Official Report 943KB pdf
The next item of business is a debate on motion S6M-15613, in the name of Jackie Baillie, on addressing the crisis in social care now. Members who wish to participate in the debate should press their request-to-speak button.
14:57
The Scottish National Party Government has been in power for 17 years. It has had 17 years to come up with a sustainable plan for social care, but it has simply failed to do so.
The national care service was a Labour idea that arose more than 13 years ago, following the Clostridioides difficile outbreak at the Vale of Leven general hospital, where people were discharged straight into care homes without testing. The parallels with the treatment of older people during Covid are self-evident. Had the SNP reformed social care—as we told it to do all those years ago—the outcomes for older people during the pandemic might have been better.
The failure to reform means that, on the SNP’s watch, things have simply got worse. Delayed discharge has risen to a record high, care homes have reduced by a fifth, and 9,000 Scots are waiting for assessment and care packages. There is rising unmet need, which has led to a crisis in community health and social care. Existing care packages are being cut. Just last—
Will Jackie Baillie give way?
Let me finish my point first.
Just last week, I heard of an older person who is nearing end of life and is unable to get a care package at home. Cabinet secretary, what kind of society are we that we cannot provide care in such circumstances?
Clearly, that is why we need reform. The critical issue that we have before us, which Jackie Baillie and I were able to hear directly from Scottish Care at its conference, is finance and financial sustainability. The biggest issue in that regard is the United Kingdom Government’s employer national insurance contributions grab on Scottish public services. Is it Labour’s position—
This is a speech, not an intervention.
Briefly, Mr Gray.
Is it Labour’s position that Scottish public services should be funding a Treasury tax grab, or can we unite to say that the UK Government needs to think again?
Jackie Baillie, I can give you the time back. Interventions will need to be briefer.
I am grateful to you for giving me the time back, Deputy Presiding Officer—that will probably come out of the cabinet secretary’s speech. The SNP Scottish Government has had 17 years to carry out reform, but it has failed the social care sector for those 17 years. It has responsibility right now, and that is the legacy of the SNP.
Let us take integration joint boards. [Interruption.] If the minister would be quiet for a minute. IJBs, which are responsible for the delivery of social care, are facing huge deficits. In quarter 1 of this year alone, more than £160 million has been overspent. It will be much worse as we enter the end of the year, and the cuts that they are making will have a direct impact on those who require care the most. That is happening now, on the cabinet secretary’s watch.
In that context, £30 million being wasted on the failed National Care Service (Scotland) Bill is a travesty. More than £2 million has been spent on private consultants, but not one single penny has paid for an extra carer. Instead of delivering the reform that is at the very heart of the Feeley review, the SNP is delivering a master-class in stubbornness, preferring to waste even more time and money rather than admitting that it got it wrong.
The bill is one of the worst examples of legislation that I have seen. At stage 1, reservations were brushed aside, and the committee was presented with stage 2 amendments that amounted to 41 pages, when the original bill was only 38 pages long. Every part of section 1, on the principles of the care service, was changed; in fact, little in the bill remains unscathed.
The bill is now, in effect, a brand new bill, which is preventing proper scrutiny and flouting the parliamentary process. It shows that the Government has no vision and lacks direction. If members do not believe me, perhaps they will believe Scott Wortley and James Mitchell, who are two experts in policy and law making. They described the national care service bill as
“policy-making on the hoof.”
I think that they were being unduly generous, because they were not to know that, just days before the stage 2 deadline, the Scottish Government would pause the bill again. Meanwhile, unpaid carers, care workers and disabled and older people continue to struggle in a broken system.
The Government should urgently publish a timetable that sets out how it will deliver much-needed social care reforms. The SNP repeatedly states that people who rely on social care want the bill to succeed—but not, I am afraid, in its current form.
A statement from the national carer organisations this week called for investment in social care in the upcoming budget and the delivery of a commitment to remove care charging, which was promised in the SNP’s manifesto three years ago but not delivered. The statement also called for the delivery of priorities such as Anne’s law and a right to a break from caring. It called for agreement on a shared strategy for improving the provision of social care by supporting the development of a wider market of providers across all sectors. All those things can be delivered without the national care service bill, which even the minister finally conceded at the Health, Social Care and Sport Committee yesterday. There is therefore no excuse for not acting now, rather than trying to cover the SNP’s embarrassment over its confused bill.
The UK Labour Government has delivered a record budget settlement for Scotland, which includes £789 million of health and social care funding this year and an additional £1.72 billion for next year. That is a fact. There is also up to £330 million extra for national insurance contributions. However, it is up to this SNP Government to spend it wisely and, frankly, its track record is not very good.
The SNP must address the mounting pressure on IJBs or there will be devastating consequences for people who rely on care services and for our entire healthcare system. It must deliver for front-line health and social care staff. It is time to stop spending millions of pounds on failure. The SNP Government has had years to deliver the reform of social care that is so necessary. I have been here long enough to remember the endless Government working groups on ending the postcode lottery of care. There have been lots of warm words but little action. The time has long passed to deliver real change in social care. Instead of trying to save face, the Government should get on with what it can do now.
It should deliver a right to respite for carers, through the Carers (Scotland) Act 2016; ethical commissioning, through the Procurement Reform (Scotland) Act 2014; collective bargaining, through the Public Contracts (Scotland) Regulations 2015; a national social work agency, which does not even need any legislation; and Anne’s law, through the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011.
Reform can start today, but the SNP is making a choice to delay. Those proposals command support across the chamber, and the Government should get on with delivering them.
I move,
That the Parliament notes that the Scottish Government formally committed to introduce a National Care Service (Scotland) Bill in September 2021; further notes that the Scottish Government’s proposed amendment to part one of the Bill setting out the establishment of a National Care Service board has been roundly rejected by stakeholders; understands that the cost to date is £30 million, without a single penny being spent directly on care; urges the Scottish Ministers to accept that the Bill now has no realistic prospect of success in its current form; calls on the Scottish Government to take immediate steps to alleviate the crisis in social care, including delivering sufficient support for health and social care partnerships, and further calls on the Scottish Government to set out a timetable, before the Parliament’s Christmas recess, for progressing reforms, including a right to respite care, Anne’s Law, ethical commissioning, collective bargaining and the establishment of a National Social Work Agency.
