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I think that everyone acknowledges just how challenging the landscape is at the moment, given the pressures that we face. This has been a long review of SDS, and some pressures were building before the pandemic. We have an ageing population demographic—it is great that people are living longer, but they are living longer with more complex health issues and are, therefore, requiring more social care support—and people with certain conditions are living independently in a way that they would not have been able to do in the past, so some pressures are built in.

There have been 14 years of austerity, which have, as nearly everyone acknowledges, challenged all our local services. All our public services are feeling stretched to the limit. Any changes that could be made to improve efficiency have been made, so any further savings have an impact on delivery. People are feeling like that across the board.

The pandemic has caused a real challenge. The health portfolio team has a meeting every week before the Cabinet meeting, and this morning we discussed some of the challenges that we face in relation to the stage at which people present with an illness, because people are presenting further on in their illnesses and when they are more acutely unwell. There is more complexity than there was before the pandemic, and there are also more Covid cases—there has been an increase in the level of Covid in our community.

All those issues still exert pressure on our health and social care system, so it is undoubtedly an exceptionally challenging time at the moment. In order to rise to meet the challenges and address the pressures that we face, we have weekly charging for residential accommodation guidance—CRAG—meetings where we look at the whole system in order to assess what is happening in health and social care in Scotland and to consider what can be done to improve the situation.

You will have heard from the First Minister that there is a real focus on delayed discharge, for example. The figure for delayed discharges used to vary by season—it would go down in the summer and up in the winter—but the pressure from delayed discharges has been relentless all year round for a number of years, since the start of the pandemic. Over the next few months, there will be a real focus on trying to improve the situation in order that we have some headroom.

From the letter that I sent to the committee yesterday about the national care service, you will know that we have paused our discussions on one or two amendments that have still not been agreed by me and COSLA in order to free up the space to focus on acute system pressures over the next few months, rather than on the systemic solutions that might be a little further down the line.

I do not know whether my colleagues want to say a bit more about eligibility options in the future.

In my casework as a constituency MSP, I certainly hear that concern. People think that option 1 is SDS, and that concerns me, because it suggests that people who are trying to access social care at the coalface are not being talked through the whole suite of options that are available to them, and that option 1 is being used as the default setting. That is a real challenge that we recognise.

As Rachael McGruer said earlier, we are working closely with NCS colleagues to ensure that the SDS principles are embedded within the creation of the NCS bill, and that the SDS improvement plan, which we are working through at the moment, is completed and embedded into the national care service, so that improvements in practice, that genuine offer of flexible choice and that change in practice are embedded in future social care delivery and available to everyone across the country.

Joanne Finlay, do you want to say a little bit more about that?

You are right. Everybody working in the health and social care system as a whole needs to have an understanding of how social care in Scotland works. One of the aims of our current work to tackle the acute issues that the system faces, as Ruth Maguire was alluding to, is working with healthcare systems to try to ensure that there is early referral, with early discharge planning for example. That requires an understanding of what is available in the community and who needs to be involved in the process of putting together a package of care post-discharge.

There needs to be a level of working knowledge in both the healthcare system and the social care system to ensure that things are operating efficiently and effectively across the board.

Certain professions are crucial, though. Social workers are crucial to the high functioning of the system—I am more and more convinced of this every day. From my perspective, as a general rule, it is really important that we support that profession and that we ensure that they are supported to make the professional and statutorily underpinned decisions that they are meant to be making to support individuals’ human rights as they access social care. We can do that by tackling both undergraduate and postgraduate support and training.

The work that we mentioned earlier to support and mentor newly qualified social workers and to ensure that there is a pathway in place for social workers who want to pursue higher qualifications—postgraduate qualifications—is really important. That needs to reflect not only the practical operation of SDS, but the culture and ethos of SDS, which is about flexibility, choice and upholding people’s independence. I joke with the SDS audience, “I’m all about independence.” I absolutely get how important it is to individuals that they have the autonomy to make decisions to have social care that supports them to work, for example, or to do whatever it is that they want to do. That is crucial.

For people who are working in the system, we have an opportunity, through NHS Education for Scotland and Scottish Social Services Council registration, to provide training packages that work in a multidisciplinary way right across the system. I think that that will be really helpful in tackling some of the barriers.

People with learning disabilities are one of the communities that struggle to have their rights upheld. There are good training opportunities for everyone who works in the system in how to engage with people with a learning disability. NES offers multidisciplinary, postgraduate and post-qualification or post-registration training to everyone who might come across such people so that they can help them to engage fully in the process of decision making and make good informed decisions that suit them, that uphold their rights and that fulfil their dreams and ambitions for their lives.

