 Good morning, and welcome to the 35th meeting of the Health, Social Care and Sport Committee in 2022. I have received apologies from David Tollans for today's meeting, and he will be substituted by James Dornan, who is joining us online. The first item in our agenda is to decide whether to take item 3 in private today. Are members agreed? We agree, thank you. The next item in our agenda is consideration of a negative instrument. The instrument is SSI 2022, a bleak 335, and that's the national health service charges to overseas visitors. Scotland amendment number three regulations 2022. The Delegated Powers and Law Reform Committee considered this instrument at their meeting on 22 November, and they made no recommendations. The purpose of this instrument is to ensure that overseas visitors from the bailarick of Guernsey and Malta will not be charged for certain treatment provided by health boards in Scotland in accordance with reciprocal healthcare agreements. No motion to annul has been received in relation to this instrument. Any members have any comments to make on this instrument? I propose therefore that the committee does not make any recommendations in relation to this negative instrument. Does any member disagree with this? Nope, we're all in agreement. Thank you very much. We'll move on to the next item of our agenda, our substantive items today, continuing our consideration of the National Care Service Scotland Bill. We've got two evidence sessions, and both panels this week will focus on ethical commissioning and procurement and the long-term sustainability of social care services. Our first panel are with us, and I welcome them. We've got Rachel Cackett, the chief executive officer for the Coalition of Care and Support Providers in Scotland, or CCPS. Karen Hedge, deputy chief executive of Scottish Care. Jenny McCormack, head of commissioning of Glasgow City integration joint board. Julie Welsh, chief executive of Scotland Excel. Joining us online is Sandra McLeod, chief officer of Aberdeen City health and social care partnership. We'll move straight to questions. I'll start things off by talking about the proposal of care boards. I'm interested to get, particularly those Jenny McCormack and Sandra McLeod initially, to ask you what the current arrangements you are involved in. What's the potential for care boards to maybe integrate services more? I mean, one of the things that we've been hearing is that there are certain things that IJBs and health and social care partnerships can't do just now, or hence necessitating the need for care boards. What's the arrangement now in terms of procuring services? Who's involved? Who's round the table in terms of voting rights? And what's the potential for care boards to perhaps further that integration? I'll go to Jenny McCormack first of all and then I'll go to Sandra McLeod online. Thanks, convener. Currently, within Glasgow IJB, we have all care groups represented within our integration authority. There's a healthy relationship in terms of contribution and discussions at a very early level in terms of the strategic planning that informs future commissioning directions. I think currently and also in any future composition to support the care bill, I think consideration would need to be given to the time that is required for planning and to ensure voices from all of the stakeholders and participants and crucially the end recipients of services in support. That's an element that, increasingly, we need to recognise that a focus on services has to include the support element in terms of early intervention but a whole system approach. That is applicable just now as we work with our current IJB and I think it has to be a major consideration in any future composition of a care board. I think that the membership would be crucial and both in terms of the composition but the strength and the support offered to people who may require additional supports to be part of such a system. At the moment you see that it's working well where you are so there's obviously a lot that you want to take in good practice. Is there any opportunity for care boards to do things slightly differently that you would like to see that you're not able to do right now? I think in terms if it was to facilitate time and the part about the resources for people contributing and opening up. It's a bit of accessibility in terms of the involvement of individuals who may require some additional support to be fuller members. Basically more inclusive but with the actual resources in place to allow that support. I'll go to Sandra MacLeod from Aberdeen. It's helpful to hear your views on how things are working in Aberdeen City and how things might work with a care board and what opportunities you see or potentially you might see with a care board. Sandra? I feel within Aberdeen that we had a large review of our care at home a few years ago and that helped us reshape how we look at our strategic commissioning and our engagement there. We have a strategic commissioning board that is made up of our private, third sector and independence along with others that helps us shape and does help shape how we move forward on our commissioning. I feel that this is, although not part of the main IGB, it certainly is part of our governance framework. I feel that it has a strong voice there and is able to really make substantive contributions to how we move forward on our commissioning arrangements and our procurement arrangements. Yes, because Aberdeen has been held up as an example of where things are being done slightly differently. We visited Aberdeen three weeks ago now and met with the Granite Care Consortium and they put it to us that they are actually a model for a care board. What's your view on that? I think absolutely. We've actually had with Granite City Consortium that was in it and it's been a really positive outcome for us within the city. I think that going back a few years it's just that picking up on other colleagues who are suggesting about time. The one thing I would say is that the move from previous time and task commissioning to outcome-based collaborative commissioning did and we had to invest heavily in that and it was a big shift from what the current form previous provision was. It is important to have an equal partnership round about any kind of board when you're talking about commissioning and that everybody is able to understand the views of each of the participants around the table. When you've got a shared vision and when you're looking for the positive outcomes and understand each other's limitations, that's really what helps. The Granite City Consortium is definitely born from solid understanding of what it's like to be on both sides of the fence, from the commissioning and procurement and also a lot of trust, a lot of relationship building. Those things are absolutely key within developing anything there. I think it's just to have that equality in the procurement process. Thank you. Just before I hand over to my colleagues, I'm going to come to Rachel Cackett because in your submission you made some points about the notion of care boards and you made some recommendations as to how you would see them made up. Given what you've heard of two areas where they're effectively working like a care board already, there's good practice going on, from your perspective, what do you want to see in terms of care boards from your perspective? I think that we have very good relationships with our providers, with many of the current IJBs, but when you say they're working like a care board, I guess the issue of trust from my colleague was just brought up and at the moment we're having to trust what those care boards will look like. So we don't actually know if you're yet working as a care board. We know that there are really good examples of practice that's emerged through the work of integration, but we also know that the status quo isn't enough and both providers and people receiving services are very clear of that. So there is something about what can we take from what we've got and learn from it, but there are some key questions for us around the structure of the national care service as far as we have been able to see it so far and certainly we're calling for greater clarity in the bill. In the model of reform that we've put together, which we hope helps to create a vision for where we would want social care to go, there's a really important point in there which is the point of subsidiarity to the individual and actually there's an awful lot of battle going on at the moment about who has power in this future of a national care service and you know we could see that at the beginning of integration as well and I was involved in the Public Bodies Act as it passed through Parliament, but actually the far more radical approach is to say that social care is an issue of relationship and that relationship happens at the front line between people who require care and support, their carers and people who deliver that care and support and actually we should be putting as much there as possible which is why the self-directed support legislation which we still haven't implemented fully is really important, it's an important point about the relink between SDS and ethical commissioning. We should then be looking to the care boards to do the things that can be done as local as possible but not at the front line and only going up to the very top at the points where nothing else can be done locally. The issue is because it's a framework bill we don't know that much yet about care boards and I understand the process of co-design but actually they are a fundamental part of the bill and as as we read the bill we've become less and less sure of whether the national care service is a commissioning body, a standard setting body or a delivery body and part of that depends on this issue of whether 73,000 staff are transferred from local government into a delivery body or whether local care boards become a commissioning arrangement and to us that's not yet clear and that seems really fundamental. We're not quite sure about their local accountability either so wherever the rights and wrongs of the current system it's really important that social care holds that relationship within its local community, it's a really important part, most social care is built from the community up and we need to be really mindful of not removing that. The points colleagues have made around co-design and time I think is really key, again the bill leaves a lot open to that. We're about to commission a piece of work to look at the experience of third sector providers in the current arrangements so that we can learn from that and think about what could we take from that if we end up with a situation of a number of care boards but there's also something for us which is really important about putting co-production and co-design at the very top so whilst there will under this legislation be care boards we're not exactly sure what will happen to iJBs and whether they will be completely repealed and replaced or they will be morphed into this care board arrangement and I think that's very uncertain for staff at the front line but above all of that we think the co-design should also go to the top and so rather than having a direct line from care boards to ministers we actually are really strongly in support of Derek Feeley's original suggestion of a national care board with a diversity of voices, good decisions are made by diversity of voice hence you have committees with people from different parties sitting and looking at the detail and we think that should be applied to the national care service as well which is not to remove the minister's desire for ultimate accountability for social care and what has been heard through consultation but actually accountability with good advice and good engagement is a much better set of accountability so we would like to see an additional piece put in which is not a civil service department but actually a group of people with a lived experience of what it is to be in relationship at the front line advising the direction but we do also want to see far more about what care boards will be are they commissioners are they deliverers are they both how does it link with our ijbs that we currently have I think it is very interesting that some of our colleagues who've always said that they don't particularly like ijbs now really like them and I think that's been a transformational shift but do we need reform yes but we need to be really mindful of what we're asking for and how we keep the local local that's very helpful and a really good start to the conversation about you know what we need to keep where the gaps are and what our aspirations are for reform can I bring in Stephanie Callaghan Stephanie thanks very much campaigner and thanks for being here this morning panel just just picking up Rachel on on what you were talking about there I'm just wondering at this point in time how much involvement is there from community planning partnerships people with lived experience looking at local improvement plans how much is that involved in your ijbs at the moment I suspect my colleagues in the ijbs will be able to answer that far more fully we are certainly looking at where providers are engaged and I think that engaged process is probably in a different place depending on which ijb you talk to and the the I guess there's something really important there in what we're currently calling strategic planning but we hope to move into ethical commissioning and one of the things I think is a really important point here is ethical commission doesn't need to wait for the legislation so we could already move to a far more ethical commissioning framework and some of the examples that you're hearing from colleagues today are moving us in that direction has anyone got it completely right yet clearly not because we're all we're all working in that direction but the important points of ethical commissioning are how you involve people in decision making where that decision making sits how much trust there is between partners to be able to be given the flexibility for example to to amend care packages according to needs rather than having to wait for another assessment to be done the way in which funding is trusted to those who are providing care and that emphasis on that very frontline relationship so I think where we can begin to see that happening and our commissioning and procurement programme which is funded by the Scottish government to help us take that forward with partners we're working with a number of partnerships around Scotland and in fact ran an event last week looking at ethical commissioning and perhaps how we could move more quickly than a national care service to get there I used to be a local authority commissioner so I've sat there in different seats on that table and have that experience I wanted to maybe just cover a bit in the implementation gap that we've seen with the public bodies joint working act and my concern I suppose with the creation of care boards is are we just recreating a system that just moves people around to sit in a different seat so what is really important is the underpinning principles and how what is that we're trying to achieve in that space particularly in the localism space in that ideology the ability to have local strategic plans to drive that forward I also think it's really important to note that where we have seen for example the creation of the granite city care consortium in other areas that has happened because there has been investment in the sector to be able to engage in that strategic space and you'll see that the areas where we have more progressive so less competition more collaboration with the sector are in those spaces where there is very importantly as Gerry said that investment to give people time to digest and to come along and engage at that senior strategic level for instance having representation of care providers and IJBs at Scottish care we have a network of independent sector lead and independent IJB reps they're not on every IJB in Scotland but I would say that would be fundamental to any care board going forward thank you and I'll bring in Sandra McLeod Sandra thank you convener one just to really pick up on a couple of points one with regards to the ask about the community planning partnerships and how the IJBs are currently involved in that I would say that from a local environment within Aberdeen City our strategic plan is absolutely linked into a local outcome improvement plan and we're fundamentally a strong part of that community planning partnership I think that the IJBs in the health and social care partnerships have an absolute key role to play within their local community especially looking at that whole that whole lifestyle issues looking at poverty about child health as well as adults and moving forward so yes there's fundamentally strong links already built there in definitely within Aberdeen City the other point I would like to make is about the ethical commission that colleagues pick up absolutely within Aberdeen City that was where we started off from was about looking at that ethical plan and it did take quite a considerable amount of time but having been as Kevin said on the commission side having been previously on a provider side in the private sector and having moved over and then being within analeo and then within and working that through there are some key things that we all know that affects sustainability within any community and staff in this for starters moving away from zero hours contracts given staff the ability to be on there looking at funding looking at giving the providers just exactly as Rachel's said the contract the money is handed over you know is given over there is that ability to shape and shift contracts all of that is possible under the current legislation it is possible under the current iGB and it is possible under the system I think the key thing that's really important is that there has to be mutual respect and trust and it's where people come together and have that belief that we're here for to provide the outcomes for people and what we're not doing is a race to the bottom on time and task and commission and trying to save funding because all that does is create us problems in the longer term but what I would say is regardless of what the shape is moving forward the current structure does allow that when people are brave enough to start to take those tips forward thank you thanks if I could just pick up on that Sandra there because I know as well that certainly when we've visited Granite Care Consortium that you know the providers themselves were stepping up care stepping down care without having to reference back which I think is something was it yourself Rachel that mentioned earlier on there and how important that had been and also the fact that there were reduced hospital admissions during Covid as well that you had the evidence of that in the final report and I appreciate that you know that there are criticisms or there are concerns about moving to national care service but actually assuming that's going to come through are there positives that we can actually take from for example what you're doing there in Aberdeen for the national care service because I appreciate the fact that you know there are some of these things or there's lots of these things that can be implemented in the current system but currently they're not being implemented and that seems to be where the real real problem is so what are the kind of biggest takeaways that we can take from what's happening in Aberdeen just now as far as a national care service coming into effect and making sure that other areas are picking up on those real strengths. I think it goes back to the key point that someone said it's about relationships isn't it and about that mutual respect there and