15:04
Over the course of our lifetimes, every one of us will be touched by social care, social work or community health support, whether we access care directly or have family or friends who do so. It is the backbone of a thriving civic society. In Scotland, our unpaid carers and paid social care workforce do an outstanding job in providing care and support to those who need it.
More often than not, however, they are working in a system that feels as if it is working against rather than for them. I know that that was reflected to the minister and to the Convention of Scottish Local Authorities lead, Councillor Paul Kelly, at the carers parliament this morning. I also hear that point time and again from people who access services, which was something that Jackie Baillie’s speech ignored.
There are pockets of good and excellent work taking place locally and across the country but, despite that, there are fundamental issues that urgently need to be addressed if we are to ensure that the sector is fit for purpose for future generations, to end the postcode lottery of care provision and to ensure that we are delivering for people who are in receipt of social care.
All of that is well and good, but what is the cabinet secretary going to do about the massive deficits that are accruing in all the health and social care partnerships across Scotland, to the tune of hundreds of millions of pounds?
We have invested an extra £1 billion in social care over this session of Parliament. We are providing a substantial investment to health boards and local authorities. Clearly, there is a budget next week in which we will seek to ensure that we provide the support that is required to our communities.
This is what Derek Feeley found during his work leading the independent—
Will the cabinet secretary take an intervention?
I will need to make progress, but I will try to come back to Ms Duncan-Glancy if I can.
Derek Feeley recommended that we establish a national care service, underpinned by a human rights-based approach, giving voice to people with lived experience at every level. That was accepted by the Government in full, and we have been working to fulfil that commitment ever since. Thousands of people told Derek Feeley then what they are telling us today: that things need to change. Last week, disabled people’s organisations published an emotional and powerful open letter in which they highlight that
“wholesale reform is so urgently needed.”
The Health and Social Care Alliance Scotland, which is a collective of third sector providers across Scotland, said that it is
“committed that as long as there is a Bill, we’ll work to make it as good as it possibly can be.”
Age Scotland said:
“The Bill is absolutely vital and it can be better, there can be more detail of course, but I think everybody has to think about what more they can do to deliver good quality social care.”
Our communities across Scotland are begging us to do the right thing. We need to get on and deliver what people want, which is a rights-based system that puts people at its heart and that allows for greater monitoring, consistency and oversight.
As outlined in the amendment that I have lodged, it is clear that there is unacceptable variation in performance across Scotland, and it is the people of Scotland who are paying the price for that. Our work on delayed discharge has shown that people are more than 10 times more likely to be delayed in hospital in the worst-performing area in Scotland than in the best.
Colleagues might be interested to know that, for example, in Ayrshire, which spans three integration joint boards and a single shared health board, delays vary from 25.5 per 100,000 in East Ayrshire to 98.2 per 100,000 in South Ayrshire. That is an absurd and unjustifiable level of variation. It is simply not good enough, not least for those who should really have been at the heart of the discussions: those who receive social care.
I will give way briefly to Pam Duncan-Glancy and then I need to conclude.
One area that the cabinet secretary has not picked up on in the letter that was shared with him this week is the comment that,
“As we wait for reform, members of our Movement are reporting that they cannot get washed, dressed, go to the toilet or eat”.
That is what is happening in social care services across Scotland today. What does the cabinet secretary have to say to disabled people today who cannot get washed, dressed or go to the toilet?
I say that that is totally unacceptable, which is why we need reform. We need investment to be delivered where it can make the best possible change for disabled people and those who require social care.
Anyone who is trying to frustrate the process of reforming social care needs to reflect on those facts. The system is not working. We need to focus our energies on accelerating the process and making progress in the areas that we can agree on, but challenging ourselves on the areas where there is not agreement.
Ensuring that we provide a social care and community healthcare system for the future is an investment for us all. Contrary to Labour’s factually inaccurate motion, we have increased the investment that is going into social care by £1 billion in this session of Parliament. However, investment alone has not driven the kind of improvement that people need and expect.
The danger of the employer national insurance contribution calamity looms large across the social care sector, which will need to find an estimated £84 million to survive. Frustrating the progress of social care reform through the development of a national care service is to ignore the pleas of the very people who are desperately calling for change, and accepting crippling and punitive taxation through ENICs is to actively work against them. For too long, individuals have been telling us that social care needs reform. Now is the time for the Parliament to exercise its duty to listen and to act in the best interests of the people of Scotland.
I move amendment S6M-15613.4, to leave out from “formally committed” to end and insert:
“introduced the National Care Service (Scotland) Bill in June 2022 to address the substantial concerns highlighted from the Feeley review, which noted poor and variable levels of social care around the country and the need for nationally enforceable standards of care; further notes that the Bill includes a right to respite care, Anne’s Law and ethical commissioning; welcomes that the Scottish Government is developing a collective bargaining approach for social care in collaboration with local government, trade unions and social care providers and its continued commitment to establishing a National Social Work Agency; acknowledges the open letter from disabled people’s organisations, which states that wholesale reform is so urgently needed; agrees that the service users, their families and carers should be the focus of a National Care Service; deplores that the increase in employer national insurance contributions from the UK Government will negatively impact on care services by increasing the cost to third parties contracted to deliver adult and children’s social care services by almost £90 million and, according to COSLA estimates, to local government by £265 million, and agrees that, if the UK Labour administration does not reimburse this in full, it is the provision of these services that will feel the brunt.”
15:10
I declare my interest as a practising national health service general practitioner.
The motion that is before us highlights the SNP’s mismanagement of its flagship National Care Service (Scotland) Bill. At the heart of the failure is Maree Todd, the minister who is in charge of social care, who told me yesterday that she was in charge of the bill, although she was, seemingly, not trusted to lodge the Government amendment today. Time and again, the minister has assured us of her commitment to reform, but her actions tell a different story.
