Meeting of the Parliament 29 February 2024
I refer members to my entry in the register of members’ interests, as I am a practising NHS general practitioner. I am also a member of the Parliament’s Health, Social Care and Sport Committee.
Despite warnings that the SNP-Green Government is unable to articulate and communicate how the national care service would work in practice, Parliament is nevertheless asked today to support a bill on the basis that, come stage 2, all will be revealed. Really? That is not how scrutiny of legislation is supposed to work. We are not here to give the Government the benefit of the doubt—I know that the islanders of Arran would not and neither would those using the A9 nor patients waiting for cancer treatment.
The Law Society of Scotland is also concerned about the bill as presented. It says that effective scrutiny is a crucial element of the creation of good law. It is therefore essential that there be further clarity in both policy and drafting terms at an early stage to allow for proper scrutiny and appropriate stakeholder engagement.
I am mindful of other flagship bills that the SNP-Green coalition has tried to push through Parliament over the past couple of years. Here we go again. When it comes to the latest SNP rebrand of the National Care Service (Scotland) Bill, Health, Social Care and Sport Committee members are well aware that there is a dearth of detail and so many unanswered questions. The bill is far from ready for a stage 1 vote. There is criticism from professional organisations, unions, charities and councils. All four members of the committee who are not SNP or Green dissented from up to 46 of the 110 recommendations, including support for the bill’s general principles.
The so-called principles are so broadly drawn that it is not clear who the principles apply to, how accountability and enforcement would work, how the principles will be evaluated and how they fit with rights under the Equality Act 2010—we all know how important that is lest legislation goes pear-shaped.
The SNP-Green Government argues that we were asked to approve a framework bill, that much of the detail will be set out in secondary legislation, and that it is simply trying to work at pace and be efficient. However, the many areas that we highlight are ones that should be addressed in primary legislation. The Law Society of Scotland’s view is that that is not inconsistent with the aim of ensuring responsiveness and adaptability. Furthermore, the approach whereby the bill is scrutinised in advance of the co-design process limits our committee’s role to provide full and effective scrutiny at that stage of primary legislation, given that important details are simply not available.
The SNP-Green Government’s approach to co-creation is highly problematic. There is no statutory basis for the co-design process in the bill and no statutory guarantee for meaningful engagement from a full range of stakeholders. There are many understandings of co-design, but we do not know what the SNP-Green Government has in mind, nor do we have a plan for how it intends to go about it. That might suit a Government that has a reputation for secrecy and—according to some of its own members—authoritarianism. The Scottish ministers will be responsible for the national care service in a way that seems to them to best reflect the national care service principles. Despite shared legal responsibility with COSLA, the Scottish ministers are responsible for monitoring and improvement of services, with significant discretion afforded to themselves.
We all agree that social care reform is well overdue. The Scottish Conservatives support key recommendations of the Feeley review, including national employment conditions for staff and treating social care as an equal partner to the NHS. However, instead of opting for a centralised, top-down approach to care, as advocated by the SNP, we believe that there are many approaches tailored to those needing support that we could be doing now, as Monica Lennon suggested earlier. That can include caring for people with a terminal illness, many of whom are spending their end-of-life journey at home. By 2040, 60,000 Scots will have palliative care needs—10,000 more than today. We need to ensure that everyone in Scotland has a right to the palliative care that they need.
The SNP-Green coalition is bent on centralising social care at the expense of local authorities. This has all the hallmarks of a power grab that will not improve social care delivery, and it is an expensive power grab at that. Parliament’s Finance and Public Administration Committee has repeatedly raised concerns about how it will all be funded and the fact that the costings do not, and could not, reflect the actual cost of the provision of the bill. The SNP Government decided to plough ahead with its failed scheme, ignoring the concerns of experts.
The SNP-Green Government is spending more than £800,000 every month on civil servants for the national care service already. We were told by the Minister for Social Care, Mental Wellbeing and Sport, Maree Todd, that to get a national care service up and running, we should expect a total spend of £1.6 billion—now we are told that it will be less, but it will still be almost £1 billion.
The type of national care service that is advocated is the wrong priority for Scotland. Where are the efforts to eliminate delayed discharge that were promised by Shona Robison by the end of 2015? Yes, you heard right—2015. As the Royal College of Physicians of Edinburgh reports, in the year ending in March 2023, there were more than 660,000 days spent in hospital by people whose discharge was delayed because they did not have a social care package to support them at home. There is a double whammy: Scottish Care has warned that one care home per week is closing in Scotland. We now have 19 per cent fewer care homes than in 2013, with private care homes being cheaper for the public purse.
Humza Yousaf is the mastermind who drafted the National Care Service (Scotland) Bill in June 2022, with a plan to complete stage 1 by March 2023. The fact is that the NCS bill has been delayed four times. It had to be radically overhauled, and implementation was postponed until 2029, but just yesterday and today Maree Todd tried to tell us that she was going to prevent delay. The SNP-Green coalition is making up the timeline as it goes along.
If the issue were scrutiny, we would have everything with us already. We need to ensure that the enormous challenges that are faced by patients, young and old, are dealt with today.
15:23