It is my understanding of standing orders that members should treat each other with courtesy and address each other via the chair. Can you confirm that that is correct?
]]>The consensus agreement with the Convention of Scottish Local Authorities on shared legal accountability means that a number of the bill’s key aspects will need to change. Accountability for social care will no longer be transferred from local authorities to Scottish ministers, and integration joint boards will no longer be replaced by local care boards. Instead, a national care service board is proposed, and local government will now retain social care functions, staff and assets.
Although many people welcome that shift in approach, we need to acknowledge that others have been left feeling disappointed that it fails to reflect the core aspirations of the Feeley review. There will be a job to do to rebuild trust with those people.
Our committee has noted the Scottish Government’s intention to bring about changes to the bill through amendments at stage 2. A majority of the committee expressed a willingness to recommend that the general principles of the bill as introduced should be approved at stage 1. However, we have made that majority recommendation on the understanding that the Scottish Government is prepared to give the committee sufficient time to take further oral and written evidence on the details of those amendments prior to commencing the formal process of considering and disposing of amendments at stage 2.
I acknowledge the interim response that was received from the minister yesterday, and I am grateful to her for providing the committee with a summary target operating model for the proposed national care service. The minister has also given a commitment that she will formalise the extensive input that has so far been received from a wide range of stakeholders in a legislative advisory group that will guide the on-going development of the bill.
A majority of the committee specifically called for the full text of the Scottish Government’s stage 2 amendments, a marked-up version of the bill as introduced that incorporates those amendments in a highlighted format, and an updated policy memorandum and explanatory notes to be published no later than 29 March. I am particularly encouraged by the minister’s commitment, in her interim response, to accept that recommendation and
“to facilitate what the Committee requires, and to do this as quickly as possible.”
I look forward to listening to all the contributions to this afternoon’s debate. I acknowledge that, ultimately, it was not possible for the committee to reach a consensus position on the general principles of the bill. I recognise the strongly held positions of all members on the committee and across the chamber. However, if, later today, the Parliament agrees to approve the general principles of the bill at stage 1, as the majority of the committee recommended, I hope that all members, whatever view they express today, will continue to engage constructively with a reinforced scrutiny process at stage 2.
]]>I thank the Health, Social Care and Sport Committee clerks for their support during the committee’s inquiry and preparation of our stage 1 report. The committee began its stage 1 scrutiny of the National Care Service (Scotland) Bill in October 2022, having issued a call for evidence during the summer. There was extensive engagement with the initial call for evidence, and I thank everyone who contributed. The committee has listened carefully to all the views that were expressed throughout that process, which were invaluable in informing the committee’s recommendations.
The committee took oral evidence on the bill at nine meetings between October and December 2022. We took further evidence on the bill in May 2023 and at three meetings in October 2023. I am equally grateful to everyone who contributed oral evidence to the committee during that time.
One strong message that we heard throughout our scrutiny concerned the case for reform of social care. Such reform is badly needed to address existing inconsistencies in access, to ensure consistent application of guidance and legislation, to address on-going challenges in the social care workforce, to improve commissioning and procurement of services, and, most importantly, to improve outcomes for people who receive social care and support.
The case for reform motivated Derek Feeley’s independent review of adult social care to recommend the creation of a national care service. In responding to the Feeley report, the Scottish Government has sought to give people with lived experience a stronger voice in shaping the proposals through a co-design process. A witness who gave oral evidence to the committee described that as “a bold approach”.
At the same time, the committee heard many stakeholders raise concerns about an on-going lack of clarity regarding the definition, the precise scope and key areas of focus of co-design or the anticipated outcomes of the co-design process. In a recommendation that was unanimously supported by its members, the committee, in its report, calls on the Scottish Government to
“set out an overarching plan that includes a clear definition of co-design, parameters and intended outcomes of the co-design work and a timetable for its completion.”
We also want the Scottish Government to
“recognise the critical role the Scottish Parliament has to play in undertaking”
on-going scrutiny of the bill’s implementation,
“including in relation to the outcomes of the co-design process.”
During its scrutiny, the committee heard widespread support for the principles that are set out in section 1 of the bill. At the same time, our report highlights several areas in which the majority of committee members believe that those principles could usefully be clarified and strengthened.
Although the committee acknowledges the Scottish Government’s stated commitment to fair work principles, the majority of the committee would like the bill to be strengthened to include a
“clear and comprehensive definition of ‘fair work’”
and provide clarity on how those principles will be consistently applied and enforced.