The handling of the bill has been a shambles. So far, it has cost the taxpayer £30 million—money that could have gone towards delivering care for our most vulnerable people. The money could have paid for a million hours of social care, or it could have funded 1,500 care workers for one year. Instead, the bill is dead in the water and has been rejected by stakeholders, experts, trade unions and councils.
How did we get here? The SNP has had 17 years to address the issues in social care, but it has squandered every opportunity. The best part of four years has been wasted on the flawed bill, which has caused more uncertainty than progress. Instead of improvement, we have chaos. The minister’s approach has been one of denial and deflection. She has tried to pit one group against another.
In yesterday’s Health, Social Care and Sport Committee meeting, I asked Maree Todd whether she had been entirely truthful about her dealings with the Convention of Scottish Local Authorities, the representative body for local authorities, and she claimed that she has been. COSLA has been clear since February—which was nearly 10 months ago—that serious issues with the bill remained unresolved, so its withdrawal of support two months ago was no surprise to anyone, except Maree Todd.
By June last year, there were three outstanding matters on which the Scottish Government simply refused to listen. The Government produced its draft amendments to the bill, which COSLA was not shown until one hour before they were made public. The amendments caused further significant concerns, which showed, again, that COSLA was simply not being listened to.
A particular sticking point was the SNP’s decision to include children and justice social work services, directly against COSLA’s wishes. Council leaders repeatedly warned the SNP that such changes required more consultation and agreement between the various spheres of government, but their concerns were simply ignored.
The SNP’s mishandling extends beyond the bill itself. Scotland’s hospitals remain gridlocked, and families who are seeking respite care are left unsupported. Meanwhile, morale among care workers is at rock bottom. Maree Todd’s leadership has failed to deliver not just the policy, but basic immediate solutions for those who are in need.
Under Labour-backed policies at Westminster, employer national insurance contributions are set to rise while the salary threshold for employee contributions is lowered. The changes are already hitting care organisations that are struggling to recruit and retain staff.
Let us be clear: by her own admission, Maree Todd is responsible for the National Care Service (Scotland) Bill, so she bears primary responsibility for the crisis. If the minister is actually in charge, she has shown gross incompetence. The bill is a costly distraction and has failed to gain public confidence. As the cabinet secretary said, we need to make things better, but Scotland deserves better than this parade of incompetence.
I move amendment S6M-15613.2, to insert after “directly on care”:
“, despite over 6,000 people in Scotland currently waiting for a social care assessment to enable them to live independently at home or in the community”.
I call Gillian Mackay, who joins us remotely.
15:14
I welcome the opportunity to speak in the debate and will reiterate points that have been expressed by colleagues.
It comes as no surprise to us that the social care sector is in crisis and that we must address the pressures as a matter of urgency. The ambitions and efforts behind the introduction of the National Care Service (Scotland) Bill were driven by a profound recognition of that urgent need. Its core aim was to address the long-standing issues that are plaguing the system, including unequal access to care, inconsistent standards and lack of fairness and sustainability in the delivery of care across Scotland.
Initially, the plans followed a bold commitment to delivering compassionate person-centred care, with the aim of ensuring reform in key areas, including enhanced support for unpaid carers, care home visitation rights and efforts to improve the experience of the social work and social care workforce.
Back in June 2023, COSLA leaders and Scottish ministers reached an initial agreement on shared accountability for the NCS that would have seen councils retaining their core responsibilities and workforce, while a new NCS national board would be created to provide enhanced strategic leadership and oversight. I mention that to underline the fact that those developments were part of a larger process and efforts to ensure support across the board.
Although I welcomed and consistently demonstrated my support for the ambition to create a fairer system, the bill in its current form raises significant concerns. It lacks clarity on how statutory responsibilities will be shared between national and local bodies, and it leaves questions about accountability and service delivery. The bill risks the removal of key local decision making and local accountability, while introducing new complexities that risk further aggravating the situation. The past months have seen increasing opposition to and concern about the NCS bill from key partners, and I believe that any reform must be backed by key stakeholders, and that its being unable to move is to their detriment.
I will also take a moment to acknowledge that several organisations are disappointed by the further delays to the bill and by a process that has come to resemble a bureaucratic dispute between different levels of government and parties. We cannot afford to let the situation slip, but must ensure that we remain focused on delivering on the commitments and pledges that have been made throughout the process.
The establishment of a national care service must be informed by the voices of lived experience, including those who access support and care, the workforce and unpaid carers. Progress in fair work for the social care workforce must continue as a priority, in tandem with any potential transformation.
The plans must also enjoy broad support from stakeholders who are meant to be at the forefront of delivery. We also want to ensure that ethical commissioning is a core part of the service and we are concerned about that not being included in amendments at stage 2.
Can Gillian Mackay confirm the stance of her party on the continuance of the national care service bill? I read in the press that the Greens had reversed their support for the bill.
I thank Mr Cole-Hamilton for his intervention.
At my party’s conference earlier in the autumn, the party voted for a motion that removed support for the bill in its current form, but expressed that we want to continue to support the provisions that will make progress for unpaid carers and the workforce. We are willing to work with the Government to see which of the issues that we all agree on we can continue to progress. I urge all parties to make sure that social care reform is their top priority and to bring forward alternative proposals and say what they would be willing to see to ensure that we make progress in social care reform.
I am coming to the end of my time, so I will leave it there for now.
15:18
I am grateful to Jackie Baillie for making time for the debate. She hit the right tone with her opening remarks and did well to remind members that, for this Government, social care is often an afterthought. That was never more true than it was during the pandemic. The tragedy of Scotland’s pandemic stories is, indeed, found in our care homes.
Although I am grateful that I am speaking in the debate, I sincerely hope that this is the last time that we will have cause to debate the ill-fated national care service. To paraphrase Monty Python, I say that this is a dead parrot of a policy. It has joined the choir invisible. The only reason why it is not pushing up daisies is that it has been nailed to its perch.
