National Care Service (Scotland) Bill: Stage 1

– in the Scottish Parliament at on 29 February 2024.

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Photo of Annabelle Ewing Annabelle Ewing Scottish National Party

The next item of business is a debate on motion S6M-12331, in the name of Maree Todd, on the National Care Service (Scotland) Bill at stage 1.

I note that we seem to be missing a committee convener. I hope that he will appear very shortly, because he is down as the third member to speak.

Photo of Maree Todd Maree Todd Scottish National Party

I thank everyone who has contributed to the consultation on the national care service, our co-design sessions, the annual forums and the many meetings that my officials and I have undertaken. We have heard from thousands of people and, overwhelmingly, the message is the same. We need to improve the social care and community health system across Scotland. We need long-term, widespread transformation to fix some of the ingrained issues in the system and ensure sustainability for the future.

The bill is our chance to effect the meaningful change that we all agree is needed. The national care service will provide greater transparency on the delivery of care, improve standards, support improvement in pay and conditions for workers and provide better support for unpaid carers.

I thank the seven parliamentary committees that have taken evidence and reported on the bill at stage 1. The committee scrutiny has been comprehensive and robust, and I welcome that.

I acknowledge that the Health, Social Care and Sport Committee has restated its intention to consider further details of the Scottish Government’s proposed changes to the bill at stage 2. I have already provided a great deal of information at stage 1, in the interests of being transparent and helpful, and I have committed to giving the lead committee what it requires during the stage 2 process, as requested in its letter of 7 November. I repeat that commitment today. Information will be provided as soon as possible.

The starting point for this work was the independent review of adult social care that was conducted by Derek Feeley. The review, which the Government commissioned in the summer of 2020, has been the guiding force behind the bill. It recommended reforming social care in Scotland and strengthening national accountability for social care support, and it outlined the limitations of our current delivery structures. Those limitations included a postcode lottery in relation to user experience, a lack of national oversight and co-ordination, and a lack of collaborative and strategic leadership. The review also said that we should take a human rights-based approach to social care. All of that has been confirmed through our engagement and our co-design work. We have heard repeatedly that the current social care and community healthcare system must change to drive up standards to a consistent level across the country.

Many campaigners have been waiting a long time for this, but some do not have a long time. I know from listening to them that the status quo is not an option and that we cannot delay change. I was very moved when I met an advocate for those with motor neurone disease recently. He told his story powerfully. He might have only a few months to live—too few to be spending time as a delayed discharge in an intensive care unit when he could be at home with his family. As a country, we should be good enough at planning, managing and delivering social care so that people such as him get exactly what they need when and where they need it.

Feeley highlighted a need to reconsider the way that we think about social care. Globally, social care support is seen as a burden or a drain on society. In a country with an ageing population and unprecedented pressure on our national health service, we cannot afford to view social care as a burden. It is an investment in our society. Good social care, wherever people live in Scotland and whatever their needs are, enables and empowers them to live independent lives.

Photo of Pam Duncan-Glancy Pam Duncan-Glancy Labour

As a disabled person and a user of social care, and as someone who gets a lot of representations on the subject in my inbox, as many of us do, I have to say that those things have been said to people who use social care for a decade. For a decade, the Government has promised people who use social care that they would get greater access to it, that they would not have to pay for it and that there would be care workers to provide it when they needed it, but that is still not the case. Without any detail on that in the bill, how can the Government expect people to believe it this time?

Photo of Maree Todd Maree Todd Scottish National Party

I agree that people have waited a great deal of time for this change, but let me assure the member and the public that change is coming. Over the past 10 years and more, we have established that primary legislation and structural change are required. There are parties in the Parliament that still oppose that idea. I absolutely agree with Pam Duncan-Glancy on the need for change—I am unequivocal about that. We will deliver change, and I am keen to work with everyone across the Parliament to deliver the change that Scotland needs and deserves.

The bill as introduced sets out the principles of a national care service. It commits to a national care service charter, it sets out a national approach to managing complaints, it sets out provisions relating to data sharing and care records, it includes provision for breaks for carers and it includes provision to enact Anne’s law so that people in care homes have the right to be visited by their families. The engagement that we have carried out over the past year reconfirms that all those provisions are essential to improving social care in Scotland, and they remain central to the Government’s planned approach.

As I have set out in some detail to the committees and in the information that I have shared with all members this week, I intend to make three significant changes to the bill at stage 2, should the Parliament agree to its general principles today. They respond to evidence that was taken at stage 1, they follow engagement with the Convention of Scottish Local Authorities and the national health service, and they respond to on-going feedback from stakeholders.

These are the main changes that I want to make to the bill at stage 2: a national care service board will be established to oversee delivery across Scotland; we will not create new local care boards, as originally planned, but will, instead, reform existing integration authorities; and local authorities will retain responsibility for current functions and the delivery of social work and social care services, with no transfer of staff or assets.

That change in approach reflects the challenges of a new fiscal environment, in which it is more important than ever that we demonstrate value for money. The changes will substantively reduce the cost of the bill by removing the need to set up care boards and to transfer staff and assets. As I set out to the Finance and Public Administration Committee, that means that the cost of setting up the national care service will be up to £345 million over 10 years, whereas the proposals that were set out in the bill as introduced would have cost £1.6 billion over the same period. Collectively, we spend more than £5 billion a year on social care provision. The costs of change will be less than 1 per cent of current spend. We can make meaningful and lasting change for that relatively modest amount.

The national care service will bring change to children’s social care, social work and community health services. We have a real opportunity to improve the outcomes for children and families. An NCS will help to simplify the currently complex landscape for children and will lay the foundations to deliver much-needed improvements.

I will set out the difference that I believe the national care service board will make. The board will include, as a minimum, an independent chair, the Scottish Government, local government, the NHS and people who have lived experience of receiving and delivering community health and social care. The board will have an overview of the planning and delivery of community health and social care provision across Scotland. It will look at what is spent, what care is provided, who receives it and the outcomes for those people. The board will have a support and improvement framework that will drive improvement and innovation and will help local areas when monitoring indicates that standards and needs are not being met, and it will intervene if necessary.

The national board will give us a level of transparency that is not possible in the current system. It will let us understand where there are inconsistencies in people’s experiences across Scotland, build on good practice and tackle challenges. It will reflect the approach that we have taken to building the national care service by ensuring that we listen to the voices of the experts—

The Deputy Presiding Officer:

The minister is about to conclude.

Photo of Maree Todd Maree Todd Scottish National Party

The experts are the people who use community health and social care, as well as unpaid carers and the staff who provide the care.

I repeat that the status quo is not an option. We must make changes and invest in the future. The NCS is our vehicle to do that, and I believe that it can make a real difference to those who urgently need change.

I move,

That the Parliament agrees to the general principles of the National Care Service (Scotland) Bill.

The Deputy Presiding Officer:

I call Clare Haughey to speak on behalf of the Health, Social Care and Sport Committee.

Photo of Clare Haughey Clare Haughey Scottish National Party

I refer members to my entry in the register of members’ interests, which shows that I hold a bank staff nurse contract with NHS Greater Glasgow and Clyde.

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.

Photo of Monica Lennon Monica Lennon Labour

I am glad that Clare Haughey mentioned Anne’s law, and I welcome the report’s recommendations. I note that the committee agreed that Anne’s law should be fully implemented as soon as possible to ensure a human rights-based approach to care. Did it consider different options for its implementation, other than in the bill that was before the committee? Across the chamber, there is frustration in that, although we all agree on the need for Anne’s law, it perhaps does not need to be part of this bill. It could be implemented in other ways.

Photo of Clare Haughey Clare Haughey Scottish National Party

The committee considered the bill in its entirety, including all the different sections, one of which concerns Anne’s law.

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.

Photo of Kenneth Gibson Kenneth Gibson Scottish National Party

Thank you, Presiding Officer. I apologise for missing the first minute of the minister’s opening speech.

I also convey my thanks to the Finance and Public Administration Committee’s clerking team, who have been very strong in their support of our deliberations. Following on from Clare Haughey’s contribution, I note that our committee reached consensus in our deliberations, which I am about to discuss.

I am pleased to contribute to the debate on behalf of the Finance and Public Administration Committee and highlight the key issues that we identified during scrutiny of the financial memorandum to the bill.

The committee examined the costs that are associated with the National Care Service (Scotland) Bill and the programme and first reported on the FM in December 2022. Our report raised

“significant concerns in relation to the costings” in the financial memorandum. We considered that the financial memorandum

“does not provide best estimates of the costs the Bill gives rise to.”

We requested

“a revised Financial Memorandum, including full details of the underlying assumptions, updated estimates for the gaps identified in this report, as well as updates to the existing cost estimates set out in the FM.”

Last December, the minister provided an updated FM, along with a summary of the financial implications of changes that were proposed to the bill following agreement between COSLA and the Scottish Government on shared accountability for the NCS, as well as a programme business case.

We took further evidence from the bill team and minister on 23 and 25 January respectively, and set out our conclusions in a letter to the Scottish Government on 8 February.

The changes that the Scottish Government proposed would remove a number of the uncertainties that we originally highlighted, including around the transfer of staff and assets, and the number of care boards, and would extend the timeline for implementation to a 10-year period.

The original FM presented costs ranging from £644 million to £1,260 million over a period of five years. The updated FM, based on the bill proposals as introduced, estimates costs of £880 million to £2,192 million over a decade. Under revised proposals that are to be introduced by amendment at stage 2, total costs over a 10-year period fall dramatically to between £631 million and £916 million—substantially lower than in the original and updated versions of the FM.

The committee has acknowledged the work that has been undertaken to improve the cost estimates that are associated with the bill since we published our report on the original FM in December 2022.

That includes narrowing the variances between the lower and upper cost ranges and enhancing the level of detail regarding the costs associated with the rights to breaks for unpaid carers, which now form the bulk of the proposed expenditure. The reduction of the maximum cost variance from 225 per cent to 45 per cent, when comparing the 10-year costings of the new FM with the original, is a welcome indicator of the work to provide more accurate and lower costs.

Nevertheless, the committee has concerns regarding the approach taken by the Scottish Government in introducing a framework bill and using co-design to develop the detail of the policy as the bill progresses through Parliament. We would prefer co-design to be undertaken as early as possible to enable inclusion in primary legislation. Had the committee accepted the original financial memorandum, it would have led to significant unnecessary expense for the public purse at a time of severe strain on Scotland’s public finances.

