National Care Service (NCS) National Forum 2024: speeches

Neil Gray, Cabinet Secretary for Health and Social Care

Introduction 

Thank you so much, Katherine, for welcoming us and kicking off the day.   

I had the fantastic opportunity to visit Age Scotland in the summer to see their incredible work. The work of their helpline staff and also their dementia team. It was amazing to see the progress that is being made in enhancing support for those living with dementia. And I am delighted that they are with us today, sharing their knowledge and experience, so thank you, Katherine.  

The energy in the room, the buzz, is palpable and so I’m really delighted to be involved in today’s event.  

We know that social care is a vital service. That it helps people live their lives as they want to, honours their human rights, allows people to live in or close to their own homes, and supports the health and wellbeing for many of the most vulnerable people in our society.   

This is important to everyone in Scotland – that is why we collectively invest around £5 billion a year in social care.   

All across Scotland, I and the Minister for Social Care Maree Todd regularly hear examples of how essential that investment is, where the support offered through those services is truly life-changing.  

So many people access help that is essential to their wellbeing, their dignity, and their independence.   

But we know that for some people they do not get the support that they need, or the service that they should expect.   

We have heard time and again that things need to change – things need to improve.  Social care reform is one of the most important challenges this government and many other governments are facing.   

People want and need services delivered in a way that best suits their needs, builds on their strengths and makes sure they can live their lives well. The Feeley Review reinforced this and brought home the importance of putting people at the heart of reform.  

We have a responsibility to deliver meaningful change to the people of Scotland. And I say “we” advisedly. Of course it is government’s responsibility to lead on this change, on this reform, but we all in this room and beyond have agency, have a responsibility to deliver that change. 

That’s why working with and listening to people with lived experience has been so vital in the work we’ve done together to design the National Care Service.  

Those who experience the system first-hand are the real experts, and it’s crucial that they play a role in the accountability and oversight of the way we develop the social care, social work and community health services in Scotland. 

You have told us that the current system is not transparent.  People find it hard to understand what help is on offer, and how to access it; and there is a huge variation in the services available in different parts of the country as Katherine referenced in her speech, and to different groups of people.   

You have also told us that it’s not clear who is accountable for the services available, and who can take action when improvement is needed.   

The pandemic has highlighted that people hold Scottish Ministers accountable for social care. That is not unreasonable, given the large amounts of public funding allocated to social care and its importance in people’s lives. 

That is why progressing with the National Care Service Bill is so important and why we are committed to doing it. 

The recent Expert Legislative Advisory Group, that many of you took part in, helped us shape the draft amendments to the Bill and helped us to move forward. 

The group made it clear that people have a wide range of opinions. We will not always reach consensus but it is important to have the opportunity to hear from all perspectives.  

There are different viewpoints and there are disagreements, but that’s okay. The one thing I don’t hear anyone arguing for, is the status quo.  

We know we can make changes voluntarily within the existing system, and we have started to do that, but sustainable and long-term reform requires legislative change.   

The draft amendments are currently making their way through committee in Parliament and many of you will have had the opportunity to respond to the call for evidence on those so thank you again for engaging and sharing your views. We have committed to listening carefully to what we’ve been told, and we are working closely with the Parliament during this stage of the Bill. 

But the NCS is much more than just the Bill – there are other things that we have already been making progress with alongside.  

Delayed discharge 

One impact of the current challenges facing the health and social care system is people who are unable to leave hospital because there is not suitable support in place at home or in the community. It is critical that people have the opportunity and the support to live well in their communities.  

Improving the care and experience for adults with incapacity is a priority and it is unacceptable that people are spending time in hospitals or in other care settings when they are medically fit for discharge. Although we have made some recent progress through ongoing work to reform the Adults With Incapacity Act, there is more to be done.  

We know that the current system isn’t working, and delayed discharges are a symptom of wider system failures.  

The number of delayed discharges in some local authority areas is ten times the rate than in others.  

A national mission has been established jointly between the Scottish Government and COSLA to tackle delayed discharge. 

Alongside this we are providing targeted support to local systems on AWI delays through Healthcare Improvement Scotland.  

The Delayed Discharge Mission and improving experiences for adults with incapacity are key strands in our overall approach to reducing delays and across the Health Service, improving matters for people. I want to reaffirm to you all that our focus here is on ensuring that people are able to access the care system and can do so within their own communities. 

We are working closely with local partners, through existing structures, to try and tackle this issue.  While I am grateful for their collective work to address delayed discharge, this is a type of targeted effort on a single issue and it is not a systemic approach. A National Care Service will allow us to address this kind of disparity in care support across the country on a wide range of issues.   

Social care pay 

Pay in the social care sector is an important area where we have been able to make some progress.  

And it is timely that this event is taking place at the start of Child Poverty Week.  

A key priority of this government is to tackle the harm caused to children through being born into poverty, something no child in Scotland should have to suffer.  

Fair work is one of the most important things we can do to help tackle poverty.  People working in good jobs with good terms and conditions, earning enough money to support themselves and their families, is what will help make our communities thrive.  

The social care workforce in Scotland is 80% female, and the average age of those working in private care is 41.  

We know that child poverty is intrinsically linked to female poverty so that, by paying our social care workforce a more competitive wage, that they deserve, we can help tackle the child poverty gap.    

Minimum wages are an important way of supporting people into the workforce, stimulating economic growth, and reducing the children’s poverty gap.  

Enabling and supporting parents to increase their income through paid work and earnings is an important part of tackling child poverty.  

It’s not a 'silver bullet', but it is an important way of improving access routes and removing barriers to employment.  

Increased earnings can also alleviate financial stress for parents, which can have positive effects on parenting and family dynamics, leading to a better environment for children.  