If we are honest with ourselves, we accept that the Scottish Government has now moved from adaptation to damage limitation to just trying to save face—and I fear that it might even be beyond that, because nobody wants the bill any more. The Government has lost the dressing room. In Gillian Mackay’s response to my intervention, we heard that even the Green Party has recognised that the idea is toast and that there are aspects that are contained in the bill that we can adapt through other means. I will come to that later.
It is not true to say that no one wants the bill. The letter from disabled people’s organisations was very clear, and I am sure that Mr Cole-Hamilton is receiving the same representations as I am receiving. Does he not accept that, at this stage, it is best for us to work together to achieve the maximum possible consensus on reform, and for political parties to put differences to one side and to move forward to bring about reform for our service users?
When disabled people’s organisations learn that £30 million has already been wasted on this bureaucratic exercise—that is the equivalent of 1,200 care workers’ salaries—they are astonished and outraged. That is why the Government has lost the dressing room. The bill has been roundly rejected by trade unions and councils, which have been joined by members of the care sector in saying, “No thanks,” to the Government’s plans, which, in the cold light of day, amounted to very little more than a bureaucratic centralisation and a ministerial power grab.
The Scottish Liberal Democrats is the only party to have been against the Government’s proposals from day 1. Right out of the traps, we saw them for the mistake that they were. We are pleased that every other Opposition party, including the Green Party, which was once squarely behind the bill, has now reversed its support. Two years since being introduced, the Government’s national care service proposal is dead in the water, with nothing to show for itself, other than the £30 million black hole in our public finances that I mentioned in my response to the cabinet secretary.
If ever we were looking for an example of Government mismanagement, it is this. Our social care service is in dire need of attention and reform. It is in crisis, yet not a single penny of the £30 million has been spent on solutions to the problems. How galling that must be for the thousands of people in this country who rely on social care or who, for years, have worked in the service under immense strain. Those workers, who care for the people whom we love, who did so much during the darkest days of the pandemic and who have been underpaid and undervalued for so long, have been roundly ignored by this Government. All of what has happened is a slap in the face to them.
Many of those workers are not even on permanent contracts—many of them are on zero-hours contracts—while poor terms and conditions contribute to rising absences as a result of sickness and burnout. It is no wonder that there is such a large vacancy rate across the entirety of the care workforce. The wasted £30 million is money that could have funded 1,200 care workers, whom we desperately need, given how high delayed discharge continues to be in this country.
My party wants hard-working social care staff to have the better pay and conditions that they deserve, right now. In fact, we wanted them to have it years ago, before the Government embarked on its ill-fated misadventure. We want them to have access to the collective bargaining and standardised career progression that would put them on a par with teachers and nurses, and would go some way towards making social care a profession of choice once again.
You need to conclude.
We do not need the bill in order to introduce the key vital aspects that the Labour Party has identified in its motion. We can find other mechanisms to do so, and we should.
We move to the open debate. I advise members that we have no time in hand. In fact, we are already behind schedule.
I call Paul Sweeney, to be followed by Clare Haughey.
15:23
It is a pleasure to support the motion.
The cabinet secretary is right to highlight the fact that the national care service, or its concept, is essential for the future of Scotland. Social care is so critical to all aspects of our civic society that most families in Scotland will have experience of care requirements in their own households. Therefore, it is essential that we get this right. Unfortunately, it seems that no good idea can survive contact with the calamity of this Government’s administration of it.
Time and again, all parties have offered good will to the Government in an effort to get the bill right. Numerous months have been spent in committee trying to support the Government to get the bill right, but we have ended up in a position in which key stakeholders across local government, the trade unions and the social enterprise sector have withdrawn their support. That is a disastrous performance by the Government, and it should be reflecting on it with humility instead of simply trying to deny reality.
The commitment to establish a national care service was made by the Scottish National Party Government in 2021, in the wake of the pandemic, but, in the three years since then, £30 million of public expenditure has delivered precisely nothing of any real value to the people of Scotland. We are no further forward, and the crushing issues in the social care sector persist: rising delayed discharge rates in the national health service, low pay, poor working conditions and a lack of choice and agency for people who receive and provide care.
In pursuing the bill, the Scottish Government has tried and failed to be all things to all people. It has lacked decisiveness, grit and a vision of what the national care service should look like. It should have learned the right lessons from the creation of the national health service. When Aneurin Bevan steered that legislation through the UK Parliament, it was not some immaculate conception; there was immense challenge and dispute around the creation of the NHS. It took grit, determination and a decision on what it would be—it would not happen in local government or in privatised hospitals but would be a national service. At least, at that time, the Government made a decision; the minister, the cabinet secretary and the Scottish Government have not had the gumption to do that on this occasion.
Paul Sweeney has made a really good case about the SNP trying to dress up the NCS in the clothes of the much-loved national treasure that is the NHS. Does he also recognise that the NHS is free at the point of use, whereas nothing about the NCS would make that true of social care?
Mr Cole-Hamilton has made an astute point. In fact, the Scottish Trades Union Congress has highlighted the fact that more than £100 million a year leaks out of the social care system into profiteering. The Government does not mention that point often when it is tackling the issue of efficiency in public expenditure, nor the fact that people often have to sell the assets that they have worked their whole lives to build up to fund social care. Private profiteering of asset sales is a challenge in our society today.
Three years into a Parliament that was meant to introduce a national care service bill, it is no further forward. Indeed, the number of care home places has dropped by 6 per cent in the past decade. Precious time has been wasted when the Government could have been acting to deliver the immediate changes that are needed in social care—the minister conceded as much at the Health, Social Care and Sport Committee yesterday. We have no Anne’s law, no right to breaks and no collective bargaining—the list goes on.
Those changes could have been introduced long before now. We could have been building the framework of the national care service without holding it hostage to one grandiose piece of legislation. Indeed, the minister mentioned yesterday that the recommendations in the Feeley review could have been implemented without primary legislation. However, the end of this parliamentary session is fast approaching and instead of taking those steps, the Government remains devoted to pursuing change through one labyrinthine bill that has unfortunately run out of steam.