As we explored during evidence, some risks and uncertainty around costings remain, such as the potential for VAT liability should direct funding be provided to the integration authorities; costs associated with the proposals for information sharing or the creation of an integrated health and social care record; the format, functions and membership of the national care board; and the unknown level of unmet need that the NCS will need to address.

We heard in evidence that the co-design process continues to support development of the policy detail to be included in secondary legislation after the bill has passed, and that business cases are being developed to support that work. We welcome the Scottish Government’s intention to share those with the committee, along with associated costs. We are concerned that the piecemeal nature of providing updates in different formats is not conducive to effective parliamentary scrutiny.

We will continue to monitor the finances that are associated with the bill and take this opportunity to reiterate our request to the Scottish Government that the committee is kept updated of all costs relating to the bill and the programme as they progress.

Photo of Sandesh Gulhane Sandesh Gulhane Conservative

I refer members to my entry in the register of members’ interests, as I am a practising NHS general practitioner. I am also a member of the Parliament’s Health, Social Care and Sport Committee.

Despite warnings that the SNP-Green Government is unable to articulate and communicate how the national care service would work in practice, Parliament is nevertheless asked today to support a bill on the basis that, come stage 2, all will be revealed. Really? That is not how scrutiny of legislation is supposed to work. We are not here to give the Government the benefit of the doubt—I know that the islanders of Arran would not and neither would those using the A9 nor patients waiting for cancer treatment.

The Law Society of Scotland is also concerned about the bill as presented. It says that effective scrutiny is a crucial element of the creation of good law. It is therefore essential that there be further clarity in both policy and drafting terms at an early stage to allow for proper scrutiny and appropriate stakeholder engagement.

I am mindful of other flagship bills that the SNP-Green coalition has tried to push through Parliament over the past couple of years. Here we go again. When it comes to the latest SNP rebrand of the National Care Service (Scotland) Bill, Health, Social Care and Sport Committee members are well aware that there is a dearth of detail and so many unanswered questions. The bill is far from ready for a stage 1 vote. There is criticism from professional organisations, unions, charities and councils. All four members of the committee who are not SNP or Green dissented from up to 46 of the 110 recommendations, including support for the bill’s general principles.

The so-called principles are so broadly drawn that it is not clear who the principles apply to, how accountability and enforcement would work, how the principles will be evaluated and how they fit with rights under the Equality Act 2010—we all know how important that is lest legislation goes pear-shaped.

The SNP-Green Government argues that we were asked to approve a framework bill, that much of the detail will be set out in secondary legislation, and that it is simply trying to work at pace and be efficient. However, the many areas that we highlight are ones that should be addressed in primary legislation. The Law Society of Scotland’s view is that that is not inconsistent with the aim of ensuring responsiveness and adaptability. Furthermore, the approach whereby the bill is scrutinised in advance of the co-design process limits our committee’s role to provide full and effective scrutiny at that stage of primary legislation, given that important details are simply not available.

The SNP-Green Government’s approach to co-creation is highly problematic. There is no statutory basis for the co-design process in the bill and no statutory guarantee for meaningful engagement from a full range of stakeholders. There are many understandings of co-design, but we do not know what the SNP-Green Government has in mind, nor do we have a plan for how it intends to go about it. That might suit a Government that has a reputation for secrecy and—according to some of its own members—authoritarianism. The Scottish ministers will be responsible for the national care service in a way that seems to them to best reflect the national care service principles. Despite shared legal responsibility with COSLA, the Scottish ministers are responsible for monitoring and improvement of services, with significant discretion afforded to themselves.

We all agree that social care reform is well overdue. The Scottish Conservatives support key recommendations of the Feeley review, including national employment conditions for staff and treating social care as an equal partner to the NHS. However, instead of opting for a centralised, top-down approach to care, as advocated by the SNP, we believe that there are many approaches tailored to those needing support that we could be doing now, as Monica Lennon suggested earlier. That can include caring for people with a terminal illness, many of whom are spending their end-of-life journey at home. By 2040, 60,000 Scots will have palliative care needs—10,000 more than today. We need to ensure that everyone in Scotland has a right to the palliative care that they need.

The SNP-Green coalition is bent on centralising social care at the expense of local authorities. This has all the hallmarks of a power grab that will not improve social care delivery, and it is an expensive power grab at that. Parliament’s Finance and Public Administration Committee has repeatedly raised concerns about how it will all be funded and the fact that the costings do not, and could not, reflect the actual cost of the provision of the bill. The SNP Government decided to plough ahead with its failed scheme, ignoring the concerns of experts.

The SNP-Green Government is spending more than £800,000 every month on civil servants for the national care service already. We were told by the Minister for Social Care, Mental Wellbeing and Sport, Maree Todd, that to get a national care service up and running, we should expect a total spend of £1.6 billion—now we are told that it will be less, but it will still be almost £1 billion.

The type of national care service that is advocated is the wrong priority for Scotland. Where are the efforts to eliminate delayed discharge that were promised by Shona Robison by the end of 2015? Yes, you heard right—2015. As the Royal College of Physicians of Edinburgh reports, in the year ending in March 2023, there were more than 660,000 days spent in hospital by people whose discharge was delayed because they did not have a social care package to support them at home. There is a double whammy: Scottish Care has warned that one care home per week is closing in Scotland. We now have 19 per cent fewer care homes than in 2013, with private care homes being cheaper for the public purse.

Humza Yousaf is the mastermind who drafted the National Care Service (Scotland) Bill in June 2022, with a plan to complete stage 1 by March 2023. The fact is that the NCS bill has been delayed four times. It had to be radically overhauled, and implementation was postponed until 2029, but just yesterday and today Maree Todd tried to tell us that she was going to prevent delay. The SNP-Green coalition is making up the timeline as it goes along.

If the issue were scrutiny, we would have everything with us already. We need to ensure that the enormous challenges that are faced by patients, young and old, are dealt with today.

Photo of Jackie Baillie Jackie Baillie Labour

Social care is in crisis right now. Care packages for some of our most vulnerable people are being cut, almost 10,000 people are stuck waiting to receive assessments and care, and providers are handing back contracts because they cannot afford to deliver. Staff morale is at rock bottom, with people leaving the profession in droves.

Nothing in the bill addresses that immediate crisis. Instead, we have a framework bill with little detail that was introduced 20 months ago. Despite the minister’s warm words, implementation will not happen until 2028-29, at a projected cost of £2.2 billion. Not one penny will go towards care packages right now, and there will be nothing either for hard-pressed social care staff.

The bill should have been about raising standards and quality of care; removing care charges; standardising eligibility criteria; encouraging independent living; valuing the workforce with consistent terms and conditions, collective bargaining and pay; and bringing about cultural change not just structural change. It is a framework bill with little detail that has frustrated stakeholders and Parliament. It has been described by many as a bill without vision, a bill that simply does not address the challenges now and a bill without ambition.

The bill, as introduced, has been considered by numerous committees—the Health, Social Care and Sport Committee; the Education, Children and Young People Committee; the Finance and Public Administration Committee; the Delegated Powers and Law Reform Committee; the Local Government, Housing and Planning Committee; and more besides. Concerns have been expressed by the overwhelming majority of them. Indeed, the Finance and Public Administration Committee has looked at the bill twice and still does not believe that the sums add up. It is not alone—the voluntary sector, the independent sector, carers, those experiencing care, and trade unions all have concerns. The committee report runs to more pages than there are sections of the bill, and page after page is filled with criticism.

I will not rehearse the arguments made yesterday about further scrutiny, but it is really simple. The bill, as introduced, is about to change beyond recognition because of a deal done with COSLA. It has simply not been scrutinised. The SNP and Greens do not care about the integrity of this Parliament; they want to ride roughshod over the legislative process, and just railroad the bill through. It is a mess, and this is a recipe for bad legislation.

I will consider a few of the provisions that we do support: Anne’s law and the right to respite breaks. We support Anne’s law 100 per cent. The right of relatives to see their loved ones in care homes must be legislated for. We cannot repeat the heartbreaking experience of too many families during Covid. The current provisions in the bill are weak, but there is a strong argument to decouple them from the bill. I invite the minister to consider amending the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011. That would be a much faster legislative vehicle, which would undoubtedly carry the unanimous support of the Parliament.

We also support the right to respite breaks 100 per cent. Again, there are other legislative opportunities that can be explored, but the truth is that that element will take resources. The financial memorandum estimates that the amount of additional money required for 2025 is £5 million, rising to £133 million in 2035—and that is for just 10 per cent of carers. It is fantasy budgeting. Like so much of what the SNP does, this legislation might be passed but it will not be enacted, and carers will be let down in the process.

Social care staff are the backbone of the delivery of quality social care, yet they are leaving their jobs—they are going to work in Lidl or Asda because they pay more. We first proposed £12 per hour in early 2021, rising to £15 by the end of the parliamentary session. Had the Government done so then, the hourly rate now would be worth £14.43, and we would not have the haemorrhage of social care staff.

It is, regrettably, always the same with this SNP Government. It talks a good game, but it fails to deliver. Where are the fair work principles in the bill, including the improved terms and conditions, the right to full sick pay from day 1 and the opportunity for sectoral bargaining? They are simply not there.

Today, the

Daily Record outlined the pressure that social care workers are under. A recent GMB survey of front-line care workers in Glasgow shows that 80 per cent of social care staff believe that workloads are now unmanageable, and 89 per cent are warning that vulnerable service users are now at risk. One carer said:

“We are rushing from one visit to another, always chasing our tail, never being allowed to give enough time to people ... I used to absolutely love my job but am terrified someone is going to be so rushed they make a terrible mistake. I just want to get out before it’s me.”

The National Care Service (Scotland) Bill will do nothing to address those problems. It will do nothing for those whose care packages are being cut now, nothing to help a sector that is on its knees and nothing to stem the flood of staff who are leaving.

It was Scottish Labour that proposed a national care service more than a decade ago, but the SNP said no. The bill as it stands does not implement the Feeley review. It will not work as it stands. We will continue to engage constructively at stage 2, but the process must be lengthened to allow for proper scrutiny. There is no room for arrogance or hubris in something this important, and I fear that, instead of listening to the many reasonable suggestions from stakeholders, the Government is now hard of hearing.

