Chamber and committees

There has been a significant increase in front-line investment in the current parliamentary session. Our ambition was to increase investment by a quarter, and we achieved that earlier than expected. I expect, given our ageing demographic, that our front-line costs will increase in the next five years.

The financial memorandum is about the cost of the bill, not the cost of social care. At the moment, we spend £5.75 billion per year on social care.

The £345 million does cover some front-line services.

Absolutely. Part of the reason for having this discussion is that we make sure that members of the committee understand that there are things that we can do by different means. There are subtle differences in how we can achieve things.

Take Anne’s law, for example. Relatives of care home residents were initially very keen on the idea of that being achieved through primary legislation. One reason for wishing to use primary legislation is that it cannot be changed so easily. Were we to face another pandemic, changing primary legislation would require a level of scrutiny from Parliament that changing secondary regulations would not require: the latter do not attract the same level of scrutiny.

There are definitely different ways to achieve the same thing. I need to spend time listening to stakeholders and to political parties in Parliament, then I will need to navigate a way forward. It is really important that I work closely with stakeholders. I am content to come back to you with a clearer idea and a proposal. In my letter, when I asked for a pause, I said that I would like to set out in the new year what I think the next steps are likely to be.

You are absolutely correct to pick out the examples of really good practice that we have in Scotland. As I said, although there are areas where brilliant things are happening in our social care system—the Granite Care Consortium and the Fife care at home collaborative would be exemplars for ethical commissioning and procurement—picking up on them and ensuring that things happen that way all over the country is a challenge. Through ethical commissioning and ethical procurement, fair work principles will be embedded in social care tenders and contracts—where we can manage to do that in a non-discriminatory, proportionate and relevant way in relation to the subject matter of the contract. There are some tricky issues of law to navigate, but we will be able to do that.

You mentioned the definition of ethical commissioning. There has been concern from people who are examining the legislation that the profile of ethical commissioning has slipped. There has certainly been no policy change from us—we are committed to ethical commissioning and procurement. If there are issues with the drafting of proposals to remove bits from the legislation or to give them a lower profile, we are more than happy to take the committee’s guidance and make sure that those areas have prominence .

We know that there is a big implementation gap between the commissioning intent and the delivery of social care for people. There is an inconsistency of approach in different areas, and the views of people with lived experience are not always heard. We established the adult social care ethical commissioning working group to look at improvements to the current commissioning process. We did that in partnership with COSLA, because ministers are not responsible for commissioning and procurement of social care—local government is.

The group is considering existing good practice, such as the examples of collaborative commissioning that we have within Scotland. It is also looking at what the barriers to ethical commissioning might be. As you say, the hike in employer national insurance contributions may well be a spanner in the works, so it is looking closely at the barriers and the financial considerations.

Local examples have been looked at very closely. I would caveat this by saying that it is not a case of one size fits all, and although I hear great things about Granite Care, for example, we cannot make things work exactly like that in every part of the country. However, the way that Granite Care is working is certainly something to be examined, picked up on and learned from.

You are absolutely correct—there are real challenges. There are some structural reasons why the social care workforce is disempowered compared to other workforces. First, caring is not generally valued in society. That is not my view, but care is regarded as a drain on society rather than as an investment in society globally. We need to shift that narrative.

It is a largely female workforce; I think that more than 80 per cent of the workforce is female, and we know that, even 50 years or so after the equal pay legislation came in, women are not paid equally in society.

The workforce is also largely non-unionised. Less than 20 per cent of the workforce is unionised—I think that the figure is just about 19 per cent .The workers who are unionised are largely those who work for local authorities. Social care workers in the private sector tend not to be unionised. I think that many of us around the table would have concerns about that and would recognise that unionisation would be a way of strengthening the workforce’s hand and ensuring that they were empowered and recognised within the system.

I regularly talk to unions about that—I say, “I’m not sure if you think I’m an unusual sort of Government minister, but I would be far more comfortable if this workforce were more unionised”. I cannot introduce unionisation to the workforce; in lieu of that, I can work with the unions to take away some of the barriers. We are working carefully on sectoral bargaining. We think that that is very close to being ready and that it will deliver an improvement in pay and conditions for the sector. Sectoral bargaining has been really challenging to deliver, and the unions were very helpful to us in recommending academics who could help us to unlock some of the barriers. The challenge is that there are more than 1,000 different employers and we in Government are not part of the negotiations, but I think that we have managed to make really substantial progress, so I am pleased about that.

We need to try and give effective voice to the workers in the sector. I should make it clear that when I talk about lived experience, I am talking about the lived experience of people who access social care—people who use social care, their carers, the people whose loved ones use social care, and the people who work in social care. To me, those are the voices of lived experience, and they need to have representation. My idea for the national care service board was that people working in social care would have representation on the board as well.

There are things that we can do. We will work with the UK legislation that is being introduced. Many of the barriers to progressing fair work in Scotland are because employment law is reserved, so we do not have the power to tackle many of the issues. We try to get around that through procurement and commissioning.

We now have a different Government in the UK and the legislation that it has introduced is interesting. We are significantly further ahead in Scotland in delivering fair work in social care, and I am keen to work with the UK Government on the issue. Of course, I want it to devolve powers to the Scottish Government because we are much further on, and the social care situation in Scotland is sufficiently different from that of England to warrant it. We will work together however we can to ensure that we make a difference to the people who work in social care.

