 Fodd ddwyg meddiech i'r cyflawni dutable ar gyfer din conferenceau y newid yn 2020 o'r parol iawn i ymddiffyr ein sgwmitau. Mae'r un�u'r diwyllfa ar y regen ystod yn ei ryddyn i gyflawni ymddiffyr sy'n sgwmpelt ynghylch yn gael ei ddweud o'r Ysgrifetegol Ffianniseol Ysgrifetegol o'r ysgrifetegol yw gyffredigol. Ysgrifetegol gweithio ystod yn y Dyma Scottyfos Cymru, Donabelle, ysgrifetegol Ffianniseol Ysgrifetegol ym Gweith outdoor Lee Flanigan, y Comercial Care Service senior finance manager, Richard McCallum, director of health and social care finance, digital and governance. I welcome my witnesses to the meeting and invite the minister to make a short opening statement. Good morning, and thank you very much for inviting me to speak today on the financial information that I provided to the committee on 11 December 2013 in response to the committee's stage one report on the national care service bill. Mae cychwyn i gyda'r ffordd i ddod i gael'r ddau'r ffinansau a'r ddau'r ddau'r ddau, ac mae'n gwybodaeth i ddod i ddweud ymwneud o'r ysgolau i ddweud yn y ffwrdd, sy'n gweithio'r ddweud oedd yn ddweud i gael'r ddau'r ffwydau i ddweud rydym yn yng Nghymru. Dyma yw y Sglwp 23, mae'n gweithio'r Causlaw i'r NHS. Mae'n dweud o'r unrhyw o ddweud o ddweud o ddweud. had weekly engagement between Scottish Government, COSLA and the NHS. These weekly talks built upon the shared accountability consensus reached on 30 June 2023 and have created a revised version of the national care service. I will set out the impact of that agreement on our plans for the bill in a moment. We have also been working very hard on discussion with stakeholders through numerous regional events and meetings over the second half of 2023. I believe that the proposals for reform to the existing system are a highly reasonable and balanced proposition, which accommodate as far as possible COSLA's position while ensuring that we can still affect the real change and improvements people using services today require and deserve. The proposals will also cost far less to implement than the initial plan. Indeed, our forecast over a 10-year period are £2491,276 million less. I note that, on Tuesday, my officials provided some comparative costs to clarify the scale of the changes for the bill, as well as for the proposed amendments at stage 2. Those have unfortunately been misreported to the media. The revised financial memorandum is now the anticipated costs of the bill as introduced, which are substantially less than those that were misquoted. The case for change has been made unequivocally through the independent review of adult social care through our on-going co-design discussions with people with lived experience, through almost every exchange I have with those working in and receiving services from the social work and social care sector. We already spend over £5.2 billion per year on social care as part of the 2122 local finance returns data, but the spend is not transparent and it is not clear to people who need social care and who is accountable for the service that they receive. We cannot just think, though, about the financial costs in isolation. The establishment of the national care service will deliver many plausible benefits. For example, improving care and support services could help to reduce barriers to an individual's ability or opportunity to work, to increase their working hours or even to take up a new job, thus enabling more people to contribute to their economy. Looking ahead from the shared accountability discussions, the three main changes that we want to make to the MCS bill are that local authorities will retain responsibility for all current functions and the delivery of social work and social care services with no transfer of staff or assets, reforming integration authorities rather than creating new care boards and the establishment of a national care service board to oversee the delivery across Scotland. Subject to the will of the Scottish Parliament, the Scottish Government proposed to make amendments to the bill at stage 2 in response to evidence taken at stage 1 and on-going feedback from stakeholders. As those are the main changes that I intend to make at stage 2, those changes and any others will, of course, be influenced by the consideration of this committee and other committees at stage 1. My letter of 11 December 2013 set out those changes that would substantially reduce the cost of the bill by removing the need to set up care boards and to transfer staff and assets. It is a £249 to £1,276 million saving. There will be some new costs associated with reforming integration authorities and establishing a national board, but overall costs are greatly reduced. Costs are also reduced by the new proposal because it phases in reforms over a much longer time frame than originally intended. However, we must spend a certain amount over the next 10 years on setting the national care service up to save in the long term future. If we get the national care service right, then we have potentially saved a great deal by empowering people to live their best life and to remain active in society and in the economy. That is perhaps the best saving that any of us can make in Government, because it means an economy of greater wellbeing as well as resources. In conclusion, we have worked enormously hard to reach a consensus with stakeholders and I am confident that we have the best position on which to go forward. We continue to discuss and co-design the NCS with stakeholders. In some ways, that will never stop in some form because the NCS will inevitably evolve to meet the needs of those who need it and we will continue to involve the voice of lived experience in that evolution. Financially speaking, we have revised proposals that reflect the challenges of a new fiscal environment where we must demonstrate value for money. I hope that this gives you an overview of where we are with the NCS now and I am very happy to take any questions you might have. Okay, thank you very much for that helpful and informative introduction. I was about to start with where we left off on Tuesday and I intend to do that in a couple of minutes, but I know that she said that there was some misreporting of the finances in relation to deliberations on Tuesday. I am just wondering if you can provide some clarification of that and to give things correctly on the record. I was asked to provide a comment by the Times newspaper on the back of some reporting from this committee on a figure of £3.9 billion. I was able, quite quickly, to reiterate that that was not the cost that we were anticipating for the future national care service bill. That was a comparative figure that was extrapolated out over 10 years on the original basis. We have a significantly better understanding of costs. We produced that figure in order to aid the committee in its scrutiny of the bill, but of course that is not the cost of the national care service as we intend to proceed. No, I did not think for a minute. It was actually night, Mr Farraghan made that quite clear on Tuesday, so it is obviously being picked up incorrectly. Let us start at where we finished last time. What happened on Tuesday was that I was basically asking Donna about the fact that we have a bill that is less complex than we started off with. Much less complex, so we are not having to transfer assets and staff and think about two pay in 31 or 32 potential cable boards, etc. The variance in the costs is much reduced. The variance was up to 150 per cent between the minimum and the maximum. It is now at 45 per cent, so the parameters have reduced. The delay in the bill being implemented has almost doubled. Instead of a couple of years after implementation, it is going to be something in the order of four years. I know that Donna said that we are looking at this pessimistically, but you have emphasised how important it is that legislation works for the people who will benefit from it. Surely that is an inordinate delay, and I did not feel that the responses that I got on Tuesday were great. It is still potentially quite complex if we can do the work more quickly and be happy to do so. If it is a resource issue, is it not just best to say that the reality is that we do not have the resources to implement what we want to do in the time period that we envisage? Is that the case? There are a number of factors that have come into the revised timeline. One is resource. Everybody is aware that we are in a different financial situation than we were when we introduced the idea of a national care service, and we have to work within our means. Our ambition has not dimmed any, but slowing the pace of change means that the cost has spread out over a number of years. I think that it is helpful that you highlight the people who depend on social care and who expect to benefit from this legislation. It is a really complex system of social care in Scotland, and we need to carefully manage change in order to ensure that we maintain services at all times and that there is no system failure during the changeover from where we currently are now to where we are going. We are much clearer about the steps that are required in order to navigate safely, both from a financial risk perspective and particularly from the concern of any service delivery failure for people who are accessing care. Of course, we are not going to delay on absolutely everything. As with any piece of legislation, certain parts of the legislation will start sooner than others. For example, we have done a great deal of work with the care home relatives regularly. We have largely put in place a solution to the problem as requested by Anne's law. The legislation contained in the national care service bill will simply catch up with that and make it law. That will be implemented as soon as possible once the bill is passed, so we will not be waiting for years for everything. What about carers breaks? Where is that relative to where it would have been in the previous kind of iteration of the bill? We are still working very hard to establish the costs of carers breaks. You will see that in the revised financial information that there is still quite a level of variance on that. When we are seeing improvements in the rights to carers break, we have put in funding for the rights to carers breaks without the legislation being there and making that change. We will carefully look at the costs and how quickly we can implement that after the bill is passed. In your opening statement, you talked about the economy of greater wellbeing. One of the responses from Donna was that the Scottish Government remains committed to responding to a need for reform with significant changes being needed at local level to realise the intended quality and consistency that will be required. Providing timely support when needed, we can reduce overall service costs in the long term and empower people to maintain their physical and mental health, which will in turn create a healthy level of economy. What you have said is a reiteration of this, but if you get any examples of what this will mean financially, because although that is a bold statement, and I have to say that it is something that sounds logical to me, we are only really seeing the implementation costs. We are not seeing the economic benefits from that anywhere in the financial memorandum or, indeed, any real implications about where we will reduce costs in other parts of, for example, the Scottish budget NHS. We are working really hard on quantifying those costs and looking at quantifying the economic benefits. If we look at, for example, if there is an impact on delays and discharges, we know that a conservative estimate on the cost of delayed discharges per year is about £134 million, but it could be significantly higher than that. There is obviously