Please do not ignore the warnings from those with care experience. Do not ignore them from social care staff. Do not ignore them from social workers or the sector as a whole. This bill must not be an excuse for the SNP not to act now to avert a crisis in social care. Stop the cuts to care, boost pay in the sector and deliver Anne’s law and a right to breaks, so that those things can deliver for those who work, live and care in our social care system.

Finally, we reluctantly cannot support the general principles of the bill. The committee has not scrutinised the substantial changes that are being made, but we will continue to engage constructively at stage 2.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

Here we are again, debating another iteration of what was, in essence, a line in the SNP’s manifesto in 2021. The election was three years ago, and we are here again, with another amorphous form looking for a function. I will come back to that.

Yesterday, in the debate on Jackie Baillie’s motion to refer the bill back to the lead committee, the focus from the Government evoked the establishment of the national health service. I am gratified that that has not happened so far today—although I dare say that it might—but the rhetoric would suggest that we are on the threshold of some great reform, and that the names of Beveridge and Nye Bevan are soon to be joined in the annals of our national story by the likes of Kevin Stewart and Maree Todd. However, we are not on the edge of a great reform. This is an amorphous and ever-changing structure that is looking for a role in our society. All that we have heard from Opposition members such as Jackie Baillie and Sandesh Gulhane—and rightly so—is that it is still to find that role in our society.

I have heard the minister suggest that the Liberal Democrats, in their staunch opposition to the bill and the establishment of a national care service, would also have opposed the national health service, were we all transported back to 1948. However, you will recall, Presiding Officer, that although the vision for the NHS was executed by a Labour parliamentarian, it was the brainchild of a Liberal parliamentarian, William Beveridge. When William Beveridge wrote the Beveridge report, he identified five great evils in our society: ignorance, idleness, squalor, want and disease. It was the final one that he felt was most important in establishing a basis on which we had equal access to healthcare that was free at the point of delivery and readily available in every community of this country.

In relation to the national care service, the nomenclature is where the similarities end. We know that this is a form looking for a function. No lives will be saved in its creation. Nobody who did not get free care yesterday will get it on the implementation and royal assent of the bill. No care workers will be paid any more as a result of it, but we will be paying the cost of it through the taxpayer purse. There are significant concerns about the bill among stakeholders and, indeed, members of the Health, Social Care and Sport Committee. We have heard some of that today. The committee report on the bill has been damning. The word “concerns” features 28 times in the summary alone.

Around 238,000 people receive social care support in Scotland. Many of them will be known to those of us in the chamber and many of them will be related to us. That is 4 per cent of our population. Social care is a vital and important part of our society. Those who work in it and manage the sector are clear that it needs to be better funded and, of course, that it needs reform, but they are not talking about the ministerial power grab of centralisation that lines the pages of the bill. Do not take my word for it. Listen to COSLA, which just this week said:

“the reality is that national funding decisions ... will further squeeze local care and social work services which are already under incredible pressure.”

COSLA put out a briefing this afternoon saying that, despite the agreement that it has come to with the Government, it still harbours significant reservations, particularly about the nature of the funding settlement that it has been met with this week. Instead of providing support, the Government has delivered a hammer blow to local authorities in its budget.

It is hard to imagine a worse plan for social care than the one that is before us or a worse time for its execution than now. It is a bureaucratic exercise that will cost large sums of money and consume vast amounts of time. Right from the start, there have been serious concerns about its skyrocketing costs, which could reach more than £2 billion, and about the design process. Each and every iteration of the bill has proved to be outrageously expensive and completely unworkable. That is why we keep having to go back to the drawing board, and why the Government has deferred it and deferred it again.

Care organisations, unions and local authorities have united to condemn the bill. Even SNP Finance and Public Administration Committee members have suggested that the sums do not add up, and there are still hesitations and concerns among the members of that committee. It is no wonder that the bill has been pushed back three times. I put it to you, Presiding Officer, that we are only here now because the SNP is running out of parliamentary time to deliver on its flagship manifesto commitment before we rise for the next Scottish parliamentary elections. That is why we are here today.

Just when the sector needs clarity and support, the Government has embarked on a grand bureaucratic crusade that is characterised by confusion and chaos. It is form looking for function.

Scottish Liberal Democrats have always rejected plans for a ministerial takeover of social care, and we always will. We firmly believe that local authorities, care providers and those on the front lines are best placed to make decisions about how to implement and structure care services in their communities. We believe that power works best when it is as close as possible to the people whom it is there to serve.

However, there is yet more confusion around just what powers ministers would be given as part of the plans, with the committee report saying:

“It remains unclear to what extent Scottish Ministers will have similarly extensive powers with respect to the proposed National Care Service Board.”

The Government is all over the place on that.

Right from the start, things have not been done properly. The committee says that one of its challenges with the bill is

“the lack of available detail at the start of” its scrutiny. Only this morning, the minister circulated a target operating model for the national care service, which we have been waiting for for a long time. On the day that we are expected to vote on the bill’s general principles, we are given that. It is simply not the way that we should do things.

We are now forced to waste our time voting on a hollowed-out nothingburger of a bill that does zero to address the very real issues in social care—a bill that no one on the front lines wanted in the first place. It will not make care free at the point of delivery; it will not make care a profession of choice; and it will not relieve the interruption in flow that is currently causing a crisis in our NHS, because people cannot be released from hospital because there is no adequate provision in our communities to receive them.

Free up the funds of this billion-pound bureaucracy. Scrap the bill today and use the money to improve the pay and working conditions of our social care staff, whose selfless, quiet and heroic efforts often go unnoticed and unrewarded.

The Deputy Presiding Officer:

Mr Cole-Hamilton, you must conclude.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

That is what we should be focusing on today and not this ill-fated bureaucratic waste of time.

Photo of Emma Harper Emma Harper Scottish National Party

As a member of the Health, Social Care and Sport Committee who has been present during the entirety of the committee’s scrutiny of the bill and preparation of our stage 1 report, I welcome the fact that we are debating the bill at stage 1 today. I thank everyone who has been involved in providing evidence, the clerks and, of course, anyone who provides care for our people across Scotland.

We must remember that the bill is about a change that might be described as monumental, just as the creation of the national health service was. That was done through framework legislation, just like this bill.

The evidence that we have taken at committee has clearly demonstrated that the current social care landscape is cluttered and complex and that, fundamentally, it isnae working for those requiring care, who are some of the most vulnerable people in our society. The Parliament has a duty to those individuals to get the bill right and to create a social care system that meets the demands of our society and that is underpinned by the principles of human rights, respect and person-centred choices.

There is a need for standardisation of the social care system, employment practices, education for social care workers and social care standards across all of Scotland.

Photo of Gillian Mackay Gillian Mackay Green

Does Emma Harper agree that, as part of that, we must also look at self-directed support and how that is delivered across the country? When we look at the national care service as a whole, we need to ensure that it is about not just directly delivered services but self-directed support, too.

Photo of Emma Harper Emma Harper Scottish National Party

I will come on to self-directed support, but it is part of the complex landscape that needs to be reformed, so that we can make changes and help to support the most vulnerable people who need care.

It is clear from the evidence that one of the best ways to make the necessary changes is by reforming integration joint boards, as the minister set out to the committee. The committee has heard repeatedly from people with lived experience that the current adult social care system must change so that we can drive up standards to a consistent level across our country.

One of the ways in which it is intended that the aims of the bill be met is through the creation of a national care service board. The NCS board will ensure that consistent, fair and human rights-based social care support and community health services are in place. It will be responsible for reviewing and overseeing the performance of local strategic plans. To support that, the Scottish Government proposes to transfer ministerial powers of intervention to the board, which will be able to invoke them as a last resort. That will give the board the levers that it will need to drive and support performance, and—if required—to act.

As a former clinical educator and a nurse, I am interested in how the NCS board will help to standardise how we approach social care and social work and care across Scotland. Just this week, my office spoke to a local organisation that provides care across Dumfries and Galloway about the NCS board and standardisation, and it welcomed the approach.

Stewartry Care, which is one of the largest providers of social care in Dumfries and Galloway, gave evidence to the committee when we visited Dumfries. The other day, it told my office that, although it provides mandatory moving and handling training for its staff, much of the training that it provides on top of that is not mandatory. Stewartry Care also trains staff on how to assess nutritional status, and staff are educated on how to spot the signs and symptoms of malnutrition among those within their care.

However, as was evident from my meeting with the Food Train last week, the provision of such education is not universal practice. Many care providers do not offer such education or training, despite the importance of nutrition and the commitments in the Good Food Nation (Scotland) Act 2022 that was passed by this Parliament.

That is just one example of an area of education that would benefit from standardisation across Scotland. I ask whether the minister agrees with me and whether she will consider making nutritional monitoring one of the national standards as the bill progresses. I am not necessarily suggesting that it should be done in primary legislation; I am simply saying that we should consider it as we seek to make progress on standards.

I also want to touch on the commitment to establishing a national social work agency, which COSLA has agreed with. For the people who work in the social work profession and their leaders, the establishment of a national social work agency is a vital piece in the jigsaw of reform. As has been noted by Social Work Scotland, the current national arrangements for social work are messy and inefficient, with the Scottish Government, employers, the Scottish Social Services Council, Social Work Scotland, improvement bodies and many others all separately “leading” on aspects of social work’s development.

If we are to effect the changes in social work systems and practice that were outlined in the independent review of social care and the Promise, which the profession itself has called for, we need to create an enabling context. The national social work agency has real potential to address those challenges.

Dumfries and Galloway Council pays its social workers lower wages than any other Scottish social work department. That is why some of our social workers are leaving to go and work south of the border or in other parts of southern Scotland. That issue could be addressed by progressing a national agency.

Another example is that of self-directed support, which Gillian Mackay’s intervention was about. Different local authorities take a variety of approaches to the administration of SDS. While some perform really well, others perform less well. Therefore, I ask the minister to confirm that it is the Scottish Government’s intention for the national social work agency to deal with such discrepancies, to support the social work profession and to get it right for those who engage with social work.

It is clear that the bill is needed to improve the social care and social work landscape in Scotland. I will support the bill at stage 1, and I urge other members to do so.

