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The next item of business is a statement by Maree Todd, the Minister for Social Care, Mental Wellbeing and Sport, on the national care service. The minister will take questions at the end of the statement, therefore there should be no interventions or interruptions. I call the minister for up to 10 minutes.
14:24
Strong social care and community health support are the bedrock of a thriving and compassionate civil society. Most of us will need the social care system at some point in our lives, for ourselves or for the people whom we love. I am extremely grateful for the efforts that hundreds of thousands of paid and unpaid carers, as well as our dedicated workforce, make every day to support those people who are accessing social care.
I want to talk about why reform of social care is necessary, what the Government is already doing to drive improvement, why a national care service is essential to achieve the change that people want and need, and why I have asked for stage 2 of the bill to be paused.
There cannot be one person in the chamber today who does not already understand that the social care system needs fundamental reform. The starting point for our work on the national care service was the independent review of adult social care. The social care system was acutely impacted by the Covid pandemic and that review, which Derek Feeley led, brought home the importance of the consistent delivery of high-quality care, with compassion and kindness.
It reminded us that care is not something that is needed only at the end of our lives and it reinforced the need to ensure that those who deliver care are also looked after, and that no one is left behind or falls through the cracks of the system. The recommendations of the Feeley review were unequivocal about the need for change. The Government accepted the recommendations in full and we remain committed to delivering on them.
I have personally met hundreds of people across Scotland who use social care and community health services, as well as people with caring responsibilities. My officials have met thousands more. I am grateful to all those people for sharing their time and their views. Although people have a wide range of needs and access many kinds of support, they have consistently and clearly told us that things need to change.
I want to restate for the chamber three of the key issues that people have told us require urgent action. Those are the reasons why change is so necessary. Those issues are valuing social care; access to consistent, high-quality services; and oversight of planning and delivery.
The first issue is shifting society’s attitudes to ensure that social care is fully valued. We must value the people who access care, and the impact that our carers and workforce have on people’s wellbeing and independence. We reopened the independent living fund in April to enable up to 1,000 of the most disabled people to access the support that they need to lead independent lives.
For carers, we introduced the Carers (Scotland) Act 2016 to enhance and extend the rights of all adult and young carers across the country, and we are investing £88.4 million per year to support implementation. We published our national carers strategy in December 2022, which sets out how we will support and recognise our carers and includes our plan to strengthen access to short breaks for carers. Following our expansion of easy-access voluntary sector short breaks support by £5 million in 2022-23, we have maintained a budget of £8 million for 2023-24 and 2024-25.
For people who work in the adult social care sector, we are making good progress on a way to introduce sectoral bargaining for the sector, in line with the recommendations of the Fair Work Convention. We are engaging constructively and meaningfully with the United Kingdom Government around the Employment Rights Bill, but we need it to ensure that social care is not disadvantaged by the national insurance increase.
This year, we invested £230 million for social care workers who deliver direct care in commissioned services to have their pay increased to at least the £12 per hour real living wage rate. We are also committed in the programme for government to prioritise funding to local government to maintain the real living wage in 2025-26.
The second issue is access to consistent, high-quality support and services that are targeted where and when they are most needed, with clear information about what services are available. There is unacceptable variation in that across local authority areas. For example, in some areas of Scotland, delayed discharge is ten times worse than in others, which is clearly unfair.
We remain committed to a human rights-based approach to social care in Scotland. Self-directed support means that care should be arranged and delivered subject to individuals’ choice and control. I am grateful to the Health, Social Care and Sport Committee for the work that it has recently undertaken on post-legislative scrutiny of SDS, and I am actively considering where further improvements can be made.
The third issue is oversight of planning and delivery. There are several aspects to that, and it is the area in which we have the furthest to go to reassure people with lived experience that we have heard them and are acting on their concerns.
We need greater transparency. Collectively, we spend £5.75 billion on social care services, and we have increased investment in social care by £1 billion in the course of this parliamentary session. However, we have not seen the improvements that we would expect, and there is little national oversight of where the money goes. Greater scrutiny of how services are planned, funded and provided is urgently needed; indeed, the Parliament has said so itself in its post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013.
