Seòmar agus comataidhean

Community health is a foundation of the national care service that we need to get right. Through early engagement with stakeholders, we have learned that it is imperative that we continue to engage people who have experience in that.

As things currently stand, community health—those services that are based in the community and provide the first point of contact, diagnosis and treatment—comprises more than 90 per cent of all interactions in health, and many problems are identified, managed or resolved within the community. That makes it one of the largest and most crucial areas of healthcare.

Community health, community social work and social care services are the front line. They are accessed in a variety of ways: through many of our health and care sites; in people’s homes; or remotely, supported by technology. Again, we need to look at best practice in that when it comes to getting it right for the NCS.

For clarity, community health staff will remain in the NHS. The commissioning and planning of community health will be the responsibility of the national care service. That will build on the current integration arrangements that are in place under integration joint boards.

One of the key barriers is that, as I said, there are 1,200 disparate employers that are working to contracts that the Government has no control over.

I say again that the two wage rises, which I and everybody here wanted in order to put money into people’s pockets and purses as quickly as possible, were not the easiest things to achieve. We do our level best here, but there are things that we rely on others doing, which often makes things not as easy as they might seem.

Absolutely. This is not about moving the deck chairs—I am not into that kind of game. We need to take cognisance of the views that we have heard from those who are in receipt of care and support, from their carers and from front-line staff about the improvements that are required.

I return to a point that I made in my opening statement: we canna just tinker about at the edges, here. We have a changing demography in Scotland and we need to expand the social care workforce, as I also said earlier. We need to make a real change and, of course, people have to be at the very heart of our doing that.

As always, I am more than happy to work with anyone to ensure that we get things right, as we move forward. That is not to say—let us be honest—that I will support every amendment. However, if we can work in partnership to get the most out of all this, I am more than happy to do so. I think that Ms Mackay knows that ethical procurement is one of the top things on my agenda. I want to make sure that we do our level best to get all this right and to embed fair work principles as much as we can.

However, I highlight to the committee that, as you are all well aware, this Parliament does not hold powers over employment law, so we will have to do that, as always, with great care. It has been achieved previously in other bills—including in relation to forestry, if I remember rightly—and we need to do that again. If that means co-operating and collaborating with members to get it right, I will be more than happy to do so.

Folk in the consultation said that they wanted Scottish ministers to have control and accountability over this.

I am sorry that I did not quite get it.

The financial memorandum will cover all aspects that pertain to the bill. As the committee knows, we are working at this moment to ensure that we cover all bases when it comes to any liabilities, including VAT. The best option would be for the Treasury to rule that there would be no VAT liabilities. We will continue to push and prod the Treasury on that front.

We have to have a framework before we can move to co-design. We had to show the people who we want to help us co-design the bill with us that there is a framework to blanket that co-design around.

We came to that decision because that is the logical way to do it, and because we looked at what has happened previously. I remind the committee that the formation of the national health service was based on a framework bill, and I think that the national health service has been a wee bit of a success, has it not?

What do you mean?

I could also provide quotes from people with lived experience who want to be at the heart of shaping the national care service, which is, after all, delivering for them. I recognise that some people are worried about the change; I get that. Change is often of concern, but I have said, and I will continue to say, that we will continue to be open and transparent on this journey and to listen to people and allow the opportunity for scrutiny.

I will use the example of secondary legislation. Many people out there, and in here, always feel that everything has to be in primary legislation, but that does not allow for the flexibility that we often need for change.

Self-directed support, which I mentioned earlier, is mostly in primary legislation, and we know that people are using the loopholes in that to avoid the spirit of that act. To close loopholes such as those, we have to go back to primary legislation, but it would be so much easier if things were in secondary legislation because, if we found loopholes or an implementation gap, we would have the ability to change that pretty quickly to get it right for people. I recognise that some folk do not like that, and if we were to make change we would, of course, consult people and listen to them. However, using secondary legislation is a major way to ensure that we have the flexibility to get all this right in the future.