Seòmar agus comataidhean

Thank you, convener, and good morning to the committee. Thank you for having me along to give evidence and take questions on the National Care Service (Scotland) Bill and its financial memorandum.

The National Care Service (Scotland) Bill is an enabling bill that sets out a number of provisions. The national care service, as proposed in the bill, will bring together social work, social care and community health to strengthen health and social care integration for adult services. By the end of this parliamentary session, accountability for adult social work and care support will transfer from local government to the Scottish ministers. The Government is establishing a programme of evidence gathering and research to inform future decisions on children’s services and justice social work and on whether it would be appropriate for them to become part of the national care service, too.

The aim of the NCS is to improve the already high quality and consistency of care across Scotland and to reduce variation to ensure that everyone, no matter where they live in Scotland, is provided with the best possible care. The bill sets out that the functions at a national level will focus on consistency through national oversight, while services will continue to be designed and delivered locally. That is the right approach to support delivery with and for our communities and the people whom they serve. The purpose of the NCS is not to nationalise services.

The principles of any new system will be person centred, with human rights at the very heart of all that we do. That means that the NCS will be delivered in a way that respects, protects and fulfils the human rights of people who access care support and their carers.

The bill sets out a framework for change, but the key details will be developed as part of a co-design approach. Co-design is all about engaging and working with people—people with lived experience of and people who deliver community health and care support. Those are the people who understand the challenges best and are therefore best placed to help drive forward the improvements that we all want. It represents a new approach to drafting the detail of the bill, with the intention of working more collaboratively to reduce the gap between the legal and the policy intent and its delivery, following the difficulties faced in realising the changes identified in previous service reviews.

Integrated health and social care has long been the joint ambition of local and national Government, but the people who access and deliver care have told us that it is not delivering the quality of services that is needed consistently. Combining national oversight with local expertise will ensure that the right balance can be struck to ensure consistent and fair quality of service provision across Scotland, allow for better sharing of good practice and innovation and remove unwarranted duplication of functions in order to make the best use of public funds.

The financial memorandum sets out the estimated costs for establishing and running the national care service and the proposed local care boards. It does not cover any proposed changes to wider policy, such as those set out in the independent review. It includes significant assumptions about required investments in pay and terms and conditions for front-line local government care staff if they transfer to the NCS.

Discussions are on-going with regard to the potential transfer of staff or assets from local authorities. That is a key area for co-design and one that, given its importance, will not be rushed. Work is on-going, and all financial considerations are under constant review as new information becomes available. I want to make it clear that we are not waiting for the NCS to start improving social care; we are already taking steps to improve the outcomes for people who access care and support, and our priority will be to continue to maximise front-line spending.

The Scottish Government’s commitment to fair work and support for fair pay and conditions are long-standing policies that will be embedded in the values of the new national care service. By rewarding and valuing the workforce to deliver the best possible service for the people of Scotland, we will make the sector fit for the future and more attractive to people who come into the profession.

They might argue that, but we have been at this for a very long time. It is not just a matter of the consultation itself; there was all the work that went into the independent review and all that Mr Feeley has done in that regard. Again, voices were listened to there. In fact, from what I have heard from the voices of lived experience, people think that all of this has been too slow. If you were to ask them whether the consultation was too short, the answer from most would, I think, be a resounding no.

A lot of people, organisations and stakeholders engaged with the consultation. I have spoken with and, most important, listened to thousands of people since I came into post. Officials have been engaging with people across the board. If the committee was to bring forward some folk from the likes of the social covenant steering group, they would say that things have taken too long, that the consultation was the right thing to do at the right time and that we need to move forward.

I make the point to the committee that, just because the consultation is over, that does not mean that engagement discontinues. It will continue throughout the process. A huge amount of my time and that of officials is spent talking to stakeholders and hearing the voices of those with lived experience so that we get this right. We want such folk to be fully engaged in the co-design process as we move forward.

We need national high-quality standards. Indeed, that has come across very clearly from those who are supported by carers as well as from front-line staff who believe that national high-quality standards are the way forward.

The other aspect is accountability. I have now been in post for 18 months, and at the beginning, I was surprised by how many of the folks who are supported by our care system mentioned accountability. People do not feel that there is the accountability that there should be at the local level, and they feel that ministers should be accountable for more than just the policy direction that we are currently accountable for.