a benefit if we can reduce that. If we look at, for example, young carers tell us that their ability to attend school, never mind to concentrate at school and to achieve their fulfilment potential is impacted by their caring responsibilities. If we have a care system that works and removes some of the burden from those young carers, I would expect to have a huge impact not just on their lives now, but on their future prospects, because they are able to achieve at school. It is really hard to quantify those. We live in a country in Scotland where one in four people is economically inactive. Some of that is down to an inability to access social care. We hear directly—and it is largely unquantified and invisible—women's work caring for people in the community, unpaid carers. If we have an impact on that, we really see the people who are not only being cared for, contributing to the economy, but certainly the people who are having to cut their hours. We hear very clearly from unpaid carers that they regularly, they often have to cut their hours or indeed stop working in order to fulfil their carers duties. There will undoubtedly be economic impacts and economic benefits from this investment, and we are working hard to quantify those. I would say—and you would expect me to say this—that I passionately believe in the national care service. I am absolutely certain that it is morally and ethically the right thing for us to do. I recognise that there is a level of unmet need out there. Fili spoke about that in his independent review. He spoke about the fact that there was unmet need out there and that we would have to increase our investment in social care. We are currently increasing our investment in social care. We have committed to increasing our investment by a quarter this term of Parliament. We are ahead of trajectory on that, but, economically, I am certain that it is the right thing to do. I am certain that there will be economic returns from it as well as it being the right thing to do. I will work really hard to make sure that I can provide you with the backup information on that. Thank you for that. Of course, again, that makes one wonder why there is this almost ghost loan in terms of delivery of the legislation and why there is four years after stage one when it is delivered. If this bill is going to deliver such savings and such improvements to people's lives, which I think everyone would want to see, it is worrying that it will not be implemented next year or the year after, but it is going to be in 2028-2029. On 25 per cent that you talked about, we have all had a letter that has been trailed in the media from Social Work Scotland, which actually questions that 25 per cent in whether it is in real terms, whether it is in cash terms or somewhere in between. Do you want to come in on that? Cash? It is in cash terms, so in real terms what will I actually mean, using if possible the GDP declare, as soon as that is what we will have to work with. Do you want to come back on that? Do the sum away from committee and come back? I mean what they basically said, I mean what Social Work Scotland have said, colleagues might go into greater depth. Through correspondence with Scottish Government officials, we have received some helpful supplementary information. However, overall information provides a lack of transparency and sufficient detail needs to provide a legitimate chance for parliamentary stakeholders, other interested parties and users that serve for the public. There are still concerns about the cost to the bill, which they go on to quote your letter, etc. We have raised one or two other issues, for example about the numbers and costs in the law of civil servants, etc., which colleagues might go into. If you have actually had sight of this letter at all... I haven't. I just wonder if you have any comments to me on it generally. I would need to read the letter and come back to them on the detail of the letter that they sent. Unfortunately, I haven't seen it. Leah has seen it last night, but it wasn't addressed to us. I have plenty of other things to talk about in the meantime. Obviously, there has been a huge reduction in costs over 10 years, but if the bill hasn't been implemented for three or four years, you'll automatically see a reduction in costs. If you're looking at year by year from implementation, what is the differential? It's going to be three years later than it was, so no-one would expect the costs to be annualised from 25 to 28 to be the same if it's three years later. You're not really comparing like with like, because you're not actually comparing what would be delivered in those years under what was previously considered and what is now being considered because of the three-year slippage. I'm not sure I quite understand your point, but I think what you're really trying to ask is about the value and the proportion of costs. No, I'm not asking about value, I'm asking about actual numbers on this occasion. You're basically facing something over 10 years, and so you're looking at the costs over 10 years, but then if you shift that forward three years, you're not looking at 13 years effectively three years, you're actually looking at three dead years effectively plus seven years, so you're not really comparing 10 years under the old with seven years. You're really comparing 10 years under the old financial memorandum with, in effect, apart from a few million, a few million, that's a lot of money, but relative to what it would have been in the first three years of that, plus seven years of implementation, so you're actually not comparing like with what you're currently. I mean, I think Donna wants to come on in this, but I suppose the thing to emphasise when we're considering this situation is the cost of the national care service relative to the cost of social care spend, so the cost of the national care service is represents, you know, from 2031-2022 would represent between 0.54 and 0.82, so less than 1% of the spend on social care. In terms of the entirety of health and social care, it represents between 0.2 and 0.31% of the entire spend on health and social care, so the cost of the bill is relatively small compared to the enormous quantum being spent on social care, and that's important for everyone to understand. I do understand what you're saying. I think the first thing to say is that we're not comparing like with like when you get into the realms of shared accountability, but that's one of the reasons that we have given you a 10-year projection there, because, and it isn't like when you might want to go into this a bit more, but essentially year 3 could be year 1, if you see what I mean, so we've given you that 10-year span so that there is more of an opportunity to compare that there. Do you want to say more? I mean, you know, the full delivery of the bill, because it's been delayed three years, those costs effectively are going to be hitting further on than what we're actually seeing now, so you're only really seeing in the new financial memorandum seven years of costs relative to 10 years of costs, so it's hard to compare by giving you. So 2027-2028, under the new financial memorandum, will look totally different from the old one simply because there's a lot less happening, because it's a three-year delay. There will be some costs earlier than the first three years, so the three years is about setting up the local care boards. The national care board, we will begin to set up as soon as possible after the bill is passed. Things like the national social work agency, we will be working to deliver immediately, when we're working to deliver it now, so some of these things will start sooner. Anzlo, again, implementation costs of Anzlo are likely to be small, much of the work has been done already, but there will be an education piece that is associated with that, so some of the costs will be starting from day one. Some of the costs will come a little further down than compared with the bill as introduced. Because you've extended the timeline, it's hard to get a late fully comparison. I think when looking at this, probably one of the better indicators is if we take the 3132 recurrent position, because that's under both instances, that would be full running, and if we look at the recurrent element, that gives us a better indicator of the changes that have been made. In terms of the original FFM, to the revised one, we've got a better understanding of what the potential costs of that could be, comparing that then against the shared accountability to show the changes that would be proposed at stage two. You can then look at the recurrent element to get a better gauge on exactly where we are, but your point is valid because we've moved the timeline. It's hard to get a distinct light for light comparison. We could try and model it up, but it would still be different because essentially you've got a different timeframe to what you're expected to deliver. I think to look at the scrutiny of this, we should focus in on the revised cost over the 10-year period, look at the recurrent element and then compare that to the revised cost under the shared accountability, and again focus on the recurrent element to see the benefits. So, rather than sit here and wade through all those numbers that have got piled up in front of me, I wonder if you can tell us where that would be then, what the differential would be then? If we look at the recurrent position on the revised financial memorandum using, I've got CPI and GDP after that, so if we look at under GDP, the recurrent position for the revised financial memorandum is £125 million to £458 million. Under the shared accountability, we're looking at around £33 million to £50 million under GDP. So, still a significant saving then? Yes, still a significant saving. A very considerable saving, okay? That's really interesting. One of the things that colleagues are probably all going to ask or something, number one will be about co-design because that's obviously been a major part of this bill and is an issue of concern to the committee because of the implications it has, not least for this committee's own scrutiny function. Donna gave really detailed replies to this. So, for example, Donna talked about five themes, keeping care support local, information sharing, making sure that people's voice ahead, realising rights and responsibilities and valuing the workforce, so you talked about how that was important. You said that co-design work for the primary legislation has an effect being concluded and we'll move on to development of filler work in areas such as charter complaints and advocacy. You said that you already have a good understanding of what is required for the secondary legislation, so I'm just wondering if that's the situation, is there any possibility of bringing more of that co-design into stage two of the bill or even perhaps stage three so that there is more within the primary legislation? So, I'm very thoughtful about this because I want Parliament to be able to scrutinise this bill effectively. I want your help to make sure that this is the best bill that we can possibly develop. So, I'm very mindful of how we can bring forward a way for you to be able to scrutinise better the secondary legislations. I suppose the thing is that because it's a framework bill, we think we have sufficient information. I mean, we've spoken to over a thousand people, we've had a long process of co-design. We know largely what primary legislation needs to change, but I don't think that there's any way around having the co-design process continue through the secondary regulation where we will put a lot more collectively, a lot more meat on the bones. But I'm thoughtful about how we can improve or make sure that Parliament is comfortable with the level of scrutiny