���˿���

I regularly meet the care home relatives’ representatives. In fact, just last week, the First Minister and I had a meeting with them and Campbell Duke, who is Anne’s widower. As is often the case, we had a very emotional discussion about the circumstances that have led them to plead with the Government and Parliament to bring Anne’s law to life. At the meeting, the First Minister and I reiterated our absolute commitment to delivering Anne’s law in legislation. We assured the families that under no circumstances will we allow the difficulties in legislating for the NCS to mean that we do not legislate for Anne’s law—we will do it.

It is really important that we get the bill right, and I am really grateful for the families’ continued input to that. The reason why the amendments on Anne’s law were held back from the package of amendments that came to the committee in June was that we have not quite got the bill right yet, and I have assured them that it will not be right until they think that it is right. It is not my opinion that counts; it is theirs.

On that basis, I am really pleased that Anne’s law has, in effect, been introduced in Scotland, which we heard Kevin Stewart mention in the chamber last week. He put the spirit of Anne’s law into health and social care standards for care homes, which has strengthened them, and people who live in care homes can now name family members or friends to visit them when there are restrictions on routine visiting to prevent infection. They can also name people who directly participate in meeting their care needs.

I go back to the discussion around Anne’s law. The National Care Service (Scotland) Bill was chosen as the vehicle for Anne’s law because of the commitment throughout the entire bill to people’s fundamental human rights and to embedding human rights in our social care services. There are more options and flexibility with primary legislation than through amending secondary legislation, but we will not let the challenges with the bill prevent us from legislating. We will do what the families are asking of us.

You are absolutely correct that there is an unacceptable level of variation. We often use Ayrshire as an illustration of that. As you said, the area has one health board and three local authorities. East Ayrshire has a fairly low level of delayed discharges. As I said, delayed discharge is not the be-all and end-all, but it is the tip of the iceberg. North Ayrshire has more than double the level of East Ayrshire, and South Ayrshire has more than three times the level of East Ayrshire.

There are different levels of priority, spend, grip and assurance in each of those systems, and there are challenges. Demographic differences might contribute somewhat to the differences; indeed, we probably will not get uniformity across the country, even if there is a national system.

We are hearing loudly and clearly that there is some support for recognising the situation as it stands and improving and picking up learning nationally. For example, South Ayrshire Council, which I spoke to recently, has started a frailty service in its hospital that is having a huge impact on the efficiency of its system. That is a really effective piece of work. We need to learn about that quickly and translate it throughout the country, because it is having an almost immediate impact, but we have very little in the way of mechanisms for doing that.

I think that it was Henry McLeish who said to me—he does a lot of work for Alzheimer Scotland—that if he visits an area of Scotland where there is absolutely amazing work going on and asks, “How do we get this happening in the other 31 local authority areas?” he is told that the charity or third sector organisation that is delivering that amazing work has to go and persuade the other 31 local authorities to do the same thing. A mechanism is needed to make sure that great work is picked up nationally.

When we first made the shared accountability agreement, we agreed that operational responsibility and statutory responsibility delivery would absolutely remain with local authorities. I have reiterated many times that I believe that that is really important. I come from the rural west Highlands, and what works in my part of the country will not work in Edinburgh or in Fife. It is important that delivery of social care can take into account the local challenges and the local assets that are available in every community.

However, there is undoubtedly unnecessary variation. The bill, as it was originally introduced, meant that ministers would have had sole responsibility for social care in Scotland. At the moment, it sits with local authorities. We said that local authorities, the NHS and ministers would share accountability and that together we would make sure that there was top-notch local delivery and national oversight. When the committee looked at self-directed support, it made it clear that one of the things that was required was national oversight. That is what we agreed on, and we have been working on that. We have been meeting weekly with local authority colleagues and the Convention of Scottish Local Authorities since June last year in order to deliver that. We had agreed, I would say, 90 to 95 per cent of what was required to deliver that.

As I set out in the chamber last week, around June this year, local authorities came to Government and said that they had capacity challenges in facing the delayed discharge crisis and continuing negotiation over the National Care Service (Scotland) Bill. They asked whether we would take that off the table temporarily so that they could focus on delayed discharge, so we did that. We paused negotiations but, without coming back to the negotiation table, local authorities then withdrew their support for the shared accountability agreement. I set out in Parliament that I was so disappointed with how that happened. I believe that we should have come back to the table and worked on the remaining very small percentage of areas on which we disagreed, but that is not where we are—local authorities have withdrawn support.

