Chamber and committees

The witnesses might have answered some of my questions, but I will ask about local government integration with health and social care.

The Faculty of Advocates has given evidence that there seems to be

“a lack of provision in the Bill regarding the interrelation between the proposed national care boards and local authorities”,

which was much clearer when we introduced health and social care partnerships. Do the witnesses agree that that is the case? I ask them to be honest. There has been some suggestion that health and social care integration was slow and faced a lot of hurdles. I ask them to reflect on that. Are there things that the national care service could bring to the table in terms of integrating health and social care a little more easily or quickly?

Okay. I suppose that Anne’s law has highlighted to us the need to ensure that such things are explored.

Thank you.

I just want to be clear. It has been mentioned that the bill moves towards centralisation. To give me some idea of what would be an alternative to that, will you talk me through what might allow us to get the good integration that we want?

Good morning, convener, and thank you very much for asking me to speak. I very much appreciate the opportunity.

The petitioners have asked the committee to continue to seek evidence with a view to producing a report for submission to the 2022 review on moving around descriptors within the adult disability payment. In that light, it is only fair that I give a little bit of background on the 20m rule.

Under that rule, which was introduced as part of the eligibility criteria for accessing the personal independence payment, a person who can walk a step over 20m will not qualify for the enhanced rate of mobility support. The rule does not consider the nature of fluctuating conditions or the impact of physical or mental fatigue, and it makes no allowance for people who might be required to go further distances and might have to stop and start in order to do so.

The relevant point here is that the Scottish Government is replacing the personal independence payment with the adult disability payment, but it is keeping the eligibility criteria the same. I know that the petitioner has tried to lobby the Government on that and continues to do so.

I have spoken with a number of people who have been affected by the rule—in particular, people who suffer from multiple sclerosis. It greatly affects that group of people. I have spoken to individuals and to the representative organisation.

Since the rule was introduced, the Multiple Sclerosis Society has done some research, and I think that the findings are relevant for this committee. One in three people with MS has had their support downgraded, and 2 per cent of people with MS have had to give up work altogether because they lost the enhanced rate of mobility support, which they needed to continue with their work. That work is really important not only for them as individuals but for the economy, and people should always be able to have that opportunity if they can. Around 611 people with MS gave up work altogether between 2020 and 2022 as a result of their loss of mobility. The MS Society believes, from speaking to people and from the evidence that it has gathered, that that has cost the Government in terms of support for people with MS, due to the additional cost to the national health service and the rise in claims on other forms of income support.

Having spoken to the MS Society, I felt that its points were very relevant and important.

What difference can the committee make by keeping the petition open? One consideration is that the committee is about engaging with people and ensuring that underrepresented voices are heard by giving them a platform.

The petitioner feels that keeping the petition open would offer that opportunity, certainly until the report on moving about is finalised. They also feel that people who are at the sharp end of the 20m rule want to be able to engage in meaningful debate and to continue that debate. Those people are a very marginalised group due to their disability, and they find it difficult to find avenues by which to participate in the discussion and debate. This committee has certainly allowed them to do that, and they would wish to continue. The committee has already had evidence, so it could continue that work relatively well. The MS Society feels that the Government is quite open to some of the evidence that the committee is collecting, so it would be relevant at that time.

It would seem premature to close the petition when the evidence has been supportive and the MS Society feels that the petition has been a very successful route for it and for its members. We hope that the committee will consider keeping it open, at least until the review is complete.

I support Gillian Mackay’s position on writing to the health boards. We would then have some information that we could look at, and we could speak to the cabinet secretary.

I tend to feel that we should keep all the petitions open. I do not think that any of us covers the Caithness area, although I am not 100 per cent sure about that. I would like to speak to somebody about that issue, because I do not know a lot about it. That would give me a chance to refer to somebody who covers the area.

Thanks so much for your time, Dr Connon. I am interested in two things. They are big things, but perhaps you can comment on them quickly.

The first thing is about reporting on the quality of care that individuals and families get and the second is about the staff who provide that care. Perhaps I can link those two things together by highlighting my interest in local accountability. With healthcare, we often say that the closer the decisions are made to the person, the better the outcomes will be. I wonder whether there is any sense of that in any of the models that you have discussed.

I am interested in the local accountability that exists in the models, given the ways in which the services have been set up and are managed.

Does any particular area cause the most tension, or do things depend on what you are discussing at the time?

I think that everyone would recognise that, over the time in which there has been integration, financial integration has been one of the key factors that have been difficult. Will each of the panel members discuss why, with hindsight, they think that that has been the case? Realistically, with the Government saying that financial strains are ahead, how likely is it that better financial integration can be achieved? How can we get the organisations to work together on the budgeting?