that happens on that secondary legislation. I'm very open to working with all of the committees in the Parliament. Obviously, the lead committee want to be involved as well, but I'm very comfortable with ensuring that Parliament is able to scrutinise what is happening in secondary legislation. I suppose when I sit to talk about, you know, co-design isn't a completely blank sheet. We have costed for what people are telling us at every stage. If I take the example of information sharing, there's costing in there and how we think that's going to be achieved and what we think that might cost. But there definitely needs to be a stage of sitting down with people who access social care and working out exactly what information they're comfortable with sharing, how they want to give people access to that kind of level of detail, and that doesn't need to be on the face of the bill. That is better sitting in secondary legislation. I recognise your concern and I'm keen to work with you. I mean, there may actually be some moves to put things on the face of the bill, but I mean, the reason this committee is so concerned about having more on primary legislation is so that we can scrutinise actual costings, et cetera, et cetera. I mean, we're in a situation where we have very challenging financial circumstances across the Scottish Government and we all worry in actual fact that that bill of this magnitude and this quality, if it's delivered as it should be, it doesn't actually end up doing what it says on the tin because of resources, so it's about knowing that what the resources are and the more co-design that's done before primary legislation has enacted simply the better. I think that's really the view of most people in this committee, if not all people in this committee. One of the things we asked a lot of questions about GDP deflaters and this, that and the other, et cetera, and one thing Donna had said, on five, I think, separate occasions, Donna was that you would get that information to us, so I'm just wondering when that information can be, will be given to us, so for example, costings based on the GDP deflater, et cetera. I think we've got it, so we'll get to you. So I'm just wondering when we're going to get that, because that will enable us to give that, to be able to compare it with other kind of budget lines in the Scottish Government, in the Scottish budget, which is, I think, obviously fundamental importance. Can you give me the sort of high-level differentials just now, if you want, but we can send on a more detailed breakdown as well? Both. So under the revised financial memorandum, if we use CPI, the 10-year cost was £47 million to £1 billion, £621 million. Under GDP, it was £480 million to £1 billion, £610 million, so a differential between £7 and 11 million. The recurrent position for that was under CPI, so this is for 3132, so £127 million to £461 million against the GDP, which was £125 million, if £458 million, so a £23 million recurrent differential. Under the shared accountability, the costs are, there's no material difference. Right, so basically it might, okay, because GDP deflaters are about 1.7, and you're using an inflation rate at 2 per cent of that rate. Under both instances, CPI and GDP, once we get to the end of the Scottish First full commission forecast, I've defaulted to the Bank of England 2 per cent after that. But I suppose the difference is the reason we've got a reasonable change in the revised financial memorandum and almost no change in shared accountability comes down to how we've done it more than so. There was a couple of main points for the care boards, the national board, and the integration authorities. What we've done with that to work out the cost would look to the six annual accounts from other bodies. They were based on the 21-22 data, and then inflated forward now under, let's put it in two seconds, under CPI, 22-23 and 23-24 were substantially higher than what GDP was, and so the impact of that for those specific lines was it inflated significantly more than GDP did. That's why we see the increase there. The offset to that, and it's partially the reason why, or it is the reason why, the shared accountability shows no change, is for the Scottish administration, so the core SG part, the non-staffing costs. They were not based on 22 figures, they were based on our current spend and the projected spend we would have based on the policy initiatives and the work of the teams there. At that point, GDP between 24-25 and 26-27 is marginally higher, and so that partial offset, and when we're looking at shared accountability, because the base, of course, is so significantly lower, the effect of linear off, but because obviously the care board's been significantly bigger, the differential for using the 21-22 figures inflated with CPI kicks it up, and that's where the main difference, of course, between them. Thank you for that. That's very helpful. One of the things that raised on Tuesday was regard to the financial memorandum, and the fact that it's assumed that in the first eight years, the expenditure is going to rise by 41.5 per cent across all the areas of social care services, adult social care, children's families, just as social work services strategy. So that includes the 2 per cent that you've allowed for inflation plus 3 per cent real-terms growth, so it's about a 25 per cent growth to 2,031.32. Minister, you've already said that the £840 million that's extra is going to be allocated to social care staff is in cash terms, so it seems almost as if you're, how will this be protected in real terms if at the end of the day, over this Parliament, you're talking about a 25 per cent increase only in cash terms? It looks as if there's separate measures going here and that's not being increased by inflation plus 3 per cent. In the first sort of three years of this Parliament, we've already seen in cash terms an increase of over £1 billion against that £840 million. Now we can do the translation into real terms on that, but I think what probably we're showing is in cash terms we're well above the increase of the £840 million that we had projected, so and that really does reflect the investment that's been made in social care staff, the increase from £10, £90 to £12 in 24, 25, as well as increases in the past couple of years, so I think we're certainly in cash terms running well ahead of that £840 million. What we can do is then translate that into real terms and give you that information as well alongside that. It's just for consistency, it's very difficult to scrutinise when you're effecting a look at one that's increasing by cash and one that's increasing by inflation plus 3 per cent, I mean it just seems that you're almost looking at two separate measurements which will inevitably have different figures and you know there's obviously what social work Scotland have said is there are concerns that that target won't be met. Now you're obviously saying it has been met in cash terms, but they're obviously thinking perhaps we meant it to be in real terms, so I think there's some clarification on that. We can absolutely provide that and we'll follow that point. Okay, thanks very much. I'm going to open up the session now to colleagues around the table. The first task question is a bit listed before by John. Good morning. Donabelle explained to us Minister on Tuesday that the substantial changes that you made to the bill last year arose from the feedback that you'd had from your co-design partner saying that there were issues, and I quote, surrounding relationships, deliverability, likely disruption and costs. Could I just ask about the relationships? What were the co-design partners telling you about problems over relationships? So I can't speak for Donna, it might be easier for Donna to answer on that, but I mean certainly when I came into this role as Minister it seemed that many of our partners who we are working very healthily with now were quite opposed to the bill and that would include... So was it relationships between yourselves and these co-design partners, or was it relationships about how the bill would work in terms of the different stakeholders? What I was referring to on Tuesday was feedback about the operation of integration authorities at IGBs, and it's an area that Audit Scotland picked up in 2018 in their progress report on integration authorities and one of the areas that's come out of the co-design. So I don't think it's not about our relationships, it's about the relationships that exist at local level which aid collaboration and delivery. So can I just ask the minister this question that when it comes to these issues that were flagged up in the time where you were reconsidering the bill, are you confident that you have solved the concerns of those who are advising you on co-design? Yes, I mean I am confident that the compromises we have come up with are absolutely the right way forward. Okay, now can I just ask, in relation to an answer you gave to the convener, you said that you're absolutely certain that the economic benefits that will result from the bill will be far reaching and obviously are important in delivering the care that you want to in terms of helping people to have a better wellbeing etc. Can I ask, did the Scottish Government measure what you felt the likely economic benefits would be with the previous iteration of the bill and have you measured what you think these benefits will be in terms of the new bill? No, as I said we're still working on the detail of the economic benefits. I suppose the economic benefits come from having a social care system that delivers for people. The economic benefits come from having a workforce that has better pay. The economic benefits would result if we were able to successfully introduce a social care system that works well for both the people working in it and for the people accessing care. We'll get those economic benefits. Minister, I understand why the economic benefits are so important, which is why I'm asking the question, because if the bill is to be successful, it is absolutely essential that those who are scrutinising it can see what the economic benefits will be projected to be. You seem to be suggesting that even at the initial stages of the bill there was no calculation of what you think that economic benefit would be to society, and it seems that you're still working on these costs just now. My point is twofold. First, I think that to be able to appreciate what those benefits will be helps us in the understanding of how that might allay some of our concerns over potential costs, but the second point is that if co-design is on-going, which both your officials and yourself have said it is, it's quite difficult for us to understand what the potential costs of that co-design are going to be in the future, never mind just now, because you've said that there are quite a few things that you're still working on, carers costs being one. Do you accept that it's really very difficult for us to scrutinise what the longer term costs of the bill are in relation to what your projected economic benefits are, because neither seems to be particularly complete on its data? As I said, we're working on robust economic information and there are some things that are easily quantifiable, like, for example, the cost of delayed discharge. I will attempt to put a figure on it. We can put robust detail around it, how much we expect to see that improve, how much that would save the public purse. The principles of the bill, the general principles of the bill have not changed since we introduced it. The delivery has changed and the costs of delivery have reduced substantially, but the benefits from the bill, what we're hoping to achieve with the bill, hasn't changed at all. The ambition of the bill hasn't changed at