Photo of Elizabeth Smith Elizabeth Smith Conservative

When a major committee of this Parliament concludes that it is concerned that the Scottish Government has, so far, been unable to articulate and communicate a model of how some proposed new legislation would operate, that is hardly a ringing endorsement. It is worse still for something that is supposed to be one of the most important pieces of legislation that the Parliament has seen.

Both the minister, Maree Todd, and First Ministers Nicola Sturgeon and Humza Yousaf argued that the National Care Service (Scotland) Bill was to be a flagship piece of legislation. Indeed, in their words, it was to be

“the most ambitious reform of public services since the creation of the NHS”.

That is quite a pledge. I do not doubt the Scottish Government’s ambition, but, in the usual way with legislation, particularly given the flagship nature of this bill, we should have had the right to expect a well thought-out, wholly coherent and well costed bill. We should also have had the right to expect a fully watertight scrutiny process that would give committees and parliamentarians the maximum opportunity to engage in detailed scrutiny, but that has not been the case. It is not the case with the structure of the bill and it is not the case with the costings, which I will come to in a minute.

The first iteration of the bill faced considerable criticism from no fewer than four parliamentary committees: the Health, Social Care and Sport Committee, the Local Government, Housing and Planning Committee, the Public Audit Committee and the Finance and Public Administration Committee. There was no clarity whatsoever about the related costs, which is why, as Kenny Gibson rightly said, the Finance and Public Administration Committee would not accept the first financial memorandum. It was also why the Delegated Powers and Law Reform Committee raised concerns. Just as importantly, the bill faced widespread criticism from local authorities and health service stakeholders. In short, the bill was in deep trouble last summer, including in the view of some SNP MSPs.

Given those circumstances, Maree Todd was well told that there must be a major rethink. What did we get? We got three changes to the bill, two of them very major. There would no longer be any transfer of local authority staff and assets, and there would be no new care boards for each of the 32 local authorities. To accompany those changes, there was a second attempt at a financial memorandum, which was marginally better than the first but still did not satisfy the Finance and Public Administration Committee, as its members have made clear.

There are also issues regarding parliamentary scrutiny. The Scottish Government has made substantial changes to the accountability and governance provisions in the bill, but it has not provided detail in the legislation of what those changes will look like. The finance committee has particular concerns about the lack of detail on the new national care board. The minister tells us that the bill is only a framework bill and says that she will share the detail of governance and accountability provisions should the general principles of the bill be agreed to, but that is unusual territory and is not something that we feel makes for good legislation.

Framework bills have suddenly become quite fashionable here. If I was being charitable, I would say that that is because of the principle of co-design, which allows ministers and stakeholders to work together to design bills. I will come back to that idea. If I was being less charitable, I would say that the Scottish Government is finding it impossible, for whatever reason, to produce the detail that Parliament needs.

If, as someone who has been here for a long time, I may be allowed to say so, having too many framework bills on the statute book presents a scrutiny problem. That might be an important issue to consider when the Presiding Officer looks at parliamentary reform, because, as Jackie Baillie rightly pointed out, we cannot have bad legislation.

The finance committee remains very sceptical about the co-design process—not in principle, because there are many good things about co-design, but because of the lack of estimates to allow measuring of the economic benefits as set against projected costs. It is also sceptical about how to measure the co-design costs at all, given that that process is still on-going. We feel that the co-design process should have been completed before the revised bill was brought to Parliament.

We know that having a framework bill has been roundly criticised by stakeholders and Parliament committees because of the lack of detail about what would appear in primary legislation and what might appear in secondary legislation. That is not good enough and it is why, during the first iteration of the bill, committees put their scrutiny concerns on record, with the DPLR Committee making what I thought was a revealing comment when it said that the Scottish Government’s approach is

“unacceptable and risks setting a dangerous precedent, undermining the role of the parliament.”

I will say that again. It risks

“undermining the role of the parliament.”

I have said before that I can remember occasions when there were issues with financial memoranda. The Children and Young People (Scotland) Act 2014 and college regionalisation are two examples, but they were not so out of kilter with the ambitions of the bill that was presented, so lacking in detail and so risky to taxpayers.

The Scottish Government, yet again, is guilty of negligence when it comes to the provision of baseline evidence to support the policy basis of a bill. One wonders how on earth ministers ended up in this situation.

Photo of Ivan McKee Ivan McKee Scottish National Party

I think that everyone agrees on the critical importance of social care. It is a requirement for more and more people in society, and that will continue, due to demographic changes. It has an impact on the wider health system and its lack can be a potential blockage in relation to delayed discharge and many other aspects of the wider system. So, it is critical that we get this correct, and I welcome the Government’s focus on taking this work forward.

There is a commitment to provide long-term sustainable solutions to the challenges that we face not just in Scotland and the UK, but internationally, and to build on the work of the Feeley review, which lays out clearly the steps that need to be taken.

I suggest that everyone can agree with the general principles that are articulated in the bill as introduced, such as the recognition that spending on social care is an investment in society; the need for financial stability; the commitment to fair work; the human rights focus; the importance of dignity, equality and inclusion; and the commitment to co-design. I think that, so far, everyone can absolutely sign up to those principles.

It is unfortunate that too much of the recent debate on the bill has focused on process. It is important that we recognise that process is there for good reasons. It is there to ensure that we make good legislation that delivers on the principles that are clearly articulated in the bill. It is important to get that right.

It has been recognised in the debate that the Health, Social Care and Sport Committee and other committees have identified uncertainties in the proposals that have been laid out, and significant changes have been made to the bill as introduced in order to arrive at the proposals that have been agreed with the Government, which the minister and COSLA have articulated over the past few months and which have been taken forward in the co-design process.

I very much welcome the provision by the minister and the Government of the target operating model, which came out in the past two days, and the fact sheet that was sent to MSPs alongside that.

Photo of Jackie Baillie Jackie Baillie Labour

I understand that the member has been asking for the target operating model for some time. Does he think that it is acceptable that it appeared only yesterday, when there was no time for committee scrutiny?

Photo of Ivan McKee Ivan McKee Scottish National Party

As Jackie Baillie identifies, the committee has been asking for that information for a while, and I am glad that it came out before the debate. To be fair, the Government’s commitment was that it would come out in advance of the debate, but we would obviously have liked more time for scrutiny, and I will come on to that as I continue my remarks.

I look forward to the Scottish Government providing stage 2 amendments by 29 March, as was asked for by the committee. That will enable the committee to undertake extended stage 2 scrutiny in order to meet the timetable that has been laid out. I am glad that the minister confirmed during the debate that the amendments will be lodged by that date.

I know that the Government takes the bill very seriously as a priority, and I understand that the team that is working on it now numbers 160 civil servants. We have been given assurances by civil servants that there is no lack of resource being deployed on developing those amendments and taking forward proposals to thrash out the details of the bill as amended.

I would like to focus briefly on the finance proposals in the operating model, which I have looked through over the past couple of days, and on the fact sheet that was provided and the minister’s responses. There is a commitment to have a clearer funding model with greater transparency, and there is a provision for ministers and the board to fund specific local activities directly in certain circumstances, but I would like clarity from the minister on that. That seems to suggest that the bulk of the funding—around £5 billion in total, I think—will continue to flow, as it does presently, either through health boards or through local authorities. Some clarity on that—on what is meant by the suggestion of greater transparency in the funding flows—would be helpful.

A key priority that is critical to get right for the whole sector is its pay rates. The commitment to, and delivery of, a minimum of £12 per hour is welcome, as it takes everyone to at least the real living wage and shows that the mechanism was already in place to deliver that in advance of the bill. That increase and future increases towards £15 per hour will help to tackle the sector’s major challenges in recruitment and retention, notwithstanding the impact of Brexit, immigration restrictions and the lack of devolution of immigration to Scotland, which have significantly hampered the sector.

We all recognise that that pay rate and the taking forward of the wider fair work agenda are absolutely critical. However, I make the point that that is not only to the benefit of the staff and those who are served in the social care sector. Because of the scale of that sector, any additional pay increases that are delivered to its workers have a wider economic benefit not just in how that money is spent, but in driving the labour market in the private sector to increase wages across other sectors that, unfortunately, still suffer from low wages. I suggest that that is one of the most cost-effective ways in which the Government can tackle poverty across society more generally.

In conclusion, I hope that the debate can now move on to issues of substance in the Government’s proposals and to amendments to the format of the delivery of the national care service. I look forward to the details of the Government’s main amendments—as do stakeholders, so that they can take their positions on those—and I look forward to the further evidence that we will take at stage 2 and our engagement with stakeholders on that. I welcome the Government’s commitment to supporting the committee and others in that work, because, as I said at the outset, it is critically important that we get this right, to deliver for generations now and into the future.

Photo of Carol Mochan Carol Mochan Labour

I thank the clerks and members for their participation in the process. The establishment of a national care service gives the Parliament the chance to be bold, ambitious and innovative. Members should take seriously that opportunity and the responsibility that comes with it, and act in a way that our constituents would expect: that is, to read the report, act with conscience and truly decide whether the bill should progress to the next stage.

I am extremely disappointed by the Government’s approach to the progression of social care—and definitely by its approach to the progression of the national care service. I am disappointed in its unwillingness to co-operate and its inability to work with people to enhance what is a crucial piece of legislation. The minister’s contribution at the start of the debate is not based on the reality of the past 10 years.

When it was clear that the bill was not ready to proceed—a view that I am sure was held by many SNP members on the committee—the Scottish Government pushed those members to carry on and progress the bill. Again, last night, it pushed its members to vote against a sensible proposal to refer the bill back to the committee. The contribution from Ivan McKee shows that some people on the committee are considering the points in hand. If the bill moves to stage 2, I hope that we can work together. I mean that genuinely.

The opportunity to improve the bill—to extend stage 1 and to take more time—was made available to the committee by Labour members. The report confirms that. However, sadly, the SNP and Green members did not take that opportunity. The report that they pushed through includes a Scottish Government and COSLA deal that was not properly scrutinised, agrees general principles that have changed significantly from those that were originally set out, and is absolutely laden with requests for more evidence and further information. Anyone who reads the report will see that.

