Meeting of the Parliament (Hybrid)16 February 2021
The Scottish Green Party thanks everyone for their involvement in the review process and in what the cabinet secretary referred to as the “road map”. The Scottish Green Party supports a national care service.
The 53 recommendations set out how adult social care can be improved, but that should not be taken as a suggestion that the delivery of care is not already of the very highest standard, by and large. Overall improvement is needed, however, and it is important that we look forward, rather than backward.
Families feel a range of emotions about care. They welcome the support, but they worry about changes in care, and about continuity of care. They worry about transitions and about their loved ones being institutionalised if care is not available at home—which is ideally where we want care to be delivered.
There is a role for self-directed support, but I issue a slight caution about that: in the wrong hands, it can be seen as a way for those who are responsible not to meet their obligations.
The report discusses a more “collaborative approach” to adult social care. I can identify with that, reflecting on my days with Highland Council. The council and NHS Highland were the first to come together in what remains a unique model. The assessment of the effectiveness of the delivery of care at home found, strangely enough, that the teams that were co-located had the best results. That will surprise no one—the more collaboration, the better.
Integration joint boards have been mentioned. They are not universally welcomed, and their status relative to that of some local authorities is an issue.
There is talk of a step change in capability to address the implementation gap. That should not be at the behest of the profit motive, with private companies cherry picking high-density areas, leaving behind the remote, less densely populated areas, such as the one that I represent. Then there is the local authority, which has the statutory obligation and extols how much cheaper it can do things. There are many fine examples of good work being done by commercial care deliverers, but the statutory obligation of the limited company is to deliver profits for its owners, and I and my party are certainly of the view that care and profit need to be separated. I recall mentioning that in my first speech in the Parliament two sessions ago.
It has been said that the voice of lived experience needs to be amplified when it comes to proposed service design, and I absolutely get that. There is a suggestion of consultation fatigue. Of course we seek input from individuals, but their experience is not the whole story. We all experience things differently and the way ahead is to take a patient-centred approach.
Local authorities are concerned about accountability. I had representations from one authority last night. I have been a bit critical of the relationships in some of the joint boards, but I find that a bit ironic, particularly as—in my experience—they have sometimes sought to sidestep their own accountability and to blame central Government.
That said, it is important that we listen to COSLA. I am delighted that the cabinet secretary has indicated that there has been engagement there. I do not think that we are clear about the shape of the system. Is it entirely new and innovative? I certainly want it to be innovative, but I do not think that we want to discard some of the good practice that has been set out.
The need to set out a clear vision is covered in the review. Vision is good and passion is good; empathy is much better. I am not sure that that has ever featured as a qualification in any procurement process. The new system must be consistent, and the statutory responsibilities must be very clear.
I do not think that private companies have a role here at all, but it is important that we discuss the recommendations in a positive, constructive manner. We must recognise that posturing sometimes puts people off, and we want public support for what goes ahead, which must be evidenced by the information that we have at hand.
I like the suggestion that a national care service should be “on an equal footing” with the NHS, and I hope that, over time, we will see the warmth and affection for a national care service that we have seen for the NHS and what it delivers.
It is very important that we take a human rights approach. The Highland Senior Citizens Network was involved in ensuring that Scotland’s national action plan took a human rights approach. I remember speaking to someone who was very cynical and thought that human rights related to prisoners. However, there were many issues at that time, such as hydration for people in care homes. Making human rights relevant to people is important, and they certainly cannot be more relevant than for people who require—[Inaudible.]
The recommendation on a national improvement programme is good, and so is the one on shifting from markets and competition to collaboration in commissioning and procurement practices. I do not think that there is a role for the profit motive; it is about delivering fair work.
In the very short time that I have left, I will turn to the rural dimension. There must be subsidiarity in all aspects of this, because we want a care system that delivers across Scotland.
We will not support the Conservative and Lib Dem amendments, but we will support the Labour amendment. We share Labour’s aspiration of improved conditions, but there are many other areas that we care about, and we will address those through the budget process. “Care after Covid: A UNISON vision for social care” does not contain the £15 per week figure that Labour’s amendment mentions. Sectoral bargaining arrangements would be far more important than any figure, and it is important that Labour, like everyone else, explains where the money would come from and meaningfully engages with the budget process.
It is important that we all get behind the creation of a national care service.