Health, Care and Sport Committee - 09 September 2026

Good morning and welcome to the third meeting of the new health care and social support committee. Um we've got no apologies and can I just begin by asking the committee if they agree to take consideration of our approach for the pre-budget scrutiny in private and all future consideration of our work program and reviews of evidence in private. Are we agreed? >> Everyone happy with that? Super. Thank you. So this is the second of a series of meetings uh we're having to enable members to gain an overview of the key issues uh in the health and care socials care and sports centers. So today it's about social care and we'll hear from cross section of key organizations individuals and um we can run as long as uh 11:30 I understand professor Macascal has to leave before that. So if you do if we are running that long and you need to go that's understood. Thank you. So um I'd like to thank our witnesses for coming. Um welcome. And we have Paul Trainer from the head of the head of external affairs from carers trust. Uh Rachel Kackett the chief executive of the coalition of care and support providers in Scotland. Professor Donald McCascal uh chief executive of Scottish Care. Uh Jill Laspa, policy manager at Cosla. Um Gareth Am Adam Hammond, chief inspector for registration and complaints careerate. And remotely we have Donald Mloud, chief executive of self-directed support Scotland. So thank you all for joining us. Um we didn't ask for opening statements. you've I think everybody's probably put in uh uh additional material for us to look at beforehand, but I'm happy for you to give us really what we're obviously focusing on. Uh if you can give us a brief overview in the short time that you've had of what your organization is thinking with relation to the changes the program for government is suggesting. And so if I I'll just start at the right with Mr. Trainer and go around the table coming to Don Mloud last. Thank you very much, Cavvenina. Um, and thank you for inviting us today um to the committee. Uh, unpaid carers, as you may be aware, um, didn't really weren't listed very specifically within the program for government. Um, and that's something that we are concerned about. Um, as an organization, carers trust is one of the national carer organizations in Scotland. We are also a membership organization of local carer centers and young carer services all across Scotland. Um and within the program for government, one of the the key aspects which was was really um apparent was that lack of um note of unpaid carers specifically listed as well as wider uh local carer organizations. Um I think one of the biggest challenges is that gap between growing demand and and available support. Um and unpaid carers are often those that are taking up some of those gaps that are experienced across society when health and social care services are limited or reduced which is why we think it's vitally important that unpaid carers are specifically mentioned in the plans for program for government. Um going forward um one of the key uh Scottish government pieces of legislation that passed in the last parliament was a right to break from caring um which we welcome. However, um it's very clear and it was surprised that there was not really very anything specific mentioned around that within the program for government. Although it is obviously the intention to continue to progress with with that, but more focus um around unpaid carers is a key part of the infrastructure around health and social care and the vital role they play. In Scotland, there's estimated to be between 700,000 and 800,000 unpaid carers. Um that's a mass of the population providing unpaid care. Uh but very few carers um are receiving um statuto support based on local eligibility criteria for that support which causes real complication for unpaid carers. very few meet local meet eligibility criteria for uh social security benefits and there's a lack of cers being identified and referred um systematically across health and social care more generally to the support that's available. So we would have liked to have seen much more presence in the program for government for unpaid carers. >> Thank you Paul. Um and Rachel if you would like to give your organization's perspective. Thank you, convenor, and good to see you all and to be back around the table after the election. Um, so CCPS, as you will know from our submission, represents not for-p profofit providers of care and support across all age ranges across Scotland, um, from very, very large organizations to much smaller ones. And I guess our response to the program for government was mixed but open-minded. So on the one hand, in terms of the announcement of a reform to social care, we would absolutely agree that the need for social care reform is way overdue. It was attempted in the last parliament, didn't get through, and I'll briefly lay out why that reform is desperately urgent. Um, and I I think what we also really appreciated was an acknowledgement in the written program for government of the precarious state of the sector at the moment. it's under untenable pressure and is no longer in a sustainable place to take us through to the ambitions of that the government has set out. So we we really need to focus on that. I guess where we were ambivalent and we are still working with our membership to come to conclusions. Some of it took us all I suspect by surprise was we have a three-month period I believe in which to respond. Um, at this point in time, we aren't actually sure if that 3-month period has started, when it stops, what the key questions are for that period, what we're being asked to answer, and how we will be engaged. Although I can see there is a commitment to engage with ourselves and providers that we represent. So it feels uh like we have to move pretty quickly because the urgency is there and that urgency is important but now we need to see the plan for how we get to a conclusion and that at the moment is missing. Why it really matters um comes to me from my providers every single day. First of all, up until the program for government, the three words that we were using were not national care service but public service reform. And I think it's important to say to the committee, it's important to us that it is public service, not public sector reform. And I think our big message is that social care provision, most of which is not done within the public sector, but commissioned by the public sector, is an essential part of the public service that is offered to communities across Scotland. And so public service reform must be reform in service of the public. And that has to be our focus. The focus must be people. and we are a central part not just in the delivery but in the design of that because nothing will be designed well without our engagement from the start. The second is and we've shared some reports that we put out a couple of weeks ago on funding and governance of the sector is without a doubt our current funding and commissioning uh processes in social care are broken. They do not work. They do not work for anybody. And it's not just that there is not enough money going into the social care system to deliver on priorities, though there isn't. But we have a very fragmented approach which I I think has emerged over many years very often with good intent to try and manage perverse consequences that have been baked into the system. But now what we have is a deeply confusing process for funding getting to the to the to the front line. And the third thing is that workforce um we we we maintain a an a completely un uh justifiable differential between what the government is willing to pay social care support staff in our sector compared to the amount that is going into public sector providers to do an equivalent job. We have to deal with that. The bit that I guess we weren't expecting and it isn't in the written document, but it was in the first minister's speech was his comments around the NHS and the role of the NHS in a future social care landscape and his comment that he couldn't see that uh accountability, decision-m and funding should not be sitting with the NHS if we're going to make reform. Now, we like everyone is going to have to think about the implications of what that means. That statement in and of itself can be read in many different ways. um it's not detailed enough to be completely clear. I think though that what we're not clear on is whether we have a three-month consultation where everything is on the table and we can try and find a means of improving the social care system so that people can really thrive in their lives in their communities with the right support or are we trying to look at how do we improve the processes if the NHS are going to be in control and and I'm not yet convinced I'm clear which we are doing within this consultation period. So, I think if we're going to make a change, if we're not going to repeat the the accountability fight that was the National Care Service, which I can't imagine any of us want to do, then we need to be clear that the leadership is across our system, that we have supported people and their carers who've got a really essential voice to shaping what comes next. And this can't just be a fight with lines drawn now before we even begin about who owns the money because actually the people who should own the money are the people at the front line through self-directed support who should be able to get the support that they need when they need it. And I think we have to keep bringing the people back to the very center of this discussion, not the structures and the power structures that we have at the moment. >> Thank you, Professor McCascal. I don't want to repeat everything that Rachel has just said, but I would absolutely affirm everything that she's just said, but before I share what our organization's perspective is with regards to the program for government, I think it's important that both the committee and wider Scotland understands what we're talking about here. We are not talking about a set of services and supports whose primary focus and aim is to support the NHS, however critical that may be. We are talking about supports that enable people to live their lives to the full regardless of whether or not they may be living with a disability, living with the consequences of frailty or indeed with dementia or any other condition. Social care, the name says it all. It is about enabling citizenship, enabling people to belong to their communities, enabling them to live the life that they want to live as fully as is possible. This is therefore not about maintaining people where they are or how they are. It is about enabling structures and systems and supports to enable those individuals to live as citizens of Scotland. So I think it's really important that first of all we emphasize that social dimension because Scotland uniquely from the 1960s onwards has celebrated that care and support is in community and it is part of what we mean by community. So everything else I'll briefly say is predicated on the importance of seeing social care as something distinctive as something that enables community and that is inherently to do with our human rights as individuals. As an organization we welcomed the first minister's statement and indeed the program for government because we know that social care is not working. I've appeared before this committee numerous occasions over the last decade that I've occupied this role and it is not working to an extent today that I have never seen. It's not working for the woman who cannot get a care home bed and has to wait for 9 months at the end of her life in the northwest of Scotland. It's not working for the person with a disability who is unable to access care and support in their own home and is recommended to move into residential care which they do not wish and they do not require. It's not working for the thousands of women and men who deliver compassionate, dignified care in our communities every day, but are paid the living wage, yes, but a wage that does not enable them as citizens to thrive and to contribute. So, we recognize the system is not working. Our health and social care partners will identify nearly half a billion pounds of shortfall. And yes, there will be an opposite view which will say that the debt level is not as great as that. It's not as great as that because like the women in the north of Scotland, it takes free individuals to make a place available to die in a care home in parts of Scotland before you get a bed. And in many parts of this country today, there are individuals whose package of care when they no longer require it, only 10 or 20% of that is reprovisioned. That's the Scottish impact. But there's also a global impact. Before I came in this morning, I noticed that gas prices opened today 6% up than what they were yesterday. For our members, particularly those dependent in residential and nursing homes, they are now paying twice as much for gas supply as they did this time last year. Oil hit 100 dollars a barrel this morning. Our care at home members are struggling to pay the petrol costs which enable them to pay the workers to deliver the care and support which is so necessary. So both in terms of a global challenge and a local circumstance, we need to get around the table. And so Scottish K is delighted to accept the invitation of the first minister and others to have a thorough review. Nothing is off the table. Let's explore the possibility of new commissioning models. Let's explore a greater role for the NHS, but not a role that diminishes social care, not a role that turns care into a clinical outcome when it has to do with citizenship. Thank you convenor. >> Thank you very much. Um Miss Laspa, >> good morning convenor and thank you for having me today. Um so as the representative voice of of local government in Scotland, COS has obviously taken a keen interest in the program for government and indeed the the announcement and commitments around around public sector reform. Um and and I suppose as a politically led organization, we take our our mandate from council leaders and and our wider elected members. So I wouldn't wish to to preempt anything they might have to say about that ahead of when they meet at at the end of this week. Um what I will say is is that local government has has always been up for