having that shared understanding that people need to work together about whether the full issue of staffing about outcomes for individuals about so my own experience in both within the private sector and mindful that all our services are commissioned out and within Aberdeen we don't have internal care home services so we are all external but one of the key things is to understand that as much as we're with we've got third sector providers or independent providers they all have a different model than what we would have within a local authority model that there's no right or wrong way of delivering everybody you need a mixed economy of delivery within a lot of environments just through rurality or anything there. The key bit that I think we can take away and bring into into a care board and moving forward is that fact about having that shared ownership and about having mutual trust. One of the things about Granite City Consortium is that they've been really open with their books really open you know everything is really transparent we've helped them you know it's we're really honest and open when there's a problem it's in it's all our interests to work together it's not an interest to have providers failing. When I first came into post and previously in my allio role we had numerous providers that were failing particularly care home and touchwood we've not had a provider failure since we put in this model not within our Granite City Consortium that there is that adaptability that's supported by each other people are working collaboratively so it's creating conditions whereby that is seen as the principles of the commissioning and not as a nice to have. Emma, you want to come in on something that Sandra has said before I go to Paul? Yeah thanks, thanks, good morning everybody. It's a quick question for Sandra. Time and task is something that came up when we had the Dumfries visit and Ewan MacLeod from the Dumfries team said that they were working with the Granite Care Consortium and that was part of what what they were hoping to do is move away from time and task. Can you tell us briefly like what does that mean and what do we need to do better if we're planning this care service to in order to make I suppose make care more deliverable? So a key thing one of the big drivers is about moving away from and it's historic that we have both within and we've done a lot of work locally from care management and in our hospitals whereby people say oh you need to go home on twice a day care or four times a day care it's flipping it round and saying actually it's the provider who needs to talk to the person and what we're saying is person may need support with personal hygiene they may need support with getting up in the morning and that but that's all we say so all you would say is this is the support they need the provider then sits with the individual and says what do you need that to look like so I could give you two examples one might be currently where somebody says oh well we need a shower three times a week and you'll get a care twice a day on that day and then they'll come in but the alternative is to say to that person do you need support with your personal hygiene what do you want that to look like we personally I'd rather have a bath and once I was only getting that option can you come on a Saturday can you spend two hours with me can I get a huge bubbly bath and can you wash and do all those bits and pieces that's personal choice that's moving away we still support the same level of care the same level of cost but just delivered instead of you know two half hour quick visits where everybody's watching the clock to one really good to visit whereby that's there another option that we've had and I think some of this is where it was built on we had somebody who needed assistance with meals and it was a case of somebody coming in every day and saying they're helping with their sandwich you know giving them their own meals on meals kind of that traditional model what that person chose with that was to say actually what I would like and what their family chose was that they would come in on a Sunday the carer went in with them and spent about three and a half hours with them on a Sunday which is the same you know the same volume of time but what they did is they cooked with the lady they cooked all of her meals they put them there they went in the fridge went in the freezer and from there on in she was independent with that but she wouldn't have been able to do that without the support of the carer and it moves away from time and task needs people's needs needs the outcomes but I'm much more person centered way and moves away from you know we're in here for 15 minutes and that's what we've got to do it's about what does that person's what does it look like for them and that's if you don't give the flexibility within the funding and the commission arrangements for providers to do that we'll never move away from time and task but each of us would not like to think that you know the only time you can have a shower every day is between eight and eight thirty and that's it you know but that's just not we need to move away from that thank you Sandra Rachel wanted to come in before I go to Paul thank you convener and I think the examples that Sandra just given has shown the really human face of what social care is actually about you know we're looking at a bill that's very rooted in structure but actually it's those examples that are why social care really matters to day-to-day life for so many thousands of people in Scotland and but thinking about the bill in that context given that this is about the NCS bill I think there's a couple of things to note the first is that the principles that are currently in the bill and I know we've shared a discussion paper with the committee with some ideas of how we might strengthen some parts of the bill don't really address the issue that Sandra's bringing up about choice and control being held by those at the front line key to sds is that issue of choice and control and also we were just hearing about the diversity of providers we can only have people having choice in how they choose to have their care if we have diversity of providers and that comes to an issue which is very much about how we're managing our social care sector now and I know the committee's interested in the sustainability option issue sorry it's not an option we have to have a sustainable system and that's a really fundamental issue for us as we are dealing with providers now who are also looking to the future we have to have a sector to deliver into the future and right now the sector is under phenomenal stress through resourcing which colleagues have mentioned through lack of staffing because we cannot pay enough there are so many issues that we are facing let alone the issue of unmet need particularly during this cost of living crisis but that's not new unmet need so I think there are some key issues that we could think about in terms of the principles which would actually give us a much more radical leverage to the sorts of change I think we all want to see so I know a lot of the disabled people's organisations have mentioned the lack of a right to independent living within the bill that would be a really interesting place to start we've never really implemented self-directed support and the level of choice and control that people should have in whatever supported way works for them so let's look at why do we still have that implementation gap and how do we not do that again with this bill so I think there are lots of things that we can look at but we cannot do any of that without sufficient resource and I've been both money and people and that's a significant pressure now as we look forward so I would say there are three important messages from us as we're thinking at this point the first is we have to deal with the here and now in order to have the sustainability to go forward we have to be clear that the money available for this bill is really there and I would say it's an extraordinary time that requires extraordinary measures and I think it would be really helpful given that we're expecting stage one to last perhaps a little longer than expected for a revision of the financial memorandum given where we're at because inflation has gone through the roof since it was written even things are moving so quickly we need to be sure this is an affordable approach but then we need to come back to the bill and think what are we really aspiring to hear the sorts of things that our colleague in Aberdeen has been talking about is what social care should be about can the bill get us there and that's where I think we're really keen as providers to work with you and government and others to try and find where we can create those additional levers if this is the way forward okay thank you Paul thank you convener and I think it's following on from that point and maybe trying to pull some of those threads together if we go back to the first principles of feely which an old ritual had mentioned in the previous answer and do you feel that you know the bill can achieve the aims of the feely review and what I think everyone agreed to in terms of feely or is there too much focus now on structure as opposed to that investment piece that we've just spoken about in social care so I think I appreciate it's a broad question but I think if you if we can ask Rachel and then perhaps Karen to comment as it stands as it's been laid no as it could be maybe and that's the work that we really want to do to see if we can get closer to feely because we were really excited when feely came out I think we would almost surprise ourselves that we were how positive we were from what came out from Derek feely's independent review of adult social care as time has gone on it's felt like we've got further and further away and we had a meeting with our members last week to talk about the bill and the discussion paper before we submitted it to the committee on our website as of yesterday and what came out was just the high level of disillusionment among members from where we were post COVID a really hard time a discussion about social care being back on the agenda with a really radical reform that people could see the potential in to where people feel now which is the bill is not meeting that aspiration but actually there's nothing else in the table so the question for us is we've got a period of time now how do we shape this to be what we want it to be it's why we did our model of reform because we felt that vision that some colleagues have been talking about was a bit missing we need to be really clear what we're aiming at and then look at the bill and say can we make it that that's the work we're doing now as it stands no I think it's too far from feely thank you so in a similar vein to what Rachel has said we were also really excited when independent review of adult social care came out and then equally we had done work with members and literally everyone in your granny which culminated in a report called Calainach and actually the findings through that report that Scottish Care had published really matched what then came out of the independent review of adult social care so like yeah we're in the right space the principles are right this is the passion this is what we want to get right for the people of Scotland but what we're seeing in the bill process is very much you know very limited to to scope very limited to process and we need to get the people back in there I spoke earlier about the implementation gap from some of the really good legislation that we already have in Scotland my worry is is that the notion of a framework bill means that we have to travel even further to get to that end point because what we have is a very bare minimal skeleton that's going through the bill which means we've got much much more to build upon as time goes on totally get their advantages as well you know we want to be agile we want to be able to adapt as as we progress as our aspirations changes technology advances and the things that we want to do and aspire to in social care changes actually a framework bill is good for that but my worry is is that if we're so fixed in what is a very limited process we will never ever make the implementation gap to get there to really realise what it is that we have aspired for in Scotland what we really need to consider here is that the creation of the national care service is in itself an exercise of ethical commissioning and that comes back to you know choice and outcomes not time and task for people fair work principles it comes back to collaboration not competition so creating the conditions to work together a lot of people have spoken about trust actually trust has to be earned and in the position that we're in at the moment there's not a lot of trust left out there the goalposts have shifted so much recently work needs to go on but what we can do is underpin that through mutual respect and show those really good examples of where we've worked together recently and also progress not perfection you know we need space to bring innovation to think differently about our aspirations how we achieve those to collaborate and work together and some of that requires progress not perfection sometimes when you're trying to focus a bill on process then you're too much in the space of perfection and not actually that space of what matters to you as an individual and how do we get that into place I wonder if I can just push you Karen in terms of your feelings about the distance between Faley and the current bill and do you feel that this has become too focused on structure and not on culture well yes and part of that is also to do with the consultation process that we've experienced as well at our recent care home conference members were asked on a panel so those who were in the audience had they engaged with the consultation events for the national care service and many of them almost all of them put their hands up then they were asked did they feel as though they'd been listened to not one person in a room of 350 put their hand up so I think we need to be really really careful here because if that's the experience of providers at the moment then how do we know that other people feel as though they've been heard each and every person's thoughts considerations are being put into what is a co-design process to make sure that what we get at the end of this is what we really want and and really showcases the aspirations that Faley had in the independent review of adult social care. Can I bring in James Dornan on one line James? Thank you thank you convener. Can I just ask Rachel I think a couple of times you talked about self-directed support and use it well it seemed to me that you used it as an example of why we shouldn't be going down the road we are just now but surely a national care service with sort of like a uniform roll-out of self-directed support something self-directed support would have been a good thing I mean the problem with self-directed support as I remember very well in a Glasgow MSP was that some local authorities used it in a completely different way from other local authorities a great policy that was spoiled by the patchy roll-out across the country so I agree with the final statement a great policy with patchy roll-outs and I would say that there is therefore a need to look at how to make a great policy work and not necessarily to have to rewrite it and I cannot yet see how the NCS bill that has published which is not to say it may not look like that eventually is in support of or becomes a national delivery agent for self-directed support not least because the principles in the bill don't match the principles of self-directed support so I think if that's the ultimate policy aim let's go back to the principles and look at them again but I don't I don't see how creating a national structure a great deal of cost with no costs in the financial memorandum which are actually about service delivery when we know we have significant issues about resourcing service as it is and giving people the sorts of choice they require which also requires keeping enough providers in the market to have that choice will be served at this point in time by the NCS bill so I think if that's the aspiration then fantastic I think it would need some tweaking some significant amendment actually more than tweaking through stage two to get there but I think if the if I mean if if the idea of taking that choice and control message to people who can then direct their own packages of support and choose who they go to for those within a space where people can be assured of the quality of the service that they are receiving where fair work principles which are not certainly not currently applied are applied equally and fairly across that workforce then I'm with you but I think the bill needs quite a bit of work to get to that point okay and I'll bring you in but I mentioned to members that we're only on theme one of five we're halfway through our session I've given that a good evening because I think it's important to get a lot of things out early on but just a little kind of hint to members to think questions and maybe yeah I'll go fast what she said plus plus actually when we're talking about sds the complete ageist failure to implement sds in care homes thank you Emma commissioning and procurement thanks thank you convener good morning again so we've talked a little bit about commissioning and procurement so I'm interested that it and I actually I have the paper that was put to us Rachel from ccps on my iPad this morning and I know that you've you know you've made some recommendations these are what amendments we would like to see I think that's actually fantastic because we'd really like to hear some what we think would be good amendments for the bill that would ensure that it delivers a national care service or at least a way to go forward with co-design so thank you for that I find that it's really helpful I'm interested to to I suppose hear about commissioning and procurement and and what does ethical mean and and how do we move forward with that I suppose Rachel we could go with you first and then probably Julie as say red for Scotland excel we'll go to Rachel first and then Julie okay thank you and I'm glad the paper's helpful certainly that's our our intent I think one of the things I would say is we talk about ethical commissioning and then quite often we say the procurement but it actually has to be ethical procurement as well and I think the process the principles that have been laid out for ethical commissioning already are very good principles I do think the principles in the ncs bill would need to be strengthened for them to then be applied as we would like to see them to an ethical commissioning and procurement practice I also think within the legislation there's been quite a lot about the procurement process that's in there two things I would note an awful lot of ethical procurement as we've already said can already be done it doesn't need to be done but I'll say three things that's the first the second is that the bill although it restricts has the potential to restrict contracts it doesn't remove competitive tendering and we think that's a real issue so I think that that's one area that we need to look at a great deal more in the legislation but we think the definition of ethical commissioning is very scant at the moment and needs to be stronger so that everybody is understanding of what this endeavour that none of us have completely cracked yet we've got really good examples around the country but we haven't really cracked as a process even though we could be further along and I think that's something to do sometimes with risk appetite we hear from members that sometimes there's an appetite locally to do it but sometimes there are legal questions there are there