The committee’s report seeks clarification on the remit of the planned national social work agency. The Scottish Government has said that the agency’s responsibilities will include monitoring and improving service quality, overseeing and supporting education, improving and scaling up good practice, workforce planning, training and development, and work on terms and conditions, including pay. The committee is keen to understand why the agency’s proposed remit is limited to the social work profession when there is an equally pressing need to address such issues for the wider social care workforce.
Furthermore, if the agency is to be set up as a Scottish Government department, how will it be ensured that it has the necessary operational independence to fulfil its role effectively?
I look forward to receiving the minister’s considered response to those concerns.
For a long time, we have been talking about the creation of a single electronic health and social care information record. Completing that work will be fundamental to the success of the proposed national care service and should be treated as an absolute priority. The committee’s report also highlights the importance of monitoring and evaluation. Without that, how can we judge whether a national care service has successfully achieved its objectives?
The committee has unanimously called for appropriate provision to be made in the bill for effective monitoring and evaluation of the proposed national care service. I acknowledge that the committee has been unable to reach a consensus position in many areas, but I am pleased to note that our recommendations on the parts of the bill on creating a right to breaks for carers and on implementing Anne’s law were unanimously supported. I hope that those important measures can be implemented with all due care and speed.
The Scottish Government’s overall approach to the legislation has shifted significantly since the bill was introduced in June 2022.
]]>The committee also went to Aberdeen, where members met representatives of the Granite Care Consortium and visited the Camphill community to engage with staff and service users. We visited Dumfries, where members had informal discussions with Stewartry Care and other organisations that represent registered care homes and that provide registered care-at-home services, as well as with wider community and third sector organisations. On a visit to Glasgow, committee members met representatives from the Coalition of Care and Support Providers in Scotland and service users and front-line staff from the organisation Key, before holding a formal meeting at the William Quarrier conference centre.
Meanwhile, six other committees have undertaken their own scrutiny of aspects of the bill that are relevant to their remit.
On 12 July last year, the Scottish Government wrote to inform the committee that it had reached an initial consensus agreement with COSLA on a partnership approach that will provide for shared legal accountability with respect to the proposed national care service. On 20 September, the Government confirmed its intention to lodge amendments to the bill to reflect the changes that were required as a result of the consensus agreement with COSLA. My committee subsequently wrote to the Government on 7 November requesting additional information regarding the precise implications of the consensus agreement for the bill, and we received a detailed response from the minister on 6 December.
The committee’s stage 1 report, which was published last week, sets out in detail the conclusions and recommendations that we have reached as a consequence of our exhaustive scrutiny. The consensus agreement with COSLA on the shared legal accountability means that a number of key aspects of the bill will need to change. Accountability for social care will no longer be transferred from local authorities to Scottish ministers. Integration joint boards will no longer be replaced by local care boards. Instead, a national care service board is proposed, and local government will now retain social care functions, staff and assets.
The Scottish Government has made clear its intention to bring about those changes to the bill through amendments at stage 2. On that basis, a majority of the committee has recommended that the general principles of the bill be agreed to. However, we have done so on the understanding that further scrutiny of the changes that the Scottish Government now proposes to make to the bill should take place as part of an elongated stage 2 process. That would include a further written call for evidence and the gathering of additional oral evidence before we progress to the formal part of stage 2, which is the consideration and disposal of amendments to the bill.
I regret that it was not possible for the committee to reach a consensus position on the general principles of the bill at stage 1. However, I underline my commitment to ensuring that substantial further scrutiny takes place at stage 2, as I have outlined.
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]]>The Deputy First Minister has already quoted some of the evidence that the Parliament’s Health, Social Care and Sport Committee took on Tuesday on Scotland’s minimum unit pricing policy. We heard from numerous stakeholders, who spoke about the impact that minimum unit pricing has had on reducing consumption, hospital admissions and deaths. Indeed, a Public Health Scotland and University of Glasgow study indicated a reduction of 13.4 per cent in deaths wholly attributed to alcohol consumption in the first two and a half years after minimum unit pricing was introduced. Can the Deputy First Minister outline any further evidence that highlights the benefits of the policy?
]]>However, Westminster is failing to act in the areas for which it has responsibility, including energy costs and spiralling mortgage bills. Does the cabinet secretary agree that the UK Government should have introduced a £400 energy bill support scheme to help households during the winter months, that it should have set up a social tariff to help more vulnerable customers, and that it should look to introduce mortgage interest relief to help home owners?
]]>The first of those themes relates to multiyear budgeting. Many respondents to the committee’s call for written views highlighted that the current model of single-year budgeting hampers the delivery of services and stands in the way of the transformative change that is required in the sector.
