Chamber and committees

As I said earlier, I have responsibility for policy direction. Some folk probably wonder why the Government would want accountability for some aspects of delivery. When members write to me, I have to reply that it is a matter for the local authority and for the local health and social care partnership. That is frustrating both for me and for members. We need to make the change.

There are a number of aspects around delivery where we need major change, which is why the national high-quality standards that will be in place are so important. However, I cannot put those quality standards in place now, because I do not have the power to do so. The bill and what we are doing at the moment will give us that opportunity.

As you do, Ms Duncan-Glancy, I hear such stories fairly regularly. It is annoying and frustrating for me but even more annoying and frustrating for the folks who have to make those choices.

We have to move away from some of the things that we do now that are not beneficial to anyone. We must move to much more preventative care, and we must ensure that it is person-centred care—that it recognises people’s needs. We talk about person-centred care a lot, now, but it does not happen in certain places.

As you are well aware, there are postcode lotteries whereby people are very well served in some parts of the country but not in others. We cannot have that either. The NCS gives us the opportunity to rid ourselves of those postcode lotteries.

Pay and conditions are important, but so are career pathways, which are lacking. That means that, often, it is difficult to entice young people, in particular, into the care profession. We have to change that, and there are opportunities to do so.

In addition, the NCS gives us the opportunity for national sectoral bargaining. The fact that that has not existed has meant low pay for a long time. Adult social care pay is greater here than in any other part of the United Kingdom, and we will continue to look at all those issues, because fair work has to be at the heart of it as well. It is about not only changing services for people but recognising and valuing a workforce that often feels that it has not been valued.

Finally, that move away from crisis and towards prevention is extremely important. Crisis costs the public purse a huge amount of money. However, there is also a human cost in not getting it right for folk. Making that shift, with those high-quality standards, can make a real difference in savings to the public purse and can stop some of the things that should not happen to folk. We can then put those savings into the system, to continue that work.

Finally—I have said “finally” twice; I hate it when folks do that, so I beg your pardon, convener—another aspect is about freedom and autonomy for front-line staff. There is much better service delivery when front-line staff have that freedom and autonomy. The prime example of that is in my home city of Aberdeen. I am sorry to bore some of the folk who were at the local government committee meeting on Tuesday by repeating this example, but the Granite Care Consortium’s care-at-home staff have the ability to step up or step down care, in consultation with the person who is being cared for, and their family. As folk can imagine, there is more stepping up than stepping down, but giving the staff that ability means that folk are not reaching crisis point. Beyond that, there is the obvious impact of stopping folk requiring additional services or maybe even being hospitalised.

Good morning. Thank you for having me along to give evidence.

It is fair to say that the national care service is one of the most ambitious reforms of public services. It will end the postcode lottery of care provision across Scotland and ensure that the people who need it have access to consistent, high-quality care and support to enable them to live a full life wherever they are.

The NCS bill sets out a framework for the changes that we want to make and allows scope for further decisions to be made. That flexibility enables the NCS to develop, adapt and respond to specific circumstances over time. I will reflect on why change of that scale is necessary.

Scotland’s community health and social care system has seen significant incremental change over the past 20 years. Despite that, people with experience of receiving care support, and of providing it, have been clear that there remain some significant issues.

We are not making changes to address only the challenges of today. We must ensure that we build a public service that is fit for tomorrow. About one person in 25 receives social care, social work and occupational health support in Scotland. Demand is forecast to grow and the NCS must be developed to take account of our future needs.

We will build a sustainable and future-proofed system to take account of the changing needs of our population. The principles of any new system will be person centred, with human rights at the centre of social care. That means that the NCS will be delivered in a way that respects, protects and fulfils the human rights of people who access care support, and their carers.

Improved carer support is one of the core objectives of establishing the NCS. As part of the human rights-based, outcome-focused approach, carers and people with care needs will be able to access support that is preventative and consistent across Scotland.

Nationally and locally, the NCS will work with specialist charity and third sector providers of social care as well as other third sector organisations in the field of social care to meet the needs of people.