are financial questions about how much power to give up we need to be able to deal with that the other thing that we need to be clear on is that the the procurement parts of the legislation are intended to be used they're not just taking EU regs and putting them into scots law but that's where they sit because we could have used some of those already and we haven't so it would be really good to get that clear intent of we will move to this ethical procurement process but we should be removing competitive tendering from social care social care is about relationship based care and support that should not be put into the place of competitive tendering Julie and then Jerry wants to come in thank you thanks for your question so as you know we're a national shared service for local government and HSCPs and we put in place I suppose a number of different types of arrangement for care services for children adults and older people and the point about competitive tendering contrary to what was stated in the fully report for the national frameworks there is absolutely no competitive tendering within care and I actually agree there isn't a place for that it's all about the standards and the quality and the rate will be assessed but it's certainly not competitively assessed as in you'll be excluded if your rates too high nothing like that happens in national frameworks so I think what we do is we we've got that collaboration for everything that we do we work very closely with local government with HSCPs to design the specifications of what we need for these national arrangements and I think the collaboration is really important and we've been building in more ethical arrangements for the past few years now prior to the fully report and an example of that would be in our care and support framework which has been up and running since 2020 and someone mentioned earlier about well if you've got the levers to do it why haven't you done it and I've got a really good example of that so caring support we went out to the market for for that arrangement and it's completely flexible it's not based on comparing rates it's all about quality and standards and we've built in things like travel time being included for the individual the individual carers and things like that but despite all of that we couldn't get all of our councils and HSCPs to use the national framework and there's a good reason for that because the sustainable rates come back 14 percent more expensive than the rates that we're currently being paid within local government and HSCPs I suppose so the point I'm making is it doesn't matter how good the vehicle is if the money isn't in the system to pay for what's required then then people will find other ways to do it and that caring support example is that I think a really good example of a really good vehicle that we've got that isn't used as widely as it should be Jeremy Cormack thanks very much and I suppose part of the challenge just in terms of national practice and description is that there's no one common standard across the peace and variations and respect to Glasgow and encompassing a lot of the principles that we're discussing that are essential that we see as part of national care boards going forward and it would be the Glasgow Alliance 10 commissioning and I think that really demonstrates a number of the values in respect of ethical commissioning and procurement approaches that have been undertaken but I think a key fact that should help inform the development of the bill is about the learning from that very process from all of the stakeholders point of view and I think so for example Health and Provence Scotland considered Glasgow's experience in terms of a lessons learned and going forward and I think that we have to maximise what's around so use the examples from Granite consortium that are there use practical examples I think it's the opportunity of where we learn best and just finally and quickly what was based in that was the relationships that all of the colleagues are mentioning that we do believe in and as recently as last week all of us here not Julie but a representative are in the ethical commissioning national group representing so we there is a cohesiveness that will support but it is about the relationship it's a bit risk enablement and the respect of what's around and trust and that's a whole system approach that we really need to address for individuals in the IGB in the future potential care boards and across the whole system community planning etc can I bring in Karen Emma before you those for ethical commissioning so rather than repeat them I can ping them over to the clerk later if that's helpful and what I did really want to raise though is the the gap between or to reinforce really the points made about the gap between commissioning ideology and what happens in procurement and the financial resource or other resource available to enact that I'll give an example there are some areas who require providers to sign up to fair work charter they should be signing up for the fair work charter because if you have staff that are having fair work terms and conditions then they're more likely to be happy in the work to stay in the work you know all those things that we know about but the problem is that those particular areas then aren't getting paid that sustainable rate to being able to put those fair work principles into action so there's a huge question there you can just throw something into a contract a requirement that's been put upon a provider but if they're not able to deliver that because they haven't received enough resource or there hasn't been enough work in a strategic planning context to create the conditions to enact that then we're just responsibility lie and I think that's a big question we need to consider for ethical commissioning. Rachel I know you want to come in but Emma is there anything you want to put to and move a Rachel can pick up on yourself very conscious of the time got my in the clock all the time. I will be quick on time I'll just cite some specific information that we heard from Dumfries and this will go directly to Julie as well and I'm using that example because Dumfries is like my patch and you know I was at the table when they were saying this but they were one of the things we heard was that sometimes Scotland excel can be challenging to work with examples where delays in passing on uplifts and pay which led to staff leaving and delays in processing variations or refusing to consider variations I don't know the specific detail but with a standard rate despite local differences in cost so it would be interesting to hear from you Julie about any direct experience around how the Scotland excel works with the providers and what would happen if Scotland excel were no longer involved in commissioning arrangements for care for social care. I don't recognise some of the examples that you've given me but if you can give me specifics I'll certainly have a look and see what's happened. There are sometimes delays to the process of variations because it's a really complex area and when we did our first national care arrangement which would have been 2012 I think we totally underestimated how long it would take to actually get all the the right parties around the table and make sure that we built in all the right things so sometimes there are delays. In terms of a standard rate despite differences locally the only example of that I can think of is a national care home contract which is something that I work with colleagues here around what we're actually looking at can we change that can we redevelop that. There is a single national rate for care homes that's established and agreed with the group here and others so but generally things like caring support the providers will submit their rate and that will be their rate and we'll ask them particularly in that framework to submit a sustainable rate that involves payment of the real living wage and different things. So there's only one example where I think that would apply and that's the national care home contract. In terms of what would happen if we weren't here well I suppose it would mean well it depends on what happens with the national care service really. If the status quo was as it is now then you would then have 32 local authorities or HSCPs that would do this work on their own which I think would would further dilute what we're trying to achieve which is to try and standardise good practice and ensure that people get the real living wage and other benefits and so I think there's a real risk in that but then over and above that there's a whole resourcing of that which is you've then got numerous exercises going on with different councils HSCPs that providers then have to respond to so I suspect that it would be likely that there would be a number of local arrangements and when we've kind of mooted that to the sector for the national care home contract that's not really a route that anybody wants to go down and they like the fact that a lot of this gets done at a national level maybe not all perfectly but it certainly frees them up to do the things locally which is actually the commissioning the good commissioning. Okay I'm going to bring in Sandra McLeod once to come in the specific point Sandra. Thank you convener yeah I do think that while I fully understand colleagues you know suggestion it is prior either when there's you know maybe national thing in national procurement and national commissioning we do need to be really mindful that Scotland is very different and I think even things like the air home contracts and the care at home contracts it's not applicable necessarily what's in the middle of Glasgow does not suit what's up in the middle of the Cair and Gorms kind of thing so we need to be mindful that there are local variations that are needed the principles we can agree on but it is requirements of us working together to make sure that we get the best principles there but we do have the ability for local variation because it isn't okay for and and I do appreciate that things can take local time but in some areas that time can be the to the detriment of provision of service about employing and all that so I think there is yes absolutely a national level we need key principles and some you know guidance and support on on how we can do that to help share the burden but we cannot move away to just saying one national this is the national standard and that's us moving forward because it will not work across the whole of Scotland. Shetland and Orkney are very different from Glasgow and Edinburgh and we need to be really mindful of that. Colleys I know there's people asking to come in and add I'm going to have to go to other colleagues questions and move things along so can I go to Gillian Mackay first of all. This is probably a question for for Rachel in the first instance giving funding pressures how likely is it that voluntary providers will be able to deliver on fair work principles under the bill and how can we strengthen the bill to ensure that this is a reality for voluntary sector providers. Well that actually picks up on why I put my hand in the air in the comments that had come previously so that's really helpful. I think fair work is absolutely crucial here and I understand some of the legislative competence issues around what can go into the bill. We've been promised fair work for some years now and this year we have gone further away from fair work in the year in which we're looking at an NCS bill not closer so when the uplift was given to social care staff in the third sector at the start of this financial year which was less than five percent it was actually done on a formula which we don't quite understand on not on 100% contract value so it was given on an estimate of how many staff at a certain level you had within an organisation. That's had all sorts of profound impacts even before we got into future pay rises for other parts of the sector which meant that individual employers couldn't maintain differentials it was very hard to fill management jobs and actually we then got into a situation where pay offers were then offered to other public sector colleagues now I certainly don't begrudge them that in the slightest people should be paid fairly for what they do but first there was a local government offer then an NHS offer then a revised NHS offer which bears no resemblance to the sort of take home pay that a care worker working in third sector social care providers would enjoy. So £10.50 an hour is the minimum threshold now for a social care worker the new pay offer to the NHS puts about for 13 more than £13 an hour we've been looking across recruitment sites to find a £3,000, £4,000 difference in starting salaries between public and third sector. So when we speak fair work we're way off at the moment and we are entirely beholden as employers of commissioned services to the contract value so when when I was listening to Julie's points about you know we ask for people to put in a realistic amount that amount is just not payable it's not there the uplift has not been given and so we then have the real living wage announced and whilst I appreciate the deadline for that it's May for payment nevertheless the living wage foundation has asked for that to come in quickly because of the current situation over the winter. If we were to maintain the differential before that announcement between the real living wage and a starting salary in social care then social care staff would already be on £11.55 an hour as a starting salary if we then compare it to our public sector which is what I thought we were aiming at here which is parity we're way off so I guess there's a little scepticism maybe quite a large lot of scepticism in in the sector about what the fair work exemplar wording means because we're not there and we've been told that for years and we're worse so I don't think ethical commissioning as we currently attempt to do it including through the national contracts through Scotland excel can possibly deliver on fair work and I would like to see the bills significantly strengthened part of that for me is about how allocative decisions are made at a national level for what goes into social care so I'm very aware in all the winter pressures work you know the winter plan in Scotland talks a lot about the NHS and additional staff doesn't say that about social care it offers the local government pay award offers triple sc fees to be paid by national government doesn't offer that to the third sector so we are far far apart and I think our our members would be very keen to see the bill strengthened so that we can trust we go back to that word we can trust that that fair work principle which we have all signed up to can be delivered through all commission services and let's remember the 1050 uplift was only for registered adult social care it was not for all of social care and it was not an uplift for all staff and it's now far behind other uplifts that have been offered there is no mention in the public discourse so we've talked about the the value of our social care workforce through Covid and beyond but it's not being matched in the slightest by the value placed on them through contracts and awards through pay offer to keep it short because actually Rachel just went on to say what I was going to add which was the point about the cost of regulation as well being included in the local government offer but also to say you know we have exactly the same scenario for independent sector care providers as we do for specifically for our voluntary sector care staff as well fair work principles apply across the board but it's not possible to enact them on the rates that we are currently paid and of course we have that 1090 aspiration at the moment based upon the fair work conventions recommendations but in reality even that's not enough Julie have you got a follow-up yes please so this is specifically for for Karen you'll have seen the paper from the STUC on profit in the care system have to stress that this is not all private providers but some are taking a significant amount of money out of the system in profit and given the pressure on funding for services and workers wages and wages in the sector should the amount of profit allowed out of the system be capped under ethical procurement and should companies be prevented from banking in tax havens I think what we need to consider is first of all that at the moment profit is capped through government payment so the national care home contracts caps profit or return at 4% and the funds which are paid to providers and the cost modelling that are done locally often for care at home providers is capped somewhere around about three three or four percent now for a bank to consider a company to be financially sustainable they need to make something called EBITDA and that sits at 7.5 percent if you compare the sector to other industries for instance the competition and marketing authority was suggesting that a return rate should be sitting between eight and nine percent hear dressers get about 11 percent hotels get 14 15 percent so there is already a cap in place for publicly funded care what I'd also like to add actually is when you break it down I actually don't know if people understand what the national care home contract rate works out at it's the national care home contract rate for a care home at the moment is somewhere around about five pounds an hour if you compare that you know that's fairly complex care people with advanced dementia you know quite a significant and important level of care is delivered in care homes now quite different from maybe 15 years ago 10 years ago even even five years ago but you compare that for instance to my kids after school club local town church hall it's more than half than that for an hour of care so there is something I think it's worth explaining is is actually what the rates are that are out there and for a local authority to deliver the equivalent you're talking two two point five times that cost and the equivalent hospital bed alone is three times that cost so I think that an undertaking this work in the national care service maybe some some more explanation of of actually what the cost lines are and how we've got to where we are is is definitely worth considering and I'd be very happy to to work with people on that. National and local governance arrangements we've touched on this throughout but we have specific questions first Emma and then from Paul. I think a lot of the discussion we've already had this is being quite so I will be really brief so I suppose one of the issues that's coming out is about how like local government want to be part of delivering care and now we're having to or we're going to create national care boards for instance so I'm interested in how I suppose I would have to direct it to one so I'm okay with doing that is about how how do we manage this moving forward to make sure that we are able to show the local authorities that this is about local delivery with national guidance so it's not about taking control into ministerial offices this is about delivery of care at a local level with national guidance that underpins what the care quality needs to look at or look like. I wasn't actually looking to come in so if anyone else would want to come in before me that's fine but I guess it was about if I have the opportunity I shall in terms of creating that local guidance and that local flexibility that is really important for local innovation to flourish and to create the conditions for people to collaborate and affect change we also have to bear in mind the role of the regulators in this space as well many of them also have a role in improvement so if we're talking about quality and conditions we just need to make sure we're tapping into aspirations there and obviously we have the independent review of regulation going on at