all. Minister, I understand that the principles are the same, that you've changed the mechanism for delivery of these principles. I absolutely understand that. What I'm asking, and I think what this committee is interested to know, is that if we want to scrutinise the new bill as it stands and its related costs, it is essential for us to be able to understand exactly what these costs are going to be in terms of a financial memorandum, but they can't be exact, but they can be well estimated. Also, in relation to the economic benefits that will be forthcoming from that bill, it seems to me at the moment that we don't have any certainty about this at all, and therefore it's very difficult for this. You do have the business case, and the business case is a dynamic document that is updated on a regular basis. We've supplied that to you along with the paperwork on the 11th of December, and I'm certainly content to continue to update you with that to furnish the committee with the updated business cases as we go along, which is where we are working on the economic case. That's where the detail is laid out and what the economic case is likely to be rather than the budget tree cost. Again, I understand that, Minister. Stage 1 is approaching pretty fast. Parliamentarians never mind those who are on the committees that are addressing the concerns about this bill. We need to have a bit more detail, surely, about the likely costs, as the minister, as the convener has said, over a period of 10 years and how that relates to the initial costings, but also what these benefits are likely to be. That's the issue for us. Never mind the party politics on this. This is about the scrutiny of what is, as the convener has said, an absolute flagship policy of the Scottish Government and how workable it is. Do you agree with that? I think that the information that we've given already is fulsome. Not every bill that comes through this Parliament has an accompanying business case, so you don't get the economic impact, you don't get that level of detail about the value of the investment with every bill in Parliament. I'm happy to work with the committee on furnishing you with more detail. I want robust quantifiable figures, but the reality is that much of caring is female work. It is unseen. It is unaccounted for in our society. That's one of the challenges we are facing. That is one of the reasons we are determined to improve the delivery of social care. There are accurate numbers on how many unpaid carers that are out there. We know from looking at that population. We have an idea of how many there are. We know that it's a gendered issue. We know that there are far more women impacted by unpaid care than men. We know that for working age carers it impacts their ability to work. Unfortunately, we live in a society where women's work is unaccounted for and invisible. Getting you robust evidence is tricky, but I am determined to work to improve the quality of evidence that you have. Where are we with the national care board in terms of the format? The detail of the format will be worked out in co-design in secondary legislation. It doesn't need to be in the primary legislation. I have ideas on who needs to sit on that bill. I'm fairly certain that, as well as the shared accountability partners, the NHS, the local authority representation, ministerial representation, there needs to be lived experience, potentially people accessing care, as well as unpaid carers. There is a lot of interest in ensuring that the sector itself is represented on that board. Is the national care board not a very essential part of the administration and the workability of the bill? The powers of the national care board are very clear. We have agreed what the national care board will do, but the detail around the composition, who sits on it, voting rights, all of that is still being negotiated and designed. I am afraid that that doesn't give me much confidence that we know exactly what the national care board is going to be like. The accountability is essential, I would have thought, because we absolutely need to know what the make-up of that national care board will be and where the accountability lies. I understand that that is one of the big changes between the first iteration of the bill and the second one, and why you changed your mind on having 32 different boards on the national care board, but I will leave it there. Thank you so much. While we are on the national care board, is there a decision yet as to whether it will be a legal entity public board on its own or some other? We are still working through the detail of that. I understand that the Government's assumption is against new bodies unless there is a very good reason for it. If there is a very good reason for it, that is what we will do. That is fine. I did ask on Tuesday, as your colleagues will remember, a bit about integration authorities, but I wonder if I could touch on that again. The relationship between the integration authorities and what is around them, which was, I think, the councils, the NHS and then the new national care board. My feeling in the past has been that the integration authorities or whatever, because the councils and the NHS looked at things like budgets in a slightly different way, it did cause a bit of a challenge for the integrated authority. Will that become more complex when we have got the national care board as well? I hope not. The intention is for these things to be simpler and more transparent. The integration authority is, we think, will fulfil the purpose of the care board, as the bill was introduced. The link with the national care board is that they will produce their local delivery plans. The national board will look at those and hold them to account on delivery. However, I think that that will, if anything, improve the situation in terms of ensuring that adequate funding is put against aspirations in order to ensure that delivery occurs. I think that that is the relationship between the local integration authorities and the national care board. Would you expect the NHS and the council to hand over some of money to the integration authority? Will they have complete freedom in what they do with that, or are we expecting both the council and the NHS to take a very hands-on approach, especially as to how money is spent but other things as well? Will the national care board then have any involvement about spending in things? The national care board will be interested in service delivery. We will certainly, particularly if there is service delivery failure, have powers to intervene. It is somewhat similar to what happens at the moment in the NHS, where there is an escalation framework of support to ensure that local NHS boards are helped to deliver as required. In terms of the ability to direct budgeting and things, I think that the system that we are introducing will enable far better financial scrutiny. The local authorities and the NHS are signed up to this. They are inviting this level of scrutiny and shared accountability in order that we can do a better job together. There will still be room for a bit of variation around 31, because presumably the way Shetland does things and the way Glasgow does things would always be slightly different. There will definitely be room for variation on delivery and on operational delivery. There has to be, and I have said time and time again, that I live in rural West Highlands. The way that care is delivered in the village that I live in is very different from the way that it is delivered in Inverness, which is within the same local authority and within the same NHS board. Necessary variation is not what we are worried about. One of the things that I noticed, which I do not think that we have got around to on Tuesday, was in the programme business case. It talks about another key area of benefits resulting from the NCS is the possibility of efficiency savings. I was just wondering what kind of efficiency savings would be in there and does that involve the third sector and the private sector as well? In terms of efficiency savings, I meet people day in, day out and anecdotally I am told just how difficult a system of social care is to navigate. Every MSP around this table will have experience of hearing from people who are bounced around from pillar to post in order to access care. There is duplication of effort. There is inefficient sharing of information in effect. Sometimes that is costly. We can all see it in our mailboxes day in, day out. If the system works better, undoubtedly there will be efficiency savings. I think that there will be a level of unmet need. I agree with Feely on that. I think that there will be a level of need that we have not identified. People who are not successfully navigating that system and getting the care that they need. There will be some increased cost as well. If we do this right, there will be unmet need that we have to meet as well as efficiency savings. Is that unmet need that we need to meet in the budget or will that be additional further down the line? We recognise that it is there and it is hard to quantify because it is not being properly counted at the moment. We go back to better data, better financial scrutiny, better understanding. We will have a better idea as we go along of the costs involved. We have an ambition to increase spending. We recognise it is there. Yes, because I think that when the answers we did get on Tuesday was that we would better understand unmet need and I think you are confirming that. I suppose I am a little bit surprised that we do not know what that is. For example, I guess we have people at home who need to be in a care home but there is not a budget in the space. We have a really good understanding in the social care system of who gets what once they get a package, so they spend for each individual once they have successfully navigated the system and got a package. We have a good understanding of delayed discharges. We have a good understanding of the people who have been referred for a package and not yet seen, a good understanding of the people who have been referred for a package, assessed for a package but do not yet have it in place. What I am saying is that I am reasonably confident and the independent review of adult social care would confirm that. I think that every individual around this table's mailbox would confirm that there are some people who are not in the system at all and it is very difficult for us to quantify that. There are two different kinds of unmet need in a sense if you like the one we know about and the one we do not know about. So how quickly would, even if you take the one we know about, I mean I just as a personal example and I should say probably I used to work in the care sector, we decide as a family my mother was falling regularly she needed to be in a care home but it took quite some time for the local authority to also confirm which they did eventually that she needed to be in a care home. So in that gap period my mother was able to afford the fees herself but eventually then the council makes its contribution. Will that change at all? Yes, I would expect it to work more efficiently but I think we can furnish you, we can send you PHS published data on that type of issue already and we can make sure that you're aware of that. So that's the kind of unmet need that we know about at the moment and I think we can probably furnish you with that information from Public Health Scotland's publications, make sure you're aware of it. Yes, I would expect the system to work more efficiently at the moment it is strained and reactive. We have come through a pandemic, the health and social care system and its entirety is facing the most challenging times it ever has but all of this is designed to improve the situation and