Labour remains committed to a national care service and open to collaboration to reform social care. However, the minister should accept that the bill in its current form is simply not salvageable and is not the way to deliver that change. The Parliament cannot afford the public expenditure required for us to spend more time considering the bill in its current form. I urge the Government to return to the drawing board with a focus on the actions that we can take now to realise areas of consensus and effect crucial change in the social care sector.
15:27
It is difficult to overstate the importance of our social care services. They are absolutely vital to individuals who receive care, their families, our communities and our society as a whole. Most of us will need the social care system at some point, for ourselves or a loved one, and I am extremely grateful for the commitment and compassion of the hundreds of thousands of paid and unpaid carers who support others.
Last week’s open letter from the disabled people’s movement criticises how the national care service has become a “political tug-of-war” and I agree that it is hindering crucial progress. However, many areas of the draft amendments have broad support across the chamber and across stakeholders—the devil is in the detail of others.
It is abundantly clear that the status quo cannot continue and that the social care system needs fundamental reform. Last week in the chamber, and yesterday in committee, the Minister for Social Care, Mental Wellbeing and Sport reiterated that point.
The conversations that the minister, her colleagues, and many of us will have had with constituents underline the reasons why change is necessary. They are around access to high-quality, consistent services where and when they are needed, and around ending a completely unacceptable postcode lottery and huge variation across the country. They are around oversight—this year, the Government has increased investment in social care by £1 billion, yet we have not seen the improvements that we would have hoped to see, and we must understand why. Governance and planning must change and must include people with lived experiences in a meaningful way.
Those conversations are also around valuing social care and the social care workforce, which is largely—more than 80 per cent—female, many of whom work part time. The minister reported last week that good progress is being made towards sectoral bargaining, which is a vital tool in tackling wider issues such as in-work poverty that have a disproportionate effect on women.
I will briefly touch on the issue of the UK Government’s changes to employer national insurance contributions, which could cost the sector £80 million each year. The minister has warned that that impact could be catastrophic, especially where systems are already precarious. That is not £80 million for one year—it is £80 million for every subsequent year.
Will the member take an intervention?
I do not have time.
We should not forget, of course, that staffing in the sector continues to be deeply impacted by the on-going effects of Brexit, about which the UK Labour Government continues to bury its head in the sand. I have written to the chancellor to express my deep concerns regarding the national insurance changes, which seem to have stemmed from a lack of detailed modelling or any consultation on social care in Scotland. The sector must be exempted from that tax rise as a matter of urgency, and I urge those on the Labour benches to press that point with their UK colleagues.
I will finish with a quote from the open letter from the disabled people’s movement, which has been mentioned in the debate. It states:
“The Movement and its members, alongside the third sector and carers, have invested huge amounts of time, energy and emotion in trying to develop a truly participative and positive National Care Service; one which will value the user as well as the workforce; one which will be the envy of the UK and the world. This must not be wasted.”
Our social care system requires fundamental systemic change, and those changes and the human rights approach that they encompass need to be embedded deep in our legislation.
15:31
Last Thursday, the minister in charge of the bill reported her total failure to the chamber without a word of apology. Four committees of the Parliament told her that the bill was flawed. Every major stakeholder told her that they had no confidence in the bill. Thirty million pounds of taxpayers’ money was squandered. What made it worse was her unwillingness to accept any ministerial responsibility or to apologise.
In my professional experience, any employee in any other job or walk of life would have left the building with their belongings in a cardboard box. However, when I put that to the minister, she told me:
“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.”—[Official Report, 21 November 2024; c 65.]
That is not true.
My mother had dementia. The carers in the home that she was admitted to were exemplary—they were truly wonderful people doing a difficult job with tact, love and good humour. That is why I want how we value care and carers to change. In time, my sister and I had to sell the family home that we grew up in to fund my mother’s care. My wonderfully decent parents always lived modestly. They paid their taxes and saved, but, at the end of the day, every penny that they had saved, including their principal asset, their home—the council house that they had bought—was needed to pay the bills. My parents wanted to pass something on to their grandchildren, to help them with the start of their adult lives, but it did not quite work out like that.
My family is far from unique. We all want our parents to have the dignity that they deserve in their senior years, especially when they become dependent on others. The Scottish Conservatives want to end the disparities in choice and quality of social care across Scotland. The SNP says that it recognises the need to address those inequalities, but its execution has been disastrous. It wanted, as in so many of its so-called reforms, to take power from local communities to the centre. Here is what COSLA said in 2021:
“Council Leaders together voiced their opposition to the recommendation which proposes the removal of local democratic accountability from Adult Social Care and the centralising of the service under a National Care Service with accountability falling to Ministers, a move that they described as being detrimental to the local delivery of social care and its integration with other key community services.”
Nearly three years ago, the Finance and Public Administration Committee was
“not confident that the figures presented in the updated financial memorandum and the accompanying shared accountability paper are an accurate reflection of the final costs of the bill.”
Last month, the Scottish Trades Union Congress general secretary—not someone I, as a Scottish Conservative, would normally quote—said:
“Care workers are on their knees trying desperately to cover shifts and visits to those in need.
There is a shortage of staff across Scotland with local councils and employers all struggling to deliver the vital social care. Yet the government is ploughing on with the National Care Service Bill which fails to address fundamental issues about how care is delivered ... The Scottish Government seems hellbent on repeating the mistakes of the past.”
The SNP Government has ignored expert advice, prioritising central control. Meanwhile, health and social care partnerships across Scotland are heading towards certain bankruptcy.
The Government is out of ideas and out of time, and at times—the minister should listen to this—it is out of decency. Whoever follows those ministers into office will inherit a total shambles from the most incompetent and economically illiterate Government that Scotland has ever endured.
15:36
At the height of Covid, a day rarely passed when I was not contacted by a constituent who raised a heartbreaking story. Families did not have access to loved ones in care homes because we could not get our act together on testing. Social care packages were being removed. There was pressure to sign do not attempt resuscitation orders. Covid inflicted an appalling toll on our care and nursing homes and the human rights of older people were cast aside.