the moment and also say that while we're discussing regulation we have seen in the pandemic the introduction of oversight arrangements which are a de facto regulation mechanism for health needs and I think that they need to be considered as part of that because of the way that they've been enacted they're not always beneficial in the front line and have led to challenges for individuals living in care homes so when we're talking improvements and standards I guess I'm saying it would be great to work with providers in that space and see you know what sort of work they have been doing and the good stuff that's going on out there there's great examples so happy to contribute those as well Paul. Thank you convener I wonder if we can just look at those relationships that already exist on a local basis I think both ccps and scotland excel have expressed concern about you know the focus on structure essentially could could be to the detriment of those local relationships that already exist I think Rachel's already had some comment on that which was helpful but can I maybe ask Julie you know to maybe elaborate on those scotland excel concerns and do you feel that there is a risk that the bill could damage already well established and successful local relationships? I don't think we know enough at the moment to say whether that's the case or not and someone mentioned earlier I think it was Rachel we don't know whether this will be a commissioning model or a delivery model and that's quite fundamental to your question and if the intention is to replace exactly what we currently do on another national body then I imagine we could duplicate those relationships in some way and I imagine that the staff would transfer across in order to do that so I think it's achievable and I think probably what gets lost is is potentially the years of experience in doing this and the learning from this that we've had along the way so I do believe the relationships can be maintained but it'll all depend on the structure that's decided upon basically. Very briefly if I can do you feel though that people are become fatigued by structural change because I think it's fair to say that in this sector particularly we have seen a degree of various structural changes over many years and actually I think what people are driving at is a cultural change so for example we're not quite at the 10-year mark of integration it would be an example of that just your thoughts. I mean I suppose we're fortunate more fortunate than some of the others here and that they are more in the front line of this than we are I mean we basically put in place the arrangements so fortunately we're not front line dealing with those changes that you've talked about in the same way speaking from my own teams that do this I think there's a lot of concern as you would expect because they really don't know whether jobs will be and I think that can be detrimental to performance and the kind of work that we're trying to do now and there's a bit of a risk that because we're focusing a lot of our efforts in supporting the NCS work that we're not maybe doing innovative things with with our current portfolio that we should be doing so I think there's a bit of a risk in that as well so for us it's maybe less about the fatigue because we we didn't experience that at the last time but more about the concern and the worry about how is it all of this going to look and what does it mean for people. Thank you Rachel I was looking at your submission and something stuck out to me and in it it says in the current form the bill is a curious mix of specificity in relation to the powers it gives to ministers and permissiveness in relation to the interpretation of the delivery of key principles so can I ask are you saying the bill gives too much powers to ministers and to clarify that part of the statement and would you like to see autonomy retained at a local level okay I think it's actually quite hard to answer the first because although the bill does place intervention powers for example with ministers when they feel things are not going right and they meet a certain bar at the same time the core accountabilities of ministers that are set out on page 2 of the bill are very thin indeed and we're concerned then in our paper our discussion paper which we just submitted to you yesterday we've said that we feel that if ministers want to be accountable for social care then the clarity on what that accountability is for needs to be clearer not necessarily stronger but clearer and also the way in which that accountability is then held to account needs to be clearer so we're very aware that in the legislation there are for example no provisions apart in from in one place where there would be regular reporting to parliament like there would be in other bills often the social security legislation is highlighted as a model for this being a framework bill but the social security legislation comes with a commissioner approach which is not replicated here though I would argue it would need to come with more resource than perhaps was put into the social security legislation so for us it's more about ministers it's a political decision where ministers what ministers choose to do and it's for parliament to decide whether that's the right thing if that's going to be the way forward then certainly it has to be done with clarity and with the ability for recourse to be clear when that accountability is not being discharged as it should I think in terms of the local and it's interesting picking up on the previous conversation we're obviously now getting into a discussion I think about should we stick with ijb's or should we move to local care boards and we're going backwards and forwards on should it be joined accountability between local government and national government through ijb's through the NHS or do we create this care board but we're not quite sure what they are and I go back to my original point in the model of change which is we should be looking at subsidiarity to the individual we should be leaving the responsibility and accountability for how care is delivered to that very front line space that is then supported by the local and then the national and we need to be clear what sits at each so the decision about what care somebody wants what care somebody feels they need should be done at the front line and that we already have not necessarily very well implemented but very good policy around self-directed support so I think it's not as simple as saying should it be what we've got already because what we've got already is not working everywhere and we know need is unmet and we know some people have had and still have a very poor experience of trying to get the care they want in the time that it is required because we don't have enough resource we don't have enough staff and some things go wrong at a relational level so I don't think it's as simple as question as we're now being presented with because we have a framework bill that's about taking or not taking accountability to ministers I think we've got a bit stuck in a groove and actually we need to we need to sort of almost step back and think okay let's be clear about what accountability is being is to be held by ministers let's make sure that accountability can be held to account in a way that is transparent but let's start at the other end what needs to happen at the front line and work up and what we've got a bit is a bill which sets up if you like a culture which is starting at the top by holding things and then going down and I would argue that's probably the wrong way around okay thank you and follow up question yes and I don't mean to to keep picking on you Rachel but I do want to just come back to something that you said there and James Dornan said this in when he asked you a question about patch delivery and you have said previously that says quo is not good enough and in your response to me you were talking about that so with our local governance arrangements we have right now and the way that we do have ministers in charge of health and social care could we not be doing a lot of these things right now without having a national care service bill so fair work could we be closer to fair work than we are without a national care service bill absolutely ethical commissioning could we be further down the line of ethical commissioning in some of the ways that some of our colleagues here have described that they're starting to make those moves yes ethical procurement similarly the there are some tweaks at the edges that could be improved legislatively but actually the core of what we could do we actually don't necessarily need to change legislation there is clearly though despite the new found evangelism for ijb's some things that are not quite working as well as they should and audit Scotland will have been sitting in front of this committee looking at some of their reports that's not to say that there aren't improvements that we can always make we know that at the moment the way in which third sector providers are commissioned and procured in many areas is not good enough we know that the availability of care and support for people in many areas is not good enough so there is something which is why in in in our discussions with members we've been really looking at what do we need to do now which is not to say that reform is not required and our membership is really clear with me that reform has to be there which is why we came up with this model we need to look at where some of these things could and should be legislated for and how they translate to a bill so i am not saying there should not be a national care service nor a national care service bill i think there are things that could be really improved by that national oversight and setting of frameworks but we need to not wait there are things we can do now while we wait for this to come in and we all try to shape it together and certainly in terms of the sustainability of the sector we published a document about a month ago very first of the month of november which was looking at the immediate actions we felt scottish government could take to ensure a sustainable sector was here for a national care service and that's a document that we're waiting for a response to move on and i think that this probably is something that we've skirted round throughout the morning is the sequencing of the legislation and the co-design process and how you want to see that work i'm going to go to James Dornan to start questions off on this and then i'll come to Paul James thank you convener the i was interesting just to hear what Rachel was saying there because most important line that she said was that this should not be top down this should be bottom up i mean given that there are some concerns from the witnesses about maybe not so much as are in need for it but should it be now and what should it look like it's the likelihood is let's work on the basis that the bill will pass and all these organizations here are going to be involved in the co-design of it what would you like to see in that co-design surely this is an opportunity to create the national care service that you would like to see can i ask we'll go to Jerry first thanks convener in terms of the involvement in co-design i think what we would like to see is being cleared about what has been working and what should we should continue and acknowledgement in terms of the fatigue that's around for consultation and what i would say at the moment from a Glasgow perspective that we can cite that what is working well is partnership working and that's across all areas and that's in terms of organizations individuals having a clear voice and it's listening and i think more than that it's about ensuring that we're acting and a constant dialogue in terms of where we are going in terms of the views that are around so therefore the national care service might give you a platform to espouse what you're doing as being a way for other parts of the country to be doing or the national care service to be working in the same sort of basis yes it may do that and i think further detail on how the consultation will develop would allow us to be reassured or more reassured in terms of what that will bring and i suppose that's where our starting point is so in terms of the principles of engaging with all stakeholders it's important essential that that's continued but we don't lose what is quite a strong baseline of current evidence and practice that we can bring forward thank you Karen you want to come in thank you just picking up what gerry was saying there about a malaise the care sector is currently experiencing a crisis like no other we thought things were hard during the pandemic but the aftermath of the pandemic for a variety of reasons is significantly worse we've seen in one area of scotland alone a 32 percent increase in unmet need we are really really in dire circumstances here our members don't have capacity to engage effectively in a co-design process because they're out there pulling shifts frankly so how do we really move at this point in time to ensure that we're supporting the system through the current winter pressures that we have and i've called on scotish government for an immediate stand down of all non-essential demands upon the sector to enable them to get out there and to support social care and through doing so you know people who access care and support their loved ones and the health sector so that we can then have more space and capacity coming out of winter to be able to engage effectively we fundamentally agree that reform is required but the current pressures are not enabling people to engage in a way that's effective and any public session that they have been to there has been no no one there representing providers so at the event speaking perhaps on panels or informal sessions so they've often felt as though their voice is not represented and in fact oftentimes there is a an opportunity for an unrealistic view of what a provide care providers aspirations are is presented at those meetings because it's a very very one sided and because they don't have that space to put their own voice out there so fundamentally reform is required in the midst of a crisis not really you know i made this call at our conference but you know sitting next to someone from scotish government and they said yeah hear what you're saying but see that a survey on technology it's really really important we need it for the national care service so could you just do that it's not important looking after people is important right now looking after our staff can i ask you then working on the basis that will be put in that room what would you like to see in that bill so the bill has to be co-designed and you know we did that piece of work a couple of years ago that fed into the independent review of adult social care so i'm happy to submit that to the clerk and there's a there's a framework for a national care service and there's a paper called kalena in terms of representation of the sector we'd be looking to when there are panels when there are public sessions to have providers represented to speak and to have a space to come now we have had the offer from scotish government to now to come and speak to providers but now is not the time they just don't have the capacity to do that so we need to be able to create the space in the system to allow people to contribute effectively at a point in time when they are able to presumably that that would mean to inform the secondary legislation that will actually fill in some of the detail on how how the service is going to work yeah yeah at the moment they're putting at fires uh huh but but in terms of the framework the framework will then provide the platform on which to have that secondary legislation so we're looking at a couple of years down the line but there are demands upon the sector now to fill in copious numbers of surveys to inform that work okay Stephanie you wanted to come in at that point then i'll come to Paul yep just just quite briefly um really when we go back to what granite care consortium we're doing up in Aberdeen there's been that real shift in power so you had the health and social care partnership essentially handing over a budget and the providers being at that table and being able to work collaboratively to provide that seamless care to shift things about if something wasn't quite fitting to shift it to each other and i keep hearing about you know we don't want to lose all the good work we've done and i totally appreciate that jerry that there's been lots of great work that's come out of ijb's but we're still getting this you know voices are not being heard providers feel that they're not heard they need their voices to be at the table surely if we're looking at care boards that is really what they're all about is having those providers voices at the table not as someone who can speak to the ijb because there's that difference between engagement and listening and actually co-designing and then being part of it all the way through and continuing to be part of it as well so i'm kind of a i'm kind of a worried about this idea that we would lose lots of good work because surely you wish to have those people around the table who are already there but you also have the providers and you have the lived experience as well so you're moving forward together and it's very much a collaborative process that is grown and moving forward along so i'm not quite quite sorry a couple of points i think the question was asked about what that would look like and i think it picks up on there as well i absolutely understand that we and fully support that we need lots of views and lots of voices and everyone needs to co-design this but it's understanding where that work takes place and what the purpose of the board would be and in many cases of a board it's where the board there is asking is providing a level of scrutiny, a level of governance and then a level of approval or not as things are progressing i think it's important to have the voices are heard just as i think Rachel had said right down at a local level whereby so it's how was that enacted the board is just not just apologies for that language the board is an area whereby decisions will be made where scrutiny will be held and that the work will happen that will bring the papers and the decisions forward to that board in other areas it's how do we find resources and how as Karen and Rachel have both said how do we give providers and third sector and in service users people who are actually using service and lived experience how do we create them the space to be engaged in the co-design before it even gets to a board so that that's where it's involved and i think that's the bit that's the worry for me that we're missing is that we're so focused on who'll be around a board that we're not focusing on how actually that information will get to the board and how that co-design is being made because fundamentally that is still made by officers across there that cultural that we have at the moment will not change and it's the cultural aspect that we do need to do and the only other ask i think that i would say is looking for what that board needs to look like for me is i think a national care service absolutely but we cannot escape what Covid has shown us and what i suppose from my own perspective health and social care are entwined you cannot do anything across health across primary care across social care that does not impact on one part of the service and those boards need to be really balanced as well as the work streamed in the groups that enabled decisions to be made that we can't pull out health from this and we can't just have about care service we'll have to make sure that we've got all that and trying to together thank you Paul and then i'll come to the test thank you convener Rachel in the ccps submission