and really clear about the need for improvement and and reform across the system in particular across social care. We've we've been really vocal about the challenges facing health and social care partnerships but but also our our our providers that are commissioned to provide these services. Um and so going forward in terms of the the discussion around public sector reform, local government really needs to be right up the center of that, I think local government has a strength in terms of integration in in terms of our democratic link to communities, but but also the services that that we deliver um that are placebased and that keep people well and and that's much wider than social care, that's housing, that's employability. So, a really kind of key role in terms of that democratic link to our our communities and and into integration. Um, I suppose a a kind of key interest of ours in terms of the next few steps in in in the program for government and public service reform is the extent to which this enables us to deliver on that early intervention and prevention that that we've talked about for for so long now. um the extent to which these reforms are allowing us to invest in our workforce as has been touched on already, invest in in in supporting unpaid carers to to continue in their role. Um and and crucially, are are these national reforms enabling local government and and kind of wider community- based partners to to continue to build capacity and and and deliver services because as all of the submissions have have outlined, there's significant challenges in the system. So, so we'll be watching closely and and I'm sure we'll be keen to understand the the sort of next steps in terms of that. >> Thank you. >> Thank you and thank you convenor h for the opportunity to be here today to help support the committee's understanding in terms of social care, social work and and the provisions therein. H as a care inspectorate we are the independent scrutiny assurance and improvement body for social care, social work and child uh care across Scotland. Within that context we bring a very unique perspective in terms of how well those systems are operating uh where improvement is required and support that improvement at service and and sector level. We understand that the program for government has set out a number of key ambitions uh in terms of social care reform and and Julie note the dropping of social uh within the committee's title and within the minister's title but naturally uh keen that that any consultation uh in that regard places people working across those services and social care, social work, uh early learning and child care central to to any conversation and consultation. The workforce that that supports people using services, social care services, social work and so on have expert knowledge uh experience, capabilities and competence and an understanding of what's required. So having an equal space at the table for any consultation is incumbent on anybody who leads forward uh that consultation. Um, it's crucial that that individuals who experience care uh and use social care services are also central to any conversations on on change or reform within the social care sector. The care inspectorate naturally place a great emphasis on the experiences of people using care services and and naturally h use that to support our understanding of how well services are operating. Those are the individuals who who naturally have a great deal of expertise and understanding in terms of resilience in terms of future proofing uh the sector uh as any conversations uh on whatever shape uh the the social care uh landscape looks like uh now or or in the future. And naturally as as the independent regulator uh for for social care, social work and early learning and child care, we'll continue to carry out a role within that structure or any structure that that moves beyond that accordingly and in the context of public sector reform. Thank you. >> Thank you. And Mr. Mloud joining us remotely and we're grateful to you for finding the ability to join us. >> Thank you very much. Morning everyone. Um I don't want to reiterate what's already been said but one thing I would go over is that our primary concern was the the comments that have been made around uh the challenges facing social care without a single line of decision making accountability and funding with the NHS taking the lead as others have said um our organization is a although charged with improvement and implementation of self-directed support of the of the legislation at a local level and we're also a disabled people's organization represent 70 members organiz organizations who represent the people and we're primarily from we come from the independent living movement in Scotland where the notion of um personalized support was was developed in Scotland so that the fear of the medicalization of social care is what our members um expressed is um the fear that there's a medical model being imposed where people are given treatment due to illness versus the social model of disability where a disabling world is the inhibitor rather than impairment. Um unfortunately we increasingly find that in times of austerity as we're in now with eligibility criteria tightening correspondingly so does flexibility and it's the only area that we have for for maneuver for movement just now um recommendations coming from our recent research into cuts to direct payments um and from the national care service advisory board prioritize a need for improved data and increased flexibility but a risk averse culture however works contrary to that um we've currently been operating an SDS improvement plan which is coming to an end this year that was developed through a body called the national SDS collaboration um it's formed with disabled people's organizations social care social work third sector and independent and support. So they all intersect there and it's critical that in developing um a new strategic driver because we're we're heading towards a time where we won't have a strategic driver um that the national collaboration and all its members that are involved in that. Thank you. >> Thank you very much. Um we'll move on to questions that the committee have about a range of things have been mentioned and some which haven't. So we'll try and keep them structured and if people can keep the questions short and the answers short, we'll hopefully get through what is quite quite a list I see in front of me. Um so I think Adam, you had a question specifically following up from some of the issues. >> I do. Thank you, Canina. Um so I think I'll probably uh ask specifically to Scottish Care. Um in the submission uh for the to the committee, you say you recognize the opportunities presented by reform of the system uh but also highlighted a projected funding gap of almost 500 million across health and social care. Do you think addressing the financial gap would do more or as much as restructuring the system? I think I think we have to do both. Social care from our perspective is a critical infrastructure of the whole of Scottish society. Our language and even the way in which we have addressed social care has traditionally used words of deficit, drain, cost. We don't see social care like that. We don't see it in the daily experience of the women and men who benefit from support and who deliver care and support both paid and unpaid. It's something that enables our communities to thrive and keep going. We've not been able to maximize the potential of social care because of the fact that there is insufficient funding within the system. And I I have great sympathy for commissioning and contracting officers who are having to make decisions which have to do with not meeting their statutory duties but choosing which duty to meet on that particular day because there isn't enough resource available. So we cannot ignore the reality which everybody knows when they're waiting for a care and support package or indeed delivering it that there is not adequate resource in the system. It is up to government and others to decide if there is a cap on totality of resource how do we better spend that resource. From our perspective, if you're wanting preventative care and support, if you're wanting early intervention and reduced delay discharge, then you have to invest in social care. So, at the same time, however, the way in which we structure social care is clearly not working. So, we recognize and have always recognized that we need to reform the system. The problem has been that efforts at reform have not been fully inclusive. Some voices have been more dominant than others and there hasn't been a real honesty that you cannot reform without an an adequacy of resource. It's a bit like having an engine at the moment which is the engine of social care which I believe is at the heart of our community. We are no longer running in the red. We're running on empty and there's a fatigue and there's an exhaustion on the part of both those receiving care and delivering care. We recognize things need to change. We want to do the work of reform, but we want a realistic honest conversation about the inadequacy of resource as we do so. So, >> so you say some voices have been more dominant than others in the past when there's been attempts at reform. Which voices do you feel have been unheard? I I think there are lessons that we can gain from other jurisdictions and the one I know best is the way in which social care reform has transformed itself in Australia in which after a very challenging royal commission which isn't unlike the flee commission we've done the work of knowing what the future could look like everybody was included around the table we've not done that in Scotland we rushed in my opinion to legislative answer when we had not at the moment built upon the consensus which at that time existed and with due respect to everybody in this room who is a member of a political party we politicized the debate about social care reform. I along with many others have called for uh the removal of party politics from this most crucial and critical social question. That's not to demean the value of political contribution, but it's to say in a sense that the lessons from elsewhere show that we only gain consensus and movement and change if this becomes an issue for the whole of society rather than the vehicle of one political opinion against another. So I think it's important as we move forward and I hope the first minister will do so that the voices are as collective inclusive as is possible. Thank you. >> Thank you, Jack. I think you maybe had a followup on this. >> Uh, roughly, yeah, I think it's mostly directed to Miss Kit, but anyone is is open to answer. You've said in your submission that you're looking for parity of esteemed, paying conditions between social care and public sector workers. Will the NHS taking the lead, absorbing some accountability here? Will that help in that regard, do you think? And what would your hopes be um how how that's actually actioned by the NHS? So if that were to happen, I guess at the at this point in time, I I don't know because all we're working off is the statement that the first minister made. I don't know the scope of what that would mean, whether we're talking about like mass 2P transfer and the end of third sector organizations or whether we're actually talking about a different way of commissioning. Um so I think it's very open from our perspective. We've been talking for some time. Donald and myself have been in rooms for a very very long time trying to get a process of sectoral bargaining across the table and agreed with the government to enable there to be a move to improve the terms and conditions of of of staff. I don't think the public always understands that it's actually government funding that determine the baseline rate of pay in commissioned providers of social care and support. And there's very little wiggle room there for providers then to enhance that pay, particularly as we can see providers propping up public sector contracts through the use of reserves. So if we're going to have parity, then we we really need to be serious. Why is it acceptable to have a band three NHS agenda for change paid worker in the NHS who let's remember is not a regulated member of staff paid £3,000 a year more as a base rate than the government is willing to put into social care staff on the front line who are professionally regulated to do that work. That's the situation we're in. Since 2019, the government made a commitment to fair work and social care. We're actually further apart in that now than we were in 2019. We need to be encouraging people to stay in this sector. We've got such amazing staff working in this sector and we need to be encouraging new people to enter the sector. The way we do that is to get to par so that we're not creating a strange and and unhelpful internal market for staff within health and social care. Whether the structural change that was hinted at, but not really very clear to me yet, would change that, I don't know. But however, whatever the structure is, we still have to address the fact that in our public service, we should be paying people fairly with equity for the job that they do. >> Thank you. Uh Joe, I think you maybe had something in this area. >> Yes. Thank you very much, Convena. and and I'll note again my register of interest show that I was employed as a director of social care organization in the third sector until the 18th of May. Um I wanted to ask Rachel Khakit and Donald McCascal a bit about commissioning. Um you both mentioned it in your submissions and in your opening statements. Um the FEA review in 2021 led to a lot of discussion about structure and governance but one of the key elements of that was about collaborative and ethical commissioning. Now that may be about culture and process as much as it is about structures of governance. So I I I guess I'd like to just tease out a little bit what would good look like in terms of ethical and collaborative commission. How does that differ from the status quo at the moment? Start. >> So just waiting for my mic. >> Thank you. >> Um so at the moment um we did a piece of work a couple of weeks ago which shows five of our providers um anonymously who shared how money flows into their organizations. It's a very uh arresting graphic when you see just how complex the situation is for providers