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Official Report: search what was said in Parliament

The Official Report is a written record of public meetings of the Parliament and committees.  

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Dates of parliamentary sessions
  1. Session 1: 12 May 1999 to 31 March 2003
  2. Session 2: 7 May 2003 to 2 April 2007
  3. Session 3: 9 May 2007 to 22 March 2011
  4. Session 4: 11 May 2011 to 23 March 2016
  5. Session 5: 12 May 2016 to 5 May 2021
  6. Current session: 12 May 2021 to 25 August 2025
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Displaying 1343 contributions

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Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

That is not the case. I do not know what has been said, so if I could get any quotations on that, we will have a look at them and respond accordingly.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

No financial commitments are being directly made through the financial memorandum. The process of co-design will continue, and detailed work on the preferred options will be done through our business case process before spend is committed to.

Again, a number of things have been said about the financial memorandum that are not quite correct. For example, it is clear in the financial memorandum that more than 40 per cent of the projected costs relate to improved pay and terms and conditions for front-line social care workers, and not to bureaucracy costs. The estimated costs in the financial memorandum largely represent investments in service improvements and terms and conditions for front-line staff. Any suggestions that the figures relate exclusively to administration or bureaucracy costs are totally false.

Additionally, investment in areas such as support services will directly improve areas such as data analysis, planning and reporting, which will allow us to better understand outcomes and tailor future investment in order to have the biggest impact on our citizens.

The Scottish Government has said that we will increase social care spend by 25 per cent—some £840 million—by the end of this parliamentary session. That is in our manifesto, and we shall do it.

However, I recognise that there have been criticisms of the financial memorandum, which was produced before the current financial and economic crisis. We will consider what has been put to us and come back with an enhanced financial memorandum. However, not all social care spend that is going on now and will continue to go on is covered by the financial memorandum, which covers bill aspects only.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

We have had a fair amount of discussion already this morning about implementation gaps and the postcode lottery, as well as about the fact that folk often feel that their complaints and concerns are not properly addressed. There are three things to take from that. We want to ensure that the implementation gaps are plugged and that we end postcode lotteries. It is galling for some folks to see people who live not far from them getting better services for their condition. The national high-quality standards will be important in ensuring that we end the postcode lottery. We also need to garner knowledge from people to help us to fill implementation gaps.

Preventative approaches must be at the heart of all that we do. We talk a lot about person-centred care; lots of folk get person-centred care, but we need it to apply to everyone. That is why getting it right for everyone is also at the heart of all this. Crisis costs a lot of money, so it would be much better for the public purse, and in terms of the human cost when we get it wrong, to move to there being more prevention, rather than dealing with crises.

Ethical procurement and fair work are important to delivery. We need to ensure that we improve recruitment and retention, which we know are problems. More than that, as I said in an earlier answer, we need to attract new folk to the profession; we need to attract young people into this vital work. To do that, we must show folks that they are valued—not just in terms of pay and conditions, but in terms of career progression. At the moment, we have 1,200 employers; it is often difficult to deal with that many. However, ethical procurement and fair work being at the heart of every single contract will mean that we can do much better.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

The National Care Service (Scotland) Bill will allow the Scottish ministers to exercise powers, under section 78 of the Public Services Reform (Scotland) Act 2010, to require care home service providers to comply with any directions that are issued by ministers.

The key issues that you have talked about as having been raised by stakeholders are that our proposed approach to delivering Anne’s law through such directions does not go far enough and that Anne’s law should be extended beyond adult care homes to cover additional settings. We have talked to others about that, and there is dubiety about it.

Stakeholders have also talked about the importance that is placed on local decision making and, understandably, the importance of human rights and a person-centred approach. In the recent parliamentary consultation, some respondents indicated concern about whether our approach of using directions is the right one. It is absolutely the right approach.