speed up those decisions and ensure that people receive a quality service and are treated with dignity and respect. So the bill is going to make the system better but won't actually produce more money because one of the reasons South Lanarkshire council couldn't put my mother in a care home is because they didn't have enough money so it's not actually going to put more money into the number of people in care. So we have a commitment to increase the spend on social care so we're increasing the amount of money, the quantum anyway. There will be efficiency savings if we do it correctly. A simple calculation would be anecdotally what I am told is if we help and support someone before they reach crisis to an elderly frail person, if they spend 10 days in hospital that will cost them 10 years of muscle mass. If we can help and support them to live independently in their own home with a good care at home package, we will be able to help twice as many people, they will need half as much care as if when they reach crisis and require care on exit from hospital. So that is the type of efficiency saving that should, if the system works better, if we can genuinely shift the spend to early intervention and prevention there will be efficiency savings which means that we can help more people. I mean literally with that change alone we can help twice as many people before crisis as we can after crisis. Okay well that sounds positive, I hope that's the case. I mean when I said the word efficiency I mean one of the thoughts I had was that certainly when I was in the care sector there was quite a move from smaller care homes to larger care homes and certainly some of the third sector and other homes are quite small. So I mean one way of efficiency is to close the smaller care homes and have much bigger ones like Glasgow has tended to go down that route. Is that part of the thinking here as well or is that separate? No that's certainly not part of my thinking as a highland MSP that is not going to work that that kind of market efficiencies are not going to work for us in the highlands and as I say I'm always mindful if I can get this social care system to work in the highlands I can get it to work anywhere. Right and are the third sector and private sector involved in all of this? Yeah I meet regularly with them here. And they're happy with where we're going? Yeah so I mean the third sector and the private sector yes I mean I think there's uncertainty so people don't like change and uncertainty but those I mean there are many excellent people, you know groups operating out there in that mixed market economy that we have for accessing social care and they have nothing to fear from this what we are going to do is improve the quality right across the board and improve the paying conditions of people working in social care. This change is to be welcomed but I absolutely acknowledge that there is uncertainty and concern about how it will impact on their individual businesses or their individual charities and as I say I meet regularly with stakeholders and hear regularly from stakeholders in order to reassure them about the changes that are there coming. Everybody agrees with the general principles of the bill. I haven't met anyone yet who disagrees with the general principles of the bill. We all want to move to a more effective person-centred human rights based high quality social care system. Nobody is arguing against that but there is undoubtedly it is a big complex system at the moment with lots of touch points with other systems and mixed market economy and giving people reassurance during this period of change is something I'm working really hard at. I want to ask a little bit more about the core of the reform agenda here. You've touched on it already, Minister, about the problems of relationships and IJBs or integrated authorities. We asked your officials about this earlier in the week and there's a real dysfunction at the core of the issue in terms of how the money flows between the NHS and local authorities and the lack of strategic ability to address that. How will those reforms that you put in front of us address that core problem? I think that the local delivery plan being overseen and scrutinised by the national care board will help to ensure that we achieve the outcomes that are outlined in that local delivery plan so that at the moment I think there isn't that level of external scrutiny that what local areas say is going to happen happens and that strategic thinking about commissioning and it works well in some areas, it works less well in other areas and that oversight from the national care board and that ability to step in and support if there is service delivery failure I think will improve the situation. In terms of making sure the money gets I mean everybody has agreed with this so that the local authorities and the NHS have agreed to share accountability at the moment it isn't you know much of it is entirely in local authorities hands and they have agreed to the shared accountability in order to improve the situation so I think that that will go some way to improving it. Okay so that oversight I'll come back to that but what will it do to deal with the core problem that there's two different sets of budgets that go into one pot and there's votes from the NHS and local authorities and they can't decide strategically about what needs to be invested in. So I think we'll I don't know Donna if you want to try to explain better how the shared accountability is different from the current situation firstly there's a there's a willingness there's a recognition that as things are it is not currently delivering and there is a willingness to change going forward. Very few fail to agree on the strategic plan there are occasionally votes as we understand it but it's not a feature most most integration authorities have good relationships and I think the point that I was making on Tuesday about having the strategic plan which most IGBs currently have good strategic plans those are not always aligned with the delivery plan and not always aligned with the financial support for that delivery so a lot of the points that have been made both by Audit Scotland by Derek Feeley in the independent review and through the co-design are about getting that transparency of the flow from the strategic plan the delivery plan the finance and making sure all of those are lined up and I think being very honest and transparent about that so that is what the national board will have oversight of in the future and it will as Ms Todd says enable scrutiny to an extent but also support where the local areas are perhaps not quite in balance there either on the strategic delivery or financial elements of that no what those changes are going to look like at a local level i'll come back to the national scrutiny issue as I said we don't know what those changes are going to be how those relationships are going to change you mean you already said this morning that your relationship identifies problems in those relationships but you can't tell us how that's going to change on a local level voting rights how any of that's going to shift but it's the core problem really at the heart of this isn't it in terms of what is delivered locally that I think that the whole bill is identifying and to be fair minister you've said that local people recognise the NHS and local authorities recognise that changes need it that's why we had ijb's and before that why we had change funds and these things were recognised by the institutions and they said and we're still in the position where if you have two competing sets of priorities with voting rights on one board that the money can't flow to the strategic objective and you're not proposing anything to solve that in this bill in terms of the voting rights on the local board but we haven't decided that that will be discussed at secondary legislation how the local board is constituted whether there is an independent chair which i think would be a helpful thing whether you know whether everyone has equal voting rights and the chair has a casting vote all of these things need to be worked out in secondary legislation but I agree it's a really important area in order to ensure that we deliver change okay on the national care board we've talked about those mentioned issues of oversight I mean ministers already have the power to intervene where they see the to be substandard issues of care don't they under current ministerial powers yeah but it's proved it has proved challenging to use those so ministers have very little locust into very much of the statutory powers lie with local authorities and they are democratically and locally accountable you'll have heard me say this in the chamber many times so it has proved difficult it's certainly not the same powers of intervention and oversight as we have of the nhs and so that has proved challenging to use those powers in the past and we think with this collective and shared agreement that this is an appropriate way forward that the national board should it decide collectively that intervention is required that that will be a much more straightforward process to put in place that escalating support we were told on Tuesday that the board could do things like workforce planning why can't civil servants help ministers to do the workforce planning at the moment well I think the workforce planning really needs to be done on a national basis I think that having 32 local authorities obviously they need to have a local pipeline but you know asking Shetland to sort out the supply chain of social workers as a profession I think is a is a big ask I think and I think that you know local authority there are certain things that absolutely everyone agrees on and the idea of national workforce planning is something that is completely uncontrollable and I think you and I agree on this as well but I'm asking is why civil servants can't help you as the minister to do that right now rather than a care board having to deliver at a cost of 30 million a year because it's my understanding you have 170 civil servants working on the national care service bill is that correct and that's at cost of the taxpayer of a million pounds a month is that correct I mean that's a significant workforce isn't it that could be addressing these concerns helping you to deal with issues yeah but do you want those that workforce to be working on those issues ongoing or do you want to build a system where it's dealt with better in future and you know the workforce are not directly employed by the government that's one of the challenges and we for social work for example I think that the national social work agency is actually a jewel in the crown of the national care service it really is and that is a profession I agree work would need to go on to improve the status and support that that profession gets and the national planning for that profession regardless of the national care service but we need the primary legislation in order to bring the national social work agency into being and to fit them into the national care board so that they can have oversight of the system the national social work agency what it will deliver is better support and mentorship for newly qualified social workers better support and straightforward pathways for advanced practice all of these things and I just don't think it is possible for individual local authorities who employ social workers to do that so would the national care board replace those 170 70s civil servants I'm not meaning to go to civil servants next year asking you to chuck people out the door your suggestion is that that's where that money will come from so once the system is built there will be far fewer civil servants working on it I mean this is a change programme and there is