Seòmar agus comataidhean

On the last point in your question—the independence of this one, that one and the other—we will have to work some of those questions through. It has to be part of the co-design process. We have to consider the accountability aspects, too.

Some of that will be worked through in the co-design but we hope that we will have a skeleton—a draft—of it all by next summer. That is ambitious but I am sure that, with the co-operation of the folk who are helping us to develop the service, it is achievable.

I outlined some of the main areas that we need to consider in the co-design. I will repeat some of them, although I will not go into all the detail that I did earlier.

We continue to speak to and, more importantly, to listen to everyone. This morning, I have given Ms Harper an outline of how the collaborative design will work. I realise that that was a fairly lengthy comment, so I will not repeat it.

We will send the committee a letter on all of that, so that you know exactly what was said this morning. I will also outline the on-going work that my officials and I, alongside others, are doing in that area. I am more than happy to write to the committee to outline who we have been speaking to, who we will be listening to, the meetings that we have had, and who has applied to join the stakeholder groups. I am willing to share all that information and to be open and transparent about it. I will set out all that in writing if that is what the committee wishes.

We will set out all of that in a letter to the committee. Obviously, as part of the co-design, there will be discussion about the end product, too.

That is an extremely important question, which comes to the crunch around prevention, rather than crisis—which I talked about earlier with Ms Mackay. In some areas, freedom and autonomy are already being given to front-line staff, who are the folk who recognise whether Mrs Smith is becoming frailer or is improving.

In my home city of Aberdeen, the front-line staff at the Granite Care Consortium have the ability to step up and step down care. Obviously, that must be done in consultation with the person receiving care and support and their family, and there is of course more stepping up of care than stepping down, but the ability of the staff to do that puts the person front and centre.

Beyond that, the best way to stop delayed discharge, for instance, is to prevent folk from going in the front door of a hospital in the first place. By stepping up Mrs Smith’s care, are we saving a journey to accident and emergency and perhaps a lengthy stay in hospital? I reckon that we are doing that in a lot of cases.

We need to change that situation with autonomy, freedom and independence for front-line staff, which largely do not exist in many places, because of contracts. We are trying to change that in the here and now. I do not want to wait for the NCS if we can get some flexibility in that regard in the here and now, which would be brilliant. That would be good not only for health and social care partnerships and local authorities; it would be very good for people.

We will continue to try to persuade and give comfort to local authorities and health and social care partnerships on the matter of trying to change contracts at this point. That is clearly working in Aberdeen. Changes have been implemented in Fife, too, which I think are benefiting people there. We need to see more of that, and I want to see more of it before the NCS, although the NCS gives us that complete opportunity with ethical procurement.

The independent review of adult social care recommended the establishment of a national organisation for training, development, recruitment and retention of adult social care support, including that specific social work agency for the oversight of professional development. Again, the policy memorandum outlines the intention to establish the agency.

A number of folk have come to me with comments about the social work aspect of the bill, and we will continue to listen to what folk are suggesting. We feel from our perspective that it should be part of a national care service but, as we have gone along, we have listened to people, and we will flex, if need be, on that front. If someone can convince me of the advantages of the agency being entirely separate from Government, I will listen to them. However, we have to remember the huge linkages between community health, social work and social care, and we do not want to create any further fragmentation in that respect.

As the committee will imagine, I have had a fair amount of meetings over the piece with various social work bodies—at this point, I should apologise for missing one such meeting last week, because I was unwell—but we will continue to do that and listen to people’s voices as we move forward. As I have said, though, I have to be cognisant of the linkages and whether a different approach will cause fragmentation—and, if so, what that will mean for service delivery to people, which, after all, is the number 1 issue.

That is a key aspect. In recent weeks, the carers parliament has held events here and near here. Some folk are worried about leaving their loved ones and there are cases where some folk just canna leave their loved ones. How do we flex all this to ensure that we are putting some support in place?

The bill includes the right to have breaks from caring. However, the other week, one body argued with me that, although that right might be in place, a carer might not get that break because their loved one needs them all the time. It wanted to know what else we can put in place to enable somebody to have downtime. We have to work our way through that.

Some really good stuff has gone on in certain places to help folk who have been unable to go for short-term breaks. I am sweirt to give a specific example, as I might identify people, so I will just mention that other things have been put in place that are beneficial to them and to their loved ones. Those things might not be as good as a break, but they allow for some relaxation and downtime.

I should probably also say that we are setting up a stakeholder working group, which will include carers, statutory services and carer centres, to look at the issues that need to be addressed in that regard. Again, we will continue to listen to what folk have to say. Even in the past couple of weeks, I have heard some stories that are new to me.

I keep a very close eye on the issue, and I have already used powers of direction, as folk are aware. I get regular updates from the Care Inspectorate on any complaints that it receives to do with someone being denied access. The number of such complaints has decreased dramatically—there are very few now. I would not want to put a figure on that now, but we can provide you with that.

I also get—fortnightly, I think—a list of where there are outbreaks and information on what is going on in those places. It is rare to see a home closed for admission and it is rare for there to be no visits.

I can provide you with much more detailed information on that. However, I assure the committee that I keep a very close eye on the matter and that Scottish Government officials will challenge if they think that there is anything that is not working right for people.

I will look at what Mr Hazelwood said. He has engaged with us a fair amount. If I remember rightly, he was at the co-design process for the charter of rights and responsibilities the other week. Again, I come back to the point that not everything has to be in primary legislation. Although it is absolutely vital to get end-of-life care right, if we put too much into primary legislation, that does not allow us the flexibility to change.

I rule nothing in or out, but probably the best way of getting this right is by doing it in secondary legislation so that there is flexibility to change in the future as care in the area changes, as it has done to a huge degree in recent years.

However, on the points that Mr Hazelwood has made and others have made elsewhere, we have to do all that we can to try to meet the needs of folks at the end of life. I myself have had loved ones and friends who have passed at home and who had much better experiences because of that. We recognise that there is work to be done, but the issue is whether that needs to be in primary or secondary legislation.

Ms Mackay is taking me back to my old job.

It is often immensely frustrating when housing causes difficulty for somebody to live a fulfilled and independent life. There has been a substantial amount of investment over the past number of years in trying to get that right. If you look at where we are in Scotland, particularly with our social sector but also some of the mid-market builds, you will see that housing for varying needs has been at the heart of that. Again, my figures are out of date so I will not quote them, but the vast bulk of the social housing that we have delivered was delivered to the housing for varying needs standard so that, if folks’ circumstances change, they can still live in the same home.

However, we recognised that the housing for varying needs standard was a bit old and a review has been undertaken. I am not exactly sure where we are in that review but I will get back to the committee after liaising with Ms Robison about that. It is important to recognise that there are changing circumstances, such as people living longer, so the design guide for varying needs had to change. We are also considering changes to building standards to underpin a Scottish accessible homes standard, which all new homes must achieve.

There has also been a lot of discussion about aids and adaptations. Sometimes, a wee change in a house can make it liveable but, if it is not done, it means that somebody is unable to stay at home. There is a lot of work and discussion between areas of Government on aids and adaptations.