Chamber and committees

At the moment, national sectoral bargaining is nigh on impossible, because of the current set-up. As I said, dealing with 1,200 disparate employers is difficult.

As the committee knows, in the past year the Government has increased pay twice for adult social care workers, but it has not been easy to get that money into the pockets and purses of folks on the front line. Through the national care service, we want to make improvements to terms and conditions, as I have stated many times this morning. That will include improvements through national sectoral bargaining.

Our work on introducing sectoral bargaining is progressing ahead of the national care service, in line with the recommendations of the fair work convention. In August, Government officials held, with key members of the fair work in social care implementation group, a session to start the initial exploratory work on sectoral bargaining. That meeting was, of course, also attended by COSLA and by trade union and provider representatives. Regular meetings with those key stakeholders are now taking place to move that work forward and to establish a set of recommendations.

It would be fair to say that I have spoken with and listened to a number of trade union colleagues over the piece; I will continue to do so. I have had a number of meetings with the GMB. The last big meeting that I had with trade unions was in the company of the First Minister and Mr Lochhead to talk about trade union issues across the piece. Obviously, the national care service played a major part in those discussions. We will continue to listen to trade unionists as we move forward, and we will continue to try to make improvements in the here and now through our fair work in social care implementation group.

That is a big question—a big set of questions. I should probably start at the very beginning, because the national care service consultation demonstrated without a doubt that there is strong support for a national care service charter of rights and responsibilities, so that people know what to expect. Therefore, we have commenced the work of developing that charter.

The design and development of the charter will set out the rights and responsibilities of people accessing national care service support, information on the national care service complaints and redress system, which will provide recourse if the charter rights are breached, and information about how to access further information, advice and advocacy services.

The charter will support people who are accessing NCS services to better hold the system to account and to receive the services that they need in order to thrive, rather than just survive.

One thing that has been at the fore of discussions that I have had with folk with lived experience is the many people who have had poor service—who have not been cared for in the right way—and who have then found it very difficult to get that sorted.

I often hear the same tale and have said that, if I had £1 for every time that I heard it, I could probably go on a round-the-world cruise, although that is not something that I really want to do in a pandemic. I have heard folk say that they complained about something and were told by the health and social care partnership that it was not its responsibility but that of the local authority or the health board. It goes on and on. That is not good enough. In the work that we have done, we have also come across numerous situations in which there were arguments between the health and social care partnership, the local authority and the health board about who pays for something and the person did not get the care for a long time, which leads to some real difficulties.

We have to get the rights and responsibilities right. I want people to be empowered and, as I hinted earlier, I was at one of the first co-design sessions on the charter of rights and responsibilities to hear what folk had to say. There are some polarised views that we will have to work our way through, but we have to get it right for people.

That is not the case. I do not know what has been said, so if I could get any quotations on that, we will have a look at them and respond accordingly.

Ms Mackay is taking me back to my old job.

It is often immensely frustrating when housing causes difficulty for somebody to live a fulfilled and independent life. There has been a substantial amount of investment over the past number of years in trying to get that right. If you look at where we are in Scotland, particularly with our social sector but also some of the mid-market builds, you will see that housing for varying needs has been at the heart of that. Again, my figures are out of date so I will not quote them, but the vast bulk of the social housing that we have delivered was delivered to the housing for varying needs standard so that, if folks’ circumstances change, they can still live in the same home.

However, we recognised that the housing for varying needs standard was a bit old and a review has been undertaken. I am not exactly sure where we are in that review but I will get back to the committee after liaising with Ms Robison about that. It is important to recognise that there are changing circumstances, such as people living longer, so the design guide for varying needs had to change. We are also considering changes to building standards to underpin a Scottish accessible homes standard, which all new homes must achieve.

There has also been a lot of discussion about aids and adaptations. Sometimes, a wee change in a house can make it liveable but, if it is not done, it means that somebody is unable to stay at home. There is a lot of work and discussion between areas of Government on aids and adaptations.

They are big questions and they are questions that have been asked of me over the piece, particularly in relation to the implementation gap.

I said in my initial statement that we have been on a 20-year journey of integration and that things have improved. However, you have—quite rightly—heard from people about implementation gaps. I have, too.

You have heard about legislation that is—let us be honest—in many cases very good legislation, but the spirit of that legislation has not been put into practice and loopholes have been found to avoid implementing it in the way that was envisaged.

Why is the national care service needed and why will it make the difference? First, national high-quality standards will come into play to end the postcode lottery. An example of good legislation in relation to which there have been implementation gaps is the Social Care (Self-directed Support) (Scotland) Act 2013. Some folk around this table—Ms Harper, in particular—have seen that at first hand with me. In the case of that legislation, members of the Scottish Parliament came together to come up with what I think is excellent legislation.