There must be meaningful inclusion of people with lived experience in the governance, planning and scrutiny of social care. That will require formal structures to enable participation. We must be able to identify and share good practice and to challenge and resolve issues whenever they arise.
One specific example of work to drive that kind of improvement is the collaborative response and assurance group—CRAG—which is co-chaired by the Cabinet Secretary for Health and Social Care with the Convention of Scottish Local Authorities. It provides targeted support to local systems to reduce the number of people in delayed discharge. Significant work is occurring to ensure that discharge without delay policies, procedures and practice are patient-centred and enable people to recover in the right place and at the right time.
People have told us that the Government should be held accountable for the social care system in Scotland, and they have called on ministers to lead that much-needed change. The work that I have set out is evidence that I am already doing that. The National Care Service (Scotland) Bill is intended to support improvement, with structural reform that will further empower the scrutiny role of people with lived experience. The bill and the package of draft stage 2 amendments that I shared with the Health, Social Care and Sport Committee in June represent the Government’s view on how best to achieve that structural reform.
We have encountered some opposition to our proposals. I was particularly disappointed that, after more than a year of negotiations, COSLA withdrew its support for the NCS bill. Disabled people’s organisations across Scotland have reported being ignored by COSLA, despite their attempts to engage. I need to consider what approach will secure sufficient support to progress.
Throughout the development of the bill, the Scottish Government has been committed to listening and engaging. Operating as a minority government makes that even more important. For that reason, last week, I wrote to the Health, Social Care and Sport Committee to say that I wanted to take the time needed to fully reflect in our approach to the bill the range of views that have been expressed, and that I was not seeking to start stage 2 of the NCS bill on 26 November. That was a necessary step to ensure that we get this right for people.
There are many areas on which we agree, and I appeal to all members across the chamber to come together to deliver the change that people tell us time and again is needed. That is what the people whom we are here to serve need. Only yesterday, a collective group of disabled people’s organisations—the disabled people’s movement—published an open letter. It reads:
“we need a National Care Service and fundamental reforms to the broken systems. Disabled people of all ages need change, and the status quo is not an option because disabled people are suffering. We need vital support to live a life of dignity and choices that non-disabled people take for granted.”
We owe it to them to now come together, to agree the way forward and to deliver for the people who need it most—the people who use social care and community health services and those with caring responsibilities. We all know that the status quo is not an option. Change is needed, and we must all work to secure improvement.
The minister will now take questions on the issues raised in her statement. I intend to allow around 20 minutes for that, after which we will need to move on to the next item of business.
I declare an interest as a practising national health service general practitioner.
Four years in the making wasted, £30 million wasted and countless hours of stakeholder time wasted. It is clear from listening to the minister’s statement that she believes that the Scottish Government is correct and absolutely everyone else is wrong. The minister is trying to shift the blame to COSLA and all Opposition parties, but what she has not said is that COSLA withdrew its support after painstaking negotiations, because all its key asks had been ignored. The minister has united civic Scotland and the Parliament against the bill.
Minister, you are delaying the inevitable, as the National Care Service (Scotland) Bill is dead in the water, and it is clear that it is now the greatest barrier to social care reform in Scotland. I have three short questions. When did the minister know that the current iteration of the bill could not go forward? Subsequently, when did the minister inform the Cabinet? Minister, do you accept responsibility for your own bill?
Through the chair, please.
Much of what Sandesh Gulhane has said is completely incorrect. We are a listening Government. We changed the bill so extensively, much to the concern of many in this Parliament, because we listened and because COSLA, in particular—our local authority colleagues—asked us to change the bill. More than a year ago, we made an agreement to have tripartite, shared accountability between local authorities, the NHS and us. Over the course of the following year, we put in place a system and a proposal that we thought would work.