The Covid crisis has now been replaced by a care crisis, and the number of heartbreaking cases grows. Constituents have older relatives who are stuck in hospital because we do not have carers to allow them to go home. Mums and grans are sent to care homes miles from their families so that the delayed discharge figures can be fiddled when they only want to be cared for in their own homes. I spoke to a cancer patient in Dumfries whose last wish was to die at home, but they were not able to do so because there were no carers, so they had to go into hospital for their final days. A granddad from Wigtownshire was sent to hospital in Kilmarnock because the local community hospital in Newton Stewart was closed and he could not access a palliative care bed locally. His wife had to make a 100-mile round trip to visit him on each of his dying days.
I do not need to be told that our social care system is broken to be convinced that change is needed. I welcomed the Government’s pledge to build from the Covid crisis a positive legacy of a national care service, to put social care on the same level as the NHS and to create parity to ensure that services are properly funded and staffed. I saw it as an opportunity to deliver national standards wherever people live—in urban and rural areas—but with services being delivered locally and being accountable to local people. I saw the bill as a chance to drive up care and, crucially, the terms and conditions of care workers. I saw it as a chance to move the dial away from the privatisation of care to a public service that is publicly delivered.
However, the National Care Service (Scotland) Bill does not do any of that. Any lingering support and any hope that it could do those things have all but collapsed, yet the Government remains in complete denial. The botched bill has been slated by the Parliament’s committees. The Health, Social Care and Sport Committee, the Finance and Public Administration Committee, the Delegated Powers and Law Reform Committee, the Education, Children and Young People Committee, the Criminal Justice Committee and the Local Government, Housing and Planning Committee have all raised serious concerns. The bill is opposed by COSLA, the STUC, the GMB, Unison, Unite and the Royal College of Nursing. NHS board chairs and chief executives have warned that the bill will not address the challenges that social care faces.
The unsavoury sight of ministers in the chamber constantly pitching those who are cared for against care workers and the unions is not acceptable. Claiming that national Government will be the saviour for failings in local government will not win any support inside or outside the Parliament. However, the Government can secure the support of Parliament and stakeholders if it focuses action and resources on tackling the current crisis and delivers at pace the things that we all agree on. That means getting on with providing the right to respite care.
Will the member take an intervention?
I will take an intervention if I will get the time back.
You will not get the time back, Mr Smyth.
I apologise to the member, but I will have to continue.
We need to get on with providing the things that we all agree on—the right to respite care, Anne’s law, ethical commissioning, collective bargaining and the establishment of a national social work agency. As we have heard, all those things can be delivered using existing laws.
The Government launched its plans for a national care service with much fanfare. Parallels were even drawn with the creation of the NHS, but just saying something in a press release does not make it so. There is no rescuing this proposal. The Government should scrap the bill and get serious about dialogue to create something that will really be a national care service, rather than just something that is called a national care service.
15:40
This is one of those debates where we come in and think that we are going to say one thing, but we are actually going to say something completely different.
I remind members in the chamber that we were all elected to represent people, and people have told us loud and clear that they want radical change in care delivery. People want an end to the postcode lottery, they want national standards that apply everywhere and they want a human rights-based approach to the delivery of care.
However, what we have had of late is many in this place ignoring the wishes of people the length and breadth of the country who are care service users. We have a situation in which the debate is all about politics, power and resources and not—as it should be—about people. I hope that folks in the chamber today will listen much more to the calls from the voices of lived experience about what they want to see. The cabinet secretary and Ms Haughey mentioned some of those folks, who have made it quite clear what they want, including the disabled people’s organisations that say that wholesale reform is needed and Age Scotland, which says that the bill is vital.
On Monday this week, I went to visit a constituent at home—a disabled constituent who is about to have part of their care package removed. That will mean that that person is no longer able to live a free and independent life in their own home. It is a decision—
Will the member take an intervention?
I do not have time.
It is a decision that has been taken without due regard to that person’s human rights, their independence or their freedom. At the end of our conversation on Monday, we started to talk about the rules that local authorities and health and social care partnerships follow—often, rules that they apply themselves. That person called for change and for national standards to be applied everywhere, with no postcode lottery.
I said that this debate is now more about politics, power and resources, and there are folks who want to keep the power and resources. COSLA has gone about handling this in entirely the wrong way. It has failed to listen to the voices of lived experience, many of which have no confidence whatsoever in councils because of how they have been treated.
My appeal in all of this is to say, “Let us cut the politics, move the power more towards the people through a human rights-based approach and use the resources in the way that is required to ensure that people continue to have independence and freedom.” Let us cut the politics, give the power to the people and make sure that we target the resources properly.
We move to the closing speeches.
15:44
I do not know what hope the debate will have given to anyone who is concerned about their care or that of a loved one. They will have watched MSPs shouting at one other and talking about parliamentary process rather than the vision that we should have for social care reform and, crucially, what we are going to do individually. I am committed to ensuring that we see reform and that there is equality across local authorities in what people are entitled to.
No one can argue that money is not hugely important but, as I stated at stage 1 of the National Care Service (Scotland) Bill, we do not need money to change the culture. The culture is a huge part of the issues that we have. We should have made an awful lot more progress on a great many things long before now. Jackie Baillie noted where we could amend other legislation to give effect to those things that the Parliament agrees on. The time that it could take to do that is one of my big concerns, especially as the Health, Social Care and Sport Committee is hugely busy and has a massive legislative load. I appreciate that the bill has been paused, but I still believe that substantial amendment and passing the aspects of the bill that we agree on would be the most expedient way to make changes. A great many stakeholders and individuals have put in time and effort on some of the provisions in the bill, and I remain hugely concerned about how demoralising it must be for those who have given their views in the process and how badly social care reform could be set back if we do not do something quickly and give those people hope.
The cabinet secretary mentioned disabled people’s organisations. I had the pleasure of speaking to some of them after our party conference and they were rightly angry that the bill is being used as a political football. They told me that although, for us, it is a legislation-making process, for them, it is their lives. It was hugely emotional, and I am very grateful to them for sharing their experiences, which have certainly stayed with me.