you said that the Scottish Government appears to have taken the view that aspects of the detailed implementation of the bill should be subject to co-design but the overall approach to system redesign and structural reform should not so i suppose can i just check do you feel that this is back to front in some ways that co-design should have been done in advance of the bill to then inform what the bill looks like and how would you respond to other people who've called for a pause in this legislation to try and get this right so i think we are where we are did the bill has the bill embodied the principle of co-design in its development no having got to this point though i think picking up what Karen has said is it's really important from here on in that that trust that the process that we are being promised as the bill is implemented is now fully embraced through the process of what happens from the bill from this point on now the government obviously are setting up some groups i go with Karen that actually this is a this is a very difficult time to get providers engaged but our providers are i mean i've run two events on on this bill in the last two weeks and had a fantastic turnout because people know that this is the bill that's going to reform the sector for good or ill depending where we end up at the end of the process so it really really matters to people they do want to be engaged it is a difficult time to do that one of the things in the legislation at the moment and it's in the discussion paper we've shared is that despite the language of co-design even in what's being proposed for the post framework process and the strategic process that will happen locally is still quite a traditional consultation process we will write a document then we'll give it to a few people and they can tell us what they think that's not co-design so i do think we need to look at fundamentally what is in the bill and the expectations that are being set by primary legislation on what co-design is i go back to what one of my colleagues said which is i think co-design requires purpose and sometimes the purpose here is not yet clear enough and it goes back to the issues of the principles being stronger the fact that we are where we are and i think Derek Feeley's work was very engaged so if we can get ourselves back towards that then i think we probably salvage a little bit of that sense of people's engagement i think people were very engaged through that process despite it being covid so we're not we're not saying that we're at a stage of pausing the bill i'm not quite sure what that would be yet what we are saying is the bill is not yet where it could be we are doing everything we can with our members and with you and others to say can we make it a better bill and closer to what we want it to be and that's the process like you as a committee are in we're at stage one we need to see what what the potential is to get this to where we want it to be but as i said before it's not where we would want it to be now that's why we have these sessions which is great absolutely um Pivriann Tess my question is for Sandra McLeod in your written submission Sandra you emphasised it's essential that scrutiny of legislation by parliament and stakeholders is not diluted by using secondary legislation over primary legislation what would you prefer to see on the face of the bill at this stage and what do you understand by by co-design with respect to the bill thank you thank you um i feel probably a lot of my colleagues have picked up some of the key parts is that in the moment at the bill it does feel like a very much just a framework which is not giving us that explicit direction of there which means that the secondary legislation can then allow it that to be a bit more work for that to be interpreted i think Karen clarified that point quite clearly so i would i would support that i think with regards to the co-design it is absolutely the co-design takes time it takes time for us to be around all in the same space i would echo what Rachel had said that fundamentally if we don't have clear purpose and we don't have clear principles then anything that is set out in that can then lose track those are the fundamentals that we need to make and sure so exactly what are what is the the broad outline on what this will look like is it commissioning is it not commissioning is it going to be local is it going to be what exactly are we working with and then we can start the co-design so will this be a commissioning framework or will it be you know is it not are we going to have all the staff across there what will that look like what's the geographical boundaries going to be get all of that clarified in the first bill and then the secondary legislation we can then start to work through and co-design test thank you have you got a follow-up no oh it's very kind thank you um so what i would like to ask is about the transparency of co-design once we've actually had people feeding in as as we think they will be it's about well how does this then get decided how do we um see and come to the decision of where the conflicting views are who sits to make those decisions what is the transparency we see here what what do you understand as well um and i suppose julie if i could ask you um i think it's quite hard actually to understand the landscape of the various groups and meetings and requests for information just uh surely because of the scale of what's being requested right now so at the moment it doesn't feel terribly transparent but i think that's more just because there's so much going on it's quite difficult to keep your head around what groups we should be on what groups we shouldn't be on should we attend this should we go to that um so i think that's something we could hopefully improve over time as part of that process because that's been challenging for us as well it's just that whole resources required particularly at the moment because i think i've had a discussion with a number of people about work is still being done and the guys have given loads of examples of how important that work is how do you find the space to free yourself up to get involved in the co-design discussions and so on when when you're facing the kind of challenges at the front line that these folks are so so if there was some way to make that simpler and a bit easier i think it would help us all to thank five of you for the time this morning it's been very very helpful i'm particularly glad that you're coming forward with suggestions of what you want to see on the bill and what you want to see in terms of the process that's extremely helpful for us as we put our report together and we're going to pause for 10 minutes to allow a change over in panels thank you right we now move on to our second evidence session on the national care service bill and i want to welcome our second panel we have got fincia kelly chief executive of blackwood homes and care margott mcarthy chief executive officer for crossroads caring scotland and pete mccormack the managing director of randolph hill and joining us online we've got nick price representative of the granite care consortium welcome to you all i'm going to hand over to my colleague jillian mckay thanks convener to what extent does the panel believe that the bill will enable or support care services to uphold fair work principles and improve conditions for staff and how if at all will it help to address workforce challenges around recruitment and retention and peter's looking at me so i'll go to peter first yeah i suppose to some degree it's difficult to answer a lot of these questions because the bills in it in its first stages and i in my response to consultation that's what i said is there's very a light level of detail at this point so it's difficult to pin things down i suppose one of the things that i probably was hoping from the bill as it progressed forward is by having a national framework we may see more consistency across the country it's obviously there are different challenges that occur around the country and they need to be treated slightly differently but i don't think that they're so radically different they need a radically different approach in each area and i think consistency across the country would help we'll go around to margaret bacharthi you don't have to press your button it'll be done by for you thank you i'll just echo what peter's saying obviously to me you know it's in the detail that we have in the moment you know where i am in principle you know thinking you know a national care service in the sense of everything being nationalised you know one would hope then that that would also include rates of pay and you know certainly from a provider's point of view we're seeing you know a mass excess of staff due to fair working pay so you know i think if we could come to point with our consistency of rates of pay and then that really means rates of how we're you know we're paid for delivery i think will make a big difference so we get to meet them in the detail that's sitting there miss kelly and i would echo at least most of that we have care services around the country different markets very different but all with a fairly consistent theme of turnover that's much higher say than in our housing services and that comes down quite often to two things one is the nature of the work personal care isn't one for everybody but also it's that thing of the pay level relative to what you can get in hospitality and retail so though that combination when personal care isn't for everybody along with other opportunities at least depending on the local market and the local economy then it means that we consistently have high turnover and what that means in turn is that the business margins are very fine quite often negative and you've invested quite a bit of the available money in training in induction and then people leave so my board consistently asks is that us or is that the sector and all the data would show that it's the sector and we do the best we can in terms of paying for travel those kinds of issues and given people that wider set of benefits that we can but it's to me there's a very simple thing that it's still the period does not equate to what can be what's what's there in in this is a mainly hospitality and retail so for me it's not a question i think you're asking but given the amount of money that's going to have to be invested in structures if i had a preference it would be to put a lot more of that into front line recognition of the work that people do and i think our care staff particularly those we were talking earlier of the people who've been around for a long time where this is you know a huge commitment rather than career for them in many ways they are after pandemic particularly they really did feel valued they worked extremely hard but they felt that there was a recognition of the value for society that they brought and that's gone again so there definitely needs more of a change on that front and you know i think the principle of fair work is here you know i do think that's one that could build on but and possibly the issue maybe for the committee as well as we're looking at much more of everybody does talk about the crisis in care and while i tend to go on solutions rather than crisis i have to say it is a very difficult time at the moment and leading up to the period of when the national care service is established i think we need much clearer signals that it's understood as something that's got a major value to probably all of us in scotland and i'll come to nick prace nabrodine thank you i think when derrick feelys report was first published there was a huge flurry of excitement throughout the sector because it encompassed a lot of what majority of providers across scotland have been calling for for Jesus as long as i can i can remember i just have to remain optimistic that what his recommendations are going to follow through into the the structure of the national care service i've worked in health and social care for for a long time and i can honestly say that the last six to nine months is the hardest i've ever ever seen it we've always managed to to recruit retention that the churn within the sector has always been has always been high but the recruitment pressures now are ones that i have i have never never seen experienced before we so speaking as a provider rather than as a co-chair of the granite care consortium now we typically don't lose care and support staff to other care at home providers we lose them to our nhs or health and social care partnership colleagues or we lose them out with the sector and i mean that the primary reason for that is terms and conditions jillie to pick up on what nix just said about terms and conditions obviously pay is a huge amount of the recruitment and retention side of things but we also hear from people working in the sector that things like zero hours contracts holiday pay all these sorts of things are a huge part of their of their working life as well what would you like to see if i can come to nick first possibly what would you like to see in the bill to ensure that we can continue to improve terms and conditions for for workers and make sure that we can both recruit and retain the current workforce I don't want to step outside of Scotland but the UK HCA or I think home care association is the code now that they've published a sort of a recommended rate for years which is significantly over and above even what we're paid by our best paying partnership so some sort of structure that would align with that I think he was mentioned in the previous session that our NHS colleagues are paying I think banned for about 13 pounds 50 an hour that's a level that we need to be at to pay our care and support staff but we need to be able to pay staff as a care of home provider on shifts so we need those guarantees from from our commissioners because the majority of care and supports in Scotland is spot purchased on half an hour 45 minute in some areas 15 minutes now that doesn't fit into into ethical commissioning at all I've always said on a personal note that I'm happy to commit but providers obviously need a level of profitability I know that's a bit of a bit of a bad word but we need to be sustainable I've always said that I'm happy to to commit to not exceeding that level as an organisation and to pass as much as we can over to our workforce because without our workforce then we don't have sector I don't think that we answered your question thank you that's thanks Nick certainly as a provider we do pay holidays travel so we try to set the best terms and conditions we can we think that should be standard and we think the standard should be set in terms of whether it's triple sc or whoever the regulatory side is as well that those are recognised and therefore funded in that way as well so I think that's all I would say Margaret yeah I just kind of want to kind of size that as well you know I think you know if you ask most providers they actually don't want to have zero hour contracts with their staff a lot people choose to have that because of work life balance for them but as an organisation you know we do pay travel time we do pay all training everything is paid at the rate of the 10 50 so you know I think for me where the issue for that is when you are paying that all out when you look at the rates we're given from certain councils they actually don't meet that rate so you inevitably dip into your reserves as a provider and that's where deficits come in for providers quite often so you know I think for me there's a whole thing about the consistency about the ethical commissioning about you know looking at how we're delivering care generally you know you know I think there needs to be a real revamp of actually how we deliver particularly care at home which then would retain staff but actually would I think service our communities better as well but I emphasise again I think what we're talking about here is rates that we're given you know to deliver service actually don't actually meet what we're putting out as providers and coming if I may to what you just said about you know that local authorities giving you a particular rate and then you're paying your staff more than that you see that would be something that a national care service might address that that issue I think that takes me back to my answer from the first question you know which is that I would hope that spirit was that's why I said that you know in a positive way I would agree with that as long as we are looking at a national rate now I know that will be very difficult depending on rural areas because you have additional travel time and mileage etc but there should be some standard and I would take back to you know the home care rate that's out there you know we need to get to a point where rates are paid that are equal and we need to get to a point where staff are delivering care at home or any other care home or home care service in the community based architecture are paid an equivalent pay that health sport staff are paid as well because that's a big issue we have people moving yeah if I make I'd like to come back to next because nick you mentioned about churn between social care providers and we know from visiting from speaking to when we came in our our visit to Aberdeen that that was something that granite care consortium has has been trying to address and to stop the sort of like the churn between providers can you maybe tell us a little bit about how you've managed that have a very transparent approach amongst the 10 board members of granite care consortium which is a combination of independent and third sector organisations so we have have shared our terms and conditions now obviously there are differences in organizational structures and some are national providers some are local but I think that transparent approach has supported that we try to get as close as possible to pay sort of the same hourly rate and I know that the majority of GCC providers pay a good bit over and above the 1050 but I I'm not actually sure that that has really been the key element that stopped it I just think that people are looking outside of care at home because they know that they can go and do a similar job in NHS environment they're not out working all hours they're on set shifts they know what they're going to walk away with pay wise at the end of the month they've got support on hand from other colleagues nurses doctors it's not alone working environment I just think it's a far better more appealing more better paid option than going from house to house in all weathers I just think the appeal of the care and support worker is just unfortunately going downhill thank you can I um jillian i'm assuming that you've finished your question on yes the fact that I jumped in and took over test you have some questions in this area thank you convenient I have one question to fan chair and Margaret please so the question is the Scottish care chief executive Donald mcaskill has estimated that 30 to 40 percent of the country's residential adult care facilities may close permanently because of the immediate challenges they're faced would the projected £1.3 billion earmarked for the national care service in your opinion be better invested in local delivery of social care now that's a good question you know I think I said early on I think the crisis is now and if we want to retain a proper understanding of what kind of care is needed in Scotland then I do think it needs to be invested in the near future I fully understand the pressures on the overall budgets but I think that's a choice and it's one that we will need for a range of adults in it I think one of the things and again might come in later um you know without seeming over optimistic um I think one of the things that we need to think more about is how you prevent crisis because crisis is more