It is no wonder that I was taken by surprise by COSLA’s withdrawal of its support. It had asked us to pause negotiations over the course of the summer, because it had capacity issues in relation to being able to turn its attention to the delayed discharge problem and to focus on negotiations about the bill. So, we set the bill to one side and, without coming back to the negotiating table, COSLA unilaterally withdrew its support.
I am not seeking to blame COSLA. I am trying to say that there is a very strong case for change. In the foreword to his review of adult social care, Derek Feeley said:
“In the improvement world, there is a maxim which reads something like ‘every system is perfectly designed to get the results it gets’. That is the basic challenge for us. We have inherited a system that gets unwarranted local variation, crisis intervention, a focus on inputs, a reliance on the market, and an undervalued workforce. If we want a different set of results, we need a different system.”
Now—
Very briefly, minister.
I heard from COSLA at the end of September, the Cabinet was informed immediately and I have been working hard ever since to resolve the situation. [Interruption.]
I am going to need slightly briefer responses. I am also going to need front-bench members not to hector the minister as she tries to respond.
I agree with the minister that the status quo is not an option, but the Scottish National Party has had 17 years to fix social care. In fact, it has had more than three years to get the bill right and has simply failed to do so.
Scottish Labour first called for a national care service 13 years ago, but what has been brought forward by this Government simply does not come close. Contrary to the minister’s assertions, the bill does not deliver on the Feeley recommendations. The Government simply has not listened. It has wasted £30 million, and it has let down disabled people in the process. People’s care packages are being cut right now, delayed discharges are at a record high now and staff are leaving in their droves.
I ask the minister how long the process will now take. The Scottish Government could use alternative legislation to do many of the things that we agree on far more quickly than it could through this bill. Anne’s law can be done with secondary legislation, as can carers’ respite, procurement, ethical commissioning, fair pay and collective bargaining and the national social work agency does not need legislation at all.
Will the minister stop the dither and delay and tell members what she will do to improve social care right now?
Each time Jackie Baillie speaks about the national care service, she reiterates her personal commitment to having such a service. We are well aware that, in England, Labour is introducing a national care service and, in Wales, Labour is introducing a national care service, but here, Scottish Labour opposes the introduction of a national care service, much to the dismay of disabled people’s organisations.
I will quote Tressa Burke from the Glasgow Disability Alliance, who said:
“Our voices, priorities and needs have been drowned in this political backbiting where the very people who are meant to be at the very heart have been forgotten ... We would much rather have made amendments and made sure that the changes were being made as we go.”
That is what disabled people’s organisations are telling me and that is what they are saying in public.
I intend to return in the new year with a proposal for the bill, which I will take to the Health, Social Care and Sport Committee.
Jackie Baillie continues heckling me from a sedentary position. She has a small window of opportunity in which to come forward and show disabled people her commitment to a national care service in Scotland.
I remind everyone that we need briefer questions and shorter answers.
Social care users across the country are, ultimately, at the heart of this discussion and they require our support and reassurance in light of the delay to the bill. Will the minister outline how the Scottish Government will engage directly with care users about the next steps in the process and how those care users will be supported in the meantime?
As I said, I have personally met hundreds of people across Scotland who use social care or community health services or who have caring responsibilities, and my officials have met thousands more. I absolutely reassure them all that, by working in partnership with them, we are committed to reforming the social care system in Scotland.
We are building and co-designing the detail, through continued engagement with people who have experience of using those services. We regularly meet partners and stakeholders, who are the experts in delivering social care services, to develop the final scope of a national care service that delivers for everyone.
Traditionally, when one is in a hole, one stops digging. When the Scottish Government is in a hole, it announces a review and continues digging, looking in vain for a face-saving exit. This is rapidly becoming the legislative equivalent of the Monty Python dead parrot sketch. As far as everyone but the Scottish Government is concerned, it is an ex-bill.
Will the minister please now accept that the proposals are not an answer that the social care sector can work with and will she engage with colleagues from across the chamber to deliver a much-needed solution for the sector?