Alex Cole-Hamilton mentioned the workforce. As I reflected on early in my time in the Parliament, that is one of my biggest drivers because of my experience as an unpaid carer for my grandpa. Social care staff are hugely skilled and they deserve recognition and pay for what they do. We should have collective bargaining, as Paul Sweeney mentioned, as well as maternity pay, sick pay and clear career progression and training opportunities. I hope that the minister or the cabinet secretary—whoever will be closing in this debate—will be able to point to any progress that is being made in that area.
As Ms Mackay well knows, I was horrified when I was the minister to find that people were not receiving maternity pay in the 21st century. To a degree, that was fixed. The amount of negotiating that it took to get maternity pay in play was quite unbelievable. We need a national care service so that we can ensure that we do not have difficulties in securing fairness for the workforce.
I know the negotiating effort that that took, but there are other things that we should be exploring, such as ethical commissioning. That would allow us to put in some of the provisions so that organisations do not take advantage of their staff or have profit leak from the system. We need to ensure that there is fair funding for all in the social care sector.
This week, many colleagues will have had emails about hospice funding. Many third sector providers are concerned about how their care homes are going to continue to operate. We also need to acknowledge the issues that the national insurance changes have caused for the sector. I know that Jackie Baillie heard about that at the conference that we both spoke at.
I am privileged to be the convener of the cross-party group on carers. I will be looking to amend some of the provisions that relate to unpaid carers in order to strengthen the access to carer support plans, and many other things.
I am aware that I am running out of time, Deputy Presiding Officer. There are many other issues that we need to solve, and I do not think that we have gotten anywhere close to them in the debate.
The recommendations of the Feeley review remain relevant. Today, indeed, they are more relevant than ever. It is vital that those recommendations are implemented to the greatest extent possible.
15:49
I start with a point of consensus. I know that everyone in the chamber recognises the growing crisis in our social care sector; it not only impacts that sector but has a significant knock-on effect on service delivery in our NHS, which is also under intolerable strain. We are all desperate to see positive outcomes for social care and our NHS, and I absolutely believe that the cabinet secretary and the minister share that view.
When summing up a debate, I am normally able to say that the debate has been interesting, robust or, at the very least, enlightening. Unfortunately, listening to this debate has been nothing but frustrating because, as we have heard, since the bill’s inception, there has been nothing but robust pushback against it.
Apart from every Opposition party in the chamber consistently warning against the proposals, we have had four parliamentary committees saying that the bill was not fit for purpose. Councils have said the same thing, and COSLA withdrew from the negotiating table—for which, I may add, the minister and the cabinet secretary blamed COSLA. What on earth are they listening to? What are they hearing?
I found it extraordinary to listen to the cabinet secretary talk about the disparity in service delivery by the three councils in the NHS Ayrshire and Arran area. Has he asked them why that is? The Government has had four years to find out. It has never said what the problem is. However, I asked on Friday and was given an answer. In the committee meeting the other day, the minister talked about the difference between Argyll and Bute Council and Highland Council, which have similar demographics. However, I did not hear an explanation for that.
The reality is that, to come up with an effective plan, we must identify the correct starting point. If we do not understand the problems that we are trying to solve, we end up with bad policy. That costs the public purse and eventually has to be changed by future Governments. That is the modus operandi of the SNP Scottish Government: it starts with a solution and then works its way back to find a problem that fits it.
In the process ahead, we are genuinely trying to find consensus. On the basic principles, Feeley gave us the answer, which is about national standards. Do the Conservatives agree that we should have national standards that are implemented across the country?
Of course we want high standards across the country. However, the problem is that there are different issues in rural and urban areas. I was at the same conference that the cabinet secretary said that he and Jackie Baillie attended, when we heard about the lack of capacity in care home beds for step-down care in urban areas, where capacity has been reduced by 20 per cent, and then we heard that there is a lack of staff in rural areas to deliver the necessary capacity, because of rural to urban migration, which has never been recognised by this Government. In Dumfries and Galloway, 90 beds are empty because there are insufficient staff.
As we heard in Stephen Kerr’s passionate speech, the problem in the independent care sector comes from the fact that there is unfairness in its treatment in comparison with the public sector. Providers are told what they can charge and what they will receive, all while ensuring that they staff safely. They have no flexibility or ways to compensate for Scottish Government policy. This is the deal: a week’s stay in a hospital bed costs £1,900, but a week’s stay in a care home bed costs £900. I tell the cabinet secretary to do the maths. He should increase care home places in order to reduce delayed discharge and he should allow for an increase in carers’ salaries, so that we can encourage recruitment and retention in the sector.
I have much more to say, but I will leave my comments there.
15:53
The Government’s vision for the future of social care has people, not structures, at its heart. Throughout the development of the national care service and our on-going reforms, engagement with those who are accessing or delivering services has been consistent, positive and productive. What have we heard? That the status quo is not an option and that the social care system in Scotland is broken.
The Government is doing all that it can to protect the social care system while pushing for long-overdue reform. Our work is ensuring that we get accountability, scrutiny and flexibility into that system. Collectively, we invest more than £5 billion annually in social care, but there needs to be greater transparency and oversight to ensure that that investment is going to the places where it is needed. Under our current proposals, a national care service will provide the support that is needed in local areas and a clear, structured route to intervention when local performance is not meeting needs or standards.
Underpinning all our reforms is our commitment to ensuring that human rights are at the centre, so that people are heard and conversations are honest and realistic and so that, when things go wrong, we acknowledge that and have a clear idea of how to work together to do all that we can to improve things.
The path that the bill has taken has not been an easy one. That is often the case for the most important pieces of legislation. When I heard my colleague quote Nye Bevan and his work on bringing the NHS to life, I was reminded that Nye Bevan said that he stuffed his opponents’ mouths with gold. That option is not open to me. [Interruption.] We have often had to work to find a path through, but this work is far too important for us not to consider where we could or should compromise when that is required. This should not be about party politics or parliamentary arithmetic—we need to put those aside. Social care should not be seen as a drain; it is an investment, and, collectively, we must have a shared will to make things better.
Let me assure Jackie Baillie, as she shouts from a sedentary position that we are not investing in social care, that we have invested—
Presiding Officer, I was not shouting.