expensive and that's the piece that is consistently including in the bill I think not given enough attention and it's not given enough attention because it's difficult but everybody knows from their own family and their own circumstances and certainly in our businesses that if we can do more on prevention and early intervention then it's what people want and it actually saves the state money as well and we've got evidence on that but you know I think Donald may well be right that you lose quite a lot in the next couple of years while the national care service has been set up and that's something we need to really juggle properly I think I would agree with you there I mean I think but for us as an organisation the one thing that we are seeing a lot of stress on and I think a lot of money could be invested better prevents those unpaid carers because obviously quite a lot of our work we're going in and we're actually getting into a household with two people in it husband and wife for example you know and then you know where we're into care for the husband and the wife's the main carer you know and there's a real lack of investment in giving people purposeful breaks at that point so you know I think if we're kind of long-term looking here would I think the money would be better invested at this stage I would totally agree I'm a wee bit concerned the amount of money that's been spent on the national care service but I actually do agree with it but I think there is a crisis now about how we actually address our social care as a society in our communities and you know I think you know as an organisation and having been in health and social care for over 37 years you know I think I would agree with Neil I'm probably this is the worst I've ever seen it and I'm really concerned about if we wait two years and we wait for this to get pushed in a lot could happen in two years we will lose staff more you know I have real concern that there will be more crisis than when we've ever had and you know I think at the end of the day the one thing that's missing a lot of time and I know share care Scotland to put that forward to yourselves is is the role of the unpaid carer at the moment and that's going to put so much more pressure on them members want to come in Emma thank you convener good morning I'm interested in in the the bill that contains language about training and when we're talking about recruitment and retention of the workforce that we are now starting to move away from time and task and looking at like real ways of helping support retention and recruitment and valuing people by engaging in training so I'm wondering what you think about the aspects of the bill that basically say that the Scottish ministers or care boards may provide training and that way it helps look at valuing our staff maybe even retaining them even longer and supporting the continuing recognition of the professionalism of care because a lot of the care that's provided is really complex and so that's something that I'm interested to hear from you about your thoughts about the what's in the bill as far as the language around training I think training you know is organisations we all have managed trainers training we all have to do your right very complex care requires very complex training at times and you know to access some of that at times as an organisation is very difficult and if that was nationalised in some sort of way where providers could tap into that better that would be that would be amazing you know I'm particularly thinking around some very complex training and you know I think for me but we're back to the same question it's the investment of the money in that and you know how much money is going to be put into that training budget in general and how we retain our staff around there as well so if the government was committed to supporting on-going continuing professional learning and supporting aspects of that in order to tell basically unburden providers with the financial aspects of having to actually send people away to do online training or physical training face-to-face would that be something that you would welcome as far as looking at you know recruitment retention professional on-going learning I think we're back to the detail of that again you know what kind of training we're talking about we're talking about moving and handling we're talking about first stage you know what kind of level of training are we talking about and you know and where does that come off in the sense of rates as well you know so is there going to be money taken off of our rates to to sort of furnish that you know that budget as well so it's not I don't mail commit I do because we do have difficulty sometimes accessing training and so yeah I think that's going to be in the detail of that if I'm honest okay yeah you know I agree with Margaret Sen on it I suppose the kind of practical thing is that we absolutely want good training and we see that day in daily that that's hugely important I think the thing is when people are training there's a cost to cover for shift or whatever it is so you still that's where you end up having to do you know rotor schedule and you still need numbers of staff to make sure that's covered so that that's really in the detail I think that Margaret's talking about that is probably where we'd all all of our heads would go as we start to say absolutely would support good training on a consistent basis but the the logistics of that would still need to be taken into account in terms of how we're commissioned and just I mean it's just finally not all training is done like away from any any place so as a former clinical educator I used to go right into the ICU right into the operating theatre and do direct education whatever ward it was so like education can be delivered on the ground in the area where care is provided as well you know providers are very good at doing that because we have had to think out of the box about how we especially during the pandemic how we've actually showed our staff are still able to deliver you know in within their legislation of triple sc so you know we use a lot of no hands-on training a lot of online training you know I think for me if there's an opportunity to pull out some of the bigger training that actually has to be done in person or actually some of the complex training that we have because of clients needs you know that we have to try and navigate through health to get is quite difficult sometimes so if we're talking about the level of training that would be welcomed but I do think as providers we are very good at sourcing that kind of online and doing the hands-on and peer support and peer training you know already okay thanks can I bring in yes when I first started 20 years ago in this sector there was a lot of training that we were able to access through the the health sector the health board etc there is the history of this has been there's been a slide to provide less support to the care sector and so we've taken this on board ourselves to do an awful lot more training so I think if we're going to be moving this way by by going back in in direction and having more support centrally I think it needs you know that word co-production that's used that I think we need to be involved in which bits of training are the the most sensible ones to do and I think there needs to be a long-term commitment because as I say I from our point of view we lots of things that used to be standard that were shared have evaporated over the last 20 years and are no longer very low thank you can I bring in nick price and then we move on to question from cabin walking thank you well peter's just put me to the post on one aspect I was going to to raise the other one is a triple sce registration and the mandatory sq2 which obviously comes at quite a significant cost but if that could be funded centrally that would help but I mean learning and development in the sectors essential so any any suggestion that's going to increase funding or increase availability because that is in turn going to increase retention within the sector thank you convener I just want to take us back to something that was mentioned I've done quite a lot of work with allied health professions who are very keen to talk about early intervention and prevention and I just wondered whether the panel thought is this about a change you know in an attitude a changing approach or should we see something actually in the bill that would help that happen thank you we would definitely like to see something in the bill I mean we were very encouraged during the failure review that we're talking about independent living and helping people and for us if you're helping people to live independently you're also broadly looking at preventing crisis don't know closely and we think that there really isn't enough clarity in Scotland not just in Scotland about helping people to live independently is in itself a way that we should be looking at a set of standards how we work across disciplines and so on so I think we would really welcome seeing something there particularly when you give when you get both the demographics in Scotland with more of us hopefully living longer but needing support rather than necessarily full care and also given that you know in local communities there's a whole way of looking at that so a set of standards around that and a recognition ideally on the face of the bill that says Scotland wants to create a whole new sector we've talked to the institute of housing about this as well and I think they're very interested we've talked to the cabinet secretary for housing too about whether you could do some more to actually encourage that as one of the probably more radical changes in Scotland that would mean that the bill is well it rightly has to focus on structures that it doesn't seem to most of us to be just about that so actually introducing a whole part of a sector with standards with a recognition of what that means professionally we would really welcome thank you and Nick Price wants to come back in thank you a more focused sort of view on early intervention is an approach that we've taken in the granite care consortium providers have got the autonomy through the contract to step up and also to step down packages of care when when when deemed necessary so if I don't know if someone's a a period of crisis through infection or or something else and they need a high level of care then that can be put in for one two three weeks whatever's required they improve that can then be stepped back but that's only really been achieved through a step away from a time and task model through a purely outcomes focused personalised model of care delivery thank you and can I come on to talking about commissioning and procurement questions from Emma Harper and then I'll bring in Stephanie thanks convener we heard in the last session about ethical commissioning and procurement as well and and the language around ethical commissioning is it's really important and how we proceed in order to I suppose procure services and the bill talks about reserving the right to participate in procurement by types of organisation and I'm interested to hear what your involvement has been currently in how services are commissioned and in the bill what would you specifically want to see to support ethical commissioning and procurement framework there's two different the panel members here we work in sort of two two associated but slightly different sectors so in the care sector we've got the national care home contract but equally in the care at home sector tends to be more sport purchases and regional purchases but I suppose when we're talking earlier about the terms and conditions for staff particularly um you know my experience the national care home contract and the sort of sport purchases they really just provide the the sort of bare minimum for a contract of employment so we're talking about things like sick pay we're talking about we weren't talking about you know mentioning things like pensions they're not really covered in there they're covered in national care home contract only provides for statutory sick pay um and so many providers so you made steps to add in additional terms and additions but they're not really doing it from the money that they get from these core contracts so there's a whole whole whole raft of things you know that that many people enjoy in other sectors and you can name them all yourself you'll know what they are it would be ideal if these could be basically included in the framework of the legislation so as part of the primary bill or looking at co-design in the future you know obviously what you're describing as far as um I suppose looking down the line for somebody's pension for instance it's a huge consideration in a job and I think some of the evidence that we took way back at the beginning was that most carers are women they're aged between 50 and 65 and they're often carers themselves so so when we're looking at the way that contracts are created and delivered we need to obviously bear in mind particular groups of individuals that are providing the care is that something that you would want to see as as part of the co-design development process once the bill moves forward and then we look at how we're going to actually what's the devil in the detail for that in the future the ethical commission aside of that is you know I think there's some you look at answer a bit of your question you said have had any experience of where we are with that you know I think there are some authorities that have made steps forward and how they work with providers in developing contracts moving forward and how that actually looks so you know I wouldn't want to say that that it's it's negative across the board because it's not because there are some authorities that are very good at that and I think you know certainly around the authorities looking at test of change and looking at how they develop contracts around that too but in answer to your question about you know the the I suppose the majority of staff that we have you know you're absolutely right you know I would probably say you know out of 400 some staff the majority of ours are all female and they are nine times out of ten working months so you know I think there has to be something we're building up contracts about how we manage that moving forward in respect of pension childcare in respect of time out for after school care all of those things are things as an organisation we're building in but it's not built in when we do a contract so I would like to see that moving forward as well there's a recognition of you know childcare responsibilities as well in there okay Nick Price wants to come in on that okay can I bring you in thank you I think like Margaret said there's a lot of good work going on in pockets across Scotland a lot of councils put sort of ethical demands within their contracts but unfortunately they're they're not appropriately funded so therefore they're not achievable but I guess you know the councils can only I guess pay out what what they're funded it's very difficult I think aspiration the aspirations are there certainly with all the councils that we work with I just think that there's a lack of funding there but in terms of moving forward I think one sort of essential criteria is that is parity on fair work and fair job across social care health and the health and social care partnerships you know people are doing the same job in the three different areas but social care is is pretty much the the poor relation at the moment and yeah that's a problem just a wee final question I guess it might be back to nick we heard last weekend in fris that the integration joint board in fris are actually now going to be working with granite care consortium to to look at what you're doing in Aberdeen so that that can then be mirrored so there's obviously some really good work that's taken place and you've highlighted that there are local authorities and integration joint boards with some really good examples of care working collaboration working and delivering care in an ethical way so that's something that personally I'd like to see going forward is that something that we think we should be taking these bits of good work that's happening right now and building that into the co-design so that when the care service is being delivered in the future we're actually using some really good examples that are out there right now that's part of what we're hearing about granite care consortium and now they're linking with Dumfries and Galloway. Yeah definitely I agree entirely with everything that you've said we've been really fortunate in Aberdeen I mean the the chief officer had the vision of where she wanted to get to and you know when she took that decision right at the beginning of the pandemic it did raise quite a number of eyebrows and I think the thing I asked at the time once I've got my head around that the proposal was you know if not now when because someone needs to take that step forward this is what we've been asking for as providers for as long as I can remember and absolutely there's a lot of good work going on around Scotland the NCS should capitalise on that and not look to completely reinvent the wheel but what's really worked in Aberdeen specifically is the trust the co-production the partnership the trust between the partnership and the providers but also the the 10 providers who make up the consortium having shared values a shared vision and ultimately wanting to deliver the best services that they can for the supported people that they're ultimately working for that the culture has to be right if the culture isn't right and the trust isn't right then you know that that's the essential foundation for it yeah so I mean absolutely agree in the whole issue of cultures one probably hard to put on the face of a bill but important and the other thing I think for instance when you're talking about female workforce and so on for we've got about 600 people and around the country and it is mainly women but not only lots of grandparents you know just people at different stages of their life as well and that part time work so the part time piece of that's just very important then in terms of you know where people are in their own lives and able to survive on that but I think one of the things in terms of the overall commissioning and I'm not sure about the language quite right but the Pelt and Social Care partnerships have a requirement to produce almost a market statement before the commission and that market statement should really set out what the conditions are locally and what you're then commissioning against and those are not ones that have in our experience been very successful you know because quite often the commissioning is against immediate problems rather than for a future plan and knowing your local market your local conditions in terms of employment the workforce and so on actually strengthening on that side of it that people have to engage in that kind of discussion before the commission the services I think would still be helpful because the idea on that was quite right for us but as I said the practice has been really not one that's even properly recognised I think okay thank you Stephanie thank you thank you convener um just going to follow on up on Amos question um she's already touched on it there I'm just really really interested in asking Nick what differences has it made having that kind of coordinating role as compared to having the competing with each other what differences has that made to yourselves as providers and also to those who are receiving care from you um I think removing that the competitive element um has meant that good work practices um the different business ideas different recruitment retention strategies we've been able to share um all these things in a safe space and you know frankly