I am going to ask Joanne Finlay to come in on that.

On the need for flexibility, we are doing work around the country to try to ensure that SDS is delivered as flexibly as possible. At the moment, we have a request in from Highland Council to clarify some of the flexibilities that it might need in very remote communities where everybody is related, frankly. That is a challenge that I have in my constituency.

We have to ensure that there are tight controls on the possibility of exploitation of vulnerable people, but we also need to recognise that family support might well be the only option that people who live in very remote and rural communities have. We are working with the council on ensuring that we can deliver those flexibilities while safeguarding individuals’ human rights, and also on ensuring that it works for people, because saying, “We are not going to do that” is not an appropriate answer.

We also have work going on across all parts of the country on exactly the same challenges. One of the challenges that we have, and one of the reasons for variation across the country, is the level of risk averseness that individual local authorities and integration authorities have. We are trying to support them with that to ensure that they know that they are empowered to be flexible.

Rachael McGruer, do you want to comment on that? Were there plans to measure it before 2013, or were there plans in place on metrics when the legislation was introduced to measure whether the vision had worked?

I agree that it is not always recognised that it is the primary delivery mechanism. I meet constituents on a regular basis—as you all will—who say, “I’ve been put on to this SDS,” and they do not realise that that is the way that we deliver social care. For example, they think that option 1 is the only option with SDS.

As well as the geographical variation, which reflects culture, delegation practices and the levels of integration in each area, we operate in a system that has different external pressures. The pandemic has undoubtedly been a huge pressure on our systems, as is the financial situation in which we find ourselves. The post-Brexit challenges of immigration and the labour shortages that we have across the country are another pressure.

Even in the geographical area that I represent, I have seen real changes. When I was first elected, I met local representatives in the Highlands who blew me away with their description of the amazing opportunity that people had to live their lives to the full and avoid being institutionalised in any way, and I met young people who were using their SDS to follow their dreams. It was magical to hear about.

Now, I more commonly hear concerns that—this is probably common for every representative around this table—when there is market failure, when the local authority has struggled to provide care, people are being told, “Don’t worry, you can have this budget and find care for yourself.” That is not the intention. People are meant to be able to choose the option that works for them. Option 1 is not meant to be the final stop when market failure has occurred.

We are well aware of those challenges. I suppose that the way to avoid those challenges for people who are trying to access care is to focus our work on improving workforce planning and ensuring that sufficient funding is going into the system. We have a lot of work going on across the piece to do that. We committed to increasing the funding of social care by a quarter during this session of Parliament. We have delivered that two years ahead of schedule, but we are often not feeling that at the coalface.

We need the national care service to provide some grip and assurance in relation to following the money and making sure that the money is getting where we need it to be. The workforce issues are undoubtedly challenging. We will improve those by not just tackling pay, although that is really important, but social care conditions and the level of support for social care staff, so that they feel well supported and can flourish in their vital professional role.

Work is under way right across the piece to do that, but it is not as simple as flicking a switch, and it is exceptionally costly, so it must be done carefully. I would like us to go further and faster, but I think that we are on the right path. Each social care worker in Scotland is paid £2,000 more than they were paid last year. Their wages are going up substantially each year. Social care workers in Scotland are paid more than, and pay less tax than, their counterparts in the rest of the United Kingdom.

We are on the right pathway. We are not where we want to be, but, as a Government, we have set out our stall and are making incremental improvements in social care that will help us to solve the big-picture problems.

Absolutely. As I always say when answering questions of that nature, I am a Highland MSP, and I know at my core that one size does not fit all. In fact, where I live, in a rural west Highland village, social care is delivered very differently even from the way that it is done in Inverness, which is just along the road and within the same local authority and integration authority area. It is challenging to be prescriptive. However, that should not prevent us from recognising that there is an issue. Time and again, when we have looked at the health and social care system, we recognise that the variation is too great and that there are not good reasons to explain it.

We can see real and significant variation, and we talk about good and bad variation, or necessary and unnecessary variation. We are not interested in ironing out the sort of variation that has to occur in a remote west Highland village where limited assets are available. In that situation, we really want flexibility. In my part of the world, I mostly meet people who are desperately keen to stay in their communities and who are happy to tolerate some variation in how care is delivered to enable that core aim.

The unnecessary variation, which comes from culture, systems and, in particular, risk aversion, is what we need to iron out. We need to give people the confidence to operate the system properly and to properly put the person at the centre of decision making and in the lead on that. That will not look exactly the same in every part of the country, but it will reach the standards of quality that we are aiming for with this legislation.

