Seòmar agus comataidhean

I would like to start by thanking the committee and all those who have taken time to give evidence during the past few months. I very much welcome any chance to shine a light on self-directed support, which is a policy with which Scotland leads the rest of the world.

The SDS journey began with the passing of the 2013 act, which signified a fundamental shift in mindsets, recognising that individuals are the experts in their own lives and should be fully supported to make their own decisions about their care and support. Since then, we have witnessed the tangible impact of the introduction of SDS on the lives of countless individuals across Scotland.

Through personalised budgets and tailored support plans, people have been able to live more independently, pursue their passions and participate in their communities in a way that just was not possible previously. I have seen for myself the impact of SDS on individuals, including at a recent visit to the Lothian Centre for Inclusive Living.

Although I am aware that the committee has heard of many examples of SDS being implemented in accordance with the 2013 act, I am aware and have heard that work is still to be done across a number of areas. They include ensuring consistency of implementation across local authorities and in provision of information and access to advocacy; addressing wider workforce issues, including recruitment, retention and training of staff; and clarifying how SDS will work in the context of the proposed national care service.

As members will be aware, the self-directed support improvement plan that was jointly published by the Scottish Government and the Convention of Scottish Local Authorities sets out how we are continuing to drive improvements in SDS. The plan recognises the need for a whole-system approach. Although the Scottish Government can set the legislative framework and foster connections to promote collaborative working in the areas where it is most needed, it is vital that delivery partners across the statutory, third and independent sectors all play a role in implementation. That includes local authorities and integration authorities, which have statutory responsibility for ensuring that people can get the support that is right for them. The plan is supported by updated guidance and a framework of standards that make clear the expectations of local authorities in provision of care and support.

However, I want to be clear. It is not right that an individual in one locality has limited options available to them in comparison with their counterparts in another part of the country. Such inconsistency in access to SDS is an example of the reasons why the Scottish Government has introduced the National Care Service (Scotland) Bill, which will allow Scottish ministers greater oversight over the quality of social care in Scotland and greater ability to drive consistency in order to reduce the inequality that we all know exists in the system.

Through the national care service national board, there will also be the opportunity to share good practice further across the country to enable it to become more widespread. With the NCS will also come greater financial clarity and transparency, which is something that becomes more and more important as financial pressures continue to build.

The 2013 act was a significant step, but we still face many challenges, and I recognise the need for further improvement in delivery of SDS at a local level. The Scottish Government remains committed to driving forward improvements in the way in which social care is delivered, and that commitment extends to embedding the principles of SDS in the national care service.

That is a really good question. This committee will be well aware of the complexity of the health and social care system and how challenging it is to have an impact from the centre. One reason why I am so committed to the national care service is that I recognise that, although we absolutely need to have Government direction and responsibility, we need to work with local systems, as well. It cannot be one or the other; it must be both. The tripartite accountability agreement that we struck with the national care service will help us to bring some cohesion to the complex landscape in which we are all operating.

The other challenge that we have in health and social care systems as a whole is that we cannot afford to get it wrong, because people’s lives depend on it. These are essential services, so we really need to manage change very carefully. We are well aware of that responsibility, and we are managing change carefully.

One thing with self-directed support is that, rather than it being about the operational directions and guidelines on how to do it, it is really about the ethos of it. That was a huge shift in culture to where the person is at the centre of the decision, and a shift to where their human rights are upheld and early intervention, prevention and support are wrapped around that individual in order to make decisions that suit them and help them to achieve their life goals. I think you will see that ethos firmly embedded in everything that we do from now on. We know that it is absolutely the right thing to do. It is challenging, but this post-legislative scrutiny of the act is welcome. We are keen to keep going back and looking again to see how we can improve it.

Again, and you would expect me to say this as somebody who is steering the National Care Service (Scotland) Bill through Parliament, I see an opportunity through the bill to pick up on areas of good practice, as well as to bring grip, coherence and assurance to areas where practice is falling down. I see an opportunity to pick up on areas of good practice and to quickly translate them across the country. That excites me, because that has been challenging in the past.

As you might imagine, as I represent Caithness, Sutherland and Ross, that issue is very close to my heart. Work is being done in collaboration with Samaritans Scotland. I recently visited its project at its base in Fort William. The project is assessing the risk of suicide and is doing suicide prevention work among lone rural workers, recognising that they are a particular risk. People can be very isolated working in the Highlands and, often, because of the work that they do, they have access and means. It is an important piece of work.

As you might expect, I was hugely impressed by the work that Samaritans Scotland is doing. It is a national organisation with a real level of respect among the community and the nation, but here it was, in a local community, working very carefully and sensitively with some of the groups that were already operating in the area.

