Hansard

In essence, the report tells us that, in everything that we do in its delivery and how we treat its workforce, we need to accord adult social care the same value as we accord our NHS.

The review’s report has been widely welcomed. It recommends that we change the narrative of social care, put human rights at its heart and move from a competitive market to one of collaboration and ethical approaches to commissioning and procurement. It recommends that we put an end to charging for non-residential care, as well as a revised funding structure for free personal and nursing care.

Crucially, the report calls for the

“creation of a national care service”

to drive delivery of consistent, high-quality social care support and put adult social care on the same footing as our NHS. To support the introduction of those changes, the report suggests that we need “a new social covenant” for adult social care to ensure that it reflects our values and, as a society, our commitment to each other.

We need to build on the strong foundations that we currently have in the system. Legislation is in place to underpin self-directed support—the Carers (Scotland) Act 2016—and we have our commitment in legislation to integrate health and social care. Although many people already receive good-quality care and support, that experience needs to be consistent across the country, and that is not the case now.

We need to redesign parts of the system. That process will include legislating for a national care service with reformed integration joint boards focusing on prevention, early intervention, de-institutionalisation and, at its heart, the involvement of the people who use services, unpaid carers and the workforce. The central role of IJBs will help to ensure that local representation will be vital in the shaping of services.

The national care service would also introduce

“a national improvement programme for social care”,

which would initially address three key areas:

“the experience and implementation of self-directed support ... the safety and quality of care provided in care homes”

and the improvement of

“commissioning and procurement processes”,

to embed fair work principles and inform reformed regulation, inspection and improvement.

Although there is widespread support for the review’s recommendations, there are also concerns. Let me touch on two that are among the most important. The first is the understandable concern that the Convention of Scottish Local Authorities expressed on the issue of accountability. I understand that concern and I know that local government is a critical partner in taking forward the radical change for which the review rightly calls.

Yesterday, I had the first of what will be a number of meetings with COSLA to learn more about the concerns that it has and begin to work through how we might jointly work through them. Local government has experience and understanding of local communities and their needs, and it provides a range of vital services that are closely connected to social care—the report recognises that point—so we need to work together to find the best way to secure the review’s recommendations and the spirit of its intent.

What is abundantly clear is how much we and COSLA agree on. I hope that before Parliament rises for the elections in May, we will have reached areas of agreement with COSLA that form a firm foundation for the work of the next Scottish Government.

The second concern comes from those whose lived experience contributed so much to the review who think that this will be another report of fine words and laudable sentiments that, in the end, goes nowhere, because vested interests combine to make little real improvement to people’s lives, and because we spend all our energy and time arguing about structures that we fail to grasp the opportunity to deliver. I understand that concern too and take it seriously. For those people, there is no time left to waste and there are too many lives still to be fully lived.

We can take immediate action, however, to secure improvement. On the associated themes of individual autonomy and citizenship, I am pleased to announce a new community living change fund of £20 million to deliver a redesign of services for people with complex needs, including intellectual disabilities and autism, and those who have enduring mental health problems. The fund will focus on delivering a proper sense of home for people with complex needs, including those who have encountered lengthy hospital stays or who might have been placed outside of Scotland, and who could, and should, be more appropriately supported closer to home.

The report also highlights the fundamental role of unpaid carers in our society. The Carers (Scotland) Act 2016 is a building block for strengthening the rights and status of unpaid carers and must act as a springboard for major improvements. I have already prioritised support for the implementation of that act, and I have backed that with significant investment, which now stands at £39.5 million a year, with an additional £28.5 million uplift that is earmarked in the budget for 2021-22. That brings the total investment in local support for carers to £68 million.

The report recognises and highlights the critical and invaluable support that the social care workforce provides to people all over Scotland. A key recommendation from the Fair Work Convention’s report “Fair Work in Scotland’s Social Care Sector 2019” is to consider establishing a?new sector-level body with responsibility for ensuring that social care workers have effective voice and developing a collective bargaining role in that sector. I confirm our support for that work, which is being taken forward through the fair work in social care group, which is chaired by Andy Kerr. By the end of May, we will establish a minimum set of standards that reflect fair work, effective voice, what that will look like and how it will play out in terms and conditions, and how it will be applied across all our social care workforce.

Since 2016, we have provided funding to enable adult social care workers to be paid the real living wage for waking hours. During 2018-19, that commitment was extended to include those undertaking overnight social care support. We want to ensure that there is no delay in the annual uplift being received by the workforce. I confirm that, with the fair work in social care group, as a priority, we will seek to agree a national approach to implementing the real living wage for adult social care workers for 2021 and future years.

The report rightly highlights how commissioning for the public good can drive change and that ethical commissioning and procurement can support the standardisation and implementation of fair work requirements and practices. I have therefore asked that this year’s minute of variation requirement for the national care home contract should also embed changes that drive the fair work agenda, and that, for the first time, union representatives should be party to the discussions on the contract.

I want to work towards parity with the national health service, in which healthcare and social care are both free at the point of delivery, so we will work with local partners as quickly as is practicable to end all charges for non-residential care. I have already announced a significant uplift in the allowances for self-funders, and I want to move swiftly towards a position in which all care is fully funded in residential settings.

Finally, the report has recommended a number of important areas for substantial investment not in more of the same, but in supports that will propel our vital social care system forward and make it work consistently and to a high standard across the country for those who need it.

The report sets out how we need to invest in adult social care financially, and it highlights the wider economic benefits of investing in our social care system. Many may be tempted to ask how we can afford that, but—for me, for the report authors and for many members across the chamber—the answer has to be, how can Scotland now afford not to do it?

I believe, as the report sets out, that improving adult social care gives us a tremendous opportunity to improve people’s lives, build our economy and invest in high-quality, fair work. This is just the beginning of a process for improvement. It is now up to us, in the Parliament, to consider carefully the practical application of the recommendations and to build on good practice in order to ensure a social care system that consistently delivers high-quality services across Scotland, is founded in fairness, equality, and human rights, and puts lived experience at the heart of its redesign and delivery.

I move,

That the Parliament welcomes the Independent Review of Adult Social Care and supports its recommendations, which provide the foundation to enhance adult social care provision across Scotland; expresses thanks to the review’s chair, advisory panel and all the individuals and organisations who shared their views and experiences through the programme of engagement; believes that the incoming parliament should implement these recommendations as quickly as practicable, including scrapping non-residential social care charging; commits to establishing a human rights approach to social care that incorporates equality, individual autonomy and citizenship; recognises the fundamental role of unpaid carers in society and commits to providing them with improved recognition and support; agrees that increased and more effective investment in social care will benefit everyone in Scotland, in terms of economic growth, as well as wellbeing; recognises the critical support provided by the social care workforce on a daily basis and commits to providing improved pay and terms and conditions that reflect the Fair Work principles, and delivered through national bargaining, and commits to establishing a National Care Service in law, on an equal footing with NHS Scotland, to provide national accountability, reduce variability and facilitate improved outcomes for social care users across the nation.