Chamber and committees

Absolutely.

No. I am, as always, very happy to continue to engage with the committee, convener. You can be assured that, as our work continues, we will update you as and when.

Commissioning is an aspect in which, I think it would be fair to say, there are vast differences—let us put it that way. Mr Torrance will be well aware, not only as an MSP but as a former local authority member, that commissioning arrangements can be vastly different in different parts of the country. We need to make changes there as we move forward. I have put great stock in ethical commissioning. That is extremely important. We have tried to provide some comfort to local authorities around changing their commissioning at the moment and I hope that we can make more progress on that front.

Let us look at what the independent review of adult social care said about current commissioning arrangements, because what we are trying to achieve is to begin to look at its recommendations and implement some of those.

I talked about trying to give comfort at the moment. On 6 December last year, the Government issued a Scottish procurement policy note, which was co-designed with key stakeholders, to advise public bodies that are involved in the commissioning and procurement of social care services of the action that they can take here and now to improve their commissioning practice. It is clear to the Government that, by taking action now to embed ethical commissioning and procurement principles, we can help public bodies and providers to fully engage in the new and changing responsibilities that will come with a national care service.

The procurement policy note includes advice on how to use resources well and how to extend or modify contract terms to support the transition arrangements, and it asks that, where a new procurement is required for community health and social care services, efforts are made to embed the ethical commissioning and procurement principles that I think we all want to see as we move forward.

There is a fair amount in there.

I highlight the point that the Government has raised pay for social care staff twice in the past year. The minimum pay has been £10.50 an hour from April this year. That is an increase of 12.9 per cent for those workers over the course of the year, and that increase is much greater than the increases south of the border and in Wales.

I agree with Mr O’Kane that the cost of living crisis is having an impact on everyone, including folk in the social care workforce. I appeal to the UK Government and the Chancellor of the Exchequer to get the finger oot, get on with an emergency budget and ensure that we are doing our level best for individuals and families throughout the country who are being impacted by the rises in fuel prices, energy costs and the cost of their weekly shop. I appeal to the chancellor to get the finger oot and take some action there.

On the specific issue of transportation costs and mileage that Mr O’Kane raised, I highlight the point that there are 1,200 employers out there. The Government is not the employer. Those employers need to step up to the plate, as well. The Government does not set the mileage rates that are paid to social care staff; they are agreed and set by their employers. However, we are actively engaged with our partners, including local government, to understand the impact that the increase in fuel prices is having across Scotland and how social care providers can support their staff through this period to ensure that they can continue to deliver the invaluable support that they provide.

We as a Government have a long-standing commitment to the principles of fair work for the social care sector, and we are fully committed to improving the experience of that workforce. As I have pointed out, that includes increasing the levels of pay and, as we move forward, delivering consistent fair work conditions to staff who work in social care in Scotland.

There is not a lot that I can do. I have no power to push the 1,200 employers into some actions, but the committee can be assured that we will continue that active engagement with local government to see how we can move forward on that front.

I have previously given frank answers to questions on data, particularly in the chamber to Ms Mackay, who has vociferously asked numerous questions on that front.

We have implemented a data improvement programme, working together with local and national partners. That should challenge the issues regarding the consistency and quality of social care data and with data sharing. It should also address gaps on unmet need, workforce data and modelling future demand. That programme is developing and I am more than happy to come back to the committee or otherwise inform it of the improvement work that is going on in the short to medium term.

We must get that right in the transition to the national care service. As part of the work, we have been working with Public Health Scotland, IJBs, NHS boards and local authorities to improve management information on pressures on the health and social care system. That will enable us to respond collectively to pressures and issues arising, as well as to improve planning for the future.

A vital aspect of this is our proposal for the national care record. One of the key issues for many people who are accessing care is the number of times that they have to repeat their story. That is often frustrating and can be triggering, because they are having to repeat difficult stories again and again. The national care record will make a real difference by ensuring that we get it right for people as we move forward.

I am more than happy to continue to update the committee on what we are doing to improve data.

I will write to the committee with indicative timelines. I do not want to be specific about any of this, because, as the committee will be well aware, this is an ever-moving feast. I am also, as are my officials, reliant on other partners in all this. However, we will give you indicative timelines.

