland) Bill. They asked whether we would take that off the table temporarily so that they could focus on delayed discharge, so we did that. We paused negotiations but, without coming back to the negotiation table, local authorities then withdrew their support for the shared accountability agreement. I set out in Parliament that I was so disappointed with how that happened. I believe that we should have come back to the table and worked on the remaining very small percentage of areas on which we disagreed, but that is not where we are—local authorities have withdrawn support.

On accountability, I think that you have heard in your evidence sessions that the disabled people’s organisations say that we have given far too much power and responsibility to our local authorities, and the local authorities say very clearly that we are trying to take too much power away from them. The fact that we have those polar-opposite views is just the reality of the situation that we are in at the moment. We have to strike a balance between those polar-opposite views—accountability being entirely the responsibility of local systems and democratically accountable to the local population but with no national oversight, and national oversight with no differences in local delivery. We have to find a balance in the middle, and I thought that we had found it. That is why I am frustrated and disappointed by what has occurred.