Chamber and committees

As many committee members will know, I have a background in local government—I served for 13 years on Aberdeen City Council—and I recognise the importance of local government and local democracy. As we move forward with the national care service, local government will still play a major part in the delivery of services, if it chooses to do so. It is extremely important to set that out.

We have also said—I reiterated this at the Finance and Public Administration Committee last week—that, with the changes that we propose, we aim to create a cost-neutral position for local government as we move forward. However, it is clear to us from the feedback in the consultation, and it was absolutely apparent in the responses to the Feeley review, that people want to see a change in accountability for how care is delivered in Scotland. Disabled persons organisations, individuals and other groups feel that accountability is lacking at the moment. When I took up this post, I was surprised to find how important accountability is for people. At the moment, there is no national accountability to Scottish ministers. We aim to change that and to make local accountability more important.

One issue is that people often feel that they are pushed from pillar to post—the committee may have heard that but, if not, I appeal to you to go and speak to those who are receiving care and support at the moment. People go to a health and social care partnership with a complaint about the care that they are receiving and will be told, “That’s not our responsibility—it’s the local authority’s responsibility,” or that it is the NHS’s responsibility. Therefore, accountability is extremely important for the many people whom we have talked to and, more importantly, listened to. It was also raised as being an extremely important issue in the evidence that Derek Feeley took. That is why his recommendations moved us towards introducing the national care service.

Since the beginning of this parliamentary session, we have put a number of things in place in order that we can listen to the views of people, including the social covenant steering group. Some folk think that a framework bill is somewhat unusual, but a framework and enabling bill is exactly the way in which the NHS was established.

In listening to people—those from the social covenant steering group, in particular, but also other stakeholders—it became very apparent to us that people wanted to be involved in the co-design process all the way through, and that is why we decided on a framework and enabling bill, as was done with the NHS, to allow folk the opportunity as we move forward to co-design all the elements that slot into that framework bill. It is very important, particularly for those folks—the voices of lived experience—that we have done it in that way.

I know—I heard it at the Finance and Public Administration Committee last week—that some folk have asked why we did not do it the other way round, but it is difficult to design something without the framework of primary legislation in place. That is why we have done it in that way.

I think that I should say exactly what I said at the FPA Committee. There has been a concentration on some aspects of what we are trying to do here and not on others. I said to the FPA Committee last week that what people need to do is to look at the suite of documents that we have produced—not just the bill and the financial memorandum but the policy memorandum and the other documents that were produced. That gives us a very clear idea of what we are aiming to achieve here.

Some people want answers to all of the questions now. However, if I was to answer all the questions now, giving my opinions, that would blow the entire concept of co-design out of the water. What I want is for stakeholders and the voices of lived experience to be at the table to help us to co-design the service.

As you can imagine, I have been watching the evidence sessions not only of this committee but of others too. Many of the witnesses have vested interests in terms of where power, accountability and resource lie at the moment. What would be good to see is a committee taking evidence from those folks who are receiving care and support, their carers and families and front-line staff.

I have spent the past 18 months or so listening to people about their experiences, and where they think we have done well and where we have gone wrong over the past two or three decades in terms of changes to care support. It is a duty on all of us not only to listen to those folks who have a vested interest—there is no doubt that they are important stakeholders—but to listen to people. That is why so much emphasis of the work that we have put in is not only to listen to COSLA, SOLACE, the Chartered Institute of Public Finance and Accountancy and others but to go and hear the views of people. That is why we have had numerous events not only during the course of the consultation but since. That is why we had the national care service forum in Perth the other week, which was extremely well attended.

I ask the committee to look at the responses that came out during the course of that national care service forum. I also appeal to you to listen to and hear from witnesses from disabled people’s organisations, from third sector groups, such as Enable, and from people themselves about their experiences. You will then garner the reasoning why co-design is so important in order to get rid of the implementation gaps that have existed in previous changes that have been made.

One of the key things will be that we move to more independence and autonomy for front-line staff. We see in parts of the country where independence and autonomy are given to front-line staff that there is better service delivery, less crisis, lower costs to the public purse and the human cost of getting it wrong is stopped.

There is a good example in my home city of Aberdeen, where the Granite Care Consortium has given its front-line care-at-home staff the ability to step up or step down care as folks’ circumstances change. As you can imagine, care is mostly stepped up, although some care is stepped down. Obviously, that happens only in consultation with the folks who are receiving the care, their families and their carers. However, that ability cuts out reassessment, which is bureaucratic and takes time, and it is much better for the individual because change happens much faster. Preventative measures are being used already that we need to see being used across the board. That is another reason for the changes.

