Hansard

I welcome the opportunity to open for the Scottish Conservatives in this important debate, and I place on record my party’s thanks to the advisory panel and to all who contributed to the thorough and wide-ranging report.

I pay tribute to Derek Feeley, in particular, not just for leading on the report but for his regular engagement with health spokespeople from all political parties during the process. I can honestly say that, in all my time as an MSP, I have never felt more involved in such a review. Much of that comes down to the personal dedication shown by Mr Feeley and the genuine and sincere attempt to consult Opposition politicians. Such a radical and refreshing approach should be the way forward for future reviews and reports.

It is important that we reflect on why the review was commissioned in the first place and why it is critical that we make changes. One factor behind the review—it was not the only factor, of course, but it was an important one nonetheless—was the tragic loss of life in our care homes during the Covid-19 pandemic last year. That is still happening, although, thanks to life-saving vaccines and better practices, the mortality rate is declining.

The latest figures show that there have been 3,146 deaths in care homes in respect of which Covid-19 was mentioned on the death certificate. That accounts for 36 per cent—over a third—of Scotland’s total Covid-19 deaths. That is 3,146 lost mothers, fathers, grandparents, aunts, uncles, brothers, sisters and friends. It is 3,146 grieving families left behind and urgently looking for answers.

We know that more than 100 patients were sent to care homes earlier in the pandemic, despite their testing positive for Covid-19. We also know that, according to Public Health Scotland, some 3,000-odd patients were discharged into care homes between 1 March and 30 May without being tested. Those may have been clinical decisions, but they were clinical decisions that were overseen by the Government. That is why our amendment repeats our call for a public inquiry, which has already been agreed to twice in parliamentary votes.

The other key factor behind the review is the near universally agreed view that the way that we deliver social care is not working and that change is needed. The Royal College of Nursing has said:

“the current way that adult social care operates is not fit for purpose and needs radical overhaul”.

I agree with it.

There are many recommendations emerging from the report that the Scottish Conservatives agree with and welcome. We agree that

“Carers need better, more consistent support to carry out their caring role well”,

as the report states. We, as a party, have a strong record of supporting our carers, which includes the delivery of short breaks for unpaid carers as part of the Carers (Scotland) Act 2016 and our calls for an increase in the carers allowance.

We also agree with the need to remove the needlessly bureaucratic process of accessing social care. In the report, families described that as “notoriously difficult” and “over-complicated”.

There are strong and compelling arguments for applying national standards and for driving high-quality care on a Scotland-wide basis, as well as for approaching workforce issues at the national level and for a human rights-based approach to delivering care. We acknowledge that there is a need to improve training and career development opportunities for carers. The report argues that many felt that there was a

“need to improve the skillset of the workforce”

and that

“the Scottish Social Services Council is not equipped or resourced to support effective training and development of staff.”

The RCN has said that its members feel that there is

“a barrier to nurses working in adult social care”

due to

“a lack of opportunity to undergo training at work, as well as a perception, rightly or wrongly, about lack of career progression”.

As the cabinet secretary said, at the heart of the review is the call for a national care service to be placed on an equal statutory footing with NHS Scotland. We have long agreed that health and social care need to be seen as integral parts of the same system, and that implies parity between them.

The Scottish Conservatives believe that the creation of a national care service in Scotland could assist in achieving higher-quality care as well as improve the employment conditions of care workers. However, the Scottish National Party Government must provide details of how that will work in practice. Such a service must avoid becoming a centralised, monolithic structure, and it must ensure that individual people are at its heart. The Government has an unenviable record when it comes to centralisation, and there are patent dangers if that were to become another act of amassing power and control in central Government. It is imperative that any change to the delivery of social focuses on such care being person centred.

We know that a one-size-fits-all approach does not work. I note the comments of the Coalition of Care and Support Providers in Scotland, which has stated that

“any new system must also allow for local variation, flexibility and accountability”.

The Scottish Association for Mental Health notes that

“Social care providers ... also need to be involved in the design of social care services”,

with many

“delivering a support service that has not been designed with a person-centred or recovery-based ethos in mind.”

We also acknowledge the views of local government, which is concerned that some of the recommendations in the review, especially around the national care service, could see local accountability diluted.

COSLA’s health and social care spokesperson, Councillor Stuart Currie, has argued that council leaders are opposed to

“the recommendations on governance and accountability which would see the removal of local democratic accountability and a degree of centralisation, which Leaders rightly felt would be detrimental to the local delivery of social care and its integration with other key community services.”

We must be highly mindful of those views. Any new service should involve local stakeholders, and local decision making should be enhanced rather than diminished.

The review also calls for the reform of integration joint boards as part of a national care service, and more detail is needed from the Government about what that would involve. As constituted, IJBs are far from perfect, and the current system of integration raises many issues around funding, organisation and delivery.

The Scottish Conservatives believe that a local approach remains crucial in designing a new service and that local government should receive the support that it needs. That is why the Scottish Conservatives have pledged to

“enshrine fair funding for councils into law, ensuring that local authorities receive a set fraction of the Scottish Government budget each year”.

I will draw my comments to a close. The review is detailed and provides many positive ways forward in improving the experience of social care for those receiving it and for the many people who are either working in care or providing care voluntarily. I reiterate my thanks to Derek Feeley and the advisory board for producing the review during the most difficult of circumstances.

It is clear that the Covid-19 pandemic has exposed many of the weaknesses in the existing care system and that reform is long overdue, but we must be cautious in how we achieve that change and ensure that the people who receive care are at the heart of any change. All relevant stakeholders, whether they be the public, the third sector, local government or others, must be consulted and kept apprised by the Scottish Government.

I move amendment S5M-24134.4, to leave out from “supports its recommendations” to end and insert:

“thanks the review’s chair, advisory panel and all those who shared their views and experiences; believes that the creation of a National Care Service in Scotland could assist in achieving higher quality care, as well as improving the employment conditions of care workers, but that the Scottish Government must provide details of how this will work in practice, and must address, in particular, concerns raised about undermining local decision-making; believes that any changes must ensure that care is person-centred; notes that, sadly, more than 3,000 residents have died in care homes during the COVID-19 pandemic, and calls again for an inquiry into this tragedy, as voted for by the Parliament in resolutions to previous debates.”