an assumption that we've made within the financial memorandum so some civil servants will still have to continue with the business of government will have to continue to develop policy and there'll be the things that we do to support ministers as well we're working through at the moment what the staffing requirement will be as I say we've made some assumptions for the national board but again there will be a business case for that that we'll be very happy to share with the committee when it's available okay they can come on to them you said earlier that the change in the delivery timetable that the convener was questioning about was to reflect the challenges of a fiscal environment where we must demonstrate value for money when did that become apparent to you that we were in a situation where there were fiscal challenges minister I think it's very clear that over the last couple of years we have faced extreme fiscal challenges we had you know we set our budget in 22 and within three months it was worth a fifth less because of the inflation the impact of inflation so the last couple of years things have been significantly more fiscally challenging than at any time since devolution I think everyone's agreed in that you know we talk about this budget being this next year's budget being the toughest situation in the last couple of years we still had ministers in front of this committee and other committees defending the proposals that you'd brought forward in the original bill suggesting that those should be backed by Parliament so when did it become apparent to you that the country didn't have the money to pay for the legislation that you were bringing to Parliament so I don't think that that's what's prompted I mean I don't I don't think that's what's happened at all I think what has happened is a number of factors have fed in and resulted in a change no change to our ambition but a change to the pace of implementation of that ambition it is partly about the fiscal environment that we're currently operating in it is partly about safe management of that change from where we are now to where we need to be there are a number of factors that have fed into it I mean part of the reason for change was frankly the level of resistance amongst our partners in delivery so the level of resistance from COSLA the level of resistance from unions I couldn't ignore that and you'll bear in mind I only came into that I came into this role less than a year ago so certainly since I have been the minister leading this I have paid a lot of attention to the evidence that's been taken in at committee level all over this Parliament to the views of stakeholders who deliver social care and continued the co-design process with lived experience very regularly with people with lived experience to try to navigate a consensus and find a consensus way forward I think I've done that well what we were told as a committee earlier this week was that the legislation laid in front of parliament at the moment in unamended form would expose the public to a potential bill of 3.9 billion pounds is that not correct no no could you explain that then because I think it's a little bit confusing between the evidence we received on Tuesday a figure frankly that came as a great surprise to the whole committee of 3.9 billion pounds I absolutely understand that you're finding it confusing and I will ask Lee to explain that to you again so the people involved what we've done is you're taking the initial funding frame extraply the whole 10 years but when the inflation a couple of other fighters I had to get put through so that was based on again it was the bills introduced but under the initial assessment of cost what we've done now again still as bills introduced we've got a greater understanding of a number of the variables number of the assumptions that we've made and so again on the same bills introduced we've just been able to refine those estimates a bit down to bring the cost at the top end down from the 3.9 that would have been the comparator down to 2.2 okay if that helps perhaps it helps I mean I think the the idea is that we have you're really just introducing this figure on Tuesday into the public debate around to say that actually this was a figure that you previously had and then you had rejected it wasn't it really the figure we produced because the time frame before was just over the five years we never had the 10-year time frame figure that was me just doing a calculation if we kept the same basis for a recurrent cost element we could have potentially under the cost assumptions in the original finance memo would have got up to potentially top end 3.9 what we've got now again still as a bill introduced so we've got a better understanding of the assumptions in the cost base and that's allowed us to refine the estimates to bring it down to the top end 2.2 billion but I take the point over it's a that's really different because you've extended the time frame and you've moved the cables a bit so that's what I asked you Mr Flanagan on Tuesday was do you mean that if the committee had signed off the original financial memorandum we would have potentially been looking at a bill of 3.9 billion pounds your response was yes that might have been a misstatement it would have been based on a comparative point because what would have happened though would have still went through the co-design process would have still been working on refining the estimates so would have still ended up at this position so the cost wouldn't have actually got to that point that was just an extrapolation with understanding of the time that took us to that but would still end up here because we've still done the same work that we've done which has arrived at the top end of 2.2 you would understand minister that none of this is particularly ideal wouldn't you that we're talking about variances between 3.9 and 2 billion pounds in terms of trying to shave away an understanding about some of the cost base might be I mean for a finance committee to be brought that kind of evidence within the space of three days is deeply worrying isn't it so I think we were attempting to be helpful we were trying hard to provide you with information on both scenarios so that you could compare apples with apples not apples with pears but undoubtedly you have found that situation confusing and we'll take that on board and we will reflect carefully on how we inform this committee on different costings and different scenarios in the future absolutely take on board that it hasn't helped would you not consider that actually the core cause of this issue is the chaotic way in which this legislation has been pursued where you've introduced one model you've completely changed that model in the process and you've recognised for some of the reasons for that is you're talking about completely different delivery mechanisms you can't express in any of the evidence you've given today what the shape of the national care service we're bored that bored will be how integration authorities will operate and you're giving us a cost variance that jumps between 1.8 billion, 2 billion, 3.9 billion and we're not able to express any of the co-design models that will be after this point that may add or increase the costs which members around the committee have been greatly concerned about is that not the core issue in this about the way that you're handling this legislation and how it's been handled for years so i recognise that fundamentally this committee and others have expressed concern around the framework bill nature of this legislation the fact that it is enabling legislation and much of the detail is pinned down in secondary regulation i absolutely understand that i hear you loud and clear and i am mindful and thoughtful about how we can increase the level of scrutiny from this committee and others at stage at further you know at the stage of considering secondary regulation in order to improve that situation why did you not have an expert advisory group on the development of this work so we i mean we have a lot of engagement and i have made that point in the chamber just last week to your colleague jackie bailey we have a great deal of engagement with the sector i don't know done if you want to i think it was probably the health social care and sport committee who asked about this and the range of engagement that we do have so we have the social covenant steering group and we have a stakeholder group we have multiple other groups who provided advice on specific aspects of the bill and we also have the co-design work that has been outlined to you already so there's a significant amount of engagement ongoing already all of which is informing the bill and i think one of the things that we were very keen to do was to get a breadth of views and having one group that essentially advises on the legislation i think we concluded would be too narrow given i mean this towards already referred to cure home relative scotland there are multiple other groups who have a significant interest in this bill group on ending conversion practices there was an advisory group on the patient safety commissioner for scotland bill an advisory group on the age of criminality responsibility an expert advisory group on heat pumps but you didn't think that an expert advisory group was required on this would could i suggest minister that perhaps it was given what we've just described well as i said i am i am absolutely assured that the level engagement that we have with everyone with an interest in a particular aspect of the bill is sound and that we are hearing from experts including lived experience experts what they need the bill to deliver and how it needs to go i think we've i think we've come to an absolutely reasonable position we've achieved consensus and we're moving forward oh wait and see thank you can be up a jb to follow by michelle thanks very much morning minister morning to that panel again um just really following up on that i just wanted to look at some of the cost and i'll move on to the kind of main area that i had um in terms of the carers breaks uh who pays for that how's that going to be paid um and can you give me as an estimate of the cost of that okay so this will this the the rights to get the breaks from caring of which you'll see in the the financial memorandum and the shared accountability framework has it builds up over the course of the period through to 2031 32 to be 102 to 148 million um as with any uh aspect of spend including in relation to um all parts of the national care services or form part of the the budget scrutiny that we will undertake and the work that we'll do as we work up the the the budget that as it's introduced each year to to parliament what we're doing at the moment based on the revised figures that we have in the shared accountability framework is the fact of those costs in and as we take forward the plans in relation to um the the NCS as it's set out we will be building that into our budget assumptions as we move forward so that will be how we how we take that approach and that's how we'll we'll work that so will that so that'll be paid to councils but from the Scottish Government and will that will that be guaranteed every year so yeah so the the the what as it's laid out here at the moment in terms of the the funding in the um updated uh shared accountability framework that's our assumed costs some of the mechanisms in terms of how that funding is allocated and the approach that is taken as you'll be aware there's an annual discussion at the moment with local authorities in terms of the financial settlement that there is but our expectation is that would form part of that um that settlement each each year and how would that take into account factors for example um you know this bill will I