People also feel that national high-quality standards are absolutely necessary. That has come across loud and clear in almost every conversation that I have had with folks with lived experience of the care system. It has come across loud and clear from the social covenant steering group, and it has come across loud and clear from those who work on the front line.

I will give you an example, without naming anyone. I have heard time and again that, where there have been failings, folk get pushed from pillar to post. They are told, “That’s not our responsibility—it’s the responsibility of the health and social care partnership,” “No, that’s not our responsibility—it’s the council’s responsibility,” or, “No, that’s the responsibility of the national health service.” That leads to real difficulties for people, and we need to change that. That is why we need the national care service. We need to ensure that that accountability exists, so that people know what they can expect from the care system.

Indeed, convener. One of the reasons why we have put staff transfer in the bill is that local care boards will be—or may be, depending on what Parliament decides—the provider of last resort. It is important that we have the ability for staff to transfer in those situations, just as we have seen in recent times. When there have been closures of services in the independent or third sector, or people deregistering services, we have seen those transfers take place between third sector, private sector and other third sector partners or, indeed, local authorities. At the moment, that is happening fairly regularly. As provider of last resort, if that is what Parliament chooses, local boards have to be able to have the staff to ensure that there is a continuation of care for people.

Ms Bell may want to add to that.

You know how budgets work in this place. The reason for my language is that we go through a process for setting budgets. No matter what the circumstances are—and I hope that we see improvement in the public finances, although I am not overly hopeful; we will wait and see—and no matter what the UK Treasury does about public finance as we move forward, we have to be absolutely sure that we are establishing services that are fit for the future.

Key to all of this is improving services and moving away from that crisis spend, which costs the public purse a lot and also has a human cost. We need to change that situation dramatically, no matter what.

As we progress with all of this, I am more than happy to come before the committee again to talk about how we are moving forward with the financial memorandum and with updating our modelling and to talk about the business cases. What I cannot do is set future budgets, as you well know. The Deputy First Minister would not be very happy with me at all if I were to do that today at this committee.

I will let Fiona Bennett answer first and then I will come in.

Officials know my expectations in all of this and that I do not like surprises of any sort. I do not want to insult Ms Thomson, convener, but I will say this and she can have a go at me if necessary: I am a data anorak and I think that Ms Thomson probably falls into the same category. If that is an insult, I withdraw it immediately.

I just want to ensure that we get this exactly right, and that will mean having to scrutinise it to the nth degree. It will be not just you and me who do that; we have a tremendous amount of folks helping us, including those on the social covenant steering group, and those people—some more than others—want to know all the workings. We are under intense scrutiny, as is only right.

Beyond that, as I have said and as I will continue to repeat, I am more than happy to appear before any committee to outline how we are moving forward, particularly in respect of the business cases and where we are making amendments as we progress. That is only right. Ms Thomson is right to say that this is a huge piece of work—it is definitely the biggest public service change since devolution, so it is incumbent on us all that we get it right. I am therefore not afraid of scrutiny in that regard.

A number of stakeholders have said that they are unable to carry out the scrutiny that they desire to carry out. I say to those stakeholders that they should have conversations with us and that we will help them through what we are doing. The convener mentioned the Fraser of Allander Institute, which has been in conversation with officials. Anyone can do that. In the same way, as I said earlier, I am more than happy to talk to other folk about the assumptions that they have made. As I said, COSLA has made assumptions that we do not recognise, but I am more than happy to engage with it to see whether some of its workings are right and to take that on accordingly.

I think that Ms Smith wants to come back on that.

We continue to listen to NHS board chairs, chief executives and others in all of this. They are key in helping us to design the services as we move forward and will be involved all the way through the process.

I get that some folks want the process to be delayed, and I recognise the pressures that are out there, but the fact is that the pressures on delivery of care will only grow over the years, because of our changing demography and population, and we cannot have stasis. We need to invest now—which we are doing over the course of the winter—but we also need to get this right for the future. Stasis is not an option.

We will continue to listen to concerns and to ensure that we address them as we move forward. We will continue to engage and, as I have said, to listen.

I think that, if we had done things the other way round, the committee and others would quite probably have asked, “Why didn’t you do it the other way round, given that the primary legislation is the most important thing in all this?” It is a bit of a no-win situation for anyone.