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Chamber and committees

Official Report: search what was said in Parliament

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

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Dates of parliamentary sessions
  1. Session 1: 12 May 1999 to 31 March 2003
  2. Session 2: 7 May 2003 to 2 April 2007
  3. Session 3: 9 May 2007 to 22 March 2011
  4. Session 4: 11 May 2011 to 23 March 2016
  5. Session 5: 12 May 2016 to 5 May 2021
  6. Current session: 12 May 2021 to 16 August 2025
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Displaying 775 contributions

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Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

Absolutely. I am absolutely determined to improve the situation, particularly because of where I live. The geography where I live is very challenging for social care. We do not have a care home in the village that I live in. If someone is unable to manage independently in their home in my village, they have to move away from their community and family to access care, probably on the other coast. That is the reality for people in the Highlands.

One of the reasons for our focus in the national care service on shifting care upstream and getting into that early intervention and prevention end of things, to support people to live independently and healthily at home for as long as possible before care is needed, is about enabling people to grow old and frail, and potentially die in their own communities. We are determined to deliver that. I will hand over to Donna Bell to give a bit more detail on palliative care.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

I do not have the numbers in front of me at the moment, but it is significantly less than was predicted because the pace of delivery is slower. The slowing of the pace, the pausing and the phasing of the introduction of the national care service mean that it is costing less.

Donna Bell might have the table in front of her.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

I am really sorry, but I did not hear that figure. Could you repeat that figure, please?

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

No, we do not recognise that figure.

I did not say that the Conservatives slowed the delivery of the bill. The Conservatives were one group that was opposed to the bill as introduced, but there was significant opposition to the bill as introduced. I think that it is reasonable in the face of significant opposition that the Government pauses and works on the direction of travel with the people who are concerned about the direction of travel, and that is what we have done.

The bill will be delivered. We will finish stage 1 by the end of January next year. Of course, it will be down to Parliament how fast the legislation progresses, but I would expect there to be significant progress in the next few months.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

How we improve access will be crucial to the success of the delivery. We all pore over the delayed discharge figures, particularly coming into winter. We are less good at capturing the level of unmet need that we know is in the community for people who seek care packages and have been assessed, but are not able to get them, which is equally important. We know that accessibility at every step is a challenge.

One challenge that we face is that there are different levels of integration around the country. As I have said, that makes it difficult to know where services are falling between cracks. We think that services sometimes fall between cracks because of the accountability in different models of design.

I see the national care service as the natural next step in integration. This is about further integration. We see different models of integration around the country. In some parts of the country, mental health is included; in other parts, it is not. As I have said, that gives rise to some of the postcode lottery and some of the challenge in taking steps to improve accessibility. We will look at whether that serves the nation well. The issue is probably improving integration in every part of the country.

The national social work agency will produce national standards. That will be an important part of improving delivery and ensuring that everywhere operates to the same national standard. I think that that will give protection to individual social workers, who will know what they need to do at each step of the way in their jobs. That is really important.

As I have said, I am determined that the national board will have teeth, so it will not be there just for decoration. It will absolutely be there to take an overview and to take action if there is service delivery failure in any part of the country. Where problems arise, the national care board will be able to take action to correct them.

One thing that will be really important鈥擨 think that we spoke about this when I was last at the committee鈥攊s the review of independent inspection and scrutiny that has just reported. We as a Government still have to reflect on and respond to that, but I think that that will provide us with another lever to pull to improve the situation and the standards nationally. Getting the inspection and scrutiny process right is a really important part of the process. One of the aims is to shift from what is perceived to be a punitive system in which there is reputational damage if things fall short to a more supportive system in which there is an ethos of continuous improvement and support is easily available to try to improve standards where they are found to fall short.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

We are still in the thick of discussing local governance arrangements. I might ask officials to come in on that, in case I have missed anything in answers that I have given. However, I envisage that the structures that already exist will be strengthened.

At the moment, we have quite a disparate pattern of integration, which is one of the reasons why we have a postcode lottery. There is more integration in some parts of the country than there is in others, which is probably not serving us particularly well. There will be a move towards more integration all over the country, and the structure of integration joint boards and health and social care partnerships will evolve and probably strengthen in order that they can oversee local delivery of social care.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

Donna Bell can probably give more detail.

