National Care Service: Ministerial statement

Strong social care and community health support are the bedrock of a thriving and compassionate civil society. Most of us will need the social care system at some point in our lives, for ourselves or for people we love. 

I am extremely grateful for the efforts made every day by hundreds of thousands of paid and unpaid carers, as well as our dedicated workforce, to support those accessing social care.

I want to talk today about:

• why reform of social care is necessary,
• what the Government is already doing to drive improvement,
• why a National Care Service is essential to achieve the change that people want and need, and
• why I have asked for stage 2 of the Bill to be paused.

There can’t be one person in the Chamber today who does not already understand that the social care system in Scotland needs fundamental reform.  

The starting point for our work on the National Care Service was the Independent Review of Adult Social Care.  The social care system was acutely impacted by the Covid pandemic and this Review, led by Derek Feeley, brought home the importance of having consistently high-quality care delivered with compassion and kindness.

It reminded us that care isn’t something needed only at the end of our lives. It reinforced the need to ensure those who deliver care are also looked after – that no one is left behind or falls through the cracks of the system.

The recommendations of the Feeley Review were unequivocal about the need for change. This Government accepted the recommendations in full and we remain committed to delivering on them.

I have personally met with hundreds of people across Scotland who use social care and community health services, and people with caring responsibilities.  My officials have met with thousands more.  I am grateful to all of those people for sharing their time and their views.  While people have a wide range of needs and access many kinds of support, they have told us very consistently and clearly things need to change.

I want to restate for the Chamber three of the key issues that people have told us require urgent action.  These are the reasons that change is so necessary.  They are: valuing social care; access to consistent, high quality services; and oversight of planning and delivery.

The first issue is shifting society’s attitudes to ensure that social care is fully valued. We must value the people who access care, and the impact that  our carers and workforce have on people’s wellbeing and independence.

We reopened the Independent Living Fund in April to enable up to 1,000 of the most disabled people in Scotland to access the support they need to lead independent lives.

For carers:

• We brought forward the Carers Act to enhance and to extend the rights of all adult carers and young carers across the country.
• We are investing £88.4 million per year to support implementation.
• We published our National Carers Strategy in December 2022. This sets out how we will support and recognise our carers and includes our plan to strengthen access to short breaks for carers.
• Following our expansion of easy-access voluntary sector short breaks support by £5m in 22-23, we have maintained a budget of £8m for 23-24 and 24-25.

For people who work in the sector:

• We are making good progress on a way to introduce sectoral bargaining for the adult social care sector in line with the recommendations of the Fair Work Convention.
• We are engaging constructively and meaningfully with the UK Government around the Employment Rights Bill but we also need the UK government to ensure that social care is not disadvantaged by the national insurance increase.
• This year we invested £230m for social care workers delivering direct care in commissioned services to have their pay increased to at least the £12 per hour Real Living Wage rate. We are also committed in the Programme for Government to prioritise funding to local government to maintain the Real Living Wage in 25/26.

The second issue is access to consistent, high quality support and services, targeted where and when they are most needed, and with clear information about what services are available. There is unacceptable variation across different local authority areas. For example, in some areas of Scotland delayed discharge is ten times worse than others, which is clearly unfair.

We remain committed to a human rights based approach to social care in Scotland. Self-directed Support means care should be arranged and delivered subject to individuals’ choice and control and  I’m grateful to the Health, Social Care and Sport  Committee for the work they have recently undertaken on post-legislative scrutiny of SDS, and I am actively considering where further improvements can be made.

The third issue is oversight of planning and delivery.  There are several aspects to this, and it is the area where we have the furthest to go to reassure people with lived experience that we have heard them and that we are acting on their concerns. 

We need greater transparency.  We collectively spend £5.75 billion on social care services; we have increased investment in social care by £1 billion in the course of this Parliament.  But we have not seen the improvements we would expect, and there is little national oversight of where this money goes. Greater scrutiny of how services are planned, funded and provided is urgently needed. This Parliament has said so itself in its post-legislative scrutiny of the Self-Directed Support Act.

There must also be meaningful inclusion of people with lived experience in the governance, planning and scrutiny of social care. This needs formal structures to enable participation.  

We also need to be able to take action to identify and share good practice, as well as challenge and resolve issues wherever they may arise.   

One specific example of work to drive this kind of improvement is the Collaborative Response and Assurance Group, co-chaired by the Cabinet Secretary for Health and Social Care with COSLA.  This provides targeted support to local systems to reduce the numbers of people in delayed discharge.  Significant work is occurring to ensure discharge without delay policies, procedures and practice is patient-centred and enables people to recover in the right place, at the right time.  

Now, people have told us that the Government should be held accountable for the social care system in Scotland and called on Ministers to lead that much-needed change. The work I have set out above is evidence that I am already doing that.

The National Care Service Bill is intended to support that improvement, with structural reform that further empowers the role of people with lived experience in scrutiny.  The Bill, and the package of draft amendments that I shared with the Health, Social Care and Sport Committee in June, represent the Government’s view of how best to achieve that structural reform. 

We have encountered some opposition to these proposals. And I was particularly disappointed that, after more than a year of negotiations, COSLA have withdrawn their support for the NCS Bill. Disabled People’s Organisations across Scotland have reported being ignored by COSLA, despite their attempts to engage.

I need to consider what approach will secure sufficient support to progress.  Throughout the development of the Bill the Scottish Government has been committed to listening and engaging.  Operating as a minority government makes this even more important. 

For that reason, last week I wrote to the Health Social Care and Sport Committee to say I wanted to take the time needed to fully reflect the range of views expressed in our approach to the Bill, and that I was not seeking to start Stage 2 of the NCS Bill on the 26^th of November.  This was a necessary step to ensure that we get this right for people.

There are many areas that we do agree on, and I appeal to everyone across the Chamber to come together to deliver the change that people tell us time and time again is needed.  

That is what the people we are here to serve need. Only yesterday, a collective group of disabled people’s organisations – the Movement – published an open letter which read:

“We need a National Care Service and fundamental reforms to the broken systems. Disabled people of all ages need change, and the status quo is not an option because disabled people are suffering. We need vital support to live a life of dignity and choices that non-disabled people take for granted.”

We owe it to them to now come together, agree the way forward and to deliver for the people who need it most – the people who use social care and community health services and those with caring responsibilities.

We all know the status quo is not an option – change is needed - and we must all work to secure improvement.

Thank you.