imagine you'd hope increase awareness of carers and the responsibilities and support there how does that take into account perhaps more people coming forward as unpaid carers and saying look I need this I'm actually entitled to this so I know there's been a lot of work yeah that's one of the reasons for the level of the insets in it but that's sorry I interrupted sorry minister yeah no I I so we have factored in we've we've done again is the details within the financial memorandum but there is a detail calculation um of of workings to to assess the level of of people that would be in this this category there is as as the minister just said um still a bit of a range in terms of understanding fully the impact that there might be um but that that is based on a on a detailed model that we've worked through could exceed the estimates no I think we've well I think we've got a range yeah we've we've got a the high level estimate um the 148 million that it could rise to in 20 31 32 we think is a is is a top end that it could be at okay and um another issue is obviously a lot of people who are entitled to care don't receive their full allowance of care how is the uh I mean would you expect um there to be a greater up taking care um you know because of because of the bill so in in terms of social care generally as I said when I was explaining to your colleague mr mason I think we recognize there's a level of unmet need that isn't quantified out there so we think there probably are people who should be able to access social care who currently aren't but we think we have a really good understanding of the people who are in the system being assessed waiting to be assessed for care having been assessed for care and waiting for packages um so I think we have a good understanding of those unmet needs and and again because of the perhaps the the focus that will be on the bill and the kind of awareness around care and and people's rights there are a lot of people who simply don't apply for care that that they should be entitled to you think that the current funding support available for that will meet will meet any increases there so we've said that we're on a trajectory of increasing the funding for social care and I've been clear that like Feely I think that if we do this right there will undoubtedly be efficiency savings that obvious particular example would be if we can get early intervention and prevention that is significantly better for the end of the job but also saves a great deal of money and means that you can help more people but I think there is absolutely recognised that there is unmet need out there and that if we make the system easier to access and navigate and a rights based approach that there will be an increase in access. Okay on Tuesday Donabell in relation to rural and I asked from a rural perspective I asked do you envision there being any additional cost to council because of the bill the response was no we have not included any additional cost to council do you think that's a fair comment and you don't see any minister sorry I'll I can ask the minister this do you think that's a fair comment and you don't envisage any additional cost to councils because of the bill I don't envisage any additional and funded cost we're working really hard to establish the costs as we do with any introduction of any new system as Richard said there's a budget process every year where we you know part of that process we sit down with our local authority partners and look at what requires to go into the funding but that will you know councils may have a different opinion to you on on their need and when we're seeing that with the budget discussions at the moment and talk around the council tax fleet freeze so for example a council could say well we need this amount of additional support because of because of increased cost increased uptake direction from the national care board that is then for the Scottish government to agree with them additional funding so so there is a position there potentially where councils could be less short because agreement hasn't been made in terms of levels of funding required well I think what happens every year is that we do our costings and they do their costings and we come together and there's a negotiation but they don't always agree with you on the on the result of the negotiations and I think that's there is potential for disagreement in future as I say we are working really hard to ensure that our costings are accurate and that this will be fully funded as we have you know other commitments for example increase in wages fully funded not always passed on by local authorities to ijb's but fully funded by the Scottish government determined to improve the situation and we are increasing our level of spending don't know Richard if you want to say more the only thing I would add is and it maybe comes back to to Mr mason's point from from earlier I mean one of the challenges with the the current system as it is is boarded directly accountable to to the Scottish government local authorities have their own mechanisms for assessing spend but potentially there's that lack of transparency in terms of the the integration authorities as currently in place and I think on the point about efficiencies sometimes it's not always as clear as it could be in terms of the opportunities that there might be for integration authorities in terms of how they deliver that accepting that there will be warranted variation across the country so I think this will allow us to get that that greater clarity now that I absolutely accept as there is now you know there will be times where there'll be those those kind of challenging conversations there might be different viewpoints I think the national care board will be able to actually assess some of that and work through some of that but I think it will just really give us that greater transparency about where we where we are and how that spend is operating which at the moment is is is not as clear as it could be as we move forward okay if I if I can just keep keeping that point because you've talked about kind of resistance from some some stakeholders previously I was just going to come in our issues around funding still being raised by councils and I don't necessarily mean COSLA although I recognize they represent council councils across scotland but are individual councils still raising concerns over the costs and potential costs so not generally with me you know we're into the detail of how we think collaboratively we can improve the situation okay so you're quite comfortable that you think most councils or councils are on board on board with the recommendations or are they or the plans going forward or they are coming they're content enough to let COSLA negotiate on their behalf so councils do generally let COSLA negotiate on their behalf that is the mechanism that is in place for us to interact with councils I am of course you know in the course of my work and in the course of my efforts in this bill meeting with individual councils who are sometimes raising concerns with me there are other concerns are they raising and being particularly around the fiscal aspect of it so as I said it's not that that is not the main concern that people are coming to me with okay all right just just lastly if I can convener in terms of the national care board I think it was Les Smith who raised issues around the detail of it you'll know you're a rural MSP as I am it's very different as you think you highlighted different delivering in one part of scotland to the other so how do you ensure that those rural island voices are included you've said already that you don't know exactly the makeup you talked about lots of different organisations including COSLA but you know delivering services is very different in Shetland or or wherever it happens to be so how do you ensure that that rural island voice is actually included on it so I think that that's something that can be worked out in co-design but I mean undoubtedly the local delivery will still be down to Shetland island council and the local NHS but national strategy there will be a obviously the national care board is is a now a complete the vital component of this bill it's going to be extremely important in terms of strategy and oversight so ensuring that that oversight is there with a rural perspective or an island perspective is surely very important we want this bill to work everywhere in scotland absolutely the national board is more about scrutiny and oversight and support for individual local integration authorities who are struggling to deliver picking up on good work I mean you know we've talked about Shetland the way that Shetland have integrated and operate their integrated health and social care is outstanding I'd love it if everybody worked Shetland this way so the national board will be able to look at what's happening in local areas and more quickly and easily identify where things are working well and make sure that it works that you know that those aspects of good practice are shared nationally I don't have a concern that you know local authorities you know and cause I don't know if you do if you're concerned is that coslar and unable to adequately represent rural and island authorities I mean I'll always have for you know whoever happens to be in the room is representing obviously all areas but their experience may be of for example an urban a large urban council as opposed to a small island council and so it's just ensuring that those areas where it's perhaps more difficult to deliver their particular challenges are represented in terms of strategy yeah so I think the local planning and delivery is absolutely key I think in terms of the national representation cosla has its own democratic functions and structures and whilst I interact with Paul Kelly and you know we're tired of seeing each other I'm sure we meet so regularly these days we are absolutely the poster girl and boy for the Verity house agreement and he's a Lanarkshire councillor he is his work is very closely linked to the cosla leaders who represent every single part of Scotland and so I don't have any concerns that cosla is unable to represent rural and island views I think there are sufficient democratic structures within cosla to make sure that their voice and their concerns can be heard and can be represented okay thank you thank you Michelle morning minister and hello again to the panel I want to just talk pick up on some points on two areas because as it stands at the moment because of the type of bill this is we don't know what the final cost will be we don't know what the economic benefits will be we don't know what the final running cost will be and critically we don't know whether we can afford to run it as a service so firstly in terms of the economic benefits I appreciate what you said about well you've got a business case but us being the finance committee I would argue that for us the business case is not only the costs which we've talked about a great deal but also the economic benefits that's primary what we're interested in so on that are you concerned that by evaluating the potential economic benefits that will bring out an even more clear understanding of in effect further cost now you've made some very good points and I completely agree with you about the hidden work particularly that women do but by evaluating the economic benefit of arguably getting these women back into the workplace there's an associated cost and I thought there was a very good comment by the social care document that the convener talked about earlier where he was commenting that it's very difficult to get staff even at £12 an hour and we've got significant challenges around recruitment and retention and that leads on to my question about can we