I again reiterate that I am engaging right across the board with all stakeholders. The voices that are not being heard in the debate are those of the disabled people’s organisations that made clear that they want to see a national care service. Derek Feeley already gave us a review with clear recommendations about what we need to deliver in Scotland. I am more than happy to meet members from across the chamber to hear their ideas about how we can proceed and can deliver on that review.
Like so many of the folks in disabled people’s organisations and people with lived experience throughout the country, I am very disappointed that there has been a delay. There are certain things that we must progress with, though, and I want some reassurance from the minister. Anne’s law, which I put into guidance, needs to go into legislation to fulfil promises that were made to Anne Duke’s husband, Campbell Duke, her family and the care home relatives Scotland group. Can the minister assure me that Anne’s law will go into legislation? If she can explain how that is to be done, I would be very grateful.
I am absolutely committed to Anne’s law. The First Minister and I recently met the care home relatives Scotland group and Campbell Duke, the widower of Anne, to reassure them of that commitment. It is important that we get the legislation right and that we make Anne’s law a reality, and I am very grateful for the on-going input and support from relatives, care home providers and other organisations.
The National Care Service (Scotland) Bill was chosen as the vehicle for Anne’s law because it fits with the bill’s focus on embedding human rights within our social care services, as well as because more options and flexibility are provided by primary legislation. I cannot give the member a timetable, but I give him an absolute assurance and commitment that we will deliver on Anne’s law. I would be more than happy to continue meeting him to give him reassurance on that front.
In the statement, the minister acknowledged that
“We all know that the status quo is not an option.”
However, it feels as though Government ministers are the only people who do not understand that. For unpaid carers, it is quite simply an understatement. The labour of unpaid carers in Scotland saves the economy £15.9 billion each year. There are now no meaningful plans in place to guarantee breaks for unpaid carers. What is the Government doing to rectify that now?
I recognise the incredible contribution that Scotland’s unpaid carers make to our communities, as well as the pressures that many carers are under. We are investing £88.4 million a year in local carer support through local authority Carers (Scotland) Act 2016 funding. We are providing £8 million a year for voluntary sector short breaks—that funding was increased by £5 million in 2023—including £3.5 million via local carer centres. We are providing £600,000 in 2024-25 for local carer centres to expand their invaluable support to carers, including young carers.
The member is absolutely correct: there are a number of elements of the bill that we all agree on—Anne’s law, support for unpaid carers, the national social work agency, information sharing and complex care commissioning. I am asking members of this Parliament to put the politics aside and sit down and work out how we deliver those things that we agree on.
As a member of the Health, Social Care and Sport Committee and a registered nurse, I have been really interested in following the progress of the NCS bill to ensure the best possible outcomes for patients. One of the key elements of the bill is to standardise education and training for care staff. Will the minister comment on how that work can still be taken forward while the NCS is being considered?
The development and training of social care staff are critical. That is primarily the responsibility of their employers, but I am keen to support that where we can. As part of the joint social services and social care task force, we have been looking at improving the experience of the workforce. For example, work that is led by the Scottish Social Services Council and NHS Education for Scotland is updating the national induction framework and developing a portable induction passport that will allow induction learning to be transferred between employers. They are also developing a digital tool that should improve the understanding and visibility of career opportunities in the adult social care sector. We must work together to deliver more of that for our workforce.
There are things in the bill that we should still pass. Among other things, the right to short breaks for carers and the right to advocacy and information need to be progressed. However, as a party, we still have fundamental issues with some of the provisions. An issue that we often discuss in the chamber and in committee is the variations across local authorities and the pattern of integration. Given that no two local authorities are alike, during the pause, will the minister meet cross-party councillors from individual local authorities to hear their concerns and try to find a way forward?
I would be more than happy to meet cross-party councillors. I know that, particularly in relation to the COSLA leaders’ decision, the Green Party was excluded due to there not being a Green leader. We meet weekly on CRAG with local systems to try to tackle the variations in delayed discharge across the country.
It is absolutely astonishing that people in this chamber defend the incredible postcode lottery of care that our citizens face. In NHS Ayrshire and Arran, there are three local authority areas. There is a very low rate of delayed discharge in East Ayrshire; however, it is more than double that in North Ayrshire and more than triple that in South Ayrshire. The situation is completely indefensible, and we need to find a way forward.