The NCS will bring changes that will benefit the workforce, too. The importance of staff in the social care sector has never been clearer and we are fully committed to improving their experience, as we recognise and value the work that they do. The NCS will ensure enhanced pay and conditions for workers and will act as an exemplar in its approach to fair work.

Our co-design process will ensure that the NCS is built with the people that it serves, and those that deliver it, at its heart. We are committed to working with people with first-hand experience of accessing and delivering community health and social care to ensure that we have a person-centred national care service that best fits the needs of the people who will use and work in its services. Human rights will be at its heart.

Mr Briggs and others around the table know the role that I had previously and the changes that we made to homelessness legislation and regulation, as well as changes to culture. I certainly want to ensure that all of that hard work continues to bear fruit. Without doubt, that means that there has to be an interconnection of services. I recognise, as we all do, how valuable the interfaces between the national care service and housing and homelessness services will be.

We are working closely with stakeholders through the development of the national care service to make sure that all of those links are in place. We have already held our first round-table meeting with the homelessness prevention and strategy group, which I used to chair, and we will continue to engage regularly and meaningfully with the sector. I have met people, as you would expect. No matter what is in or out of the national care service, we have to make sure that those linkages with all services are there. I do not want any difficulties with transition phases such as we have seen before.

In my work with colleagues across Government, we are clear that we have to get all those linkages absolutely right; that is why there is a lot of work going on in the background. Some may argue that that involves diverting resource to deal with the NCS rather than the here and now, but a huge amount of that work needs to be done anyway in order to improve linkages and prevent difficult transitions. I am well aware of where there could be blips, and we are doing everything possible to ensure that those connections are there.

We can easily do that. We can keep the committee and Parliament up to date about how we are getting on.

There have been 400 registrations for the lived experience experts panel so far. I want that number to be much higher and we will do all that we can to boost that. There is also the stakeholder register that I mentioned already. I want as many people as possible to play a role.

Beyond the lived experience panel and stakeholder groups, I will continue doing what I have always done, which is to go out and about and listen. That is the essential element in all of this. Sometimes, when you go out, you find that folk have come up with a simple solution that has never been tried before or that happens in one place but not in another. We must export the best practice that exists. This is quite a small country, but we have sometimes not done that particularly well. The NCS gives us an opportunity to do that better, but that does not mean that we should not be doing that in the here and now.

The purpose of the charter is to ensure that everyone knows and understands their rights and responsibilities and what to expect from the future national care service. In addition, the charter will provide information on the process for upholding those rights.

The forthcoming Scottish human rights bill will underpin in statute human rights in Scotland, and we are working across Government to ensure that the co-design work which is taking place will reflect the contents of that future bill. The intention is to include information on the NCS complaints and redress system, which will provide the necessary recourse if the rights in the charter are breached. That will provide a clear pathway to empower people to claim their care-specific rights, through raising awareness of those rights and informing people about how to bring a complaint should those rights not be met.

As we move forward with incremental change, we have to continue to listen to organisations. I am pleased that you have already had a number of organisations here this morning, so that you could hear at first hand some of the things that they want to see. Their voices are required for that co-design. I have talked about the expertise of those with lived experience, but there is also the expertise of those folks who work on the third sector’s front line for many groups, including those disabled persons organisations that I mentioned earlier. We pledge to listen as we go along.

Let us be honest about the fact that co-design will have to be done within parameters. However, people understand that and they also understand that certain things might not be achievable. I have faith in people bringing their views to the table and helping us to make the right decisions as we move forward.

This may sound a bit flippant—perhaps Dr Jim Elder-Woodward will have a pop at me later—but I have no option whatsoever but to listen to Jim, and I will always consider whatever he puts forward. As the committee may or may not be aware, Dr Elder-Woodward serves on the social covenant steering group, and he has been a very strong voice for disabled people’s rights for a very long time. I give the commitment to Ms Duncan-Glancy that we will consider whatever Jim puts forward—I do not have the option not to.

There are other ways in which folk can get redress. The complaints and redress system is really important for people and we need to ensure that we listen to people on that front too. We will listen to folk during the co-design work in order to ensure that we get that right.