The most challenging issue has been in how to balance the use of the directions with the views of some—in the main, Public Health Scotland—who endorse the occasional need for restrictions on health grounds. Although the directions envisage continuous visiting during outbreaks, we expect that formal advice from Public Health Scotland will highlight that that is a risk to outbreak management. At the moment, therefore, a piece of additional work is looking at every aspect of that. However, as a minister, I want to ensure that people have access to their loved ones. There will have to be a balance, but that is my expectation.

Rightly, people will always be concerned. At the back of their minds, they will be thinking about what went on during that Covid period. We do not want that to happen again. That is why we are doing all the work that we can to ensure that we get this right for relatives, families and loved ones.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

Absolutely. The Care Inspectorate should be their first port of call. Actually, the care home should be their first port of call. They should ask why a change to access has been made and why they are being denied access. If they do not get the right answer or they do not get access, they should go to the Care Inspectorate. The number of complaints has gone down dramatically, but we will provide you with information for your reassurance.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

That would be the case if there was service failure. Let me give you an example of a provider of last resort scenario.

It might well be that a care home in a particular place collapses because the company goes out of business. In some circumstances, the local authority might, as the provider of last resort, move in and take the home over to ensure continuity of care for people. Unfortunately, such things happen fairly regularly—not only with care homes, but with care-at-home provision and so on.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

Ms Callaghan is, I think, enticing me to be naughty, which I am not going to be. I am not going to name things that are necessarily good or things that are necessarily bad.

It is clear that areas where there is increased delegation to IJBs and to health and social care partnerships, and where there are budget flexibilities, tend to perform better.

However, there are other aspects to consider, such as the scrutiny agenda. I do not know how many members around the table are as anorakish as I am, but at times I have gone out of my way to dig a little bit deeper, which I am always prone to doing. When I look at some IJB agendas and minutes, I can see quite clearly that they are taking their scrutiny responsibilities very seriously and are making key decisions.

Frustratingly, however, the other side of the coin is that in some IJBs, often agenda items that are pretty serious are for noting only, and it disna look like there is the level of scrutiny or decision making that there should be. Members do not need to take my word for that—they can go and look at the documents themselves. We need to get to a position in which local care boards are scrutinising and taking decisions, and being accountable to the populace as a whole for those decisions.

I have heard the suggestion about a national care board, but I am not entirely convinced. It might just become another bureaucratic layer, and I am not one for bureaucracy, as the committee well knows. Nevertheless, my ears are still open on that one.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

For transparency, in the letter that I write to the committee, I will give full details of everything that I have outlined already, and I will also outline how we are running public workshops on co-design—information on that is available on the Scottish Government website. There are two registers promoting this heavily, as I have outlined already. All registrants will have detailed training around co-design.

I am more than willing to be as open and transparent as possible. I know that co-design is new for many folk. Some folk see it as being very brave; I see it as being necessary in terms of our getting it right. In our letter to the committee, we will outline all that we are doing.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

As I have said, we intend to establish local care boards and the co-design and delivery of those care boards will be worked on with the voices of lived experience, front-line staff and stakeholders in order to get it right.

There is a huge amount of learning to be garnered from what has happened in health and social care partnerships. Mr O’Kane represented East Renfrewshire Council on the health and social care partnership that achieved a great deal. I come back to the point that I made earlier about areas where more services have been devolved as seeming to work better. I want to ensure that the learning and good practice from health and social care partnerships, such as the one in East Renfrewshire, are captured in delivery of our future services. I also want to look at those places where that is not working so well and learn lessons from that, too.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 20 December 2022

Kevin Stewart

That is a huge question, which might take a long time to answer. I will be as brief as I can, and I will fill in some of the other detail in writing to the committee.

With regard to the care boards themselves and the design work regarding who is around the table and all the rest, that is, as I have already said this morning, part of the co-design process.

It has been thrown at me that the bill itself means that I or my successors could appoint and discard care board members at will. That is not the case—many of the powers that we are talking about in the bill are for NHS boards, and such powers are used extremely sparingly indeed.

However, I probably need to tease out even more detail on that area for the committee, so if the convener agrees, I will follow up on that in writing. I will also provide the committee with some of the comparisons that I have made with other bodies, if that would suit you.