and how many different funding streams with different reporting mechanisms with different uh contract terms are coming to them and yet we're being asked to be efficient. So the first thing I think we need to think of is how do we simplify this system so that what we've got is money going from the public purse to the people who need support with the least friction as possible. So that's the first thing. It's got to be simple. At the moment there are too many um variables across Scotland. Now I know colleagues will say local democracy really matters and of course things are different in parts of the country but I don't think it's beyond the wit of man or woman to simplify that system and to make it an easier more more efficient system for those organizations who are trying to make provision. The other thing is that competition is rooted through our system and Derek Phel was very clear that we should be commissioning for public good and that competitive tendering like we're tendering for widget production or tarmac production is the same approach that very often we have within social care and we have third sector organizations pitted against each other in these competitive tenders where the where the tendency will always be a race to the bottom and that should not be our aspiration here and I understand our local government colleagues are having real issues as are our JBs about the amount of funding that they have but price has become too heavy a burden within a sector that's meant to be about allowing people to flourish as a social contract. The other thing is the way in which money then flows is very very difficult. So one of the things that we've talked about for years but comes across very strongly in our report are some of the the the basics the number of organizations that are constantly waiting to be paid for work that's been done. Delayed payments should not be happening. There is a contractual obligation to pay and you'll see a quote in our report of one provider said they were waiting for half a million from one council and a similar amount from another of payments that have been delayed. And I think we've got a system at the moment that is we talked a lot about accountability. The first minister talked about accountability. But with accountability comes the owning of risk. And actually what we have at the moment is risk pushed through the system to the front line where the people holding the greatest risks are the workers and the supported people and their families who were holding the risk of not being able to get commissioning right. So I would say we need to look at the best examples of the most collaborative commissioning. We need to free providers up to work in a way that's not the same as commissioning baked beans, but actually is about trusting them to know the people that they are working with and to make the right decisions. There has to be a much more outcome focused. Is this money? Is this public money helping people to improve and live their best life? That should be what we're aiming at here. That's not how commissioning is currently running. And where money is flowing, it has to be paid on time. disputes have to be resolved quickly and we have to be clear in reporting back up in a very simple way that the taxpayer is getting a really good deal here which I think our sector can do. >> Okay. Thanks. Um Paul, I think maybe staffing follows on from this and if you know if you want to address it to anyone in particular or if the panel would like to indicate. >> I just want to pick up the point that Rachel mentioned in the top of the staff and Rachel I think you're right because I spoke to Penumbra probably around about a month ago and they talked about some issues around about whether it was around the commissioning or they had a two or three year kind of contract and the difference they said between the the viability of their business the business going forward was was you was chalk and chase. So I think that's a really important point and he asked me to stress that. So I think the point he makes in terms of that I suppose the first question is probably to to Jill and Jill for me and you've all kind of said around about the staffing issue and we all know there's demographic challenges. So it's not just talking about the here and now it's the demographic challenges in the next 10 15 20 years. So whatever we need to do needs to make sure we do that in 10 15 20 years and I suppose it more a question for for gel gelots in terms of the the demographic pressures and procurement kind of issues around about that and I know that's down to local authorities had 15 years experience and the council leader previously the demographic I don't know how much that's actually been assessed at causal level and how much that needs to feed into process and obviously that then feeds into the rest of what everybody else does but can you say a little bit more in terms of the demographic challenges that you're seeing coming through and how that then impacts and staffing because that has to come through in terms of there's demographic challenges the staffing requirement is is needs to be up there and how do we have a workforce plan around about that and I'll open up beyond that but just for a cause >> yeah absolutely um so I suppose I'll start a bit with the local and and then touch on on the the kind of national um so at a local level members will be aware that that integration authorities IGBs have responsibility for the the strategic planning in in line with with their areas. So, so demographic pressures are are absolutely something that that they look at in terms of planning for what types of services that that they need to commission. I think a lot of the discussions that that we've had at a national level and and in particular around around some of the work in terms of ethical commissioning which was has been a really kind of focused area of work um shared between ourselves at between causal and Scottish government but but also um providers, trade unions um people with lived experience but it it very much is about um how do we [clears throat] engage with our providers locally so that they understand what services they need need to be able to offer commissioners. So, so there there's there's work underway there. I think at at a national level, we we probably need to be better at understanding what it is Scotland will look like in 5 10 15 20 years in terms of not just our demographic profile. Um, but in in terms of of the workforce that that is available to to meet growing and and existing unmet need. Um, people are living longer with with more complex conditions. um and and with with with more complex I suppose needs. Um and then equally we we have um individuals who are who are transitioning into adult services um and what does our housing need to look like. So um integration authorities are are critical to that but but as our as our local government. So um at a national level I I think it's something that that we really need to be focusing on over the next year. Um I note that I believe in the care reform act there's there's a provision now for um ministers now to be looking at at levels of of projected need and I think that will be really valuable in in terms of of understanding what what it is that Scotland needs to plan for locally and nationally. How do we have a workforce that aligns with that and and from a causal perspective we we would be really keen to kind of be right up the middle of that. Um I'll close by saying in terms of the social work side of things because we talked about the social care workforce um the social work workforce is also one that we need to be really mindful of in terms of of how we're planning for that. Um so the Scottish social work partnership um is a strategic partnership between Cosa, the new national social work agency and and social work Scotland and workforce planning is is really key to that and and we'll be absolutely drawing upon um some of the data that that we will need to be looking at in terms of future need and and the demographics there in terms of what does our social work workforce need to look like now and into the future. Donald, I can see I seen you nodding your head there and there's a few things you put in terms of recommendation models in terms of validate true cost of care framework which I think is really important and then you obviously mentioned and the two stick out for me is a fully funded fair working and workforce strategy for social care and you're right because I think we have to fully fund it but it has to be meet the challenges the next the next 10 15 20 years. Can you say a little bit more in terms of the importance on on these issues? Okay. So, the first relates to the fact that we need to really cost care adequately and independently. I've had the joyous task of leading the annual negotiations on our largest contract in social care, which is the national care room contract. I'm slightly euphemistic in using the word joys, but it actually hasn't been a negotiation at least for the last five or six years because it's been a take it or leave it situation because though we are basing a our decision on a cost model, it's a cost model which providers have not accepted for half a decade because it's inadequate and we all of us more publicly and privately accept it's not inadequate. So you've got a cost model in this year which doesn't pay a provider of residential or nursing care any money for technology, digital infrastructure or costs. How's that possible in this era? So we need a radical review of existing cost models and I would put forward the national kome contract as an example basing that review on ethical commissioning principles which we've all worked on which we all agree with but at the end of the day it comes back to the adequacy of resource because you can't negotiate if there's some if there's an empty packet in front of you that clearly relates to the workforce. I think most of us who provide care and support whether not for profofit, private or charitable, recognize our greatest asset are the women and men who work in the sector. And we need to and want to do more. And that's why Rachel and I have been working with the trade unions and others over the last few years to try to move to that position. I have no doubts that were we able to better remunerate and reward the women and men that are in the sector, we would hold on to them and we would do better at attracting others. However, one of the other demographic truths about Scotland which I think we too easily ignore is that we do not have enough people and that we have a growing demand. I yesterday took part and privileged to take part in a global nursing event in Edinburgh with participants from India, from Nepal, from the Philippines, from all over who contribute to the Scottish care economy because women and men have come here and decided to commit to being part of our communities and offering the most astonishing care and support. And yet we are finding it increasingly difficult as independent providers to hold on to those staff because of a toxicity of environment and to attract international workers. I want to somebody to show me where the working population is going to come for us to plan our future demographic need in Scotland without attracting from outside and making this aospitable place. And just in case somebody does a rough arithmetical exercise, yes, statistically you could say we would have enough people. But anybody who has seen somebody hold the hands of a woman in the last moments of life, who's had to support an individual who's doubly incontinent, who's had to communicate with somebody who struggles to use language, will know the job of care isn't for everybody. It's for those who are gifted, unique, and special. And they, wherever they come from, and the people we need to support and hold on to. So, it's not a simple yes or no. It's a complex picture and it's one that we need to build a workforce strategy around but which is fairly and adequately costed. >> Thank you. I think um Jack you've got a followup on this and I don't know if you wish to address uh to anyone in particular what you ended on there. I think your submission said that a survey found that about 26% of the workforce were international workers and >> it's clear that the current system makes growing that almost impossible just now. So what do you think specifically needs to happen in terms of immigration in terms of tailored routes to encourage more people to Scotland because we do have an aging population and we're going to rely more heavily on these international workers to support Scottish social care system. While ago, I gave evidence to this committee arguing that we needed to learn the lessons from Canada and Australia where there are systems which recognize first of all that there are sectors with particular needs and secondly that it is possible to operate a national model of immigration control but with regional diversity. And so as an organization we have been in favor of a Scotland specific model which would enable individuals to be attracted to want to come to this country to put down their roots and to contribute to making us an even better society than we are. I am very public in my comments about some of the toxicity and the language which has come from uh the previous UK government. uh and I think we need to move on from that and I hope with the new prime minister that might be a possibility but our members many of them employ international colleagues their experience sadly is of a system which is now designed to make it as difficult as possible to retain existing workers and to attract the women and men that we need for the future again I think it's urgent that both Scottish government and the UK government work with social care providers in all administrations to develop an immigration policy which is sensitive, which is addressing needs, but which is also humane. I don't think we have that at the moment. >> And if we don't move in this direction and perhaps double down on the the kind of toxicity that you've talked about, what's going to be the impact on the social care sector? Maybe not tomorrow, but in 5, 10, 15 years down the line, >> it's already here. We are seeing organizations unable to recruit and therefore unable to deliver support and having to close. And the people who suffer from that aren't obviously they're the workers and they're the