Hansard

I will start with a quote from Sara Redmond, chief officer of the Health and Social Care Alliance Scotland, from November last year. She said that

“people with lived experience have invested huge amounts of time, energy and emotion in trying to make the NCS work. We cannot afford to let that effort go to waste by leaving social care in its current state.”

Her view has been on my mind since I announced a pause to stage 2 of the National Care Service (Scotland) Bill last year. I have reflected on the evidence that has been taken by the Health, Social Care and Sport Committee, and views from stakeholders, people with lived experience, members of the public and political parties. I am grateful to everyone whom I have spoken to, particularly those with lived experience, for their continued commitment. Throughout my conversations with people, the case for reform has remained clear. Despite the best efforts of many, our social care system is not delivering the care and support that people require to live and thrive. There is an overwhelming need for change now. I also note that in England and Wales, similar discussions are under way and that there is rising momentum for national approaches.

We have spent three years developing plans, and significant commitment and resources from a wide range of people have brought us to this point. I will set out revised proposals for the bill and other urgent actions to deliver improvements in the social care system. We remain committed to creating a national care service, as recommended in the Feeley review and, ultimately, to improving the individual experience of everyone in Scotland who relies on social care.

Part 1 of the bill, and the draft amendments lodged in June, proposed reform of integrated social care and community health. We made considerable efforts to find a compromise and a way forward, but it is clear that those proposals are not supported by the chamber.

I have concluded that we must deliver our Scottish national care service without legislating for structural reform, securing a different means to deliver our goals. It is therefore my intention to remove part 1 from the bill at stage 2 and to proceed with parts 2 and 3 only. I realise that that will be a source of disappointment to many, particularly those with lived experience, who have been clear that greater transparency and scrutiny is necessary to drive the improvement that we all agree is needed. I want to reassure those people that I remain committed to the ambitions of the national care service. We have already made significant improvements to social care during this parliamentary session. Later in my statement, I will explain how I intend to continue that progress.

First, I want to set out what will remain in the bill. Core elements of Anne’s law are already in place through strengthened health and social care standards on visiting rights in relation to care homes, but more is needed. The First Minister and I have been profoundly impacted by conversations with families on Anne’s law. We are committed to enshrining Anne’s law in primary legislation and to working together to ensure that the bill gets that right.

We know that sharing your story repeatedly can be frustrating and traumatic. The bill enables information sharing across health and social care services with consistent information standards. That will lay the foundation for an integrated digital approach, making it easier for people to access and manage their own information and care. Digital approaches offer a great opportunity to improve people’s experience of care and treatment. Unpaid carers make an incredible contribution to Scotland’s communities and to our health and social care system. Through the bill, we will introduce a right to breaks for unpaid carers. That builds on the £88 million that we invest, through local government, in support under the Carers (Scotland) Act 2016 and the £8 million a year that is already provided for voluntary sector short breaks, as well as the roll-out of the carer support payment across Scotland.

Across the chamber, as well as across the sector itself, there is agreement that change is needed to support the vital role of social workers. We are committed to driving forward those improvements in partnership to bring sustainable reform that future proofs the social work service in Scotland for generations to come. From the Feeley review, engagement with thousands of people with lived experience and a wide range of stakeholders, and the recommendations of this Parliament following its post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013, it remains clear that enhanced national support and oversight are necessary.

Therefore, I will move quickly to establish a national care service advisory board on a non-statutory basis. It is my intention that the advisory board will include people with lived experience of accessing care services, unpaid carers, those who work in the sector, care providers, the third sector, trade unions, the national health service and local government. I expect the board to meet for the first time in March this year. I want the chair of the board to be independent—ideally someone with lived experience of accessing care or of caring themselves or someone who represents those with lived experience and who can hold the Scottish Government and all our partners to account for the improvement that is needed.

Where it is indicated that agreed standards are not being met, progressive and targeted support will be offered to those areas to help them to improve. I will ask the board for advice on the best way to do that. The current system for integrated health and social care is not delivering for people. There is no shared understanding of what good looks like and no systematic approach to tackling problems in local areas quickly when problems first emerge. That results in performance issues in some local areas reaching crisis point.

We will review our health and social care standards, agree local monitoring and reporting frameworks and improve access to information. That will enable a systematic approach to providing progressive and targeted support for local areas, where necessary using our powers of direction and guidance when standards are not being met.

The advisory board will have a wide remit. It will provide advice on national programmes that are intended to support improvement. Those include the existing implementation of the carers and dementia strategies, work to embed a person-led approach through getting it right for everyone—GIRFE—and our work to reduce the number of people in delayed discharge in the drugs mission.

We will explore with partners how we can plan and deliver more effectively for people with high levels of need across current organisational and geographical boundaries. We will empower people to understand their rights by publishing our co-designed charter of rights. We will develop national standards and guidance for commissioning and procurement to deliver on our commitment to ethical commissioning. We will continue to overhaul eligibility criteria in social care, and I will consider how we will achieve our ambition to remove non-residential charging.

It is essential that we continue to support our workforce. We are delivering on our commitments to fund the real living wage for adult and social care workers. We have a clear focus on national and local workforce planning and high-quality learning, development and leadership support for social care staff. We will build a well-deserved sense of professionalism in the sector and improve parity with the NHS workforce.

At local level, integration joint boards will continue to plan and oversee social care and community health. I will consider what changes can be made to secondary legislation, guidance and the approval of integration schemes to ensure that the voice of lived experience is heard and to increase accountability and financial transparency. I will also support Highland partners, who have decided to end their unique model of integration to align with the rest of Scotland’s IJB model.

I welcomed the news on the United Kingdom Government’s plans for an independent commission on social care, which was announced a few weeks ago. There are significant issues in relation to employment, the relationship with taxation, immigration and pensions that can be resolved only through powers that are held by the UK Government. Those include the impact that increasing employer national insurance contributions will have on the social care sector in Scotland. We are already engaging with UK ministers, and I will continue to urge the UK Government to reconsider.

I note the comments made by the UK Government’s social care minister, Stephen Kinnock, on previous UK Government attempts to reform adult social care failing due to a destructive combination of party-political point scoring and short-term thinking. I want us in Scotland to move forward collaboratively, focusing on the importance of social care reform and the vital purpose of a national care service to improve people’s lives.

Throughout the bill process, I have said that my door is always open to discussion. That is the case today. We are all agreed that social care outcomes must improve, and I urge members from across the chamber to engage constructively with us as we move forward. Together, we can bring about the sustainable change to social care that people urgently need.