People feel that some aspects of the complaints and redress system work well, but others do not. We need to look at how we make a change from the bottom up so that people feel that they are actually being listened to, that their complaints are being dealt with appropriately and that the right redress is available.

Again, I say to Mr Balfour and to the committee that we will listen to what folks have to say about the pitfalls and where the system has gone wrong for them in the past, and we will build a system that works for all.

As far as I am concerned, improved carer support is one of the core objectives of the national care service. I was at the carers parliament, and I heard some stories that were galling, to say the least. The Government has put substantial resources into carers support, and over the last period, in recognition of what folks had gone through with Covid, we provided additional moneys to allow for more short-term breaks.

However, I know from talking to folk at the carers parliament—members will also hear this in their constituencies—that that money often does not get to the people to whom it should. We have to do much better in that regard, and that is why, in the bill, we have enshrined the right to short-term breaks. We obviously have work to do on that—again, we need to listen. It is essential that we get that element absolutely right.

A man from Shetland, Jim Guyan—I will name him because I saw his name in the papers, so I hope that I winna get into trouble—said that he asked Shetland health and social care partnership and others where money for carers support is going, but he is unable to get that information. Folk should not have difficulty in getting information on where money is going.

There were discussions at the carers parliament about whether the Government should ring fence elements of carers support, but that is not popular with local government, as we all know, and it is often not popular with some of you folks who are round the table. There is a level of frustration among many carers that they are not getting the deal that they should be, but the bill will enhance those rights.

Good morning to you, convener, and to the committee, and thank you for having me along to give evidence on the National Care Service (Scotland) Bill. It is fair to say that the national care service is one of the most ambitious reforms of public services since the creation of the NHS. It will end the postcode lottery of care provision across Scotland and ensure that those who need it have access to consistent and high-quality care and support to enable them to live a full life, wherever they are.

The bill sets out a framework for the changes that we want to make and allows scope for further decisions to be made as it progresses through Parliament towards becoming legislation. That flexibility will enable the national care service to develop, adapt and respond to specific circumstances over time.

I want to take time to reflect on why change of such scale is necessary. Scotland’s community health and social care system has seen significant incremental change over the past 20 years. Despite that, people with experience of receiving care support, and of providing it, have been clear that some significant issues remain. Those were detailed in the 2021 independent review of adult social care services, which set out a compelling case for change, including recommending reform of social care in Scotland and strengthening national accountability.

We are not just changing to address the challenges of today; we must ensure that we build a public service that is fit for tomorrow. Today, about one in 25 people receives social care, social work or occupational health support in Scotland, and demand is forecast to grow. The NCS must be developed to take account of our future needs. We will build a system that is sustainable and future proofed to take account of the changing needs of our population. I believe that the principles for an NCS, as set out in the bill, support that aim.

This is not about nationalisation of services. The bill sets out that, at national level, the functions are focused on consistency through national oversight. Services will continue to be designed and delivered locally. That is the right approach, to support delivery with and for our communities and the people whom those services serve. Local government will be an important partner as we design the detail.

We are conscious of the importance of the role that housing plays in supporting independent living. We will look at how services such as housing support, adaptations and technology contribute to the principles that are set out in the bill. Of course, those services should deliver increased early intervention that prevents or delays the need for crisis care. It is for that reason that we recognise how valuable the interfaces between housing and homelessness services with the NCS will be. We want everyone in Scotland to have choice, dignity and freedom to access suitable homes that are built or adapted to support their needs. We are embedding a person-centred approach that will align the NCS with housing and health services.

The NCS will bring changes that will benefit the workforce, too. The importance of staff in the social care sector has never been clearer, and we are fully committed to improving their experience, because we recognise and value the work that they do. The NCS will ensure enhanced pay and conditions for workers and will act as an exemplar in its approach to fair work. Our co-design process will ensure that the NCS is built with the people whom it serves, and those who deliver it, at its very heart. We are committed to working with people with first-hand experience of accessing and delivering community health and social care to ensure that we have a person-centred national care service that best fits the needs of the people who will use and work in its services. Of course, convener, the service must have human rights at its very centre.