There are a number of things to address in that. A rushed visit is not good, either for the person who works in care or for the person who is being supported. Although I have heard examples that are exactly the same as that one, I have also heard examples of things working well for the folks who work in the sector and those who are receiving support and care. We need to look at those good examples and export them across the board.

Let me give you what is probably the best example that I have come across. I recently met Aberdeen’s Granite Care Consortium, which is a group of third and independent sector organisations that came together to bid for a home-care contract in Aberdeen. During the pandemic, those organisations did something that I hope others will follow suit on—I have been encouraging others to do so. They gave their front-line staff the independence and autonomy to step up or step down care in order to meet the needs of the folk whom they support. As Dr Gulhane, the convener and the committee will understand, there is more stepping up of care than stepping down.

In my opinion, that person-centred approach, with independence being given to the person in the know—the person who goes in daily and can see the needs of the patient—is the right way forward. We should have more independence and autonomy among front-line staff.

Some people would ask us to provide evidence that that makes a difference. We know that we have difficulties with delayed discharge across the country and that rates in some areas are much higher than they are in others. Dr Gulhane will know from his medical experience that the best way of stopping delayed discharge is to keep people out of hospital in the first place, and instead to provide for their needs at home, if that is at all possible.

For example, delayed discharges in Aberdeen stood at 19 on 26 April. That is very low compared to many other parts of the country, and it is particularly low compared to the other cities. The work in Aberdeen by the Granite Care Consortium and others on flexibility and stepping up care where that is required has meant that fewer folk have had to go into hospital. Flexibility and autonomy for the front line and understanding about meeting folks’ needs make a real difference. That is what we need to be doing.

Yes, it can be achieved. That is the reason for doing all this. The postcode lottery has had a real impact on some folk. It is quite bizarre. I may have touched on this with the committee before. There can be differences in service delivery even within local authority health and social care partnership areas, which can be really frustrating for people. I may previously have given an example from the convener’s constituency. Someone who lived there was absolutely, completely and utterly annoyed that service delivery for them was so different to service delivery in Peterhead, which is not in the convener’s constituency but is within the same local authority area and the same health and social care partnership.

My confidence that service delivery will improve towards getting it right for all is down to the bringing in of national care quality standards. The folks who are delivering and supporting people will know what is expected of them; the folks who are being supported will know what they should expect. It is probably true that inconsistencies in service delivery have led to a fair amount of correspondence to the mailbags and inboxes of everyone around this table. Getting rid of those inconsistencies is one of the main reasons for doing this. I am confident that we will get the national care standards right and create a fairer situation for all.

Some people have argued that standards in their area are already the best. They feel that the NCS may pull those standards down. We will aspire to reach those highest standards.

Mr O’Kane talks about the complexity of the consultation; other folk said that it was not complex enough. I recognise that folks always want more detail but, at the same time, in the areas where there was more detail in the consultation, some folks said, “Oh well, you’ve already made up your mind on that issue.” Sometimes, ye canna win in these regards. However, folk recognise where the Government is going with all of this—most stakeholders recognise that the consultation is only one part of the process. We will continue to discuss where we need to go with stakeholders and listen to the voices of lived experience, and that will include discussion of the benefits.

I am absolutely convinced that the service will be beneficial for all. We need to grasp the opportunity to get it right and ensure that we are doing the right thing in shaping the future of social care in Scotland.

Crises cost a lot of money, and there is also the human cost of not dealing with things early. The move to the preventative approach will save a lot of money that can be reinvested as well as stop some of the human costs of not getting this right. We know, because we have heard it from people themselves, that, where the focus has been on prevention, it has been much better for people and over the piece is much less costly for the public purse. It is very difficult for me to relay these things, because there is always the danger of identifying people, but I have heard stories of folks moving from almost constant crisis to a situation in which self-directed support has worked for them and crisis is now very rare. That is what makes the odds for folks, and it is less costly.

As we move forward, we have to analyse what is happening, and we will carry out tests of change to see what the financial impacts of these changes are. However, having listened to the stories of people’s day-to-day lives, I think it is beyond doubt that the move to prevention lessens the difficulties that they face, stops some of the horror stories that we have all heard about happening and is much less costly than crisis intervention, which costs a lot.