with the knowledge that there's more than enough work for everybody um it's there's always been in Aberdeen um specifically really really good provider um council um relationships but you know we're at a point now where we've got our own GCC back office team we're sharing data with the partnership open book accounts it's just a completely different but unique dynamic and it's one of trust and partnership yeah it's just it's so much healthier removing that competitive you know keeping everything to yourself um dynamic and those receiving care so we've put out um a survey uh recently um and generally it was of high satisfaction what we've able to do what we've been able to do is a consortium if is if one provider can maybe only provide five days a week and another provider can provide other two days a week we've been able to work in partnership if one provider is perhaps struggling with with a package of care because it's out with their geography that they'd normally cover we've been able to move packages around um just work in partnership with other providers um I think the thing I always have to come back to is is that we've set up the consortium during a pandemic when it was exceptionally difficult but during the sickness and absence and the high pressure periods we've been able to rely on our other consortium providers as a support network so I'm pretty confident because we've recently as a so as a provider now we've recently put out our biannual service user satisfaction and the feedback has been probably the best that we've ever had and we've also had the highest number of returns I think our return rate is normally between 18 and 20 I think this time it was just over 30 so you know increased engagement increased satisfaction and I know that's not just unique to to us thank you can I ask Nick you think that the moving away from the time and task model has meant that less people are getting into crisis and also I'd be helpful I think if you can mention how maybe the approach that's been taken by yourselves is maybe contributing to some of the the lowest delayed discharge figures in the country yeah sure I'm moving away from time and task has undoubtedly been one of the key successes of it giving providers the autonomy to step up and step down packages as as required what we're also doing like mentioned went when you're up a couple of weeks ago is we are looking at embedding enablements into how we deliver care and support in Aberdeen and we're just running a test of change at the moment with I think three or four providers it's about three months into a six month project and you know so far very very positive sorry what was the second I wanted to ask about if you think that the the change the change of of how granite care consortium we're working is has got anything to do with the lower delayed discharge figures in Grampian than the rest of the country absolutely because we were able to work in partnership with Bonacord care who are the the allio and you know as I said a couple of minutes ago you know we're able to provide as we're able to work together you know maybe one provider couldn't take on a whole package but they could take on half and work in partnership with another provider until they were able to you know take on the whole package we also have throughout back office structure daily operations meetings between all providers are invited but it depends operationally what's going on so that they can discuss you know how things are on a daily basis if they have capacity any pressures that they're experiencing any other issues we also have two monthly board meetings we've just got a structure of partnership and communication and Lisa who's the ops director with her with her team are in regular communication with all providers and also Bonacord care and also the the the resco so the resource coordinators within the partnership and also the hospital discharge team so we've got a group of staff who are pulling all of the aspects together you know health social care and and the council and it's having that communication and that place to discuss resource and and so on so it's absolutely that partnership working that that meant Aberdeen had the lowest delayed discharges thank you thank you can I hand over to Evelyn Tweed thanks convener and good morning panel thanks for all your submissions so far I would like to dig more into the pandemic and how you all go on we have heard some really good evidence about how people worked how they collaborated and Margaret you said you really had to think outside the box can you tell us what happened during the pandemic and how we can harness that to take it forward into the national care service? I have a connect, we've been in a consortium but I think what happened was providers rallied round more together and I actually think partnerships health partnerships rallied round more together I think there was more a cohesive you know all out for the one goal which is to ensure services delivered and you know and I think you know initially in the pandemic that wasn't like that but we had that kind of crisis around you know the May-June time and things were really starting to get a bit kind of heavy then you know I think collectively you know I seen that across the whole of the country because obviously we are national you know you know partnerships you know providers we're all kind of you know sitting down together and trying to figure out okay what how does it how does that work you know how can we deliver and you know I think you know from the pandemic point of view I'm back to staff you know well every other member of staff in the country you know retreated all our front line staff went forward and they were there on their own doing do they do every day and you know where there was an absolute recognition of that which I think galvanised them more because they could they could see people the public behind them on that I think they could see that everybody thought they were doing this fantastic job and unfortunately I think as we're coming out of the pandemic that stopped and that's the reason why we've had people exiting a lot quicker because they can't see where their value is you know where is during the pandemic that was a massive value and I think you know I would not like to sit here and say well we did this and did that the biggest thing for me during the pandemic that you know the experience was the staff the front line staff the the value of them moving forward and doing everything that they could to ensure their service users had some sort of delivery knowing that they were the only people that we're seeing throughout the day so you know I think the the learning course for us is an as our organisation is you know not that we ever underestimate but really not to underestimate our front line staff and actually you know really pushing up the value you know that they have but also I think that whole co-production working together collaboration I think what also helped was the understanding more from some local authorities about not paying on actual hours and paying on hours took a lot of pressure off of organisations too and where we had things like cm 2000 you know where we had to kind of clock in and clock out all of that was stopped so we were allowed to look at stepping up and stepping down on the timing task and you know I think that gave a lot more autonomy to providers and I think the pandemic proved I would hope to authorities you know that you know we are actually able to make those decisions as providers delivering the service we don't need someone telling us this is a half hour call and you can't do any more than that you know to allow us to actually give us you know an x amount of hours and clients that we've got to deliver to and we actually figure out with the client when that's being delivered to them so you know I think the pandemic certainly brought that more to light as well and a few aspects on that absolutely for us both in housing and care but we're talking about care mainly today it was it brought what our frontline staff need to be able to deliver to keep customers safe became the absolute focus and we as leaders learned that I learned more about masks than I ever wanted to know but but dead important that at all levels we understood because of the nature of the crisis at that point and how we went about procuring those supplies and so on but being able to then use the national guidance to interpret for our staff and give them those tools to say here's what you must do so they had really clear guidelines and they understood that the purpose of that was to keep the customer safe but also to keep themselves and their own families safe in that time and you know we we were actually very proud of the fact that we managed that well during that time with quite a lot of ups and downs during the period of time it none of us will forget it I think I think the piece of learning out of it absolutely massive and I think it does dictate what we do in the next 10 years probably so I absolutely agree that that kind of waste in the system was counting each other in and out which costs money and time just was not needed and it was demonstrated it wasn't needed there's bits of that in the consortium in Aberdeen we remember that too so we understand that but that's how to do is change where you're actually using your resource and and frankly for more useful output on that so quite a lot of those kinds of things but the piece for us as leaders was making clear that that recognition of the job of the front line was there and was that people were very clear how much we valued and appreciated that as we went ahead and I think that's partly why we want the committee to to also be clear that that job's such an important one now just as much as it was then in terms of keeping people safe but also keeping them helping them to live in a way that they maybe choose to live a bit more I'd like to come back in to something that Margaret has said a couple of times now is that during the pandemic staff had autonomy to make decisions based on client need without the system dictating and since the pandemic you're saying that people at that point they felt valued because they had that autonomy since that point they're feeling less valued do you think the two those two things are going in hand in hand is the system then now come back in and taking that autonomy away and how do you see the national care service perhaps being able to provide a framework so that autonomy comes back and there's better outcomes for staff there's better outcomes for the people that they're caring for I would totally agree with that not in all areas but I do think there's a bit about you know at during the pandemic you know some of our kind of partners and authorities were too busy doing other things but we'll just please go on with it you know I trust you to go on with it but now without the pandemic it's about like no we don't trust you to go on with it can we now take that back even though you've proven that you can be trusted you know so you know and I'm not being disrespectful of that because at the end of the day you know authorities have you know guidance relations that they have to work with and I appreciate during the pandemic some of that was suspended to allow other things to happen but you know from a provider's point of view it was like you know one day we have the autonomy to make all these decisions and the next day you know we don't so I you know I think for me what I'd like to see in the you know in the care service moving forward is pushing back that autonomy a bit like I suppose when it's in the round grant you know we're providers you know collectively are able to make those decisions that are actually for the grace for good that's not about us as the providers trying to have autonomy to create some you know big thing for ourselves it's actually to deliver to the people you know that we serve every day so you know I think if we're all working to the same grace or good which is for clients then you know I think some of that bureaucracy and some of that autonomy has to kind of change again and that flexibility to meet need absolutely you know at the end of the day you know I would even see that autonomy even with our own staff in front line they are in there every day I'm not you know they should be able to have autonomy to make a decision about whether or not we we do give that but we are restricted in contracting timing to ask about how much of that autonomy we can give them but you know people should be able to kind of make a decision about no we're not going to share our today we're going to do that tomorrow because that's not the best day for us to do it with yourself so you know I think there's a bit of that as well but yeah and if we get that right do you think that that will go some way to stopping people leaving the sector because they have that that I think the reason why people have stayed in the sector this long it's certainly not about pay people have stayed because they have I need to want it you know at the end of the day this is what they want to do so I think the more that we value that in people the longer people will stay and people will feel they're getting something back everybody wants to leave their job at the end of the day saying I did a really good job today I had a good day you know I think the more we go down the route of not paying staff well and we put them into boxes but they can't move and make decisions the less people will leave their work at the end of a shift and say I've had a good day so I think they both kind of come hand in hand rates and the value and nick wants to come in and then I'll come to Emma I think your conversation with Margaret has pretty much covered everything I was going to say the only additional point I was going to make is that one thing that we're hearing at the moment is the current pay disputes with the NHS and how you know care staff were considered as an equal during the pandemic you know they were trusted respected and so on and so forth now that we're touchwood out of the other end of the pandemic the NHS are looking at least a seven and a half percent pay rise whereas social care staff aren't so again they're back to feeling undervalued which speaks for itself in terms of issues okay Emma do you want to come in briefly and then I'm going to go to Sandesh yep just very briefly thanks for convener um so both Margaret and Nick have talked about trust and I know Jim Gatherham from Not When Care Home and have just said that we should be focusing on trust and relationship-centred care which kind of goes to the autonomy questions that we've just been talking about so I'm interested if you think that we should just make sure that the bill focuses on autonomy and trust and relationship building as the way that the national care service needs to focus on supporting people as we move forward I think things all around co-production at the end of the day it's all about us working together for the same goal so I would absolutely you know 100% back in the bill that there has to be about relationship building about trust and about collaborative working and everybody having an equal share in that in the table you know level playing field rather than maybe the way it feels sometimes where it's providers and authorities so I think to achieve that I think I'd like to see that maybe a bit more robust in the bill okay thank you Sandesh thank you thank you um Peter can I turn to you please? Randolph Hill is concerned about the NTS creating unnecessary bureaucracy how do you think we can keep that to a number? Well I think one of the things I put in my submission about the bill was in the pandemic there were a number of a number of different things occurred in reaction to an unknown virus and how it was going to affect people and you know to a great degree you can understand why that happened but I think an awful lot of things seem to become embedded in the system and they they just seem to be embedded and we seem to be accepting that they're here now and we'll just leave them there I think they're almost like needs to be a whole-scale root and branch look at the various things are being asked of the sector in terms of information provision just to see would we actually ask for it today is it really necessary it's all very well for somebody to think I quite like this information it's fine but I don't think there's any weighing up of the balance about the amount of work going in to provide the information and how much it's used it's used at the other end and as I say I just think there's been a whole whole raft of things that have happened some for good reasons some maybe not so good but but you know I understand in the in the the the difficulties in the pandemic why it happened and I think it could do with a pause and go back and look at some of these things. Thank you and a lot of organisations involved with the NTS seem to have overlapping responsibilities is each agency's roles and responsibility sufficiently outlined in the bill? Well I don't think as the bill is as it's written they're outlined I mean there will need to be far more detail but again I think historically in the care home sector and I think the care home sector is the same our regulating body was the caring spectrum before the pandemic there have been a number of other bodies asked to come in and look at things particularly the health boards but also the partnerships and the social work departments and I think the sort of the caring spectra is a national body and therefore it's got some parameters it works to and I can have all sorts of comments about that but at least we understand the framework they're working in but during the pandemic you've got different health boards looking at different things you've got different health and social care partnerships looking at different things I think it'd be good to have some consistency I also think it has been quite difficult in the pandemic that sometimes you are getting different advice from different agencies that conflicts with each other and that is nigh on impossible to deal with. Thank you. Steph, do you have some questions around housing and care? Yes thank you convener. Francia, am I saying your name properly hopefully? It was really helpful in your submission that you'd set out three clear priorities for the bill to discover, for the bill to deliver even, some powering individuals to have more choice, clear leadership for digital and also representation by housing organisations so just looking at the digital part of it there, I'm wondering you'd spoken about a much greater explicit join up between digital health and care strategies and focused intentions for investment too and I'm wondering what would that look like and what would you like to see in the committee's recommendations when it comes to our report? Yeah thanks, you can tell we were actually pretty frustrated that the bill has focused mainly on structures not exclusively but mainly on structure someone principles rather than also on changing the way of work and that would give individuals more choice and control in how they live that's kind of where we come from all the time and as I've said our purpose is to help people live independently and we try to do that regardless of what the service is so it might be a housing service might be a care service but a lot of what we've been doing is trying to make sure people are digitally included not just having the skills but the devices and then understanding the need that they want to use it for so for our customers we work very early on with Edinburgh health and social care partnership on a particular service that was then known as the night support service and it goes back for five years now Linda Brown our manager is behind me here and in terms of having set that out with over 200 customers going through that service it saved the health and