A couple of local charities are very prominent in the area. They have sprung up—I am sure that it is the same in every part of the country—because of tragic events and in memory of people who have been lost by suicide. I was impressed by the sensitive way in which this national organisation had come into the local community and was working very carefully, thoughtfully and impactfully along with the rest of the community. I think that that work reports fully next year. I am keen to see the outcome of that, and it will be of interest to every other rural area in Scotland.

We have specific work going on in rural Scotland. As I said, during my recent visit, I was very impressed by the way in which Samaritans Scotland is conducting that project. I am keen to get on the record that the project recognises the importance of employers and work-based interventions. We look to learn from suicide and there is evidence that it is often the case that people have sought help from primary care or they have sought non-specialist medical help. Sometimes, people have sought specialist help. However, employers are a very common theme across the board, and ensuring that employers are equipped to have sensitive conversations, recognising the role that they play in the community and the role that a supportive employment environment can have in preventing suicide, is a new thing. We are pleased to be working alongside a group of employers in the delivery of our mental health and wellbeing strategy but in the suicide prevention work in particular.

We can certainly look at the work that we do alongside charities that work with prisoners. From previous roles in the Government, I know about the work that families do to support those connections and to maintain relationships between prisoners and their families on the outside. Although that work is not particularly focused on suicide prevention, it clearly has a role to play in that regard.

I am happy to start, but I am pretty sure that nearly everyone will want to contribute.

We agree that it is not appropriate to take a one-size-fits-all approach and that we need to really understand the particular circumstances that are enhancing the risk in those communities in order to find the solutions in relation to prevention.

There is some good work going on across the piece in preventing male suicide. We recently confirmed additional funding of £100,000 for the changing room—extra time programme, which is run by SAMH and is done via football. The Cabinet Secretary for Health and Social Care visited during mental health awareness week. The awareness week theme this year was mental health and physical activity, so it was a perfect match. The cabinet secretary was blown away by the work that the programme is doing and how it is reaching out to men who are at risk of suicide by using the power of football—which, as you can imagine, is something that I am very passionate about—to give them time and space to come together in a way that they normally would not, and to talk openly about challenges.

We work with other organisations that specifically reach men, such as Andy’s Man Club and Men Matter Scotland, and we are very grateful for the work that they do to support us in understanding why men are more at risk of suicide and to reach a particular group that is perhaps stereotypically a little less inclined to ask for help and support.

On the LGBT prevention work, it is difficult because, as the committee will have heard from academics earlier on in the course of its evidence taking, the body of evidence, although improving, is perhaps a little scanty in relation to some of those specific characteristics. In that situation, all that we can do is work very closely with trusted organisations that we know work in that area effectively and are alongside those populations and try to find bespoke answers that work for them and support them in their work.

I have not heard of any delay—I think that we are on schedule.

We should be good—I mean, summer is quite a loose term, isn’t it? In the civil service, every season is quite long. I am not sure whether an outturn is part of that, though.

I know that Dr Cook wants to come in, but I should say that, with regard to the picture with data and its collection, we have a general concern about the quality and availability of mental health data and we are working hard to improve those aspects in our mental health and wellbeing strategy.

Often, when a suicide occurs, there is an extra level of investigation. A lot of learning comes from that. A common theme that emerges is the transfer of information across interfaces. We absolutely recognise that that is an important piece of work that needs to be embedded generally, with key information or data being made available across the interfaces as people work their way through the system.

I think so. Mental health and wellbeing is a key focus for the Government, and it is a high priority for every ministerial portfolio in our work with local government. I do not think that you will find a minister and spokesperson who work more closely together than me and Paul Kelly, as we do in very many areas, which reflects the priority that both spheres of government give to this work. We work together on suicide prevention, and we have launched a joint strategy on it. We have worked together on the mental health and wellbeing strategy, and on the delivery plan and workforce planning for it.

We have also developed together a groundbreaking strategy to reduce self-harm, which is a really important area for suicide prevention: self-harm is one of the biggest risk factors for suicide. We listened carefully to our lived experience community about what, specifically, was required in order to meet their needs and reduce their risk. The will is there, and effort is being put in. There are always challenges—every sphere of government has financial challenges at the moment—but there is no doubt that this is a high priority for all of us; we can see that in the numbers.

Members know that listening to the voices of those with lived experience is important to the Government. We put lived experience at the heart of our policy development and, often, legislation, because doing so helps us to get it right, but it also holds our feet to the fire on delivery. We find that it is a helpful way of working and of ensuring that we close the implementation gap—the gap between the ambition and what is happening on the ground. If the voice of lived experience is very strong during the development of a policy, that helps us to get it right and to deliver the policy well.

We have a couple of lived experience panels; Morag Williamson will probably enjoy telling you a little bit more about that. We wondered whether it might still be possible for the panel to contribute to the committee’s inquiry, because it has been so helpful to us in our development.