Suggestions that the report, or the evidence in it, portrays a positive outlook on the Government’s approach is absolutely absurd. Trade unions, third sector organisations, carers and those who receive care came to committee, and to members individually, to express serious concerns about the way in which the bill was progressing, its framework nature and the lack of clarity about things that could, ultimately, be done now, but the SNP ignored them and kept pushing on anyway.

Roz Foyer, in speaking about the commissioning service that the bill proposes to set up, said:

“Our fear is that the sort of commissioning system that is being set up will neither address nor take forward fair work and collective bargaining issues in a way that gives us any surety”.—[

Official Report


Health, Social Care and Sport Committee

, 15 November 2022; c 35.]

Indeed, after the Government took many steps that ignored the co-design process, Rachel Cackett of the Coalition of Care and Support Providers in Scotland summed up well the feeling that many hold, when she said:

“there is not, in my view, a great sense that there is a clear connection between what is being heard and what is being delivered through the bill.”—[

Official Report


Health, Social Care and Sport Committee

, 31 October 2023; c 31.]

Those are quotes from the Scottish Trades Union Congress and the CCPS. If the Government is not listening to them, many will be asking who it is actually listening to.

The Government has been irresponsible at a time of critical importance, and it has played games with a crucial bill. Labour has been calling for a national care service for years, because if that is delivered properly, it will deliver the much-needed parity between health and social care, and it will deliver for workers, carers and service users. However, the Scottish Government, if it continues in its current direction, will make that proper and effective delivery highly unlikely. It is certainly not clear in the bill how the Government will deliver on those aims.

The Scottish Government would have the public believe that in order to deliver Anne’s law, for example, we need a national care service, in contrast to the view of those of us who are fighting to improve the bill in order to deliver on its full potential. The Government’s view could not be further from the reality. It is a Government that has a distant relationship with delivery, and which has sat on its hands rather than deliver key policies. Anne’s law could be delivered—I ask the minister to address the question that my colleague Monica Lennon raised and to be clear that the Government will seek to ensure that that Anne’s law is considered in other legislation as soon as possible. That would be supported by members on all sides of the chamber.

Throughout the committee process, my colleague Paul Sweeney and I called for an expert advisory board—something that is not uncommon—but the SNP rejected that suggestion. We called on the Government to bring forward its amendments before the conclusion of stage 1 to ensure that proper scrutiny could take place, but that was rejected by the SNP. We called for the bill to be referred back to committee after third sector organisations, trade unions and many other stakeholders said that it was not clear, but that, too, was rejected by the SNP.

Despite the minister’s warm words, the SNP does not seem to be standing up for care in Scotland—in fact, it is standing in the way. As the stage 1 report makes clear, the SNP’s stubborn approach has proved exactly that.

It is with great regret, for the reasons that I have outlined, that I will not support the bill in its current form at stage 1.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

The National Care Service (Scotland) Bill offers us the opportunity to build care services that truly reflect our shared values of dignity, fairness and respect for all people. It gives us a chance to end postcode lotteries and the rationing of care, and it should lead to more person-centred care and more independence for people.

The debate around the bill has concentrated heavily on power, process and pounds. Those issues are important, but the overarching priority of all that we have embarked on has to be people. We need a national care service that leaves no one behind, and that works relentlessly to support not only those who are in need of care but their families, and the care workers who make it all possible.

Photo of Jeremy Balfour Jeremy Balfour Conservative

What one difference will the bill make to somebody who is in receipt of social care today or tomorrow? What one difference will it make to their life?

Photo of Kevin Stewart Kevin Stewart Scottish National Party

It will make a difference through having a care service that is not only fit for today but is right for tomorrow. I know that the minister is working with great effort on today, but this is about the future, as well.

With an ageing population, we have to ensure that we get this absolutely spot-on right.

The need for reform of our current care system is undeniable. The disjointed and inconsistent nature of our existing system all too often leaves many people without the support that they desperately need, and that often leads to crisis for folk and their families, which is expensive and has a massive human cost. Everyone, regardless of their postcode, should have equal access to the social and healthcare support networks that they require, with national quality standards that must be met. The bill presents us with a chance to make that a reality.

At the heart of the bill lies a vision for a more integrated and streamlined service in which there are resources, standards and expertise across Scotland, to ensure greater fairness and accessibility for all. We need to focus on self-directed support, independent living, the right to short-term breaks, Anne’s law and autonomy for front-line staff. However, the focus has drifted away from those, and process and organisation have taken centre stage. They are important, of course, but we cannot become sidetracked, as that risks the bill simply becoming a rebranding exercise.

This is all about people and their needs, their hopes and their independence. The needs of people must come before the wishes of the bureaucrats, the politicians and those with vested interests who do not want to see any change at all. The service must be a people-led one and not simply a service that does things to people.

I am glad that the minister mentioned that there will be voices of lived experience on the national care board, but I also want to see the voices of lived experience on integration joint boards. I hope that the minister will tell us more about that in summing up.

Fair work also needs to be at the heart of the change. Care workers must be treated as the professionals that they are. We know that, where they are given autonomy, we get better outcomes for those who are in receipt of care and their carers. Similarly, we need to accept that we rely on an army of unpaid carers who support family and friends. I recognise that this Government has gone further than any other in these islands to support those heroes, but the right to short-term breaks is vital and must be enshrined in law.

At any one time, one in 25 Scots will need social care support. Most of us here have had support or will need support in the future. We need a social care system that is not only right for today but is fit for the future.

I recognise that change is often disconcerting, but change is required here. Derek Feeley has told us so, many front-line staff have told us so and, most important, people have told us so. People who are in receipt of care and their carers want to see change, and they want to see change now.

The reform is the most important and ambitious reform that there has been since the formation of the national health service, which is our most valued institution. The national health service came about through a framework bill, so I do not know what the difficulty is with framework bills. It is time that we replicated that valued institution and matched it with a national care service that works for people. Let us stop the dither and delay and get on with creating a national care service that meets the needs of all our people.

Photo of Gillian Mackay Gillian Mackay Green

As a member of the Health, Social Care and Sport Committee, I echo my colleagues’ thanks to the clerks and those who gave evidence to the committee.

There is no doubt that there are glaring inequalities in social care across the country. The independent review of adult social care outlined significant challenges in the Scottish social care system. The review questioned the effectiveness of local authorities’ commissioning practices and a structure that is based on time rather than outcomes and is not responsive to people’s wants and needs.

The National Care Service (Scotland) Bill is intended to put human rights at the centre of services. Many have welcomed the opportunity to end the postcode lottery in social care and establish standardised delivery practices across Scotland. There are several aspects of the bill that I think most members agree on. We all welcome Anne’s law. We are supportive of the provisions to provide family members and other carers with the same access rights as staff. I am grateful to have met those who were campaigning for Anne’s law outside Parliament earlier in the bill’s progression. Their stories were traumatic and we should ensure that such things can never happen again.

Photo of Emma Harper Emma Harper Scottish National Party

On Gillian Mackay’s point about Anne’s law, I note that the committee took evidence from people with lived experience, the Scottish Association for Mental Health and the Health and Social Care Alliance Scotland, and they all supported our getting on with the bill and taking it forward. Is that also Gillian Mackay’s reading of the evidence that we took from them?

Photo of Gillian Mackay Gillian Mackay Green

Absolutely. I thank Emma Harper for mentioning SAMH in particular because, for many of those carers, the mental health aspect—the trauma of being unable to get to their loved ones—exacerbated the situation, and that led to the want and need for Anne’s law in the first place.

As I have said previously, although I appreciate that Anne’s law is currently proposed to relate only to social care settings, given what many people, including me, experienced during the pandemic with loved ones being in hospital, I believe that it should be extended to cover those settings, too.

We also all agree on the creation of a right to short breaks for carers. However, the appropriate monitoring will need to be in place to ensure that it has the desired effect and is delivered consistently across the country and, crucially, to carers of all ages. As co-convener of the cross-party group on carers, I note that we have heard about the difficulties that some carers face in knowing where to go for support and help or because they have not been identified as a carer in the first place. I hope that that will be factored into the on-going work on the bill.

The general principles of the bill mark a shift in the way in which care is considered. We particularly welcome the positive language on the value of care. It describes care as “an investment in society”. Meeting the aspirations in the bill, such as recognising that meeting individuals’ needs is essential to achieve their human rights and that fair work principles should be key to the delivery of services, is essential if we are to change the way that care is currently delivered.

We have heard from many organisations and individuals about the appetite that many have for change and reform of social care. The bill lays the foundations for a national care service, allowing for a big part of the substantive detail to be co-designed with people who access support, those who deliver it and unpaid carers. I have been clear in committee that we need to ensure that that is done in a sustainable manner for those who are involved in the co-design process. There are a huge number of workstreams and we need to make sure that those who give their experience are supported to do so without there being a detrimental effect on them.

Structural reorganisation will go only part of the way towards realising the ambition of change and reform in social care. Delivery and implementation of change is vital both locally and nationally if we are to make a real difference to social care. That will also have to be carefully monitored to ensure that it has the desired outcomes.

Although framework bills are difficult to scrutinise, I believe that one of the bill’s potential strengths lies in the fact that it is a framework bill. I believe that it is right to analyse the impact of reform and then adapt what is in the secondary legislation to improve outcomes, correct any unintended consequences and adapt to new circumstances, with appropriate scrutiny mechanisms attached.

We must be wary and note that having a legal duty to collaborate will not in itself lead to effective collaboration. Much of it will rely on consistent leadership and cultures across health and social care, which we have heard are not the reality everywhere.

Whereas the engagement on the bill’s general principles has been positive, we heard in committee that concerns remain about how some of them would be achieved in practice.

If we want the national care service to be as successful as possible, we must ensure that it is viable and that it addresses the issues flagged at stage 1. I welcome the committee’s commitment to a more in-depth stage 2 process and look forward to hearing more evidence from organisations and individuals on any potential changes. Several important stakeholders who have recommended that the bill passes have also been clear that there are substantial amendments to be made at stage 2. For example, the Health and Social Care Alliance Scotland recommends amendments that support the full and equal membership of people with lived experience in reformed IJBs and on the national care service board. That would include being given full voting rights and a duty to include multiple members with lived experience if any meeting is to be considered quorate. I also believe there should be workforce representation on the board.

There is very little time to get through everything that I would have liked to get through, but the establishment of a national care service must be informed by the voices of lived experience, including those who access support and care, the workforce and unpaid carers.