However, in many parts of Scotland, the 2013 act has not been implemented as it should have been. Over the course of the summer, I spent quite a lot of time speaking to folk about SDS, including in Dumfries with Ms Harper, and there are stark differences in relation to whether folk can access all four SDS options and in the amounts of money that is given to folk for their self-directed support. There are vast differences in the flexibilities that are, or are not, allowed. That is really frustrating, particularly for folks who know people in other parts of the country who get more from services than they do.

Those are the things that we need to change. That does not all have to wait for a national care service and the national high-quality standards. Many of you will know that, at my insistence, we recently updated the self-directed support guidance, in order that we can do better. To truly end the postcode lottery in care provision, we need to go one step further by having national high-quality standards.

The national care service will oversee the delivery of care, improve the standards, seek enhanced pay and conditions for workers—as I said earlier—and provide better support for unpaid carers. One key element of all that is that the national care service will support ethical commissioning of care. Our approach to fair work will be an exemplar.

You asked a question about detail. I, too, have had folk asking me for more detail. Some people think that I am dodging the question when they ask me for detail about a particular thing. We have said that we will co-design, with the voices of lived experience, what we do as we move forward. The voices of those who currently receive care and support, their carers and front-line staff will help us to fill implementation gaps. The service will be shaped from the bottom up, to work for all.

Support has to be delivered in a way that suits everyone. Time and again, I have heard folk say that they have never been offered self-directed support, that they have been denied that support in certain parts of the country or that the offer that has been made to them has been very limited. That is not how self-directed support was supposed to work: folks were supposed to have the opportunity, and the right, to decide on their own care, and to have the flexibility and independence to do that.

I am not saying that everything out there is bad, because it is not. We know that there is some very good practice and that some authorities are going above and beyond the call of duty to build in flexibilities and to get support right for individuals and families. I want to see that thinking being done everywhere in Scotland. That is why the national high-quality standards are so important.

We also need to look at where things do not go right so that we can see what the complaint is and what redress there can be for the individual and their family. That is why we have committed to establishing, for the national care service, a complaints and redress service that will provide a fair, effective and consistent approach to complaints and redress. We will identify opportunities to improve how complaints are handled. The issue is not just that folk are not getting access but that, when they complain, they feel that they are not listened to. We need to change that.

As I have said, we intend to establish local care boards and the co-design and delivery of those care boards will be worked on with the voices of lived experience, front-line staff and stakeholders in order to get it right.

There is a huge amount of learning to be garnered from what has happened in health and social care partnerships. Mr O’Kane represented East Renfrewshire Council on the health and social care partnership that achieved a great deal. I come back to the point that I made earlier about areas where more services have been devolved as seeming to work better. I want to ensure that the learning and good practice from health and social care partnerships, such as the one in East Renfrewshire, are captured in delivery of our future services. I also want to look at those places where that is not working so well and learn lessons from that, too.

We continue to speak to and, more importantly, to listen to everyone. This morning, I have given Ms Harper an outline of how the collaborative design will work. I realise that that was a fairly lengthy comment, so I will not repeat it.

We will send the committee a letter on all of that, so that you know exactly what was said this morning. I will also outline the on-going work that my officials and I, alongside others, are doing in that area. I am more than happy to write to the committee to outline who we have been speaking to, who we will be listening to, the meetings that we have had, and who has applied to join the stakeholder groups. I am willing to share all that information and to be open and transparent about it. I will set out all that in writing if that is what the committee wishes.

We will set out all of that in a letter to the committee. Obviously, as part of the co-design, there will be discussion about the end product, too.

That is an extremely important question, which comes to the crunch around prevention, rather than crisis—which I talked about earlier with Ms Mackay. In some areas, freedom and autonomy are already being given to front-line staff, who are the folk who recognise whether Mrs Smith is becoming frailer or is improving.

In my home city of Aberdeen, the front-line staff at the Granite Care Consortium have the ability to step up and step down care. Obviously, that must be done in consultation with the person receiving care and support and their family, and there is of course more stepping up of care than stepping down, but the ability of the staff to do that puts the person front and centre.

Beyond that, the best way to stop delayed discharge, for instance, is to prevent folk from going in the front door of a hospital in the first place. By stepping up Mrs Smith’s care, are we saving a journey to accident and emergency and perhaps a lengthy stay in hospital? I reckon that we are doing that in a lot of cases.

We need to change that situation with autonomy, freedom and independence for front-line staff, which largely do not exist in many places, because of contracts. We are trying to change that in the here and now. I do not want to wait for the NCS if we can get some flexibility in that regard in the here and now, which would be brilliant. That would be good not only for health and social care partnerships and local authorities; it would be very good for people.

We will continue to try to persuade and give comfort to local authorities and health and social care partnerships on the matter of trying to change contracts at this point. That is clearly working in Aberdeen. Changes have been implemented in Fife, too, which I think are benefiting people there. We need to see more of that, and I want to see more of it before the NCS, although the NCS gives us that complete opportunity with ethical procurement.