The Labour party across the UK have included introducing a National Care Service in their manifesto and recently talked about improving pay and conditions for staff as a first step. The Scottish Government has been committed to increasing workers’ pay to at least the Real Living Wage since 2016.  

And earlier this month we committed to prioritise funding to increase the pay of workers in adult and children’s social care who are delivering direct care in commissioned services so they will continue to receive at least the Real Living Wage from April 2025.   

The Scottish Government is proud to have led the way in increasing enhanced minimum hourly rates of pay for the adult social care workforce amongst the four UK nations, but we know we have more work to do. 

Unpaid carers 

The paid workforce is an essential part of our social care system, but we also know that so much of the support that people need is provided by unpaid carers. The National Care Service will also strengthen support for unpaid carers, to ensure they can access the financial and emotional support they might need.  

The National Care Service Bill will also establish a right to breaks for unpaid carers.  

Better support for carers will also improve educational outcomes for young carers and help parent carers balance employment and caring – helping address child poverty, benefitting the wider economy, supporting people to live well. 

Scottish Learning and Improvement Framework for Adult Social Care and Community Health 

The experiences and outcomes for people who use social care support and community health, unpaid carers and the workforce is critical, and people have been absolutely clear that they expect all of us to work together to achieve improvement.   

This is why we have co-developed, with COSLA and SOLACE, the Scottish Learning and Improvement Framework for Adult Social Care and Community Health.  

This framework sets out the vision and priorities for improvement in Adult Social Care Support, Social Work and Community Health, moving from predominantly focusing on scrutiny and measuring performance, to an approach that builds improvement and quality management into the system.  

Alongside this, to ensure improvement is driven by a clear and consistent set of standards across the system, we have begun a review of the current Health and Social Care Standards. These two pieces of work will be crucial in delivering better outcomes for everyone who uses health, social care or social work services in Scotland. 

Health and social care data 

Over the last two years we have invested a huge amount of time and energy into improving the data we collect and review on health and social care. 

This has led to a detailed understanding of performance and level of variation which we together can address. 

This includes data on delayed discharges which tells us not just the national picture, but also allows us to understand where outcomes are different across the country. 

To put it bluntly, there is no reason why someone in for example, Highland, has a very different experience to someone living in South Ayrshire when they are ready to leave hospital but need a social care package or placement. 

The work of our Social Care Data and Intelligence Program has also been improving outcomes for the people of Scotland, by optimising the development and analysis of social care data. With support from the sector, we have also made changes to TURAS Care Management to reduce the burden on care homes. The work we have done on data has allowed us to put in place the support that best helps local systems to meet challenges, and represents an important transitionary step as we move towards a National Care Service.  

One critical change that I want to see through the National Care Service is ensuring that the real experts – those who have first-hand experience of how systems operate, the people who receive care – are central to our scrutiny of performance, and that lived experience remains the golden thread running through our reforms. 

Future pressures 

The National Care Service will ensure greater transparency in the delivery of care, with greater accountability at national and local level, whilst strengthening the role of the workforce and providing enhanced support for unpaid carers.    

To put it simply, we can’t afford not to do this.   

Around 234,000 people – one in twenty-five of us – currently receive social care services and/or support in Scotland. With our aging population, those figures are set to increase.  

And the latest figures in Scotland’s Census show an estimated total of around 696,000 people  - that is around one in eight of us - providing unpaid care and support to people across Scotland.  

It’s not an exaggeration to say that at some point in everyone’s lives, they are likely to be impacted by the social care system. 

Whether it’s because we need support ourselves, caring for a child with disabilities, ensuring the best possible care is in place for elderly relatives, or many other situations where someone we love needs help.  

Conclusion  

The people in this room know we can do better, and the fact that there are hundreds of us here gathered today to discuss how we do that is something to celebrate. I certainly do.   

Times are tough and finances are tight but now is not the time to get smaller. We need to elevate our thinking and focus on our ambition.  

I know that the National Care Service Bill has proved to be a challenging piece of legislation; it’s certainly felt that over the last few weeks. But often the most successful policies are. Change is difficult and necessary. The challenge for all of us is whether we are ambitious enough to deliver. Not for ourselves, not to protect what has always been, but to deliver for others. To deliver for those who receive and work in social care. 

We want to continue to engage with local government on the National Care Service. The door is open for us to work constructively through continued progress on the National Care Service Bill. 

We all have agency in this process, we all have a voice and we should all be listened to.  

I’d like to ask all of you, here today and watching online, to use your voice to help us drive forward progress within the social care sector and the National Care Service. 

Tell us why it is important to you. Push for us all to deliver for you, and the people that you represent. We want to keep hearing from you, working with you to make the National Care Service work for generations to come. 

This is our chance to make a real, significant difference.  

It is hard. Of course it is. It is taking time - but that is because we need to get this right.  

The birth of the NHS was hard, but it is now a national treasure. In 76 years’ time, what do we want people to say about the National Care Service? 

High quality community health and social care support helps create thriving communities and a thriving economy across Scotland. We need to tackle the inconsistency of care provision across the country.  

It also has vital connections to other parts of the public sector. It is important that we all work together to support people in a holistic way, and to manage risk and harm across all of our public services.  

They must work to remove barriers, tackle inequalities and allow people to flourish and live their lives as they want to.  

The work that we are doing to honour what is in the Feeley Review is so important. What really matters is people who use services and social work and social care staff.  

We are committed to providing better, more consistent standards across the country. 

We want to change the system from one that supports people to survive, to one that empowers them to thrive, with human rights at its heart  

Thank you all for joining us, thank you for your support and I hope you enjoy the rest of your day. Thank you.