Following calls from our committee for the Scottish Government to bring forward its refreshed medium-term financial framework for health and social care, I note the cabinet secretary’s commitment that it will be published in the spring. I reiterate the committee’s request that the framework provides more detailed analysis than was previously set out in the medium-term financial strategy and the resource spending review.
In previous years, the committee has highlighted concerns about the availability and accessibility of data related to health and social care spending, and the Scottish Government subsequently gave a commitment to make progress in that area. However, the committee has heard evidence of on-going issues with data and the challenges that that creates in measuring and reporting on progress towards meeting defined budget and policy goals.
I welcome the cabinet secretary’s response to the committee’s pre-budget scrutiny letter, which sets out the range of data that is currently available to support decision making, analysis and scrutiny and indicates that there is
“ongoing work to improve availability and accessibility, and to improve transparency.”
The committee’s pre-budget scrutiny highlighted the importance of the NHS Scotland resource allocation committee formula in determining levels of funding to be allocated to individual health boards in Scotland. In his response to the committee, the cabinet secretary confirmed that
“Work to review the formula is underway”,
but that it “will take time” to complete.
We also heard concerns from Audit Scotland that a number of Scotland’s 14 territorial NHS boards might not be able to break even by the end of the latest three-year financial planning period, as they are currently required to do. It would be helpful to receive reassurance from the Scottish Government today that robust contingency plans are in place to deal with such an eventuality.
The cabinet secretary also told the committee that the level of co-operation between boards in reducing costs, particularly through shared services and functions, is “variable”. The committee would be grateful if the Scottish Government could keep it updated, as data becomes available, on how it is encouraging further co-operation between boards and on how effective that has been.
The committee heard evidence that workforce capacity remains the biggest risk to the recovery of NHS services after the pandemic. Equally, there is concern that any increases that have been committed to in the health and social care budget might be consumed by recent—welcome—pay settlements, which avoided strike action by healthcare staff in Scotland, and by the impact of inflation.
In that context, I welcome the cabinet secretary’s update that progress has been made towards reducing NHS Scotland’s reliance on agency staff. As the workforce is the sector’s most important asset, it is vital to retain a focus on getting the best out of the workforce, which includes using innovation to free up capacity while ensuring that the workforce’s health and wellbeing are consistently and proactively supported.
Issues that relate to preventative spend have been a recurring theme in the committee’s financial scrutiny this session. Evidence that was submitted to the committee highlighted the significant challenges of moving towards a preventative approach to health and social care spending in the context of acute short-term demand for services.
During the committee’s budget scrutiny session, the cabinet secretary made the point that performance on two key measures has been moving in the wrong direction—mortality rates are increasing and health inequalities are widening. A reinforced focus on preventative spending could have a real impact on reversing those negative trends.
We acknowledge that, in the face of the current severe budgetary pressures, maintaining a focus on prevention will be a huge challenge. However, for the long-term sustainability of health and social care services, we should not let that weaken our determination to keep that focus.
Many who submitted evidence to the committee argued for initiating a national conversation to involve the public in discussions about the future of health and social care in the context of increasing demand, demographic change and finite budgetary resources. I welcome the cabinet secretary’s acknowledgement in responding to our pre-budget scrutiny letter that, although the Scottish Government is committed to ensuring that the fundamentals of Scotland’s NHS do not change, reform is required.
Furthermore, the committee received oral and written evidence that highlighted significant shortcomings in linking health and social care spend to specific outcomes. On the basis of that evidence, the committee asked the Scottish Government how it intends to shift away from a focus on short-term targets towards a long-term outcomes-based approach.
In response, the Scottish Government highlighted that its care and wellbeing dashboard provides a framework to drive progress towards a common set of long-term outcomes. In its updated format, that is a welcome innovation. As part of the annual budget process, it would be helpful to map progress towards the long-term outcomes against health and social care spending.
As part of the forthcoming five-year review, the committee would welcome a debate about how the national performance framework can be reformed to become a more effective tool to support strategic outcomes-based policy making and spending in health, social care and sport.
The committee’s scrutiny of the budget for 2024-25 highlighted key challenges that we need to confront to place health and social care spending on a more sustainable footing for the long term. I and my fellow committee members look forward to continuing to scrutinise the extent to which the coming year’s budget is meeting those challenges in the months ahead.
I refer members to my entry in the register of members’ interests, as I hold a bank nurse contract with NHS Greater Glasgow and Clyde.
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