National Care Service (Scotland) Bill -stage 1 debate: Ministerial speech 29 February 2024

I would like to start by thanking everyone who has contributed - to the consultation on the National Care Service, our co-design sessions, the annual forums, and the many meetings my officials and I have undertaken.

We’ve heard from thousands of people and, overwhelmingly, the message is the same. We need to improve the social care and community health system across Scotland.

We need long term, widespread transformation to fix some of the ingrained issues within the system and ensure sustainability for the future. 

This Bill is our chance to affect the meaningful change that we all agree is needed.  The National Care Service will provide greater transparency of the delivery of care, improve standards, support an improvement in pay and conditions for workers, and provide better support for unpaid carers.

I want to thank the seven parliamentary committees who took evidence and reported on the Bill during Stage 1. The committee scrutiny has been comprehensive and robust, which I welcome.

I acknowledge that the Health, Social Care and Sport Committee have restated their intention to consider further detail of the Scottish Government’s proposed changes to the Bill during Stage 2.

I have provided a great deal of information already at Stage 1 in the interests of being transparent and helpful. I have committed to giving the lead committee what it requires during the Stage 2 process, as requested in their letter of 7 November. I repeat that commitment here today. Information will be provided as soon as possible.

The starting point for this work was the Independent Review of Adult Social Care (IRASC), conducted by Derek Feeley, that was commissioned by Government in summer 2020. It has been the guiding force behind this Bill.

It recommended reforming social care in Scotland, and strengthening national accountability for social care support. It outlined the limitations of our current delivery structures. These included a postcode lottery of user experience, a lack of national oversight and co-ordination, and lack of collaborative and strategic leadership. It also said that we should take a human rights-based approach to social care. 

All of this has been confirmed through our engagement and co-design work.  We have heard repeatedly that the current social care and community healthcare system must change to drive up standards to a consistent level across the country.

Many campaigners have been waiting a long time, but some don’t have a long time. I know from listening to them that the status quo is not an option, that we cannot delay change. 

I was very moved to meet an advocate for motor neurone disease recently. He told his story powerfully. He only has a few months to live – too few to be spending time as a delayed discharge in ICU, when he could be at home with his family.  Now as a country, we should be good enough at planning, managing and delivering social care, so that people like him get exactly what they need, when and where they need it. 

Feeley also highlighted a need to reconsider the way we think about social care. It said that social care support is seen as a burden on society. 

In a country with an ageing population, with unprecedented pressure on our National Health Service, we cannot afford to view social care as a burden.  It is an investment in society.  Good social care, wherever people live in Scotland and whatever their needs are, enables and empowers people to live independent lives. 

The Bill as introduced sets out the principles of a National Care Service; it commits to a National Care Service Charter; it sets out a national approach to managing complaints; it sets out provisions relating to data sharing and care records; it includes provision for breaks for carers; and it includes provisions to enact Anne’s Law, so that people in care homes have the right to be visited by their families. 

The engagement we have carried out over the past year reconfirms that all those provisions are essential to improving social care in Scotland, and they remain central to the Government’s planned approach.

Now as I have set out in some detail to the Committees [and in information I have shared with all members this week], there are three significant changes that I intend to make to the Bill at Stage 2, should Parliament agree to the general principles of the Bill today. 

These changes are in response to evidence taken at Stage 1, following engagement with COSLA and the NHS, and responding to ongoing feedback from stakeholders. 

The three main changes I want to make to the NCS Bill at Stage 2 are:

• That a National Care Service Board will be established to oversee delivery across Scotland;
• That we will not create new local Care Boards as originally planned, but will instead reform existing Integration Authorities; and
• That local authorities will retain responsibility for current functions and the delivery of social work and social care services, with no transfer of staff or assets.

This change of approach reflects the challenges of a new fiscal environment, where it is more important than ever that we demonstrate value for money.

These changes would substantively reduce the cost of the Bill by removing the need to set up care boards and to transfer staff and assets.  

As I have set out to the Finance Committee, this will mean the costs of setting up the National Care Service will be up to £345m over 10 years, where the proposals set out in the Bill as introduced would have cost £1.6bn over the same period. 

We collectively spend over £5bn a year on social care provision.  The costs of change would be under 1% of that current spend; we can make meaningful, lasting change for that relatively modest amount.

In relation to children’s social care, social work and community health services, the National Care Service will bring change. We have a real opportunity to improve outcomes for children and families.

The NCS can help to simplify the currently complex landscape for children, and lay the foundations to deliver much needed improvement.

I want to set out the difference I believe the National Care Service Board will make.

The Board will include, as a minimum, an independent chair, Scottish Government, local government, the NHS, and people with lived experience of receiving and delivering community health and social care. 

The Board will have an overview of planning and delivery of community health and social care provision across all of Scotland.  It will look at what is spent, what care is provided, who receives it, and the outcomes for those people.  The Board will also have a support and improvement framework, to drive improvement and innovation and help local areas when monitoring indicates that standards and needs are not being met, and to intervene if necessary.

The National Board will give us a level of transparency that is not possible in the current system.  It will let us understand where people’s experiences are inconsistent across Scotland, build on good practice and tackle challenges. 

And it will reflect the approach we have already taken to building the National Care Service by ensuring we listen to the voices of the real experts: people who use community health and social care, their unpaid carers, and the staff who provide it.

In concluding, I want to repeat that the status quo is not an option. We must make change and invest in the future. The NCS is our vehicle to do that. I believe that it can make a real difference to those who so urgently need the change.