employers, but they're the women and men who cannot get the service and care and support they need. I know that there are pockets of Scotland, particularly rural Scotland, where you have to go a 100 miles to a residential care home. The issue isn't a lack of need. The issue is a lack of adequate staffing in those areas. And it links, as Jill has highlighted earlier, to housing, to community infrastructure where the local village school has had to close because there aren't individuals attracted to live in that community. So, this needs a whole system approach. It's not just about workers. Unless anybody externally suggests that these gifted women and men are working on the cheap, they are not. They are working for the same wages, for the same terms and conditions, however inadequate we all of us agree, as anybody else. These are people who are the fabric of our society. And some people out there are wanting to rip that fabric apart. social care providers will not allow that to be the case. >> Okay. Can I bring in Kaylee? I think you might have something on this and then I've got something. No, it's been answered. >> Yeah. Yeah. Thank you. >> Thank you. Um yeah, I wanted to ask um anybody really about training um our own Scottish people and uh you know whether there's a role there for expanding further education. Um and you know obviously coming back to the point of people getting rewarded we tend to you know want a certificate to say right you've got something equal to that and I know um you know many of the people in care homes and I'm not just talking about care homes and we'll come back uh to Mr. Mloud perhaps on your own uh area but um I just would like to hear really I suppose from Cosa and others what you think about whether we're needing to expand courses in those particular areas. So coming back to professor McCascal's point um if we think that's you know we need more of these people then obviously we need to encourage them in in various ways and I'm just asking about that. >> Yeah. So I I suppose as as as part of of the the fair work and social care agenda, um, one of the the sort of key things we've we've looked at between causal Scottish government and and kind of stakeholders as well is is in terms of of the real value of the social care workforce. And I think a really fundamental way of valuing the social care workforce regardless of of whether or not they're internationally recruited or or um born in in Scotland is around the professionalization of of social care. we've heard about the really valuable and and really really important work that that the social care workforce carries out. Um they're with people throughout the the final days of their life oftent times. So um I think anything that improves the the value and the professionalization of the social care workforce is really important. That does also though come back to the issue of of pay. Um, so if if we're if we're going to add um further kind of professionalization and and kind of training on onto the workforce and and demands in in that regard, I think we need to to be realistic about about what we're paying the workforce, too. And I and and I won't I won't repeat what what Donald and Rachel have have really eloquently already said. But but for me, it's it's about training absolutely in terms of that professionalization, but but also the the pay that then follows that. >> Um I don't know, Mr. Mloud whether you have anything you wish to put in here. I realize you're kind of sitting in the circle there so I didn't want to miss you out either on this or or something that's been missed if you want to follow up on that. >> Thank you very much. Um [clears throat] in terms of the we've been working we've had a focus program of work on the PA workforce personal assistant workforce. There's around 10,000 personal assistants in Scotland and it's a critical workforce in ensuring that disabled people can live independently within their communities. Um we I mean we've been training social care workers, you know, for 30 years and um you know certificate that train. We've we're at the start of that. We've been at the start of that process with the personal assistant workforce over the past few years with the PA program boards that we chair. Um we've got a subgroup focusing on the needs of employers and personal assistance people who take option one who take a direct payment. So we do have a national training framework for personal assistants and we do have training modules and we have a training locator um that um personal assistant employers can access. So yes it's it's a developing area um for those um PAs regardless um of nationality. Thank you. Yeah. And do you find that that that's quite popular and do you have links with the further education colleges which um you know we could look into what they're thinking about providing going forward? >> Yes, there there have been and that's part of the the training locator work that we do. It's it's a sensitive area and it's very individualized because each but you know when you look at the demographics of personal assistants and the primarily the bulk of personal assistants are 55 to 60 year old predominantly females um who [clears throat] so it's a negotiation between the employer and the individual as to what training that particular employer needs rather than imposing anything mandatory on PA. So it's we're taking a very individual individualized approach and and making sure that the tools are there for employers to to act as such um without it being a burden. >> Thank you. Um yes m >> thanks convenor. So I I think just to emphasize to the committee that this is a trained and regulated workforce to work in this system and whether you're an existing citizen of Scotland or a future new Scot and I would agree with everything that Donald has said in terms of looking to welcome uh highly skilled people into what is a highly skilled job wherever they are from and give them a a real welcome and recognition in the communities in which they live really really matters. We've we've done a report again we can make this available to the committee on the the priorities for the workforce training and qualifications of the workforce. And one of the things to pick up on something Jill had said in the NHS we have a workforce plan for social work. We now have a new agency responsible for planning for the social work workforce. We don't yet have the ring being properly held on workforce planning for the 200 odd thousand people who work in the social care workforce. Now I know that there are conversations going on about how to do that better. But actually you the point you were asking about do we have enough courses? Are they in the right places? Are we attracting the right people? And I think that's a really important point because we all want to be looked after by people who are passionate about doing this job. That piece of work is outstanding and we're certainly calling for as part of the reform, whatever that looks like, coming next that there is a really concerted effort on bringing together all of the factors that would give us a vibrant workforce for the future because that is what we are all going to need. Um whether that is now or into the future, whatever age you are, we need highly skilled uh workforce who are um enthusiastic about doing their job. And I would say within my member organizations and when I go out to meet members, the thing that I always come away with is just the quality of the people who work in this sector is exceptional. But we are asking too much of them for too little. And that actually is an 80% plus workforce who are women. And perhaps that's why we've got away for so long with paying at a national level from Scottish government too little to this workforce to do an incredible job for our families. And we should be recognizing that wherever anyone uh began life. It's more about are we getting the right people trained in the right way and remunerated and rewarded. And in that immigration discussion, one of the things I would say is can we please stop talking about low-skilled workers in this sector? People in this sector are not lowkilled. They are highly skilled at what they do and we would do well to recognize that for all of us. >> Yeah, I'm sure we do recognize that. Paul, I think you had something you wanted to quickly add to this before we move on. >> It's probably an experience in East Loian and talking about this the staffing and recruitment issue. We worked with Enable and pulled together a round table talking about this issue. We worked with Enable. label were offering 1718 pounds to some workers to try and bring people into taste loading and it recruited a certain number but not not a huge amount to do that and there's about a 20% gap in terms of the capacity we we kind of require in terms of that I suppose some of the issues of it recruitment we struggle even in even in the remote part you know actually recruit people in terms of that so the recruitment issue for me one of the important parts is not just in terms of what we do recruitment across Scotland it's how do we recruit people in in remote and urban areas and now I'm talking 15 miles away from Edinburgh and we're struggling to recruit in Dumbar and in North Beric for example. So I don't know if you can say any more in terms of that specific challenge because I think we can talk about recruitment but it has to be in all parts of Scotland. It can't just be in where we think it we need to do. So I just I think it's a really important point for me to try and get across. >> Just answer this quickly. Another long list here for the next. So I think we've got an issue as you're saying with pay and actually you can see organizations doing their best to try and out pay but it's it also creates a differential space in terms of pay. I think we just need to speak as a country quite differently about social care. We need to be really clear about the enormous value and reward there is in this as a profession and we need to make sure that our pay structures allow for this to be a career choice for people so that they can work through. At the moment those differentials between say management and frontline roles have been eroded so far because of government pay policy that you can't necessarily always see your future as a career progression. So I think what all of us need to talk quite differently about social care. We need to promote it as a really valuable career choice and then we need to back that up. >> Um Heather I think moving on you had a question on medicalization of care. >> Um thank you convenor. Um, very powerful testimony this morning from everyone. And I just wanted to while you're sitting there, Paul, there's also 800,000 people who aren't paid um to provide care and they also need considerable support and skills development. But I think my it's picking up on your point and and where Professor McCascal started about um the job of social care is not to ease the pressure on the NHS. Um and so in this conversation it's very easy to slip into prevention but what we're doing is preventing the NHS being overburdened. So um what can what advice can you give us about how we protect that principle that social or care not just social care care is equivalent to health you know and we tried to do that with the social care service and you know that sorry the national care service being at the same level as the national health service we didn't get as far as we wanted to with that discussion but in this discussion going forward how do we ensure that care is seen as equal um and not a handservant to the health service. So that thing about and and I think Donald I picked up from you as well that real concern about medicalization of care. >> So I think the way in which you prevent the risk is to identify the distinction. It's not that clinical services in acute and secondary or even primary care are less than social care. These are complimentary sectors who dovetail which doveetail into each other and you can only reform the totality if you understand the distinctiveness of each part. You know and and and at times I think we fail to properly understand that communitarian dimension of social care. I often use the analogy that if I have an accident and I break my my leg and I go to hospital, I will receive great clinical support and probably not all that bothered with who treats me uh as long as they're appropriately qualified. But if as a result of that accident I'm going to be incapacitated for the rest of my life, that injury is going to impact on me and I require care and support then I do want to have choice. I do want to have agency and voice and the ability to determine who cares for me often perhaps in the most intimate way. So both are providing care and support. One is much more clinical and some often in an emergency response. The other is lifelong and the way in which you deal with somebody who's living with a clinical condition in a lifelong way has to be different. And I think the way in which we prevent an inappropriate conflation is to celebrate the distinctiveness. These are not competitors. They are a two parts of the system requiring parity of esteem but also parity of treatment and resource. And that's not what we've had. So I think the conversation that we're about to have and Rachel and I know as much perhaps as some people in this room about where that will lead is an opportunity for us to treat things in a much more holistic way because the citizen doesn't really mind the color of the uniform of the person who is caring for and treating them. What they do mind is having to repeatedly tell their story to multiple actors and having to have groundhog day experiences. We want a seamless integrated system where there is respect amongst professionals and understanding of what the unique contribution of each part of the system is. I don't think that's that difficult naively. >> Can I can I just come back? So the and as you say we've had one line about the lead agency being the NHS. Um if that is the case how do we protect that parity and that integrity of the care sector to ensure that there isn't a subordination of one part of care with another. >> I think the important point is to be in the design from the beginning. If that's the intent then we need to have uh people who are receiving support and care and leaders within the sector who know how the system can work and what we would need to do to