Chamber and committees

Thank you. I have heard from all of you this morning—and I think that we all understand this—that, when pressures come in, resource gets put to what you are legally obliged to do and to those who are most in need.

Some—in particular, a number of third sector organisations that have a special interest in various conditions—would see ring fencing of funding as being protective of certain services. What impact has ring fencing had on reforming services and also on how you respond to local needs, which will differ greatly between North Ayrshire and Edinburgh, for example?

Thank you, convener. I will just draw attention to my entry in the register. I was a serving North Ayrshire councillor at the time of integration in 2012, and was a member of the IJB.

I thank the witnesses for being with us. Michael Kellet touched on this point in his answer to my colleague Emma Harper. It is about Public Health Scotland’s recommendations in relation to the focus on prevention. My declaration of an interest will let you know where I am coming from. It feels quite strange, 12 years down the line, to still be talking about how we can focus on prevention. Can you just flesh out a bit more your recommendations in that regard? It would be particularly interesting to hear about what is stopping that shared focus. What are the barriers? What needs to change?

I am sorry to interrupt. On that note, one of the biggest challenges is that everyone agrees in principle that prevention is better than mopping up stuff afterwards, but it is always very hard to shift resource. What is it about having a preventative spending category that Public Health Scotland feels might assist with that?

I will bring in other witnesses in a minute. Another frustration is about budgets not being seen as being truly integrated, if you like: they often come with a “health” label or a “social care” label. Although it was a wee while ago now, one of my huge frustrations when I was a board member was on hearing the phrases “from a health perspective,” or “from a council perspective,” when, really, the purpose of integration is that it should be seen from a service user’s perspective. What is being done, or what more can be done, to try to ensure that the budgets lose their identity as council money or NHS money?

Further to my declaration of interests during the first session, for clarity, I should probably say that, although the chief officer for the IJB in my area is here, we have not worked together, but we absolutely will have corresponded on constituency issues.

I have questions about performance, shifting the balance of care and outcomes. We all appreciate that the situation with diminishing funds and increasing demand is challenging, but the data that is held does not show a marked shift in the balance of care, which was one of the main aims of integration. Do structural changes need to take place to help to shift the balance?

Further to that, what is being done, or what more can be done, to ensure that budgets lose their identity and are truly integrated? I mentioned to the first witnesses that, when I was on the IJB, one of my great frustrations was hearing phrases such as “from a health perspective” or “from a council perspective”, because I know that all of us want to talk about things from our neighbour’s perspective, from our granny’s perspective or from the perspective of the person who needs the services.

Those are a couple of questions to start with.

On that specific issue, Public Health Scotland talked this morning about having a new category of spending, which would be a preventative spending category, in the same way that we have capital and revenue categories. Do you have a view on the helpfulness of that?

The committee has undertaken scrutiny of self-directed support, and one of the things that we have heard quite consistently is that policy and legislation are not really given time to bed in before the next change comes along. That message has come across clearly, particularly from front-line workers. To what extent does integration simply need more time to bed in, or are different performance indicators required to measure the impact of changes that are happening?

I am sorry, but I am just going to jump in so that I can sneakily get an extra question in. Can you give us an example of those levers?

Thank you.

As a constituency MSP, it is always challenging when you have first-hand experience of where needs are not being met, and abstract discussions do not always resonate. I suppose that a world-leading policy is only of use if that is how our citizens are experiencing it.

Minister, you spoke about the duties of delivery partners. I guess that there are risks involved in being overprescriptive in legislation. Will you talk about some of those risks? Do you agree that there are risks around defining eligibility criteria or options for how social care is arranged?