Seòmar agus comataidhean

Good morning. Thank you very much, convener, for having Ms Haughey and me here today.

I will give an overview of our approach to the bill, and Ms Haughey will focus on services for children and young people in the context of the national care service. I should say at the outset that no decision has been taken on whether to transfer children’s services or criminal justice services to the national care service.

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 it will ensure access to consistent high-quality care and support, which will enable people to live a full life.

The bill sets out the framework for the changes that we want to make, and it gives scope for further decisions to be made later through a co-design process. 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 there are some significant issues.

We are not changing just to address the challenges of today; we must build a public service that is fit for tomorrow. Today, about one in 25 people receive 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 system that is sustainable and future proofed to take account of the changing needs of our population.

The principles of any new system will be person centred. That means that the NCS will be delivered in a way that respects, protects and fulfils the human rights of people who access and deliver care and support.

On Monday, I was in Perth to hear about Turning Point Scotland’s excellent work in supporting people with complex needs. That includes preventative work with school leavers to turn their lives around. Its work highlights the value of focusing on the whole person and collaborating across boundaries.

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

No, I do not think so, because we have done it in that way for so many other things. The Government has been clear that we will ensure that those who currently require care and support, their carers and the workforce are at the heart of shaping the new service.

When it comes to the voices of lived experience, many folks have gone through lots of other processes that have not worked for them. We need to make sure that we get it right this time. This is a great opportunity for listening, consultation and co-design. If nothing else, one of my big ambitions is to remove as many of those implementation gaps as possible. This is the right way of doing so.

Some people with lived experience—such as those from the social covenant steering group, and others—whom we have talked with and listened to since we began, would argue that the framework is the right way to go, because, if we started the co-design process without the framework, they could put in all that effort then find all of it wasted.

Again, some of the people who are very active in social care—for example, disabled people’s organisations—have been involved in things previously, thinking that that was going to lead to change, but it has not done so. The framework has to be there so that we can do the next part of the work, through co-design.

Others have argued that we could have done it the other way around. I do not think that that would have worked. If we had done it the other way around—without that framework—I do not think that many folk with lived experience would necessarily have had the confidence to participate to the degree that we want.

We want as many folk as possible to get involved in the lived experience experts panel and the stakeholder groups. We are at the early stages of that. Last week, for example, I attended an event looking at how we establish the charter of rights and responsibilities. That was an extremely positive meeting. I am not saying that no negative points were raised—some always are—but, if we go forward in the spirit in which that meeting was held, where there is a level of trust in what we are doing and people feel that they can contribute, we will do very well. That is what I want to see across the board.

The answer to the accountability aspect of that question is that the Scottish ministers are not accountable for service delivery. A lot of folk think that we are, but we are not accountable for service delivery.

I am sorry to interrupt, but I would like to expand on that. Where self-directed support works well, it can absolutely be a life changer for people and their families and carers. There are some immense stories about situations where self-directed support has made real differences to folks’ lives.

There are parts of the country where flexibility has been brought into play, because people have been listened to. In those instances, doing something a bit differently for someone, which will make a huge odds to them, is the right thing to do. However, in other parts of the country, there is a closing down of available options, and there are different payments. I spent the summer going around the country asking about SDS and various other things. There are stark differences, and we have to end that postcode lottery. I am very much in favour of giving folks as much independence and autonomy as we can.

People are always wary of change, and sometimes we tend to look at the possible negatives and challenges rather than the opportunities. There are a huge amount of opportunities here. As I said, I am happy to continue to engage with, and listen to, the housing and homelessness sector and other sectors. I want them to be involved in the co-design process so that we get the service absolutely right. Homelessness services may not be in the NCS, but we very much need those voices in order to get the connections right.

You are being very naughty, Mr McLennan, because I said that I really do not want to be drawn on my views on who should be around the table. I think that, in the discussion during the co-design phase, many folk will say that the third sector should be there—they will advocate that—but that is a matter for the co-design process.

We have said that we will form local care boards, and people have been trying to get me to say who should be on those boards. There are some folks who obviously should be, but that is really a matter for the co-design process. What I will say—I am adamant about this—is that the voices of lived experience should be on care boards and should have voting rights, which in many settings they have not previously had. Obviously, there are people who will definitely, or are likely to, be there, such as elected members of local authorities, trade unions and employees—the list goes on. However, it is not for me to dictate who should be on those boards; that has to be part of the co-design process.

The key element is getting the national high-quality standards right in order to end the postcode lotteries. In relation to the other side of my portfolio, which is mental wellbeing, I am doing something similar by introducing standards for various treatments. We now have new child and adolescent mental health services standards and specifications, which should allow change across Scotland in how services are delivered, with services improving.

You have heard me and others say that, because of the way in which delivery was changed to be much more community focused, CAHMS in Grampian got through the pandemic period in fairly good shape. The health board still delivers for people, has much lower waiting times and, in the main, meets its targets. We need those same standards everywhere. That is what we have done on CAHMS, and we are about to do the same in relation to psychological therapies. I intend to do that across the board. Those quality standards and specifications are important for ending the postcode lotteries.

Beyond that, and because all of that will be at the forefront of our minds, we also need to change the cultures that have built up in certain places that impede good service delivery and good care and support for folk. I come back to my point about not only having high-quality standards but making sure that good practice is exported across the board, because it often is not. The flexibility in the system at a local level will still lead to different ways of working, and we should learn from those and make sure that the best ways become the norm.