social care partnership significant money it gave the customers choice and control of who they wanted in their house they didn't want the 15 minute visit with people they didn't know and they could stay in control of how they contacted us and in the original assessments it helped work out what's the best way of doing that and that was through our systems called clever cogs but it helped through video conference and really a video calling system it works very well the kind of issues on it where quite often that the people who are involved in somebody's care felt that that person either didn't wouldn't be able to or the risks were too much and in many cases they were totally underestimating what people wanted to do and could do so give you a lot more on that but haven't worked through that we now have very significant experience of how people want and need a digital service that helps them look after their own health their own wellbeing and prevents things like calls to ambulances when they're not necessary however to us there is given what we've been talking about is the crisis and workforce and again with demographics that's not going to change quickly as far as we can see even with better pain conditions so we think that having a much much clearer focus on digital services which supplement augment and certainly do not replace that human element that we're missing a trick the digi fest is on tomorrow I think is the main conference and has been going on for a month in terms of online events and that link with the digital health and care strategy is fundamentally important to realise what can be done now not to talk about in three to five years time when the national care services fully operate so we think that much more needs to be on the face of the bill to recognise that that's a way of working that's legitimate and what that would also do for us in the meantime is get the health and social care partnerships and us as providers to ask and answer both questions about the appropriate use of digital in the next while it involves questions of data ownership which is big as well but it also actually just the practice of getting all of us using those more in ways that suit us is really important and as I said certainly our experience in Edinburgh it's gone back a little bit and we've got extremely good relations with Edinburgh we also do some of this in Glasgow but it's gone back a little bit into the kind of bureaucratic stuff that people feel one way or another they've got to do through the commission and routes so I think the stuff we could take away from that but it's actually more when you look at a service like that how might you look at it scaling up and mainstream and in commission in terms would be the kinds of background that the bill could help bring forward without a lot of the detail on the bill it's quite hard to say exactly how it fits in but the absence of it we think is really stark and really missing a trick that could save a lot of us time money and give people more choice in how they live. Thanks very much and just to aim with yourself for a moment there you've said quite clearly that the bill should include representation by housing organisations there is all about wellbeing and prevention and that that's absolutely central and we know that there's been variation across health and social care partnerships there's some really really good work going on to provide wraparound care for people in other areas it's been a lot of strong and you even described the mission of housing as being a really significant concern so if you could just say really really briefly how it helps you know the population will have healthier lives for longer at home very briefly and I'm also wondering as well whether the others present in the room would agree with that view or if you have an alternative view thanks. I'll be brief for us it's about neighbourhood and community and within that neighbourhood and community having a range of ways of access and the services that are needed and you can do that there's plenty of examples against maybe back to the good examples to say if those underpin the local co-production um and again we we our concern is around the big structures uh taken over this discussion whereas at that neighbourhood level how do you get the range of services that includes where people live all housing's local um and how do you then make sure that both their house their neighbourhood and their care services fit together should that join up the fit together with the right representation on the accountability structures is kind of what we'd like to see thank you and I just want to come in on that nope I'll move on and measuring success is the final theme that we want to talk about and I'll hand over to Paul Cain. Thank you convener and I wonder if I can maybe try to to draw some of this together and to think about that broad theme of how do we measure success or or otherwise of the bill? We've had a lot of discussion this morning and other panels about Derek Feeley's review and trying to achieve what was set out in that review so I suppose the question is how will we assess and measure the success of this national care service bill and is there sufficient detail currently to see whether or not it will have achieved its aims so I'll maybe start with Peter and then if Margaret and Francia want to come in after that and also we can go to Nick if that's all right? I suppose you can glibly say where you measure the test is whether people get the care they need wherever it is I guess there's all sorts of ways you can look at that I mean we talked about the health service you know the number of people who are inappropriately still in hospital waiting for a placement the number of people who are not able to get the care they need either because it's still to be assessed or because it's still to be provided so that's the sort of number crunching aspect of it but going back to the initial point it's just whether people get the care when they need it. Can I just follow up with Peter just before we move on? I think in the Randolph health submission you had spoken about being concerned about the criteria not being there in terms of judge and success or failure so is that something that you would recognise in the bill currently there's maybe not enough to be able to measure against? Well perhaps and even over the recent history you know when you're having various meetings you know with colleagues from the partnerships etc I think there's a lot of talk about the you know about the difficulty they're having about the crisis as we mentioned before and yet for some strange reason I always find it science surprising that it's not talked about in a lot of detail in the press you know it seems to be a sort of a hidden issue and I've heard at various meetings and largely based in Edinburgh and the Lothians about you know fairly large numbers of care at home provision that's not being provided because providers don't have the resources and perhaps equally the partnership doesn't have the resources to pay for it and that just doesn't seem to be a topic of the general population which just surprises me so much because for all of us we've all got elderly relatives who will all be hopefully oddly ourselves and this has a real impact on a huge portion of the population but it seems to be I don't know it just somehow seems to be an undertown in the press and not a topic that's discussed as much as I think it should be and you wanted to bring in a mic do you have any other witnesses wanting to comment on that broader piece about measuring success I think it's the the system wide sorry I think it's the system wide impact you know the flow through the system the recruitment and retention of staff into the sector the impact on unmet need within the different partnerships delayed discharges and end user satisfaction of services I think there's a multitude of elements to be considered sorry sorry just for Nick if that's okay can be done just briefly but would you recognise Nick that a lot of what you've just said is Derek Feeley's recommendations at his heart um yeah I guess so but I also think if you probably talk to any any provider or any commissioner um pre Derek Feeley's report um it would probably be saying the same thing because uh yeah sorry I don't know if I jumped in there or not it's always difficult when somebody's online as well so apologies I'll bring in Margaret you know we're not a problem I think you know measure success is always a really difficult one because you know you're working on whether you've had outcomes of measures of excess or whether you have soft outcomes so you know I think you know potentially depending how the care service develops you know there's a there has to be a fundamental shift in how we're delivering support in the community we know that we all know that we can't keep delivering what we're delivering just now so you know I think for me that this is a fantastic opportunity for the you know the national care service and the bill in itself to sort of evolve that to make that happen and for me the measure of success will be the you know the consistency about people actually getting the the service they need at the other side and and I can look that in three kind of ways you know we have staff retention and recruitment because people are really excited to join care you know that that to me would be a massive outcome of a measure of how we do this you know service users actually get the service they want at the time that they need it you know and at the end of the day if service users get what they need at the time then we will not have hospital admissions and therefore discharges will not become a thing at the past but they will not be as hefty you know on health itself and I think you know I'll keep coming back to this because we have a significant amount of unpaid carers if we get this right then unpaid carers will be able to continue to do their job in the sense of looking after their loved one and therefore actually hospital admissions and et cetera will not happen you know care home you know the the the real need to actually put in crisis service will will reduce so I think it's a very difficult one to determine whether or not we have soft measures and whether we have hard measures at the end of this but I think if the the bill is got the detail in it then you know we should see those measures at the other side can I just add a couple of things and they agree with I think the fundamentals are people getting the care and support the need the issue around early intervention or prevention it's a hard one to measure but again if you put in an obligation then we have to find ways to measure that I suppose is where we come from on it and make that clearer that you're preventing crisis and ideally then you're making better use of resources the the discussion we've had and you can probably hear it underneath is that we spend a lot of our time on things that we don't see as useful to the outcomes and therefore if you move that to having more against the outcome we think that that would be a help but the other one in terms of what I've just been talking about in terms of digital we definitely think there should be some measure of how we've looked at innovation that is served Scotland well and and actually with this given the amount of investment that would go to this it's really important that Scotland is seen as a leader in innovation on it in terms of how the population served for care and support and in our terms to help them live independently so we would love to see something on that alongside you know the normal measures of accountability on the aims but I suppose fundamentally what we are saying is some of the aims maybe need to change and bring some different measures with them. Yeah thanks convener it's just a question directly for neck and we're talking about how do we measure success and you described that due to the pandemic that granite care consortium and well the chief of the agb developed a way of working that's that's actually been successful and that's what we've heard in the feedback and everything and that's been described as or what GCC has been delivering has actually been called a care board model so is that something that you recognise and is that something that we should be looking at and harnessing as we take forward a national care services bill. Absolutely one thing that has changed since the implementation of GCC is the providers this sounds terrible and I probably don't mean it as raw as what it's going to sound but we're heard you know we're an equal partner at the table we have quarterly SMT meetings with the chief officer the chief financial officer and the head of commissioning so they are hearing from the horse's mouth you know what's going on at ground level and I think that that level of engagement that level of trust that level of partnership is critical in terms of how the NCS is going to be constituted moving forward. In terms of measuring success as well the only question I would have is at what point do we start to measure success because you know where are we drawing our baselines from do we start to measure now because the way I see it and I don't want to be doom and gloom but as I said at the beginning I've never seen the sector so bad and the gap is widening between increasing unmet need and reducing resource in terms of care and support workers and if we don't start to close that gap now then I don't know I just think something needs to be done sooner rather than later and we need to be gathering these metrics now to see that you know if and when the NCS does come in we can truly see the impact that it's having. Okay did we final question I know earlier you said that your chief operating officer or the chief officer put forward ideas and people were kind of like nervous about it I know it's really difficult to adopt and accept change some folk are total change agents and some people are you really need a lot of coercion so is that part of what we need to do is harness your chief officer because obviously there's a lot of trust in that in order to deliver the change that was necessary for Granite Care consortium and now you're leading the way because because I heard in Dumfries about how now you are working with Dumfries and Galloway in order to look at how they can take lessons from you and deliver them in the south west of Scotland so I'm interested about that whole change aspect of it. I think like any change it's having trust in the in the lead change agent and also them being credible I've known Sandra for quite a long time worked with her beforehand so I knew I got her vision I understood where she was coming from I think that the reticence was because they were looking at re-tendering the whole care at home service right at the start of a pandemic so the some of the board members of the consortium hadn't met face to face until you know a handful of months ago we did all of our tendering all of our meetings through through teams so you know and I guess what I would say is if we can achieve what we've achieved through those circumstances then there's no reason at all why why we can't achieve you know on a on a national level okay thank you and final question goes to James Dornan James and convener I mean most of the stuff that I was going to ask about has been covered but I just wonder if any of these have been involved in the co-design activities they are involved how you found it also if not would you be keen to be part of it and what would you like to see from it and if you don't mind I would like to start with fancier thanks James I mean co-design with the health and social care partnerships that's that the question you're asking or is it around the communities so it's around the NCS okay not directly on NCS but obviously we've had a chance to submit and and so on in terms of the local aspects I think there's still quite a lot of confusion about how you can be involved in a co-design on that and how we might take that forward I think our experience for example of working with the health and social care partnerships housing contribution statements strategic planning groups we know the processes we would like this probably to build on the best of that to use your phrase from from earlier on so I think certainly for us in terms of the role of housing and the role of digital support within neighbourhoods within communities we would love to see an opportunity for more co-design on that let's go around everyone on that I mean it in terms of you know have you been involved so far and how would you see your involvement being passed the the passing of the bill and into that co-design process Margaret? I think probably I've said you know we've had a probably limited amount of involvement with any of the health social care partnerships around this part but you know I do think there's an appetite you know across the country you know for us to be more involved and and I would say you know in respect of co-design this we need to be at the heart of that moving forward you know I think there is best practice across the country you know and I know Granite and I know what we work in dangers so the realities we're already starting that process to test the change of working in a more sort of co-designed way as well so you know I would welcome that and I think you know we need to look at the practice around the country and trying to echo that elsewhere would be good thank you Peter yeah I mean similarly I haven't been involved in in in any co-design work here recently on in the national care service but I mean we do work with the health and social care partnerships locally and the health boards as well we talked and we would continue to do that going forward we talked earlier though about the the whole sort of trust element I think there are quite different different ways that the different partnerships and different council areas are working and it's not all being done on the basis of trust sometimes we all work together to you know regularly but it doesn't always feel that we're always brought in it feels that we're brought in on occasion and for one of a number of different reasons but but sometimes feel a little bit blindsided by certain changes that are made and nobody ever spoke to us about it I do think one of the difficulties the sector has is you know everybody's busy of course but we all feel that we're busy and to constantly be involved in this as one provider or another is actually quite challenging from a time point of view there are various sort of umbrella organisations like Scottish care and I think if they were and they would coordinate that I think that that that would help but but I do think it goes back to earlier I said the trust it needs to be an ongoing and sort of constant process not just the dipping in and out sort of process yeah I've not had any personal involvement any co-design for the NCS but you know I would say that you know there are a lot of experts throughout the country who are involved in the delivery of care at home and services so yeah I would sort of encourage the involvement of those individuals I'm sure representatives of GCC will happily give up their time and be involved but also you know Scottish care CCPS absolutely thank you I want to thank all four of you for the time this morning again a very helpful session and it's as I said to the other panel before you it's great to hear recommendations and ideas coming forward for what you want the care service bill to look like and the care service itself to look like that at our next meeting the committee will continue our scrutiny of the national care service bill with a further two evidence sessions and this meeting will be an external meeting we're going to Glasgow to have our committee meeting on the afternoon of Monday the 5th of December but that concludes the public part of our meeting today thank you