make things better in terms of support to be in the design stage not an afterthought. So if you want to design a system to improve flow through the health and social care system, don't just have clinicians in a room who are only really thinking about the front door to the back door of a hospital. Actually design it with us. Let us bring our members and let us bring people who are actually involved in providing a huge amount of the care and support that's required. Think about language. The NHS talks about patients. Patients are people who happen to be in contact with the NHS. We don't have patients. We have people who was >> doctors of people as well. >> But actually if you look at policy and you look at the way in which the policy landscape and the way in which uh language is used in the public domain, it's very common to hear our NHS colleagues talk about patients all of the time. People are people who may be in contact with the NHS. It's almost like a capernac shift of thinking that our our center of gravity is around the NHS and we we shape around it rather than our center of gravity is around people who need various types of care and support at different points in their life and we will shape our entire public service around that. We say we do it. I would say we don't really do it but let's enter into that space and do it differently. >> Okay. As a followup from that, how confident are you then that in the proposals that's coming forward, say we get two health boards for the whole of the country that that will then integrate better because those will be very big organizations at that point. >> I don't know is my answer. I don't know enough detail. I don't know what the plan is under those two regional strategic health boards. I'm not quite sure if we are to keep our existing integrated joint board structure how that relates to two large territorial boards on the mainland. I'm not quite sure where our local government colleagues yet are on how that works. Um and and how the local dimension that goes beyond the NHS, the connections with housing, for example, that are really important to the people supported by membership a and actually many of our members provide housing support and homelessness services. How does all of that work? At the moment, what we've got is a sketch. And it may be a great sketch and there may be a lot behind it which I've not yet seen. But I guess I can't be confident until I can a see more of a direction of travel and b be really confident that members uh like mine and our partners across unpaid carers, across disability organizations and beyond children's organizations have a part in shaping it. We can see that. Maybe we'll come up with something that is genuinely what Feelely suggested we should do all of those years ago. >> Thank you, Jill. I think you wanted to come in. >> Yeah, thank you. And and I suppose just just to add, I mean, like like Rachel, it's it's hard to to know what what the the kind of future will look like with with the two health boards as as was announced last week. Um, but I suppose it goes back to to the point we've touched on in terms of the role of prevention, which Cosa very much welcomed the the emphasis on on prevention and early intervention within the program for government. It's something local governments um very much committed to and and that was articulated in in the population health framework and and and a variety of other other areas of work. I suppose from a local government perspective, what's really important to us is is how we're framing prevention and and and ensuring that we're broadly talking about the same things because you touched on um prevention not just being about preventing something happening in hospital or somebody appearing at hospital and and I suppose you know there's the vast majority something as much as 80% of of the services that keep people well in in their communities are are delivered by local government or or our community partners and organizations And again, that's housing, that's income support, that's employability. So, I think whatever the the structure looks like, um, and and whatever our sort of discussions look like nationally over over the next few months, I I think that's really fundamental to ensuring that that social care and that wider prevention agenda is is is really reflected. >> Thank you. Um, I think that leads me on to ask about IGBs. Nobody's really mentioned them and obviously that's a a critical interface. Um, so how do people see that that might go forward? Whether people feel that that's worked to a degree. Um, I think everybody feels there needs to be reform, but um, and I'll start with Jill since um, you cover that interface. >> Yeah. So I I I think from a causal perspective, we'd be interested to understand how um the how IGBs would interact with with two health boards. um members will be aware at the moment there's there's 31 integration authorities I believe and and 30 IGBs um and and that is that's the formal legal partnership between a council and and a health board. So right off the hop that that that sort of demands quite a few questions in terms of what what that means. Um if if there are two health boards um we recognize that that there's been challenges in integration. I think it it is has been relatively new. We did have a a kind of pandemic in in and amongst that. Um and certainly in in our discussions um even in back in in relation to the National Care Service bill um we we recognize that that there are improvements that could be made in terms of people's I suppose understandings of of integration but but equally how members of the public how individuals who access care how unpaid carers and how a workforce um fit within the the kind of structure of of integration. So um I I suppose from our perspective we'll be really keen to understand the the local democratic accountability component of of integration because at the moment um that that comprises councils and and I suppose with with the two health boards it it it's a bit of a a kind of wait and see in terms of what what the the outcome of that would be. >> Thank you. So I suppose I've heard that as you've said that the it's a relatively new thing and that the IGBs have improved. That may or may not be the case but that certainly um was what I've heard. So I suppose my question final question on the IGB front I think Joe's got something um would be if it has taken 10 years I think it is to to bed down is it wise to then throw it all up in the air again or is there a way of making that work with whatever's coming forward and you may not be able to answer that but try >> yeah I I mean I suppose a a priority for any reform needs to be about understanding what the challenges have been up to now and targeting the change to address that and and I suppose I reflect on on some of the themes that came through in in I think almost all of the written submissions for today's meeting and and that's around the the resourcing of the system and and the challenges around the workforce. So um I would suggest that that's probably a key priority in in terms of improving outcomes for people and improving people's experiences of care. Um, I I think IGB governance there's there's probably some some work that could be done in terms of of improving people's understanding of that and and sort of how that kind of interacts with the services they experience every day, but I don't think we're going to get anywhere in terms of improvement if if we don't start to to consider the really significant challenges around resourcing the system. >> Okay. Thanks. Um, I'll come back to you, but I think it may be related, Joe. I think you had a followup on this. sort of provocation really. I mean we've heard we've heard that health and social care integration hasn't been an integration of equals really. Um um we've heard about some of the issues around that. You know we've heard but we've heard different terms. We've heard Donald McCascal talk about dovetailing services. We've heard Rachel allude to the document about flow. Um but what we've really heard is that social care is a distinct sector in its own right. Is is the trope of integration still a useful term? Is it a term that's useful for us to use in policy? Don't have a cast. [laughter] >> Sorry. Care has an accent and I don't mean the person giving that care or supporting somebody has an accent. Care happens in a place. It doesn't happen nowhere. It happens somewhere. And place influences both the nature of the care and influences the community in which it is happening. So, and that's what makes social care distinctive. It's not happening in a building. It's happening in people's homes or a homely setting in a community. So, I think the trick for any reform process is to understand how do you enable the local, the neighborhood, the place to influence the decisions and the resourcing of the care which happens in that place. I think at times having been around integration for a long time the structures have worked effectively in other places they haven't worked effectively because in a sense they've been about the mechanics and the process and not really about how this is felt by people. I remember the architects of integration spoke about the fact that we needed to remove the postcode lottery and we haven't succeeded in that and we needed to stop people having to tell their story countless occasions to different people and that still happens and that's because I think we have not yet even in the integrated structures got that sense of place or neighborhood right. How can we develop a structure where the local is the leading dynamic? Now I I hesitate to suggest that there are parts of the world which have achieved that and one of the examples of that is South Korea at the moment where the use of new technology is enabling citizens to influence decisions around their care and support and to be a democratization of decision- making which is at the heart of for instance the self-directed support legislation where I am the person not with professionals around me the person who is in the lead, in control, in charge. So I think we need to be much more adventurous than just thinking about have IGBs worked or not. If it's a structure which is for yesterday, let's reimagine a structure for tomorrow. >> Question of integration. Um, I think when we talk about integration and we use it as a shortand and we're referring to the 2014 public bodies act, we're really talking about the integration of some social care and the integration of some health because the the act is clear. It's it's not the whole of the NHS that's integrating and nor is it often the whole of social care. There are there are formal delegations and sometimes IGBs go beyond that and integrate more. But if you look at the piece of work that we published a couple of weeks ago which was looking about governance process locally and you've got community planning you've got uh ADPs you've got all of these structures some statutory some not some with power some more collaborative what we've got is a system which is so focused on integrating parts of a system but not doing what I think Donald is suggesting which is integrating around local need and people's needs and one of the distinct features for me in social care is that absolutely emphasis like Donald was saying earlier on online which is the way in which social care has emerged which is about choice and control. You know it's written into SDS legislation. People should have choice and control. It's quite different from the NHS. My concern is the the link between the NHS and social care is strong and important though I agree they are quite distinct. However, by only integrating those two things through integration authorities, the risk is first there's an enormous power differential and that plays out. But the other thing integration was meant to do and I don't think ever did was create a budget without identity. The idea was money would come from the two partners into the IGB and it would then be spent as was required by the local community according to a strategic needs assessment. I I would wager that's really not happened. I don't think that's happened in anything like as somebody who sat on the bill group back in 2013, we all imagine this legislation would get us to. So whether it remains the right structure or not, I think I would agree with Jill. We need to be clear on purpose and then look at the problem and then decide how we fix it. But I'm not sure that IGBs have been able to work and flourish without feeling like a hands tied behind their back because of the level of constriction both in terms of available resource and how flexible they can really be in changing how money is spent. >> Um, thank you. Well, just on following up on Professor McCascal's point about being designed around place, is that then an argument for unitary authorities? So the the islands are going to be unitary authorities. Um you know the NHS is a is a big thing. Um is it possible that instead of all these things we could go back to local authorities being in charge of except for specialist care like cancer and so on? Um do you think that's a possibility anybody? >> I think it's an argument for collaborative working. And if we look back to the creation of the NHS all those decades ago, the essential model was a community and a local model. It wasn't a national hospital service that an iron bean spoke of certainly in the committee stages of the debates running up to the creation of the NHS. It was very much localized responding to neighborhood. He even used the phrase and to community. I I think the NHS has significantly moved away from that model and maybe the challenge isn't so much for the world of social care and social work to move towards that model because I don't think we've ever left it. Maybe the challenge is to redesign the NHS so that it is more local, more responsive to the needs of people and population. And that's not me being overly critical of those who work within the NHS as a structure, but it has become somewhat detached and distanced from the vision all those decades ago. So maybe the question is the other way around with respect. >> Thank you. Uh Joe, I think did you have a followup on this area or is that >> around profit in the sector? >> Um well yes, we can move on to that but I thought you had something on integration but maybe >> no that's why I asked that. Yeah. Yeah. I Our last