Will the minister outline how the Scottish Government will look to support the social care sector in light of new concerns, which have been highlighted by stakeholders, that the UK Labour Government’s plan to increase employer national insurance contributions could be catastrophic for many voluntary sector care providers?
Minister, you may respond on issues that are directly related to those that were raised in your statement.
The member is absolutely correct. The new national insurance contribution that is expected to be paid by all employers in the UK is a change that was brought in without any understanding of how the care sector currently works, without any consultation with stakeholders and without modelling the impact of change. We think that it is likely to cost the social care sector in Scotland more than £84 million. That is absolutely catastrophic. Donald Macaskill, the chief executive officer of Scottish Care, has called it
“the straw that breaks the camel’s back.”
We absolutely need that issue to be sorted. It is clearly more pressing than any discussion about the medium and long-term improvement of our social care system; it is an immediate threat to our social care system in Scotland.
Does the minister not feel even the slightest embarrassment that she has spent £30 million and got absolutely nowhere? Meanwhile, in Fife, £13 million has been cut by the social care partnership. Is there any limit to how much money she will spend and how much time she will commit to this failed project?
I think that it is absolutely essential. Look, for example, at the decision on national insurance contributions, which was made without any understanding of how it would impact on our social care system in Scotland and is very likely to tip that system into absolute crisis. I make no apology for taking the time to understand the complex system of social care that operates in Scotland, to understand and hear from stakeholders—including those who deliver social care, those who work in social care and, most important, those who access social care—and to model the impact of change.
Lives depend on the social care system, and it is important to proceed carefully in improving it.
I am sure that the minister can see, as I can, that the entire process of the bill has been nothing short of shambolic. The National Care Service (Scotland) Bill has let down everyone, including social workers and those who desperately needed Anne’s law.
The minister speaks very highly of Derek Feeley, as do I. How many recommendations from the Feeley review, which was published in February 2021, have been implemented to date?
I am more than happy to come back to the member with the detail of that.
This is rank hypocrisy from the Conservatives, who have absolutely opposed the change from the moment that it was conceived. Theirs is the party that most strongly says, “Stick with the status quo, and don’t change anything.” It is absolute rank hypocrisy to claim now to support the Feeley report—which we are not implementing in full, through our proposals, because we listened to the concerns that were raised by our local authority colleagues and changed direction.
I refer members to my entry in the register of members’ interests: I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
Stakeholder organisations and individuals have spent a significant amount of time and energy in contributing to the development of the proposed national care service, and they have voiced their concerns over the pause in the bill’s stage 2 proceedings. What reassurance can the minister offer them that their contributions will not be diminished or disregarded?
As I mentioned, across Scotland, I have met hundreds of people who use social care and community health services, as well as people with caring responsibilities, and I am so grateful to them all for sharing their time and their views, which have been extremely valuable. I cannot unhear what they have told me. The status quo is not an option; they have told us consistently and clearly that things need to change. The engagement and co-design work that we have done in recent years continues to be the most important evidence base for change, and we will continue to work together to make the improvement that is desperately needed.
The minister has lost the support of every major stakeholder, four committees of the Parliament advised her that the bill was flawed, and she has spent £30 million, but she has said that she will make no apologies for any of this. Well, she ought to.
Let me go back to Sandesh Gulhane’s question. Does the minister take any ministerial responsibility for this mess? Can she give the Parliament one reason why she should not resign or be sacked?
To be fair, that is exactly what I would expect from Stephen Kerr. The Conservatives have opposed the change at every turn. By their very nature, they like things to stay the same; that is the essence of conservatism.
There is a fundamental need for profound and radical change in our social care system. I guarantee that I have heard loudly and clearly what our citizens have told us. Notably absent from the groups of people opposing the bill that Mr Kerr reeled off were the people who access social care and disabled people’s organisations. Those people desperately need us to work and deliver, and I remain committed to doing that for them.