I have not been asked very much about palliative care. However, the reality is that the vast majority of people who go into a care home do so at the end of their lives and they pass away within an 18-month period. It is there, but it is not up front. I will let Donna Bell talk a little bit more about that.

10:00  

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

You are absolutely right. It is crucial that carers have a life alongside caring. I mentioned that I meet regularly with many people who are involved in social care. People who are caring for members of their family are often at the end of their tether, which is one reason why I am absolutely passionate about shifting care higher upstream towards early intervention and prevention, so that people do not get to crisis point before help is available to them.

It is absolutely crucial that carers have their own life alongside caring and that they can sustain their own health and wellbeing. As you are well aware, we are doing a lot of work through the bill to enshrine the right to breaks. However, we are acting now to expand easy access to short breaks support ahead of the legislation鈥攚e are not waiting for the legislation to make that change. We increased the voluntary sector short breaks fund by 拢5 million to 拢8 million, and we have maintained that fund at 拢8 million for 2023-24.

That is in addition to the Carers (Scotland) Act 2016 funding鈥攖he 拢88.4 million that goes through the local government block grant. We are trying hard to support carers before we create their right to a break by putting it in the bill.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

Thank you very much for inviting me to provide an update on the National Care Service (Scotland) Bill.

During the summer, we used the time to respond to stakeholder concerns. We have agreed proposed changes to the overarching structure of the NCS, which will help to achieve our ambition of improving the quality and consistency of social services. We have also carried out extensive co-design engagement across Scotland to understand how to achieve the change that is needed.

After being out and about over the summer speaking with people, I know more than ever that the status quo is not an option. We must act decisively so that people can have the improvements that they need as quickly as possible, and we must make wise decisions in a new fiscal environment in which resources are under pressure. That is not an easy task, but we are absolutely committed to getting it right by listening to the voices of experience. I want to outline how we propose to go forward, having listened carefully to those voices.

In my recent letter to the committee, I described our extensive summer programme of local co-design activity. We held regional events across Scotland and online. Hundreds of people participated and shared valuable and diverse feedback on the NCS. I attended several events in person, and I whole-heartedly thank everyone for sharing their experiences and knowledge. We have now published our analysis of those events. They will shape our thinking going forward and they will shape the second NCS national forum, on 30 October.

Our other major discussions over the summer were with the Convention of Scottish Local Authorities, the national health service and trade unions. We reached initial consensus on a partnership approach with COSLA in July. That will provide shared legal accountability for integrated health and social care services. Those discussions are still continuing, and more detail is being developed that will inform our proposed amendments to the bill.

It is important that we have effective national oversight and governance to drive consistency and improved outcomes for people who access support. The proposed NCS national board will provide that.

At the local level, local government and NHS boards will retain statutory delivery functions and the staff and assets to deliver services. We are considering how local integration structures can be reformed and strengthened as part of the NCS.

Additionally, we regularly discuss the bill and current challenges in social care with trade unions. Although we are limited in legislating on employment, we are committed to promoting fair work as far as possible through ethical commissioning and procurement. We will provide funding to increase the pay of social care workers and to improve workforce planning, practice and culture, and we will take into account trade union views on issues such as workforce representation in designing the national board and local delivery.

In summary, I say that the summer was very busy, with many productive discussions and positive developments.

I hope that that is a useful overview before our discussion.

Health, Social Care and Sport Committee

National Care Service (Scotland) Bill: Stage 1

Meeting date: 3 October 2023

Maree Todd

I hear that criticism loud and clear. I hear it very directly because we are engaging so closely with people who have lived experience of accessing care. Undoubtedly, there are many people for whom the situation with access has been traumatic and disappointing. They are absolutely clear that change is required, as am I. As I said, the shared accountability that we foresee will, I think, give ministers control over the system, while ensuring that local delivery is still done by the local democratically elected body. That is probably the best combination.

It is really important that the board has the power to take action when there is system delivery failure, so I am determined to reassure people that it will have sufficient power to take action when it needs to. We are envisaging something similar to the arrangements that are currently in place for health boards, where there can be intervention, if there are challenges, and escalation of interventions. We envisage something similar for the national care service, in that its board will have the power to intervene.