question then particularly with Donald McCascal. You know, we've we've talked about the financial constraints on the sector um and and the fiscal situation we're in and I'm aware that the the private sector is a diverse sector. Everything from small care homes to very big conglomerates. Um we've heard from from other people who've given evidence submitted evidence question around profit in the sector and whether there's room for that in such a fiscal constraint situation. So I wonder if you had a response to those who think there probably shouldn't be a place for profit in the care sector. >> So we have a a national care home contract which gives and allocates £1,074 per week per resident for nursing 247 care and support. uh 70% of provision is paid for by the public purse and providers utilize other capacity both private uh the cap on profit which exists in the national care room contract is 4%. So if you're wanting to make a profit from public funded care then you're on a hiding to nothing because you'd be better investing your million pounds in an ISA give or take. The reality is that we have a private care sector which is meeting the needs of people who can afford to pay something closer to the true cost of care. So if 174 is the price the state pays for care and support, the cost of delivering that care and support for a public authority, a local authority or an NHS board is roughly between 1,800 and 2,500. So effectively the gap between what the state pays and the true cost is growing each year. It's a matter of societal principle whether or not you create a system where profit or return does not happen. But if I think back to when I started this job I went to and Scottish Cave represents private not for-p profofit employeeowned and charitable providers of care and support and I visited a really deeply respected charity which ran a care home and had done so for 80 years. At that stage 10 years ago, 80% of its residents were paid for by the state under the national care contract and they had 20% which were not. Last year when I visited 90% of its residents were private because they could not make the sums that add up and they could only afford to have 10% of residents funded by the state. So I don't think the issue is profit and you know take the private sector out of this. There are private care homes who do not offer care and support to state funded individuals but for those who are funded by the state there must be an adequate level of return whether you're a charity not forprofit or a private business. And remember in Scotland the vast majority of private business is small medium-sized and many of it familyowned generational homes. The sad reality that I see and it's getting worse is that that group is shrinking. Our charitable members are going to the wall. Our small private members simply cannot have the economy of scale to make things work even if they maximize private income. And therefore, we're removing choice. Scotland gloriously had a mixed market a decade ago. That market is becoming narrower and more constrained. And I don't think that's in anybody's interest. >> So can you give us a percentage of um you know taking care homes, what percentage of them are now maybe owned by the bigger corporates uh compared to smaller providers and charities? So in the bigger corporates in Scotland and I can can look at the data and confirm this because it literally changes every week because in the last six weeks we've had significant buyouts uh from larger bodies. Uh it's roughly around about 38 to 40%. Which is significantly more than it was a decade ago but I can submit that data to the committee. >> Uh that would be good. Thank you. Um, Kaylee, I believe you've got something you want to come in. If I could ask everybody to keep questions and answers short. I've still got quite a lot here for us. >> Yeah, thank you convenor. My question is for Paul and Donald um on um pretty big picture question I think. So what asks related to self-directed support and unpaid carers do you wish were included in the program for government? um is neither were I think explicitly referenced and Donald you spoke about uh the call for improved data >> sorry Donald Mloud online >> Donald Mloud yeah um the call Mr. customer online, you called for improved data. What specific data are you looking for? Um, what questions should we be asking? Thank you. >> Thank you very much. Um, and and what I'd like to start with is just recognizing when formal services are unavailable, delayed, or difficult to access, there's more reliance on unpaid carers to fill that gap. And unpaid carers though are are often reviewed or often within policy start to be portrayed as being a resource within the system rather than people with their own individual rights uh within that. And some of the conversations we've had already this morning. Um I was I've been just reflecting on that from that unpaid career lens that you know one in three of us will be an unpaid carer at one point in our life. Many of us will be unpaid carers at many multiple times during our lives. Um and unpaid carers there was aspect around conversation around choice. Unpaid carers often don't have a choice to care. Although the carers act does talk about that part of a conversation of adult care support plan or young career statement is that uh your willingness to provide care but in reality when services aren't available um unpaid carers are often having to fill that gap and that was a real gap in the program for government that didn't that we would have liked to have seen you know reflected in that when we were talking about the professionalism of the sector as well recognizing how many unpaid carers are receiving formal training for the care that they're providing often fulfilling you know, duties that h those paid carers would be um require specific certification to be able to perform, but they're doing it because there is no other choice for them. There's no other option and lack of services um for unpaid carers. When we were talking earlier about um people being regarded as patients, often unpaid carers get regarded as families and not recognized as unpaid carers. Um and actually there's a real systematic uh issue about identification of carers and across public services there's a real responsibility across health and social care to be identifying carers and letting them know that they do have their own rights um through that and that there is support available for unpaid carers. Um the key aspect that we would like to have really seen you know within program for government is around the carers act and I put that within my submission to the committee. We've been calling on um post-le scrutiny of the carers act. We know the carers act is in in principle at a national level and the policy intent is good and strong in reality and delivery. It's not being felt by by unpaid carers. We also wanted the committee to consider that in advance of Scottish government's flagship policy this term for unpaid carers around right to breaks because right to breaks is tied into the carers act. So in order or at least what's been um uh proposed as tied in within the Scottish government's consultation is that the right to a break could be assessed through an adult care support plan or young career statement. But within adult care support plans and young career statements currently we already know that there's thousands of unpaid carers don't already don't have them. They're not being offered them. They're not being offered these statements. They're not being identified to be aware of the support that is available through that. There's also fundamental issues around the carers act more generally and and a key one that I highlighted is is around 20 million of the 88 million is unaccounted for in relation to the funding. We don't know where the funding goes to the carers act. There's no transparency um around the carers act funding in relation to that. Um and one of the key aspects around there as well is that even when a carer does get identified and perhaps has a good service through their local carer center providing a range of uh support services undertakes an adult care support plan or young carer statement they have to be basically in crisis to meet local eligibility criteria for any statutory support provision only 3% of carers in Scotland meet local eligibility criteria for a break currently in Scotland. Um and there's a real element in there within program for government that really could have addressed and recognized unpaid carers more strongly understood perhaps it's about not always creating new policy but ensuring that the policy that has been delivered is being delivered as intended. >> Thank you. Uh we'll take that up I think. Um Kayie I go on to Donald Mloud to ask yeah if you want to come in there Mr. Mloud >> um [clears throat] in terms of data is data across the board from the you know the earliest point of intervention to delivery. Um I think one of the things that we don't know about is what what percentages of people are offered the full range of of of options when there when they have discussions about self-directed support what kind of conversations they have. There's been a move since the model of social care since 1990 health act has been about care management um and it's moved the role of social workers to um relationship relational based or therapeutic intervention to one which is more transactional organizing packages and support um rather than relationship building. So you know in terms of that it's become more about what you can't get as um Paul was just pointing out there with people moving areas moving more to critical critical and substantial rather than how we can meet your support needs. Um many social workers report spending increased amounts of time undertaking administrative functions associated with budget management. So resource allocation and compliance process. So as a result there's less time available for relationship based practice, preventative community based approaches, safeguarding and therapeutic strengths based work. Um and that's contributed to the perception that social workers becoming gatekeepers of scarce resources rather than professional agents of social change and support. So you know data across the board about the the range of options that are being offered. We're hearing more and more about when there are pressures on the system. Um it's it's about the range of options that are available and some in some areas we know that there are pressures on the system because there are no resources available. So it becomes a default to offer people an option one. Option one should be it should be a considered choice made by people willing to take on the administrative and operational responsibilities that it involves. But we're here in the areas, you know, where it's option one has been allocated where there's no local resources available. But that includes personal assistance, transferring the responsibility and risk to the individual and putting pressure on the model and that creates a perceived need for external regulation which should be the person's responsibility. The other area I mentioned flexibility earlier on. Um we when we do research, we conducted research about the cuts to direct payments recently. We get of course we get the negative stories. What we don't get is those um helpful positive um bits of data around how to how to operate a direct payment flexibly. >> Thank you. Um Adam, I think you've got a follow up there. Thanks Kina. H yes just for you a quick one for yourself Mr. Mloud. You just mentioned just now about gatekeepers. You also mentioned that in your submission to the committee um that I think often um people in need of support are experiencing that gatekeeping rather than someone who's going to help enable them to get the support that they that they want and need. Could you just talk about exactly who the gatekeepers are in that scenario? Is it those on the front line who feel compelled to do that gatekeeping just because they don't have access to the resources they need and and what would help to to move from a situation of that gatekeeping to to the enabling of care? >> Yeah. No thanks. It's Yes, it's the people on the front line. It's social workers on the front line um being gatekeepers to to what's available um rather being the agents of social change and support essentially. um that that I was referring to in terms of you know I've made some suggestions I don't think it's it's a whole system approach that's required one of the one of the suggestions I've made in our submission was about um removing some of the administrative burdens around um the financial aspects of um certainly option one and direct payments but potentially moving that to the independent living fund Scotland um and that would allow the social workers to do that early intervention work, not to be administrators um to to to be those agents of social change and focus on you know crisis and early intervention and so on. >> Thank you. >> Okay, thank you very much Mr. Mloud. Um moving on to uh some questions about the inspectorate role. Joe, I think you were uh had one about that. >> Yes, thanks very much. Say for for for Gareth Adam Hammond and the care inspector. Um you know we we've got an overview in your submission about what the care inspector does and who you are and you obviously have criteria specifically that you use when you when you do inspections. I'm kind of interested in the big picture that you see. So um [snorts] you know when you're inspecting different care services what makes a good service? You know not necessarily just those criteria but the culture the leadership what is it that makes a good service and what are the patterns you see across the whole system? Are there particular areas where there's good practice? Are there particular sectors? How do the different you know third private and local authority uh um provisions compare? Just just interesting those big picture trends. >> Thank you for the question. um in terms of of what we do. So, naturally, when we're we're undertaking uh those inspections or or improvement interventions, as you will see from from our submission, there's a number of uh quality frameworks that we would use to to be able to establish how well services are performing. Uh and and that's across a spectrum of what we believe to be the the mechanisms and building blocks of good care provision. uh