The national care service offers an opportunity to improve people’s experiences of rights-based, person-centred social care, if it is implemented in a way that responds to the concerns and experiences of people who are accessing social care as well as the workforce, and if it implements the recommendations of the independent review of adult social care.

Photo of Jeremy Balfour Jeremy Balfour Conservative

I declare that I am in receipt of social care.

In many ways, politics should be about prudence. One philosopher famously said that he prefers

“the actual to the possible”.

That is a much better philosophy for conducting our politics than aiming for something that may seem good in principle but would crumble in practice. We owe it to individuals, carers and taxpayers to be prudent when making policy, which is why I am in favour of reforming our current social care system rather than building something completely new. We must acknowledge that the respondents to the consultation on the bill have real concerns about social care, and we must listen to their lived experience. To diminish their experiences would be very wrong. However, that does not mean that the only way forward is wholesale change.

We all want a more efficient social care system in Scotland, but the underlying issues will not be addressed by structural change alone. Consultation responses show that the main difficulties in social care are challenges such as finding sustainable funding and hanging on to good staff. Those kinds of problems will remain, regardless of whether a national care service is implemented. Until we address the root issues, it would be much better to target those problems and reform what we have, rather than undergoing a complete overhaul.

The bill does not honour either those who receive social care or those who work in social care. It lacks essential detail, which makes our jobs very hard, as the policies are impossible to scrutinise properly. Key specifics of the bill rest on secondary legislation. We cannot know what the bill will mean for people living their lives, today and in the future. For example, there is no explanation of how the bill will affect relationships with existing local social care structures, or for how a national care service could be equipped to respond to local concerns. In addition, areas such as data, employment implications and individual rights and responsibilities are all left completely to secondary legislation. Those are hugely important areas that should be addressed in primary legislation in order to guarantee full parliamentary scrutiny. Securing those details in primary legislation would not diminish the ability to be responsive and flexible during secondary legislation. However, it would give us as parliamentarians and those who we represent confidence that the bill has the appropriate, required powers.

Social care cannot wait for the national care service; decisions need to be made now—it is too important. The bill as it is presented is distracting us from solving the real problems that we have that people such as myself and others across Scotland live with, day in and day out.

Nor does the bill guarantee meaningful accountability from Government ministers. There is no provision on how the principles underlying the national care service will be monitored, evaluated or enforced. Section 2(2) of the bill says:

“Everything that the Scottish Ministers do in discharging that duty is to be done in the way that seems to them”—

I emphasise the words “to them”—

“to best reflect the National Care Service principles.”

Ministers will therefore become judge and jury.

It is even more important that there be effective metrics for success. I am not convinced that a centralised service will provide better care than is currently offered locally. A centralised body cannot know the exact situation of every community in Scotland. We live in a diverse country, with diverse needs. The concerns of care workers and people who need care will be very different depending on where they live in the country. The situation cannot be the same up in the north of Scotland as it is here in the central belt. The issues for those of us with rural constituencies will be different from those for members who represent urban constituents.

There is no value for money for the taxpayer in the bill. The effect of centralising social care is that organisational and administration costs will balloon and become much more unwieldy than they are currently. The result will be a dramatic increase in bureaucracy, which will do nothing for efficiency and, crucially, will do nothing for those who need or who provide care. Those funds would be better off going to social care workers on the front line instead of going into a bottomless pit of bureaucracy.

I will not support the bill at stage 1. It does not tackle the current challenges in social care effectively. It is an enabling bill, but it does not provide the level of detail that is required to stand up to parliamentary scrutiny. There is no provision in it for accountability; matters are left to the subjective judgment of Government ministers. Finally, the bill will not give taxpayers value for money.

Photo of Colin Smyth Colin Smyth Labour

At the height of the Covid pandemic, rarely a day passed without constituents raising with me their heartbreaking experiences of not being able to visit loved ones in care homes, because we did not get our act together on testing; social care packages being removed; people feeling pressure to sign “do not attempt resuscitation” forms; care home staff being frightened because they had no personal protective equipment; and the appalling death rate among people in later life. The human rights of older people were cast aside when the big decisions were being made.

Nicola Sturgeon promised to build from the Covid crisis the positive legacy of a national care service. It was to be a chance to put social care on the same level as our NHS, to create parity, and to ensure that services were fully funded and properly staffed, met national standards, were delivered locally and were accountable to local people.

However, the Scottish Government has squandered that promise with the bill. We know that it is obsessed with framework bills—or, rather, empty-frame bills—but, even by its standards, the bill is ill judged, ill thought through and incoherent.

The bill has been almost universally criticised. For example, Unison, Unite, the Royal College of Nursing Scotland, the Royal College of Physicians and many others support the creation of a national care service but are opposed to the bill’s provisions. Care providers and people with lived experience, Audit Scotland and the Convention of Scottish Local Authorities have all been scathing, and so, too, have been the Parliament’s committees.

The Local Government, Housing and Planning Committee called for the submission of a full business case before the bill was voted on, but that has not happened; the Delegated Powers and Law Reform Committee said that the bill undermined the role of Parliament; and the Education, Children and Young People Committee slammed moves to centralise children’s services that are still on the cards. The Finance and Public Administration Committee said that the lack of a credible financial memorandum breached the Parliament’s standing orders. As Jackie Baillie said earlier, that committee has looked at the bill twice and it still does not believe the numbers. Even the Health and Social Care Committee, in its watered-down stage 1 report, is unclear about how the Government’s national care service would operate in practice.

It is no wonder that that is the case. Private profiteering from big care home owners, inadequate funding, high vacancy rates, low pay, poor terms and conditions and the absence of sectoral collective bargaining have all been ignored in the bill and ignored, too, by the minister during the debate.

There is a lack of detail, big questions remain unanswered and many issues are unaddressed. Common Weal’s briefing to MSPs highlights several glaring examples of that, and I will mention just a few. The briefing says that there is no clear purpose statement that sets out the need

“for creating a national care service in the first place” and that there are

“no provisions for how resources will be determined or allocated”.

Common Weal also says that there is little clarity on who will be responsible for delivering or enforcing the crucial human rights-based approach, nothing on transitional arrangements and little on fair work principles, including national terms and conditions.

Despite that, the SNP and Greens, as in a 1960s movie, are determined to carry on regardless, but there is nothing funny about proceeding with a bill that is so fundamentally flawed. If the Government was serious about salvaging the wreck and building consensus, it would have published its planned amendments before today’s debate.

Yesterday, the bill should have been referred back to the Health, Social Care and Sport Committee to revisit stage 1 and properly scrutinise the amendments and to allow those of us who are not on the committee to debate what might be fundamental changes before we vote on the bill’s principles. Either the amendments do not exist or the Government knows that they will not allay the legitimate concerns. It is not good enough for ministers to slip out an operating model that no one has seen, never mind scrutinised, ahead of the debate.

Meanwhile, the crisis that is engulfing our social care continues. When Age Scotland wrote to the cabinet secretary recently, it rightly said that older people

“cannot wait for the delivery of the National Care Service” to fix a care system in which delayed discharge continues unabated, people are struggling to get a care assessment, more and more care homes are closing—one a week, according to Scottish Care—and older people are stuck in hospital because of a lack of carers. Ivan McKee said that about 160 civil servants are working on the bill. That is about the same as the number of vacancies in the care sector for home care workers in Dumfries and Galloway. The Covid crisis has been replaced by a care crisis. We need action now—not in four years’ time—on matters including Anne’s law and the right to breaks.

The SNP and Greens have cynically chosen to tie people’s rights to see loved ones in care homes, as well as the right to respite, to this roundly rejected bill. It is simply untrue to argue that those rights can be delivered only through the bill. The Government should get on with fulfilling its promise to families who were badly let down during the pandemic.

The mishandling of the bill has been a complete distraction from delivering on those and other social care issues, but it is symbolic of the Scottish Government’s approach to policy and legislation over the past 16 years, which is to issue a press release full of hyperbole, dismiss stakeholders’ concerns, steamroller legislation through Parliament and leave the details until later. The sad thing is that that impacts on people’s lives. It means that vulnerable members of our society—mainly older people—who need support will not get it.

The Scottish Government’s so-called national care service plans were launched to much fanfare and were described as the biggest public sector reform since devolution. Parallels were even drawn with the creation of the NHS after the second world war, but just saying something in a press release does not make it so. The creation of the NHS in 1945 was real public sector reform. It replaced a broken private healthcare system with a universal, comprehensive service that is free at the point of delivery. It had a transformational impact on working people’s lives and still does today. The SNP’s plans are pale in comparison and, to be frank, the bill is not worthy of the title “National Care Service”.

Photo of Ruth Maguire Ruth Maguire Scottish National Party

The establishment of a national care service can be one of the most significant reforms of public services since the creation of the national health service. The significance of that work is reflected in the volume and breadth of contributors to the Health, Social Care and Sport Committee’s scrutiny and in the number of briefings that colleagues have received for the debate. I am grateful to everyone who continues to share their experience and expertise.

It is fair to say that the case for change in social care is unassailable and that everyone agrees that it is necessary. The committee certainly heard that loud and clear. There is a need for all our citizens to have access to consistently high-quality social care support across Scotland, whenever they need it.

I am sure that we all want our social care workforce to flourish and would support the Scottish Government’s goal—of future proofing the social care sector—to be realised for generations to come and for people who are coming into the profession.

I have not been a member of the Health, Social Care and Sport Committee for long but, through previous work as a local councillor and a member of an integration joint board, in previous and current parliamentary committee work and—perhaps most significantly for me—in my current constituency work, I recognise the importance for our nation of getting care right and the devastating costs to individuals, families, workers and communities when we do not.

Here in Scotland we have a brilliant, committed workforce in the public and third sectors and a legion of unpaid carers who are delivering high-quality care to the best of their ability in some terribly difficult situations. We also have pockets of really excellent practice and services that enrich lives.

However, there are also far too many people whose needs are not being met. Too many people are in hospital wards when they should be at home, recovering. Too many people are waiting for adaptations to their homes to make them safe and enable them to live independently with dignity. Too many people are assessed as requiring services and interventions to realise their human rights but not receiving them because of budget constraints, distance from services, workforce shortages or rigid, inflexible approaches by institutions. To change those things, I support the principle of forming a national care service for Scotland to ensure that our citizens get the care that they are entitled to in order to live dignified lives and to ensure that, when public bodies do not meet their obligations, they are held to account.