The financial memorandum was written when inflation was much lower than it currently is, and when forecasts did not show what was about to hit us thanks to Trussonomics and other factors.

Of course, we will all be watching this week to see the Chancellor of the Exchequer’s budget statement—whatever it is being called this time—which is likely, unfortunately, to lead to further squeezing of public services. I wish that the situation was different but, unfortunately, what will happen will be what the UK Government decides. I wish that we were making those decisions here. I hope that Ms Wells, Mr Briggs and others will be lobbying the chancellor hard to ensure that there are no further cuts to public services that will impact on people here.

What I said to the Finance and Public Administration Committee is that we will continue to update Parliament about the changes as they occur according to forecasts. That does not mean that we will change the financial memorandum, which was laid when the bill was laid. It also does not mean that we will not continue to do all the work that is required to ensure that we know exactly what the costs are as we move forward. That is why I said earlier that we will update business cases.

Future investment is always subject to the annual parliamentary budget and parliamentary budget scrutiny. We will obviously have to take into cognisance the financial hand that has been dealt to us by Westminster.

However, I come back to my earlier point: it might well be that the pace of change has to be incremental and we might have to take more time over certain aspects. That might involve phasing, as the cabinet secretary said at the weekend. However, we cannot sit back and not change, because we know that a huge demographic change is about to happen: we know that the population is changing. We also know that care is changing. We need, as Mr McLennan rightly pointed out just minutes ago, to move to prevention rather than dealing with crisis. Therefore, no matter what financial cards we are dealt by the United Kingdom Government, we have to make changes for the good of the people of this country.

I think that there are huge opportunities with regard to shared services. In my experience of shared services in local government, fairly substantial savings have been made that have gone back into front-line services. Let us be honest—the national care service is all about delivery on the front line for people.

I will not go on at length, because I know that time is ticking, but I mentioned earlier that we have already said we will look at all aspects of what is proposed, including cost neutrality for local government. In order for us to get that right, we need local government to be at the table when it comes to co-design.

I am well aware of the many opportunities and challenges that exist here. Others have a lot of knowledge that they can bring to bear, too, and we are happy to listen to them and take on board their knowledge as we move forward.

What I would say to local authorities is that they still have responsibility for delivery. I trust local authorities to do what is right for the populations and the people they represent. It would be particularly daft to stop delivery and to stop investment.

With regard to your question about front-line staff—I agree that the focus of front-line staff at the moment is on delivering for the people they care for and support daily—I will use not my words, but those of Mike Burns, who is the assistant chief officer at Glasgow City Council and the vice-convener of Social Work Scotland. He told the Education, Children and Young People Committee that he agreed that change was needed. He said that there was little impact on front-line staff, that the focus of delivery at the moment was on the valuable and valued work that they do on a daily basis and that senior managers were beginning to consider the proposals.

I think that that is right. The main focus of front-line staff at the moment is on the delivery of care and services. I hope that we can get front-line staff involved in the co-design process, too. I recognise that we will have to be adept in doing everything that we can to allow them that opportunity. As far as the national care service is concerned, I have no evidence that any of what is proposed is having any impact on delivery.

I would say that the bill entirely fits in with the charter. I will write to the committee with all the details of how it does so. I have some details here that I cannot find at the moment, but I will write to the committee to show exactly how the bill fits in with the charter, if that suits you, convener.

Thank you for giving me the opportunity.

Absolutely, as we work forward in all of this, we will continue to provide business cases and impact assessments for scrutiny by all committees and by Parliament. We need to do that in the interest of openness and transparency as we move through the co-design process and we have to take cognisance of any impact on any part of the system at all.

However, as I said minutes ago, the bill as it stands has no direct impact on local authorities. There are a lot of myths going round about what may happen. Let me give you examples. You talked about transfer of staff. In the bill there is the ability to transfer staff, because care boards, as envisaged, will be the provider of last resort. If a care home or care service fell over, there would have to be the ability to transfer staff and assets in order to protect that service. However, nobody has suggested—certainly, I have not—the wholesale transfer of staff from local authorities to local care boards or to the national care service. As I said earlier, I see local authorities as being important delivery partners, which is why I want them at the table co-designing.

Equally, there has been a lot of talk of transferring assets. Again, that is not something that is necessary. It has to be looked at in the co-design, but some of the witnesses who have been at this committee and others have suggested that there will be the wholesale transfer of staff and assets including, I believe, electric cars. That is not as we envisage it, but we have to have the ability in the bill to ensure that there is a provider of last resort.