whether that be within care homes for adults and older people or daycare services for children across across that lifespan that all of us uh will will come into contact with social care services in some shape or form uh across our lives and and naturally setting those expectations clearly within those quality frameworks around good governance arrangements, management uh leadership, appropriately uh recruited, skilled, competent staff uh within those services uh and that there's environments that are set up to support independence, to support individuals to live well uh when they're they're living in a residential service or or when they're uh being supported. And and central to all of that is a recognition and understanding of outcomes for individuals. That that has to be central to everything that that we're doing in in social care and and in social work and early learning and child care. The experiences of those people who are using those services must uh inform how those services are shaped, how those services uh are run, how they're managed, uh how staff are supported to learn uh and gain skills linked to those individuals uh needs so that positive outcomes and enhancement and experience and outcomes uh and upholding of rights and meeting of needs for people uh are are you know met on a consistent basis. uh when whenever they're engaging with with a uh social care service in terms of the big picture and and and breaking that down into to more granular detail. Um that's not something that that I've got with me h here today, but happy to write back to the committee if that would be helpful uh to distinguish where uh there's there's greater performance or where there's areas for for improvement and whether that links to uh certain service types or or certain uh service provision. >> Thank you. >> Thank you. Um Heather, I think did you have something on the inspectorate role? Sorry. Leave it to roll. I think that's been answered. I've got a couple of questions to Donald about self-directed support and Paul if that's okay about Kayie. Did you still something on the inspectorate if we just take Kaylee first? >> Yeah, just a quick um on a specific statistic. You said that there was a 28 and% increase in complaints which obviously sounds quite jarring but is that perhaps due to streamlining of the complaints process and you know more people have have voice? Could you just talk through that in a little bit more detail? Sure. Thank you, >> Kayleie. So, the 20% increase in complaints was specific for care at home uh services. Um overall, we're seeing national trends of complaint submissions reducing uh over the the past uh number of years, but naturally uh o over the course of last year, we had uh a number of of submissions. I think it was 5 5,700 uh in the totality across across the system. Complaints are a valuable source of of information for us at the care inspectra in particular uh where we're looking at the the totality and and all intelligence and information that we hold about services uh and how well those services are performing. They're they're one of the multitude of uh those those facet informations that we get. Uh whether that's through notifications directly from the service, whether that's from uh local partner agents uh who who are able to give us information uh and people who are experiencing care uh being able to supply and and and submit uh complaints to us. We recognize that there's absolute value in complaints submissions and and we're very unique at the care inspect and that we're one of the only regulators who have a a statutory role to receive complaint submissions and investigate uh those complaints and where we do see complaint submissions uh naturally we assess those. We believe uh strongly uh that complaints are best resolved as close to the point of care uh as possible. However, where there is a significant and substantial risk to the health, safety and welfare of people experiencing care, naturally care inspect will will intervene and and undertake an investigation and set from that any recommendations uh in terms of improvement that that are required. Um the where where and what the care inspector have been doing over the past couple of of years is is really helping to state uh that people experiencing care and people using care services have a right to raise complaints with us. We've been actively involved uh in the National Care Service Charter of Rights uh which specifically sets out uh within that uh the complaints, mechanisms and processes and and the supports that people should come to expect when something within their care provision goes wrong. So whether that's using advocacy services to help their voice be heard and understood uh and making those submissions uh to us and and naturally the different complaint pathways that exist across the spectrum uh of the social care uh sector. >> Thank you. >> Thank you very much. Um Heather, you wanted to go back with a question on self-directed support. >> Thank you. Um, Donald, um, you were talking earlier about the role of the independent living fund and your concerns about how option one was being viewed in terms of gatekeeping. Um, and I thought I heard you say that the independent living fund could play a stronger role in managing packages of care. um if that's correct, how do you how would you differentiate the independent living fund doing that job as opposed to an option three care package from the council? What would be the difference in the way those budgets would be handled? Honestly, um well the in terms of the of transferring the administrative function to the independent living fund um I think it's about separating that direct payment administration from social work intervention by transferring the administration to ILF that would allow social workers to focus on assessment intervention and all the other things I mentioned earlier. So therefore, it's it's an administrative task that IF they're used to doing. They could take it on um and they're used to doing assessments and administering payments and it allows people themselves to take on that um independent role in terms of um managing a direct payment. Now we've through the PA program board work, we've set up a whole range of tools to support people who want to to take that on to do that. There's a whole range of uh PA employer handbooks, there's, you know, document resources that they can use. Um contract builders, all these kind of things. Um there's we've got um recruitment portals. There are a whole range of supports that people have and able to do that. So if the the financial the administrative part of it really is just about administering the money and if that could be um done quickly and and straightforward it's the personal assistance themselves aren't registered and it's not regulated. So that's you know we make sure that there are supports in place for the employer to do so. Now I know it was something that came up in the um independent review of inspection regulation security um about concerns about a a bespoke scheme for um monitoring and registration of personal assistance. So we spoke with the minister at the time and you know she felt that given that the there was a program of work in place to mitigate those concerns there would be no action taken. Um, and you know, while that program of work still in place and that's kind of going from strength to strength and we're building on that, we we desperately need more PA recruitment and sorry I could go on about that, but um, you know, we've advertised 1,600 jobs for personal assistance in the past year on my job Scotland, which wasn't available before. So, so I've probably drifted away from what your original question was, but I hope I've answered it. Yeah, I I I hear you saying that the independent living fund is like easing an administrative technical problem and I I think it was also to say to Paul um it was housing legislation passed earlier this year where we introduced this principle of ask and act so that the public sector have to ask people about their living situation and you talked about a systematic way of identifying carers. I don't know if you think there'd be any parallels there that would be useful. Um I'm aware sorry if you can answer that one quite quickly. I'm aware professor McCascal has to go in five minutes and we've got >> All right. Okay. >> Yeah. Thank you. Um in in relation to you know the systematic identification approach what's really important within there is that there are various systems happening from unpaid carers. unpaid carers have the right in relation to it being part of the conversation as part of hospital discharge for example that's not happening in reality for the majority of unpaid carers that's not the experience that that carers are are seeing um at this point in which they're identified if you take a young carer identified in school they're supposed to then be offered a young carer statement we know that doesn't happen in reality for a lot of of children young people with caring responsibilities we're aware that do you know the person that's attending GP appointments with their with their care for person. Um are often only half of carers are currently no being recorded through their their GP surgery and when they are being identified they're having to retell their story in each situation may that be where their interactions with social work teams with social care teams when engaging with trying to be part of the conversation as an equal partner within the care and treatment of the person they care for. Um there is no systematic way which as that we are identifying carers letting carers know that they have their own rights um and then building an approach so that they can be supported and that there are mechanisms and there are examples where more systematic identification has worked. So in Wales for example um they have trial um a national it's predominantly for young carers but they've trialled a national young carers identification card um which um has worked uh really well for identification in schools for college and university um we can look at at models like that and scaling that that up for carers so the carers don't are not required to consistently have a to battle because if you ever when you do speak to unpaid carers they'll say that they feel that every conversation is a um a fight to get around the table for the care of their care person when they're not often recognized as equal partner in that care conversation. They have to have a fight for for being able to get social security support, a fight for relation to get support for their care for a person or a care package when they're trying to arrange hospital discharge. And there are examples out there that we could tackle um if we look at this in a systematic way such as national identification approaches. >> Thank you. Um Jack, I think you've got a question on national insurance. >> Yeah. Can I just quickly circle back to the financial landscape that that's being faced just now and ask about national insurance contributions which was reflected in virtually every submission to the committee. Could you expand on for our benefit the impact that that's having on workforce numbers, those receiving the care and miss kacket perhaps the impact that it's having on not for profofits and having a dip into charitable um charitable reserves perhaps? >> Yeah, happy to. and uh we're just submitting our our evidence to the UK Treasury today in in in advance of the budget once again asking for uh our sector to be excluded from the the rises that came in previously. It's worth remembering that the Enix change was a two-fold change. Not just an uh an increase in payments, but a reduction in the threshold. And we have to remember that this is a relatively low paid because of all the reasons we've said previously, workforce, many many of whom work part-time. That reduction in the threshold had a particularly acute impact in our sector. And I know colleagues at Cosa who've worked across a number of our organizations has estimated in the first year that that change came into effect. That was an 85 million pound cost to the sector for which there was very little relief anywhere. Um unlike in the public sector where there was at least some relief written into the chancellor's budget, nothing came to us. And therefore providers have had to absorb those costs. And that's obviously not a one-off cost. That's an ongoing cost. And each time we increase salaries, each time we try and bring more people into the sector, so the cost increases and it it becomes particularly difficult. The one thing I would say and I'm going to give you some figures about uh what our our members have been facing is enix in and of itself is not the only thing that is causing enormous financial stress within the sector. And I'm I'm saying that because in a very political environment, it's very easy to say that Enix was is the thing and to point to our UK government colleagues on having made that decision. Do I think that decision was the right one? No. Are we still asking for it to be changed? Yes. But that decision fell into a landscape in which there was already significant financial strain within a Scottish system. um for all the reasons we've been discussing where contracts, commissions for delivering care didn't actually reflect the true cost of doing it. This was just another pressure on top. And I would point out we worked very hard with colleagues in the House of Lords. Amendments were passed that would have would have were removed to the Enix um uh liabilities from our sector and those were overturned in the commons. So we're in a highly politicized environment. But if I think about our members who between them estimated in the first year of operation 30 million of that 85 million to be found. We did uh a survey of our members in November of last year and we were finding that and also talking to chief executives um what they've been trying to do is make every single possible change they can make to their organizations in order to preserve services. That is their ultimate aim is to preserve services, but that's often meant swinging cuts to back office, changes to terms and conditions to try and keep the wheels on the bus so that people who need support get it. Despite that, and I think it's in our submission, we saw um significant projections of over 800 job losses within our membership. We were seeing significant