Seòmar agus comataidhean

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.

In taking up this post, after the First Minister asked me to take on the role, I began to do what I always do, which is to listen to the voices of lived experience, and accountability featured strongly in what people said—much more strongly than I expected. Often, when people have a difficulty, they feel that accountability is lacking.

I will give an example. Many times, my officials and I have heard people tell us their stories in which things have not gone right for them and they have gone to the health and social care partnership and been told that the matter is not the HSCP’s responsibility but the council’s responsibility or the NHS’s responsibility. That is not acceptable.

People—including MSPs at points—cannot understand that I and the Scottish Government have no accountability in any of that. We set policy direction but we are not responsible for delivering the services. Many members write to me regularly, asking me to resolve problems that they encounter with constituents.

People believe that there should be ministerial accountability. They believe that the local accountability must be more robust. For all of us who regularly deal with casework, there is nothing more frustrating than somebody coming to you with a problem—sometimes an easy thing to resolve—that has not been dealt with.

It is a bit of a surprise for me how high up the agenda accountability was for people but it is very high indeed.

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.

I do not have any responsibility for service delivery. You are right that ministers have responsibility for policy direction and resourcing, but we do not direct local government or health and social care partnerships. We have removed ring fencing from the local government landscape to a huge degree, which local government asked for.

Some things are my responsibility—I know that—but I am not accountable for service delivery. The public finds it hard to believe that ministers are not responsible for that, so one of the reasons for the change is to ensure that ministers are accountable for service delivery and that we get accountability right at the local level as well, because people do not necessarily feel that the way that that is done at the moment is right either.

Sectoral bargaining is extremely important. It does not need to be in the bill, but we are working closely with stakeholders and unions on how we move all of that in future, and I want to push the boundaries. The Parliament does not have powers over employment, but we must ensure that we get that right, and bargaining is one of the key elements to doing so. Again, we need to engage with and listen to colleagues who are on the front line and trade unions. I hope that local government will also come to the table, and I am sure that the third sector will. We need to get that right.

I have always talked about care as a profession. Long before I got this job, in speechifying that I made from the back benches, I talked about care as a profession. However, many folk do not see it that way, for the simple reason that, traditionally, it is an area of work that has attracted low pay and poor conditions. We have to change that. We have to build the workforce for the future, and I want the profession to become attractive to young people because, if it does not, it will not be sustainable. We must get all of the elements absolutely right.

There are a number of complex issues there. We are fully committed to fair work, and I have a strong desire to ensure that we get all this right. I should probably declare an interest in that I have two nieces who work in social care, one of whom is on maternity leave and very nearly did not get maternity pay. I will not go into the detail, but that is unacceptable in the 21st century. I want to make sure that we get it right for the workforce, the majority of whom are women. We need to move now on things such as maternity pay and paternity pay with the co-operation of COSLA and others. However, the NCS gives us a huge opportunity on the other pay and conditions aspects.

On your question about how we handle human rights, interdepartmental working and making sure that legislation connects, we constantly talk across Government about how we get those things right. To ensure that human rights are at the very heart of the process, we need to continue to listen to folks about where they think that their rights and needs are not being met. Again, the co-design process gives us the ability to ensure that everything that we do covers as many bases as possible—if not all bases—and does our level best for folks. Human rights are extremely important in all this; they are at the heart of what we are doing. As I said, we need to continue to listen to folk on what we need to do on that front.

Have I missed something? I have a feeling that I missed something.

We are absolutely committed to using the learning from the pandemic to ensure that people are supported to see and spend time with the folks who are important to them. I know that Mr McLennan has had a lot of dealings with members of the care home relatives group, as have I, over the piece. Some of the stories, which we have all heard, are very harrowing indeed. That is why Anne’s law is included in the bill, in order to support the rights of people who are living in adult care homes to remain connected even during outbreak situations.

We have done a lot of work on that over the piece, and the committee will note that I have already changed regulations in that regard. From talking to the Care Inspectorate yesterday—I speak to that organisation every month or so—I know that there have been no complaints since its last report regarding folks not being able to see relatives, and long may that continue. That shows that the change in regulation has helped dramatically.

Nevertheless, that is one of the areas that we need to get right in primary legislation. The bill will give ministers the right to issue visiting directions to care home providers and ensure that they comply with those directions. I am quite sure that this is one of the areas of the bill in which the public at large will have a great interest, particularly all the folks from the care home relatives group, with whom I know that Mr McLennan and others have been engaging, as have I.

The third sector is a valued part of social care in Scotland, and it will continue to be so as we move forward. The sector is currently delivering quality social care, and sometimes very specialist social care, across Scotland. Third sector organisations are vital in providing advocacy for people and a huge range of other services. I have no doubt that the third sector will continue to be a major player in the delivery of social care, including specialist services, in Scotland. We expect, with a national care service, that there will be a mixture of providers. That is the way that it should be.

Currently, many third sector organisations find that the arrangements for procurement and tendering do not work well for them. The committee has heard from witnesses earlier this morning and previously that it is much easier for third sector organisations to operate in some areas than in others because of the procurement and tendering situations that exist. We have the ability, through ethical procurement, to iron out some of the difficulties that have arisen over the past two or three decades in order to get that right. Again, that will give third sector organisations much greater clarity than, many would say, they currently have.

In addition, I highlight that a very good example of the co-operation that will be required is the work that Mr Balfour and I did with others, including some previous members, on the inclusion of changing places toilets in the bill that became the Planning (Scotland) Act 2019. That has changed the dynamic not only in planning and building standards, but in how we continue to enhance and improve such provision. That kind of work shows Parliament at its best, and I hope that we can achieve exactly the same thing with all, or most, aspects of this bill.

This is an all-Scotland programme and we have to get it right for everyone, whether they live in a city such as Edinburgh, in a rural area or on an island. We have to draw a distinction with those folks who live in very remote rural areas. I want everybody to be involved in the process, and we will do what we can to hear as many voices as possible.

On my travels—I am pleased that we can now get out and about a bit more—I recently visited Shetland. In looking at aspects such as care boards and delivery, we might well have to adapt the process for island communities and other more remote communities, and we are open to that. We need those voices to say things like, “That may not be quite good enough for us here because of this.” We will do all that we can to attract those voices.

Moving away from geographical communities, I note that we also have to ensure that we hear the voices of other communities, including minority communities, as it is often much more difficult to get them to come to the table. I am thankful to the Minority Ethnic Carers of People Project in Edinburgh, which in recent weeks gave me the opportunity to talk to Chinese and south Asian carers and their loved ones, and to folks from the Gypsy Traveller community. We are doing our best to bring in all the voices that we can.

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.