—more than £1 billion this parliamentary session in social care.
What the minister does not say is that demand has risen and that, with regard to integration joint boards, which deliver care right across the country, there was an overspend of £160 million in quarter 1, and that has got worse. That is what is happening now.
I can give you the time back, minister.
It is impossible to understand how a national insurance contribution increase of £84 million next year and every year will improve that situation. Let us all acknowledge the strain that is being experienced in our social care system and the fact that a national insurance hike on top of that strain is likely to be catastrophic.
We agree on many areas, so let us focus on the areas where we disagree and decide on a different approach that will help us to bring the Feeley review’s recommendations to life. Scotland has an ageing population, which means that more pressures will be placed on the healthcare system and workforce in the coming years. The Feeley review highlighted the projected increase in the number of people who are living with dementia, which means that we need to start planning now.
We need to shift from crisis intervention to prevention. We must work together to find and deliver the opportunities that will help us to address that challenge and to protect the sector for future generations. That must include a rethink of the crippling taxation measures that the UK Government is introducing. Each time that I have met the sector since the UK budget was announced, I have heard directly from care providers, who have told me that they simply will not survive the increase in employer national insurance contributions. They genuinely do not know whether they will be in business next April. They tell me that the national insurance hike will be catastrophic, and they face the hike at a time of immense pressure, with few options to raise money to cover it.
In areas such as the Highlands, where I live, there is already market failure. NHS Highland has lost 200 care home beds in the past two years. Care-at-home contracts are being handed back. The extra hike in taxation, for me—[Interruption.]—as someone who has advocated loudly and for a long time for extra investment in social care is galling in the extreme—
You need to conclude.
To see that, although the system is crying out for extra investment, so much of that extra investment will go direct to the Treasury—
Thank you, minister. You need to conclude.
I will finish with a quotation from Age Scotland—
You must be very brief.
Age Scotland said:
“We have been talking for years about the need for reform in social care. The NCS right now, to some degree, is the vehicle to do that. There is not a single other vehicle on the road to deliver that reform.”
I am quoting Age Scotland. It is on the Parliament, the Scottish Government and all the partners that are involved in social care services—
You need to conclude.
—to make the bill better and to come to the table with an open mind.
You have to conclude.
I call Carol Mochan to conclude the debate.
15:59
When the parliamentary session began back in 2021, there was a genuine enthusiasm about the prospect of a national care service. Only three years later, the enthusiasm is simply dead in the water. The conclusion of today’s debate can only be that the blame for that must lie solely at the feet of the Scottish Government. I wish that we could have heard a bit of reflection on the Government’s part.
Does the member agree that when the minister says that we should come to the table and give her our ideas, the Government must also listen to what everybody else is saying and take that into consideration?
We on the Labour benches have tried and tried to work together with the Government. However, as we have heard today, the Government proposed a national care service that was so unfit for purpose that nearly every stakeholder in the country—trade unions, councils and health boards—flatly rejected it. Conservative members opposite reminded us that four committees raised concerns. On top of that, the vast majority of carers whom we have spoken to simply do not recognise—
Will the member take an intervention?
I will make progress.
They do not recognise the current plans as anything close to the promises that were made. They feel let down, and rightly so. I say to the cabinet secretary that that is the message that members in the chamber are getting. The loud and clear message is that we need delivery of a national care service. I ask the Government: what is power if it cannot deliver? The Government certainly cannot deliver.
We have heard from many members today, including the minister, that
“the status quo is not an option”.
Members across the chamber are saying that, but the Scottish National Party has had 17 years to fix our social care. It has had more than three years to get the bill right, and it has simply failed to do so. Yet, today, there is no reflection on that at all. The Government brushes it aside and seeks to blame others.
Despite many Scots being in urgent need of social care, after three years, three cabinet secretaries and three First Ministers, there is nothing to show for it. Now is the moment to get to work and take immediate action to start fixing Scotland’s fundamentally broken social care sector. The minister—
Will the member take an intervention?
Of course, if it is brief.
Does Carol Mochan agree that Anne’s law could be delivered now, without the national care service? Does she share my disbelief that Maree Todd said in committee that the Anne’s law amendments were not ready?
In short, absolutely—I know that we are tight for time.
If the minister is actually in charge, she must show leadership. The poor performance from the minister in this matter cannot be overstated, and the discussion in committee demonstrated that.
To date, pursuing the bill has cost the taxpayer £30 million—money that has been wasted due to the incompetence of the minister and the SNP. Contrary to the minister’s assertions today and over the past few weeks, the bill does not deliver the Feeley recommendations—it has never touched on delivering them. The minister would not take advice on that. We have seen no commitment to do that or to progress anything with real urgency.
The Government simply does not listen. Not only has it wasted millions of pounds, but it has used up hours of parliamentary time. Most important, it has let down vulnerable and disabled people, as well as their unpaid carers and staff. Yesterday, eventually, in reply to my colleague Paul Sweeney at committee, the minister said that many of the recommendations in the Feeley review can be implemented without primary legislation.
My colleague Jackie Baillie has, over many months, and again today, outlined the legislative vehicles for fixing social care now. We could move forward on collective bargaining, on the essential Anne’s law and on the right to breaks, but what does the cabinet secretary do, and what does the minister do in committee? They talk. The Government talks; it does not deliver. Our communities would like to see action from this tired and out-of-touch Administration. For change to happen, the wheels need to be in motion now—in fact, they should have been in motion for the past few years.
The UK Labour Government budget has delivered £789 million of health-related consequentials this year and will deliver £1.72 billion for our NHS and social care next year. This Scottish Government must decide how it will deliver change in Scotland.
I will close on this point, Deputy Presiding Officer, as I know that we are tight for time. People’s care packages are being cut, delayed discharges are at a record high and staff are leaving in their droves. That is not about the UK budget, and it is not about the actions of another Parliament; it is about this Scottish Government in the here and now.
I would have liked to have said more, Deputy Presiding Officer. The reality is that we must work to get this right for the people in our communities, but it does not appear that this Scottish Government can deliver.
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