The other thing that we do regularly is talk up social care. I am not sure how much difference that makes, but I do that because I see social care as a massive investment in society. I think that I have spoken to the committee previously about attending a national forum at the Glasgow Science Centre and seeing on the wall there a quote from Stephen Hawking, who made an incredible global contribution to our understanding of the world and the universe that we live in. He would not have been able to make that contribution if he did not have social care. Social care is absolutely vital to the individuals who access it and their families, and it is vital to our communities and our society. It makes a profound difference to our society, and we must all say that loudly and clearly as often as possible.

You are absolutely correct; we are still committed to establishing a national social work agency. There is consensus that it would be a good thing, and it stemmed from a recommendation in the original Feeley report. We think that it is required for the social work profession, which does not have the same level of professional oversight and representation as do some of our other health and social care professions. An agency will help to drive change and continuous improvement and will provide support.

Committee members will all be aware of the number of newly qualified social workers who leave the profession. We want to provide a good and supportive environment so that people are supported to become effective professionals and to progress, through the course of their working life, into specialist areas, if that is required.

I think that Feeley picked out the social work profession particularly because it has a particular role in legislation. I always describe the social work profession as absolutely crucial to upholding human rights in the system. If we want to achieve a rights-based approach to social care in Scotland, it is vital that the social work profession is supported and enabled to fulfil its duties according to law in terms of upholding human rights in the system. That is why there is a particular focus on social workers.

That is not to say that there is no focus whatsoever on social care workers; everyone in the system is really important. The scale of the challenge that the social care system faces because of the change in employer national insurance contributions and how many people no longer working in the system that might translate into is really concerning. Everyone who works in social care is really important.

I am well aware that professionals such as occupational therapists work in the same sort of areas as social workers. We are working with their professional body to make sure that they are well represented in the decisions that we are making. However, it is important that social workers have their own professional body and that we, as parliamentarians, recognise how crucial that profession is to the delivery of human rights-based social care in Scotland.

We had a debate in Parliament last week about the impact of that decision on the entirety of our public services. Social care in Scotland is delivered slightly differently from how it is delivered in England. The UK Government’s decision was made without any detailed examination of how social care is delivered in Scotland, without consultation of stakeholders and, as far as I understand it, without modelling of the consequences of the decision.

The decision to raise employer national insurance contributions was made because the Labour Party boxed itself in during the run-up to the general election and left itself with few options for raising extra funding, which we all, in this Parliament, have agreed is required for our public services.

I would go as far as to say that the impact on social care could be catastrophic. We think that the cost to the social care sector will be around £84 million a year. Much of social care is delivered by private companies and not-for-profit companies, which have no way of increasing the amount of money that they take in. Most businesses can increase their charges to cover the extra national insurance costs, but it is very difficult for our social care sector businesses to do that. For example, the not-for-profit sector has calculated—it does not think that this is the entire cost; this is its initial rough calculation—that it will cost £21 million annually. It is inconceivable that the sector will be able to find that extra money easily next year.

You will all have heard about market failure and the challenges that are faced in certain parts of the country. For example, you heard evidence from Fiona Davies that, over the past two years, there has been a loss of 200 care home beds in NHS Highland. The system is extremely precarious there—we already have market failure in Highland. I believe that the added pressure from extra national insurance costs could be catastrophic for our system and I am really anxious about the impact that it might have.

My main focus is on outcomes and on what we need to achieve for the people of Scotland. I have heard loud and clear that the system that we are currently overseeing to deliver social care is broken and that we need to fundamentally change the way in which we deliver.

I ensure that the voice of lived experience is heard loud and clear, which I think is part of my role as minister. I have been dismayed at how that voice has not always been heard in the discussion about social care. Some very strong institutions are involved in delivering local and social care, and the people who access social care are often not heard within that. I consider my relationship with those people to be very precious and, when I make representations to Cabinet, I absolutely talk about how the decisions that we make will impact on them, as well as what their wishes are and what outcomes they want to see in the system.

Those people tell me clearly that they want a human rights-based approach, to tackle the variation around the country, and a system of social care that protects their dignity, supports them and has in place early intervention and prevention before they reach crisis. They also tell me that, when things are not going well, they want a clear system through which to put in complaints or concerns and to have those concerns investigated and upheld.

I am a junior minister, and I am very happy to take the guidance and wisdom of all my senior colleagues. That is what happens with collective responsibility. We have a great deal of experience around the Cabinet table and in our Government. I listen carefully to how my colleagues think that we can deliver the improvement that we need to see, in the same way as I listen to all of you as parliamentarians.

Absolutely, and I will be looking for allies who will work with me on the things that we agree on—and we agree on a great deal. I will be looking for allies across Parliament who will help me to progress the changes that we all want to see. I rarely hear from parliamentarians here that they want things to stay the same. I think that everybody acknowledges that the system needs fundamental change, so we need to work together on what that change will be.

As I said, we meet weekly with local systems—every one—across the country. The Cabinet visited Ayrshire recently to meet system leaders and had detailed discussions about some of the challenges that they face.

We very regularly meet people in some of the areas that face particularly difficult challenges, in order to drill down to find the explanation for local variation. For example, as part of my ministerial role I have regular meetings with Highland systems to look at why their delayed discharge rate is so high compared with rates in the rest of the country. There are some reasons for that—for example, rurality and poverty have an impact. However there is undoubtedly a level of variation that is not explainable only by those factors. The challenges that are faced in Highland in delivery of social care—the geography, topography, sparse population, labour market shortages and competition with hospitality in the labour market—also apply in Argyll and Bute, for example, which does not face the same challenge in respect of delayed discharges.