On accountability, I think that you have heard in your evidence sessions that the disabled people’s organisations say that we have given far too much power and responsibility to our local authorities, and the local authorities say very clearly that we are trying to take too much power away from them. The fact that we have those polar-opposite views is just the reality of the situation that we are in at the moment. We have to strike a balance between those polar-opposite views—on accountability being entirely the responsibility of local systems, which are democratically accountable to their local population but with no national oversight, or national oversight with no difference in local delivery. We have to find a balance in the middle, and I thought that we had found it. That is why I am frustrated and disappointed by what has occurred.

I have not yet made a decision on that. As I said, I am hearing from political parties in Parliament and listening very carefully on what I think we can legislate on. However, I think that it is important that we have national oversight of what is happening in social care in Scotland. We have heard that loud and clear throughout the process of developing the legislative proposals for a national care service bill.

When we paused negotiations with COSLA, there were three areas of disagreement—direct funding, removal of people from boards and the issue of children and justice, which had been contentious throughout the process. I have been clear that it would be best for children’s and justice services to be within the national care service. That is important to give an individual who is accessing care the most cohesive and joined-up experience. Children who are taken into care are often vulnerable, and they are taken into care because of issues that make their parents vulnerable. Their parents often have adult social care support or justice social care support.

It is important that we look at how integration of the whole system can mean that it works better for vulnerable citizens. That is about recognising that children live in families and in communities and that the child usually requires care not because of their own situation but because of the family situation.

The social work profession has been clear to us that it would like the profession to stay together under one umbrella, so that is something to bear in mind. However, the issue has been contentious with local authority partners, who believe that the decision whether to delegate services should be a local decision.

I do not know whether any of my officials wants to add more or whether I have explained the position adequately.

Donna Bell will take that question.

When the bill was introduced, a number of committees in the Parliament, Opposition parties and stakeholders raised concerns about it. That is why we paused and refined it. We worked hard to strike an agreement with the Convention of Scottish Local Authorities and the national health service on the tripartite shared accountability arrangements, which we did last June. From last June, we have worked together on that point.

The amendments that I sent to the committee in June were draft amendments that were intended to bring that agreement to life in legislation.

Good morning. I thank the committee for its consideration of the bill. It remains critical that we get this right. Strong social care and community health support are the bedrock of a thriving, compassionate civil society. Given the many areas that we agree on, I appeal to members across the political spectrum to engage collaboratively on this endeavour.

I also thank the many organisations and individuals who responded to the committee’s call for evidence. The overwhelming majority of respondents recognised that the status quo cannot continue and that fundamental change is required. That echoes the thousands of conversations that my officials and I have had with people across Scotland who use social care and community health services, and with people who have caring responsibilities.

In those discussions, people have told us that three key issues require urgent action, the first of which is shifting society’s attitude to ensure that social care is properly valued. Secondly, there needs to be access to consistent high-quality support and services that are targeted at where and when they are most needed, with clear information on availability. There is an unacceptable variation across local authorities.

Thirdly, there must be oversight of planning and delivery. Indeed, the committee’s post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013 highlighted the importance of that, and it is on that issue that we have the furthest to go to reassure people with lived experience. They have been heard and we are taking action. The bill is intended to address all three issues with structural reform that further empowers the role of people with lived experience.

The bill and the draft amendments that I sent in June represent how best to achieve this reform. As you will be aware, although some draft amendments garnered broad support, we encountered opposition to other proposals. I can answer questions about the Government’s policy intention behind those proposed amendments, if that will be helpful, as they are part of the consensus that we are working on. I need to consider what approach will secure sufficient support to make progress.

For those reasons, on 13 November, I wrote to the committee saying that I wanted to take the time to fully reflect the views expressed in our approach, and that I was not seeking to start stage 2 today. That was a necessary step to ensure that we get this right.

We need to come together, agree the way forward and deliver for people who need it most—those who use or work in social care and community health services and those with caring responsibilities. It is vital that the needs and voices of people with lived experience are put first, and we must work together to develop a social care system that we can be proud of.

Yes.

Yes.

I do not think so, no. It is well established that there is a great deal that we agree on in the bill. I need to hear from Opposition parties and stakeholders which parts of the bill they agree with and which parts need to be refined. I am in the process of listening, reflecting on what I am hearing and making decisions on how to move forward.

You will have heard in the evidence to the committee from people who access social care and whose loved ones depend on social care that it is very clear that the status quo is not acceptable. Many people are telling us that the social care system in Scotland is broken and that there needs to be fundamental and systemic change to deliver better social care. I will be keen to hear from all political parties in the Parliament on how we proceed.