The convener of the Health, Social Care and Sport Committee, Clare Haughey, laid out well the huge amount of work that the committee undertook to scrutinise the principle of forming a national care service and thanked all who were involved. I echo those thanks. The committee’s report is lengthy and substantial, with the summary of recommendations alone running to 15 pages. I do not intend to go through them all in my speech.

There has been a lot of discussion about scrutiny. Seven committees have reviewed the bill in the 20 months since it was introduced, and the Scottish Government has met thousands of people to discuss the national care service. I am serious about my responsibilities as a parliamentarian and of course I think that that process is important, but I agree that we will let folk down if we allow ourselves to get too tangled up in procedural delay rather than get on with the important work of scrutiny and amendment of the Government’s bill.

Committee members now have the requested target operating model, and I understand that committee clerks and Scottish Government officials are in the process of discussing stage 2 amendments to ensure that sufficient time is built into the timetable to allow for scrutiny and further evidence to be taken. I know that every member of the committee will approach that task with the vigour and sincerity that it requires.

I acknowledge that the committee was not united in its conclusions and that the support of members who did not dissent was not unconditional. The report reflects that, and the debate has given us all an opportunity to expand on the personal positions that we hold.

There is a great deal of work to be done at stages 2 and 3 to ensure that the bill achieves its potential. For me, one of the key points relates to accountability. Supporters of a national care service, and perhaps particularly those with lived experience, will want to know exactly what will be different and that, as part of that, the national care service will have clear accountability and a fair escalation and redress process for when things do not go right. Should Parliament agree to the general principles of the bill this evening, I hope that we can all come together and make sure that these important reforms are the best that they can be for the people of Scotland.

Photo of Alison Johnstone Alison Johnstone Green

We move to closing speeches.

Photo of Paul Sweeney Paul Sweeney Labour

At the outset of the debate this afternoon, the minister said that we need change—Labour members certainly agree. However, as GMB Scotland’s secretary, Louise Gilmour, said, the

National Care Service is going nowhere slowly”.

As my colleagues before me have set out, it is—because a national care service has been a long-standing policy position of our party—a matter of sincere regret that Labour will not be able to support the general principles of the National Care Service (Scotland) Bill this afternoon. It was an idea that was proposed by the Labour Party more than a decade ago, and it was a matter on which consensus emerged in the wake of the Covid-19 pandemic.

As my colleague Mr Smyth just said, that there should be parity of esteem between the national care service and the NHS is a clear mission statement that we can agree with. However, as with many good ideas, when they reach the hands of the Scottish Government, they seem to have gone there to die.

Photo of Kevin Stewart Kevin Stewart Scottish National Party

Mr Sweeney says that it is with regret that he will vote against the bill at stage 1. How much engagement have he and his colleagues had with the Government on the national care service?

Photo of Paul Sweeney Paul Sweeney Labour

I can say that in committee we have tried repeatedly to engage constructively with Government ministers. That holds for two committees of which I have been a member in recent times, including when Mr Stewart was the Minister for Mental Wellbeing and Social Care. He came before the Delegated Powers and Law Reform Committee and made the repeated dubious assertion that framework bills are a matter of normal practice and that the National Health Service (Scotland) Bill of 1947 was a framework bill. I am afraid that the Hansard Society disagrees with him: the National Health Service (Scotland) Bill of 1947 was around twice the length of this framework bill, so I have to dispute his point on that.

Critical and fundamental issues with the bill remain outstanding. Indeed, in an effort to repair relationships, including by addressing key stakeholders’ derision of the draft legislation, the Government has been trying to run a public relations offensive over the past 24 hours. I have had sight of a just-published PR statement from the Government, stating:

“the National Care Service will provide support to anyone in Scotland who needs it through social work, social care support for carers, primary care and community health services”.

Then at the end, the press release says:

“the bill allows Scottish ministers to transfer social care responsibility from local authorities to a new national care service. This can include adult and children’s services, as well as areas such as justice and social work. The Scottish ministers will also be able to transfer healthcare functions from the NHS to the proposed national care service”.

Well, which is it? We are not getting clarity on the definition, even within the same press release. Is a comprehensive service being proposed, or are Scottish ministers still undecided about what will happen with children’s services, justice services, social work and so on? There is simply no definition. We do not have confidence in the draft legislation, at stage 1.

We hoped that the Government’s National Care Service (Scotland) Bill would provide the transformation that has been alluded to by members on the Government side today, but the reality is that the framework bill, as published, no longer reflects what the bill will become. It is a travesty and a usurpation of the parliamentary process.

The Conservative spokesman made the point that the Law Society of Scotland raised concerns about the tendency towards skeleton bills, as did the Hansard Society. I mentioned earlier the concern that was raised by the Delegated Powers and Law Reform Committee on the same matter—that such a bill risks undermining the role of Parliament. Ms Mackay of the Scottish Greens said that, in framework bills, the potential exists for flexibility. I note that point, but the reality is that that does not preclude us from defining key aspects in the bill and creating a baseline. That requires ministerial leadership and heft from the Government. The mission orientation that we saw from the Government of 1945 that built the national health service is, sadly, sorely lacking 75 years on. That is what we need today—what is there is not good enough.

We need to be clear that we take no joy in not being able to support the bill at stage 1, because we have engaged throughout the process in good faith. I am sure that all members of the Health, Social Care and Sport Committee can agree that we very reluctantly had to part on that final page of recommendations, but we were largely together on a lot of the substance. It is a fact that there are fundamental issues to do with lack of definition, which mean that the bill is simply not good enough or mature enough to pass Parliament at this stage. The role of Parliament is to stand up for the people of Scotland and to ensure that the legislation that is passed into the statute books is of good enough quality to ensure that people’s lives are improved. We cannot have that confidence in the bill, at this stage.

There are major issues with stakeholders, as I have mentioned. As my colleague Carol Mochan outlined in her speech, the STUC says that

“the Bill as proposed does not address the key issues that undermine the provision of social care”.

The Royal College of Physicians says that

“serious concern must be given to whether we continue with the current proposals”.

The Royal College of Nursing says that it is

“extremely concerned that pushing ahead with the current bill will deepen the crisis”.

Stakeholders have come back to tell us that the co-design process, which is much lauded by the Government and which we would like to support in good faith, has had no transparency and no common reference points. The Coalition of Care and Support Providers in Scotland has said that there is no clear connection between what is being heard and what is being delivered in the bill. That was characterised by the member for Aberdeen Central’s speech—the text of the bill, which we have interrogated in committee, also uses grandiloquent language but, sadly, no real substance is reflected in it.

That is why, with great reluctance we fundamentally cannot support the bill. I mentioned that we had, in 1947, a bill for the national health service of 81 sections and 90 pages. This bill, of 38 pages and 48 sections, simply falls far too short, so I urge parliamentarians to reject it at stage 1.

Photo of Tess White Tess White Conservative

I have been a carer myself. No one should underestimate the importance of our social care system for the physical, social and emotional wellbeing of society. However, as we have repeatedly heard this afternoon, social care is at breaking point under this SNP Government, and vulnerable people are on a precipice.

As Jeremy Balfour rightly says, social care cannot wait for a national care service; it is too important. In 12 years, one in four people will be over the age of 65, which means that more people living with complex health and care needs will be accessing a system that is already in crisis. From staffing levels to care home closures, there simply is not the capacity to meet growing demand.

Of course, reform is needed. The system cannot sustain itself like this, and there is consensus this afternoon around that point. However, how that change will be achieved is a separate and, clearly, contentious question. The Feeley review put forward a new approach. The Scottish Conservatives supported many of the report's recommendations, but we do not agree with the top-down concept of centralising social care. We want to see urgent investment in the sector, to preserve local democratic accountability through a local care service and to avoid any unnecessary structural reforms.

In ordinary circumstances, it would simply be a matter of divergence of policy between political parties, but these are not ordinary circumstances—far from it. The stage 1 deadline for the National Care Service (Scotland) Bill has changed four times since the legislation was first introduced in June 2022. The implementation date has been kicked down the road by three years, from 2026 to 2029. Spiralling costs show that the Government is making it up as it goes along—with figures of £2.2 billion and, today, £345 million, not to mention the millions spent on the army of civil servants who are trying to keep the proposals afloat.

How can you cost something if you really do not know what that something is? The goalposts keep changing. As my colleague Liz Smith highlighted, no fewer than four parliamentary committees roundly criticised the first iteration of the framework bill. They pointed to serious issues about the lack of consultation and detail in the bill and significant concerns in relation to the costings. They said that the process set out in the bill is insufficient to allow for appropriate parliamentary scrutiny and that it

“risks setting a dangerous precedent, undermining the role of the parliament.”

Ruth Maguire today called it a “can be”. SNP MSP Michelle Thomson said in a meeting of the Finance and Public Administration Committee that she had “no confidence whatever” in the level of detail found in the NCS bill financial memorandum. SNP MSP Kenneth Gibson said that introducing the plans was

“a sledgehammer to crack a nut” and

“a monumental risk”—[

Official Report


Finance and Public Administration Committee

, 25 October 2022; c 24.]

That is hardly a ringing endorsement from the SNP back benches—[



The Presiding Officer:

Let us hear the member.

Photo of Tess White Tess White Conservative

Last summer, a controversial backroom deal on shared accountability arrangements between the Scottish Government, COSLA and the NHS was supposed to provide greater clarity on the bill, according to the disgraced former health secretary, Michael Matheson.

Photo of Michelle Thomson Michelle Thomson Scottish National Party

On a point of order, Presiding Officer.

I was unable to intervene on Tess White, but the record should be accurate. The quote that Tess White states that I made is correct, but it relates to the first financial memorandum. I want to make it clear that, in my opinion, the Scottish Government went away and did a great deal of work on the subsequent financial matters. Therefore, it is disingenuous of Tess White to quote me in that way.

The Presiding Officer:

Thank you, Ms Thomson. I am sure that all members will be aware that the content of members’ contributions is not generally a matter for the chair. Members will be aware, too, of the mechanism that can be used where any inaccuracy exists.