projections of people's care and support being negatively impacted. I am talking to members who are handing services back to local government because they can no longer make them work. Um, and all of that compounds the s the the issues that we're in. So I think Enix is really important. We would still hope that the UK Treasury will create an exemption for social care given that our new prime minister has made this his absolute priority. It would certainly be a massive shift towards increased sustainability, but it's one factor among many that has caused the problem that we're now in and need to fix through this review process that's been announced. >> Thank you. Um, >> sorry, can just very quickly >> and I completely agree with Rachel. We've written to the UK government asking for that to be removed or withdrawn completely. But again there are additionalities which I've mentioned already rising fuel costs. One which profoundly impacts residential care is the rise sharp rise in food costs which has been widely reported today. But maybe uh another one which hasn't been on the radar but we are deeply concerned about as we move into the winter period and that is the change in requirements around infection prevention and control. now make it a requirement for care staff in any social care setting to have face fitting masks that is going to cost tens of thousands of pounds to any individual provider and we've not factored that in. It's the right change to make. I should add it is the right change in epidemiological and infection evidence. But it's yet another factor together with fuel, together with with the costs of food, the sharp increase in insurance costs and increase in terms of the use of clinical waste. All of which individually together with Phoenix would have been a straw that broke the camel's back. But undoubtedly in my estimation will result especially if we've got a a a winter with a bad flu, corona virus, RSV or Nora virus, some providers going to the wall. Thank you. >> So can I just clarify is that a new requirement for the face mask? >> It's a new requirement which came in on August the 3 and there is a an ability to scale up until February 2027. But if an infection breaks out uh sadly is just a fact of life in residential settings then staff will be required to adopt the best practice which again the sector is not disputing but requires us to have significant investment uh to address a particular need. So as Rachel has highlighted it's not one factor that is making social care provision literally running on empty. It's multiple factors and that's why we will talk about reform but we also talk about survival. >> So I wasn't aware of that particular thing. I wonder if you could send us some >> can send you Yeah, no problem. >> Absolutely. That's great. And um Jack I think you wanted to move on. We've got 10 minutes. Okay. Let's move on to your next topic. >> I have a specific question for you Mr. Trainer. It's uh I can't find the submission in front of me, but I think it was section 8 and you talked about the impact um unpaid carers who are looking after those with alcohol and drug issues. Uh that's something that I tried to unpack last week as well um with with the the evidence session that we had there. Could you expand for the committee the where you're seeing most prevalence with these carers in terms of what communities are impacted, which areas of Scotland, and in terms of the Scottish government's alcohol and drug strategy, what are your asks to recognize this issue further and and what more can the government be doing in this space? Thank you very much and thanks for bringing that topic up because it's actually an area which um in relation to carers is one that doesn't get covered very often and and there's a real issue in relation to alcohol and drugs and carers caring for people affected by drugs and alcohol in the sense that most unpaid carers often don't recognize themselves as carers in in this landscape. um is it's really difficult and actually even within the populations of those carers that are accessing local carer services, they're actually usually quite a small population um of carers um accessing direct support services or have even awareness that there is support services out there. Um and and it's perhaps the stigma that's associated with that that continues to mean that carers of those affected by drugs or alcohol don't know about their rights. don't recognize that there is legislation out there like the carers act even even though you know I've highlighted some of the concerns around that um that that um those carers can um access and I mean in Scotland you know one in five you know adults are are are currently have um harmful use of alcohol over 46,000 have access um have problematic substance issues we don't actually know how many carers are caring for people um in relation to to that there's been very little work done in this area. We've just finished a study with the University of West of Scotland and the Scottish families affected by drugs and alcohol. That research hasn't actually been published yet. It's been publishing. It's going to be published in the next few weeks. We're just in the final uh points of that which is really highlighting some of those unique issues um affecting those carers. And one of the the key aspects that we've highlighted is ensure that alcohol and drugs policy. And actually there's and this is even apparent um with with some other elements of policy mental health policy as well often doesn't include unpaid carers within the consideration of the policy development and within um you know the work of the the the new um strategy. We want to ensure that unpaid carers of of those um caring for someone affected by drugs and alcohol are really part and dominated in that conversation. in order. I talked about a systematic approach for identification earlier and that is no more true than this group of carers who are often very much forgotten about in the sense um I've highlighted some concerns even in relation to some policy um in relation to to breaks. Many of these many carers who care for someone affected by drugs and alcohol say that they they although perhaps physically can take a break they emotionally mentally can never take a break uh due to the changing circumstances of the person they care for. But the element of which doesn't get discussed and more which needs to be the focus is actually uh the person surrounding the the person affected by drugs and alcohol are are unpaid carers and we need to have that conversation h so that those carers recognize themselves as carers and know that there are there is support and rights there and wider drugs policy and alcohol policy needs to bring that in as well. >> Thank you. I appreciate this is a difficult question and probably the the difficulty that the Scottish government's facing themselves, but how do you think we best identify those unpaid carers? If if if they're not going through existing organizations and services, how do we identify them to then get their views to then feed into the strategy? >> I'll be quite honest, it was really hard when we were doing this research. It was a really hard group of carers to engage with. One, carers often don't want to come forward and talk about it because there is stigma associated with that. There are specific services like Scottish families affected by drugs and alcohol that do bespoke work with families affected by drugs and alcohol in that context although they even in that context they very rarely regard themselves as carers and that's the disconnect. Um, and it's really important that that um, you can call yourself a brother and call yourself a father, but actually identifying with with the concept of a carer opens up doors of support and entitlement that that you're entitled to. You don't need to recognize yourself as a carer on a day-to-day basis. Like that's not, you know, that's down to personal choice. But those the phraseology of caring opens up rights and support. And anyone who is who any family member supporting it's the same for anyone with a long-term condition or a disability or mental health problem. anyone in that family circle are likely have a caring role of some level and that and there is a way of identifying them in in the ways in which I said earlier when the when the family members are supporting um that person I use the inverted comma of family members because they're unpaid carers >> and our [snorts] legislation under the carers act says that an unpaid carer is anyone uh who provides care or intends to provide care and that's all it says in our legislation. So all those family members that we talk about are really unpaid carers. >> Thank you. >> Thank you very much, Mr. Trainer. Um we have run out of time. Um if you I'll give you a challenge of one sentence or one minute each. If you've got something you think we haven't covered or if it's a more detailed thing, feel free to send us some more. So um I'll start with Donald Mloud. Is there anything you think we should be looking at which has not been mentioned? I mean probably there's lots but >> yeah have been covered I I'll hand over to others. Thank you. >> Okay. Thanks very much and thanks for attending online. Um Mr. Adam Hammond used to >> I suppose just to re-emphasize that um social care, social work, early learning and child care are distinct and unique uh in terms of the totality of a system that supports people uh to live well and and naturally uh it's important and incumbent on any of us who are moving forward in a space of reform and change to ensure that that voice is equally heard and equally represented at the table of that discussion. Care services provide valuable uh support to individuals and overall care services perform extremely well. 88.1% of services that we evaluated last year were awarded uh evaluations of good or better on our sixpoint uh grading criteria. That's expert knowledge uh and skills and experience and competence that that ought to be tapped into. And naturally the care inspect as an organization welcomes any opportunity uh to also be involved in consultations on any change or reform as we continue to move forward. Thank you. >> Thank you. Um Miss Laspa. >> Yeah. So I suppose fundamentally going forward in in terms of some of the commitments within program for government the the principle of of localism and and local democratic accountability will will be really important. again welcoming the the emphasis on on early intervention and prevention but I think we've heard today about some quite stark challenges particularly in the social care sector um and and a really sort of significant financial gap um that has been plugged just just to kind of stand still so I I suppose a plea for that that sort of context to to be brought into reform discussions >> thank you professor mccasal >> the women and men who receive care and support together with those who offer it every day are amongst the most amazingly creative, entrepreneurial and innovative people. They have to be involved in the co-design of a reformed system of social care. Not least in that they have the imagination which many of us perhaps in this room do not have because they live the experience of care and support every day. And in particular that community is using technology, innovation, AI in ways which I couldn't have imagined two three years ago. Any reform of today has to look forward to the abilities of putting real care and control in the hands of citizens moving from person centeredness to person-led support and that's an adventure which I think we should walk with them on. >> Thank you Miss Hacken. I think we have focused quite a lot today on many of the issues in the sector. I think it's really important to know what they are in order to know how to change them. I think like some of the optimism that's just been expressed. I remain optimistic that our sector can be offering so much more to the people of Scotland who need support. So I think if what we want is a reformed system that enables people to genuinely thrive whether you're a supported person, an unpaid carer or a member of the workforce, then my plea in this whole process to all partners who are involved is get us around the table. The the the the ability of our sector to come up with ideas and demonstrate what works is enormous. And um I think we can do so much better than we're doing if we have a genuinely open conversation and are willing to put everything on the table and look at what will serve people better than what we already have. >> Thank you. Then Mr. Trainer. >> Yeah, I think I just wanted to highlight, you know, Scotland can't achieve sustainable social care change without involving unpaid carers and local caterer organizations. And I think the preventive approach is really important for unpaid carers in that sense that if if we're not investing in unpaid carers now, they're potentially going to require care themselves in the future. Um, one of the key areas which we also highlighted was around we would like to see annual health checks for carers being introduced. Um, and I do think the conversation is really important. We hear so many unpaid carers um who delay their own health appointments because there's not replacement care. There's not services available to allow them to do that. There's not flexible appointments available. Um and we need to have a focus to ensure that carers are able to unpaid carers are able to stay well so that if they are willing and able to continue their catering role that they can do. >> Thank you very much. I'd like to thank everybody for coming today and we've had a a good turn around it, but I'm sure we'll come back to lots more of it as it becomes clearer what the program for government is going to bring forward. So, we welcome um you know submissions from you going forward. If there's a specific point that comes up um everybody's consulting in the three months that's a lot short time. So please do feel that if there's something you you wish to um put forward if something comes out of that then you can send that into us. Um next week we're taking evidence from the Scottish government on their priorities across our whole remit of health, social care and sport. Um so the ministers will and cabinet secretary will be here. Um that concludes the public meeting for today and we're moving into private session. So thank you again. Um thanks for coming. >> Thank you.