That is why we have a programme in place to try to improve the data. We are working with Public Health Scotland to improve the quality of data. I agree with you: it is very difficult if we do not have high-quality data. We are therefore working on that with Public Health Scotland. It has suspended its collection of data. We will come back with better data collection, to enable us to manage more appropriately and more effectively the whole system through the use of that high-quality data.

As Joanne Finlay mentioned earlier, we have also looked at the health and care experience survey. That is a different methodology. It is always difficult to introduce different ways of collecting information, but we look at a variety of data sources. Some are well scrutinised and of high quality, whereas others are more anecdotal and less what you would call management information. We cannot publish those because the data is not of sufficiently high quality. However, we are looking at data and we are determined to find ways to measure the right things without putting a burden on a system that is already overburdened, in order to enable us—not just me, but the local system—to have that grip and assurance, exactly as you said, in order to ensure that delivery improves.

A number of pieces of work are in place to support the social work profession to ensure that a standard level of knowledge exists across the profession for all social workers. We are also beginning a programme of support for newly qualified social workers and for social workers who choose to specialise and continue to gain qualifications throughout their career.

We are trying to standardise that approach. You will be aware that there are 32 different employers for social workers across Scotland, with 32 different sets of paying conditions and 32 different local authorities that do workforce planning for social work. We see the national care service as a real opportunity to bring some cohesion to that picture. The planned national social work agency will sit on the national care service board and bring some national standards and planning to the particular challenges for that profession.

I see the national care service as a real opportunity for social workers. As you rightly say, they are crucial to the high-quality functioning of a social care system. Supporting the profession and ensuring that social workers flourish and thrive and are able to do the job that they came in to do is a really important part of how we intend to improve the quality of social care in the future.

My colleagues might wish to add something, particularly about the social work profession.

First, as a Warriors fan myself—as I say regularly to folk, I am Glasgow by marriage, so I am a huge Warriors fan—I was absolutely delighted, in a tough weekend of sport for Scotland, that their win in Pretoria was absolutely uplifting for the whole nation. We are very proud of what they have achieved—they are inspirational to many.

With regard to the social work profession, I absolutely recognise that there is a challenge in there for Government. I will put it simply. You are a clinician, and I am a clinician, too—I worked as a mental health pharmacist for 20 years in a multidisciplinary team, of which social workers were a key component. In my experience, social workers are social justice warriors: they come in to uphold the human rights of the people with whom they work. Over a number of years, however, the system has forced them to focus on issues such as budgets and eligibility, rather than on the individual requiring care who should be at the centre, and who requires their needs to be met and their rights to be upheld.

I see it as a responsibility of Government to ensure that social workers can go back to the job that they came in to do. One of the reasons that so many social workers are leaving the profession is because they are disappointed with the reality of their job once they are qualified.

As I have said previously, there are a number of issues. We need better workforce planning across the country, and higher numbers of social workers being produced and trained. We need better liaison between local authorities and universities in order to ensure that there are training placements for undergraduates and postgraduates so that they can be supported to become the professionals that we need them to be.

We need a strong postgraduate process of further education. Any professional—there are a number of health professionals around the table—will recognise that you do not come out of university ready to be the professional that you need to be. There is a period of further training once you are qualified, so we want that post-degree support, mentoring and training to be in place, solidified and nationally led.

The national social work agency will provide us with an opportunity to put in core standards to which every social worker will be expected to work. Although—as you allude to in your question—that might be felt by some social workers as a pressure, and as a further thing that we are asking them to do, many social workers tell me that it will give them the ability and the freedom to focus on the things that are important, such as upholding the human rights of individuals. They will be expected to work to a national standard rather than follow the local pressure of ensuring that the budget is delivered.

There is a huge amount that we can do to support the social worker profession. I reiterate how crucial social workers are. When I go around the country, in areas where systems are working really well, usually the social work profession there has a high profile and is well supported to do the job that it needs to do. The evidence is anecdotal, but it is clear that if we support the profession, the quality will be lifted throughout the country.

Responsibility for the social work profession lies with Angela Constance. She is a social worker, so has a passion for that. Natalie Don also shares some responsibility, as the Minister for Children, Young People and The Promise, so the three of us work regularly with the chief social worker, Iona Colvin, and her team, to try to ensure that we are delivering a social work workforce that is fit for the future and that it supports autonomous professionals who are empowered to deliver within the system.