Photo of Tess White Tess White Conservative

Thank you, Presiding Officer. I am pleased that Michelle Thomson said that that was a correct quote.

From the Royal College of Nursing to Unison, and many more besides—[



The Presiding Officer:

Let us hear Ms White.

Photo of Kenneth Gibson Kenneth Gibson Scottish National Party

On a point of order, Presiding Officer.

Clearly, the member is trying to mislead the chamber. I, too, made such comments about the first iteration of the financial memorandum. The member should be clear about that to the rest of the chamber.

The Presiding Officer:

I refer back to my previous response, Mr Gibson.

Photo of Tess White Tess White Conservative

Thank you, Presiding Officer. I wish that there had been as much clarity and scrutiny at stage 1. It shows that my colleagues can scrutinise when they need to do so.

From the Royal College of Nursing to Unison, and many more besides, stakeholders are clear that developments last summer have breached their trust and muddied the waters even more. The National Care Service (Scotland) Bill has been touted by the First Minister as the most ambitious reform of public services since the creation of the NHS, but it has been a masterclass from SNP ministers in how not to legislate, and it is a dog’s dinner. The party of the defunct Gender Recognition Reform (Scotland) Bill, the delayed deposit return scheme and the dormant Hate Crime and Public Order (Scotland) Act 2021 has struck again. This is not just about policy but about process, and that process is a sham.

Today, Gillian Mackay asked Emma Harper about self-directed support. That is just the kind of issue that needs to be ironed out in advance of the parliamentary passage of the bill. We are in the extraordinary position of being asked to agree to the general principles of a framework bill that has changed so significantly that we do not know what we are voting on. As Ivan McKee pointed out, it was yesterday—he did not say “only yesterday”, sadly—that a model was shared, which was a week after the committee finalised its report. If no one is alarmed, they should be. It is disrespectful to the parliamentary process.

I think that we all agree that the Health, Social Care and Sport Committee’s stage 1 report is well written. However, as Dr Sandesh Gulhane emphasised in his remarks, that SNP-Green majority committee has ultimately nodded the bill through with too many unanswered questions. I have outlined two examples. There may be caveats and conditions in the report that support that, but there are no consequences. That is not a threshold of scrutiny that the Scottish Conservatives can get behind.

Photo of Tess White Tess White Conservative

You had your chance, and you did not say anything during the committee process.



The Presiding Officer:

Always through the chair, please.

Photo of Tess White Tess White Conservative

The social care sector is deeply concerned that the bill is becoming a battleground. We cannot lose—

Photo of Clare Haughey Clare Haughey Scottish National Party

On a point of order, Presiding Officer.

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 Presiding Officer:

That is the very point that I just made, Ms Haughey.



The Presiding Officer:


White, I am aware of some comments being made, but I cannot hear them clearly. I am aware of comments being responded to. Again, I underline the need for all members, at all times, to treat one another with courtesy and respect, and to remember that as we go about our work in the Parliament.

Photo of Tess White Tess White Conservative

The social care sector is deeply concerned that the bill is becoming a battleground. We cannot lose sight of those people who require care, nor of those people who work so hard to provide it. Ramming legislation through on a wing and a prayer will serve no one, especially the taxpayer, who keeps picking up the SNP’s legal bills when it eventually and inevitably goes wrong.

For those reasons, the Scottish Conservatives cannot vote for the general principles of the bill at decision time, and I urge other members to do the same.

Photo of Maree Todd Maree Todd Scottish National Party

I close the debate by thanking everyone for their contributions. Social care and community health services in Scotland need reform urgently. We know it, our stakeholders know it and the thousands of people who are impacted by social care who have spoken to us know it. I believe that all of us in the chamber know that, too. Although we are working hard to implement changes now, we need longer-term, widespread reform to fix some of the issues that are ingrained in the system. People across the country deserve better, and that is what the National Care Service (Scotland) Bill will achieve.

My colleague Jackie Baillie talked about the bill focusing on the wrong things. She noted culture, support for workforce, eligibility criteria and so on. I refer her to the NCS charter, the ethical commissioning aspect of the bill and the fact that fair work will be embedded in that. The principles in the bill set out a very clear path. Embedding human rights will address the issues around eligibility and holding people to account on delivering to meet need. On fair work, one of the agreed core functions of the national care service is to oversee and provide assurance on local strategic plans and ethical commissioning strategies to ensure that fair work principles will be applied consistently across the country.

Photo of Jackie Baillie Jackie Baillie Labour

The minister has managed to join together all the trade unions—Unite the union, GMB, the STUC and Unison—in a common view: they want all of that in the bill. Why will she not do it?

Photo of Maree Todd Maree Todd Scottish National Party

I am happy to continue to work with the unions on delivering on fair work and to reassure them on what we need to do to deliver fair work. I agree with the unions. In me, they have a minister who absolutely believes in fair work and who knows the transformation that fair work can bring to our health and social care system. I am determined to deliver it.

Jackie Baillie has also made criticisms of the cost estimates of the right to breaks. I am not sure whether she has read the updated NCS bill financial memorandum, which was lodged in December 2023. It sets out cost estimates for the right to breaks that increase gradually over 10 years to between £155 million and £225 million a year. As part of the modelling assumptions that have had to be made because of the level of uncertainty, upper and lower estimates are given. As the demand and scale of provision is expected to build over time, estimated costs are given for a longer time period than for other aspects of the bill. As one would expect, officials have been discussing the estimates with statutory and carer stakeholders to ensure that they are as accurate as possible.

Ivan McKee talked about the funding flows through local government and the NHS. Yes, that will continue, but we will provide further work on transparency, including potentially having an independent chair of the NCS board. We will have national oversight of local strategic plans. We will have direct funding in specific and agreed circumstances only, which would apply to things such as real living wage uplifts for commission staff and regional and national commissioning of specialist services. That will promote transparency of spend in the system.

Kevin Stewart is absolutely correct to talk about enhancing the voice of lived experience. We have accepted the recommendation from the Feeley review to give voting rights to all public partners, service users, carers and workforce representatives on integration authority boards. We will take that forward in secondary legislation.

Photo of Jeremy Balfour Jeremy Balfour Conservative

We all want people with lived experience to be involved in the whole process—there is no disagreement about that—but why could that process not have taken place before the bill was introduced? Would it not have been better to work out the scheme with people with lived experience, so that Parliament could have scrutinised actual proposals, rather than doing it after the bill has been considered, when Parliament will not be able to be involved in the process?

Photo of Maree Todd Maree Todd Scottish National Party

I have heard that plea many times, and I will deal with it in more detail as I move through my closing speech. However, there is no doubt in my mind that we need to act with pace on the issue. As we have heard, people have been waiting for a long time without their voices being heard. I am determined that they will be absolutely central to the development of the bill.

Photo of Maree Todd Maree Todd Scottish National Party

I would like to proceed a little further.

As ever, Gillian Mackay made wise, thoughtful and constructive suggestions. As always, I look forward to working with her on the specific issues that she raised to do with extending Anne’s law to cover hospital settings and monitoring the implementation of the right to short breaks. Those are exactly the sort of things that the bill could deliver.

I reiterate that the Scottish Government is absolutely committed to delivering Anne’s law. Anne’s law fits well into the bill, because the bill embeds human rights in our social care system. Uncoupling Anne’s law from the national care service would be unlikely to speed up the process of delivery, and it might even mean that it takes longer to deliver.

Of course, we have not waited for the legislation. Our use of existing powers to strengthen the health and social care standards and the guidance for care homes is having positive results, thereby laying the foundations for Anne’s law now. Once the bill has been enacted, we look forward to commencing Anne’s law as quickly as possible. We will do that as soon as practically possible once the bill has been passed.

Photo of Monica Lennon Monica Lennon Labour

I am glad that the minister is giving so much attention to Anne’s law. I know that Anne’s family are listening. Her husband, Campbell Duke, is listening, and her daughter, Natasha, will be listening. It is what they have to say that we all need to listen to.

I appeal to the minister to make time in her diary and that of the Government, between now and stage 2—if that is where we are heading—to listen to families such as Anne’s and so many others, who are not visitors but essential caregivers, and to take nothing off the table. We all agree that Anne’s law should be a reality. It is long overdue, and if there is a quicker and more effective route to that, let us not rule it out.

Photo of Maree Todd Maree Todd Scottish National Party

I assure Monica Lennon that I already regularly meet the care home families. I publicly thank Campbell for the beautiful book that he gave me, which is a beautiful tribute to his wife. The delivery of this legislation is so important for so many people around Scotland, and I appeal to everyone in the chamber to work constructively to deliver it for families such as Anne’s, whom I listen to on a very regular basis. Their words power me and strengthen me day in, day out in this process.

Emma Harper asked us to consider nutritional standards. I am very happy to do that. She also asked about social work. Social work is a statutorily prescribed role that involves assessing need, managing risk and promoting and protecting the wellbeing of individuals and communities. Because of that, the title of “social worker” is a protected title. Social workers are responsible for the discharging of statutory duties within a complex legal framework that has been created to protect the human rights of individuals.

The Feeley review recommended that a specific social work agency be established to have oversight of professional development. That is what we are going to do, in partnership with the social work profession.

The Presiding Officer:

I am afraid that the minister must conclude.

Photo of Maree Todd Maree Todd Scottish National Party


I am grateful for everyone’s input today. This has been an extensive and thorough stage 1 debate, which I think has been to our benefit.

I have truly listened to the feedback that we have had, both from members of all seven committees and, importantly, from people with lived experience. We have heard from literally thousands of people, right across Scotland. The changes that I will propose at stage 2, where appropriate, will take account of all that I have heard. As I said yesterday, far from asking us to slow down, the people who are trying to access social care in Scotland today want us to speed up.

The bill is the culmination of significant work, research and evidence gathering over a number of years. Most importantly, it has been shaped by the insight that we have gathered from those thousands of people from right across Scotland. We know how our current system works and where improvements can happen. I am proud to have designed a bill that is so directly influenced by the people who will use and work from it.

The Presiding Officer:

I must insist that you conclude, minister.

Photo of Maree Todd Maree Todd Scottish National Party

I look forward to seizing the opportunity and to working with colleagues from across the parties to deliver.

The Presiding Officer:

That concludes the debate on the National Care Service (Scotland) Bill at stage 1.