actually afford to run the service even if we get to that point so I'd like your reflections on that thanks so I think we are reasonably clear on the costs I think for each associated cost with the bill we have a range and I'm confident that we are we have done robust calculations on that range and that the final cost as we narrow down the final cost will come within that range so I think we have a good understanding of the of what the final cost will be and we are absolutely I mean I suppose the thing to understand is that we are running a social care system at the moment which is costing the nation a really substantial sum of money and I absolutely recognise the uncertainty of moving from the way we do things now to the way we're going to do it in future but I am reasonably confident that we will come in with a far better system with a system that delivers better for the individuals accessing care with a system that delivers better for the people working in care and the costs will be outweighed by the economic benefits and how do you know that's true if you haven't done any economic modeling so how do you know that statement is true we've done a great deal of economic modelling but I have pointed to the areas where there is still uncertainty and where we require more robust modeling so there is still some uncertainty in quantifying that unmet need that currently the system doesn't capture but I suppose the point I'm trying to make is that well this is a fundamental we've spent a lot of time evaluating costs and I have conceded to your staff that I recognise that work and I do to you as well in terms of costs and part of the nature is of the framework bill which we've had lots of discussion but what I'm probing is on now on the economic benefit if you've done lots and lots of work why haven't we seen that lots and lots of work because underpinning this is our confidence as a committee and had we seen you know given that you're saying lots and lots of work around the economic benefit that might be able to give us further confidence so so perhaps what I've done is point to the areas where we have not got robust evidence so there are undoubtedly there is I think a level of unmet need that we haven't adequately quantified yet because it's not in the system I have been best I absolutely I have been very clear that there is a unawful a good amount of the unmet need that we can quantify that public health Scotland already produced tables talking about the people who have been referred into the system and are awaiting an assessment and the people who have been assessed but do not yet have their package so much of the unmet need we are absolutely certain of we have robust evidence around that a very small proportion of the unmet need I do not have robust evidence about yet and I perhaps shouldn't have focused on that in terms of the economic benefits again I have said there are areas where it is difficult for example it is difficult to know how many carers unpaid carers are out there but in the business case we have detailed the stuff that we have robust economic case about so far example we've put in the business case in 21 22 there were 236,000 people in Scotland reportedly receiving social care supporter services we've made an assumption so if it is assumed that just 10% of that group 23,600 people experience a 0.1 per cent 0.1 point improvement in wellbeing because of the establishment of the NCS for the reasons discussed in the business case that could lead to a potential annual benefit of around 34 million and that's at 2021 crisis we've also looked at in the business case detailed there were around 130,000 people employed in the adult social care sector if it's assumed that 10% of those people so just 10% of those people 13,000 carers experience a 0.1 point improvement in their wellbeing and on the life satisfaction scale because of the establishment of the NCS then that could lead to a potential annual benefit of around 19 million at 21 prices so I don't think it's fair to say that we haven't provided any economic detail whatsoever I think we have provided really solid economic detail in the business case but I accept that we cannot be certain absolutely these are estimates we have used calculations and formulas and made a best guess at what we think it's going to deliver but I accept that there is uncertainty around that what I state time and time again is that I am absolutely certain that this is the right thing to do I am also certain that it will deliver economic benefits I mean thank you for pointing that out in the business case but the obvious thing that arrives from that is the any normal would assessment would be will or to what extent does the economic benefit outweigh the cost and the numbers you've given there and accept the rationale and the caution with which you've applied which I agree with I think that's the right approach but even just from talking through those numbers it's absolutely abundantly clear that the cost the margin between cost to benefit is significant but if we go back to a point I made to the convener about how much the national so it's this what we are scrutinising here at this committee today is the cost of the national care service bill the cost of the national care service bill is likely to be less than 1% of the cost of social care currently the cost of the national care service bill is likely to be less than half a percent of the total cost in health and social care spend in scotland and that then leads on to my second point I made at my opening sentence about can we afford the running costs of it and I gave that example about staff availabilities and skills arguably availability for the the staff to run it the other thing and I'd like your reflections on that but also the other point that that brings in is a prevention strategy because your basis of the 1% it's also interesting to work out how did you arrive at that and therefore what does that mean in terms of savings as well to arrive at that and I'm still quite uncertain about that because you're going to have to have efficiencies within what we're currently delivering that's all point to this I get that but the prevention strategy in the first place and I mean can you help me understand the bit more about that and how that pertains to costs and benefits so I think I think the evidence for early intervention and prevention is relatively strong I think Cristy more than 10 years ago was able to put out a very strong case for early spend prevent people falling into the river don't pick them out of it and there's been very robust detailing around the economic benefit of early intervention and prevention we've got fairly robust calculations of what you know what we think that will bring in terms of economic benefit I don't know I think I'm not sure what you were talking about 1% assumption I'm not sure where that came from but but we are we are running a system at the moment which is very very costly social care is costing Scotland enormous sums of money every year and by everyone's accepts that what we are delivering at the moment is not of the standard that we would want the national care service is an opportunity for us to improve the delivery of social care in Scotland and whilst I absolutely agree there may well be costs I mean freely calculated that there were 36 again this is in the business case his calculation was that there were 36,000 people in Scotland who do not currently have access to social care for whom it would be beneficial so that I absolutely agree with you that there might be costs that we are uncertain of at the moment but I am absolutely certain that if we are able to deliver better care which we will be through this national care service we will also save money and we will also bring money back into the public purse I mean you know that running a calculation on the wellbeing impact on that 36,000 people if just 10% of that group 3600 people were to experience a 0.1 improvement on their wellbeing and the life satisfaction scale the potential annual benefit would be around 5 million and I think you've probably kind of made my point for you and I suspect for me rather I suspect this committee will continue to be interested in the relationship between cost to economic benefit because the wider kind of macro economy frames out whether we can afford this and therefore the economic benefit is utterly vital and again because of the way the process is operating that's now somewhat removed from this committee which I know has been brought up before and I have to say based on the figures which I think you're reminding me of it makes me less convinced that the economic benefit that's notwithstanding the moral benefit which I think you made a very good case for but the economic benefit will be sufficient given all the uncertainties over cost which I think you've done a lot of good work on so thank you. Okay thank you just a few points then to finish off minister for we had some discussions on the 3.9 billion but just to again clarify that was on the previous bill as the and what was to be included in that bill can you confirm that over the 10-year period now with the revised financial memorandum we're looking at a variance of between six three one and nine one six million? The original one. No no no no no just look at it forget the original one I'm looking to see where we are now what is the what is the margins of this financial memorandum? So within the revised financial memorandum the cost we're looking at if we build and so if we include the carers breaks the 10-year time frame on the revised financial memorandum is 880 million to 2 billion 192 and if we look at shared accountability again inclusive of carers breaks we're looking at a 10-year period of 631 million up to 916 million. Right that's that's a figure of the skin right okay that's fine now Donna said that on Tuesday in a quote you'd expect us to build in a range of costs because of future potential uncertainties where is the greatest uncertainty now lie in terms of those variables because they're not all at 45 percent so where is the issue of greatest variables and what's been done to address that? Yeah so do you want in terms of the shared accountability I suppose some of the main areas? Sorry the overall package that we're now looking at of 631 to 916 where within that is the greatest variability is it in that? I suppose in terms of the integration authority he's exactly what the operating mechanism will be for the aim in terms of the end of staffing compliments we're built in money for additional locality support as well so it's it's forming up exactly the the numbers around that the national board based off of broadly comparable by community justice of Scotland we're about to start working through the business case for that to firm it up so they're the underlying assumptions for it so assuming that they're broadly comparable but we still need to pin that down they're probably from the NCS development point of two areas for me that I've probably the most uncertain to have are also just within the Scottish government the administration part the on-going non-staffing element I'm reasonably comfortable with the staffing element which is the biggest part of it but the non-staffing element in terms of the money that we put into there so money going towards co-design some engagement work the scale that's not massive in the context of the staffing but for me the three areas but when we're looking at the shared accountability because at the top end we're looking between 30 and 50 million the variability in that is obviously significantly reduced from the original financial memorandum basically because we don't have 31 brand new care boards that's taken a lot of it and obviously not transferring staff or assets takes a significant answer to it so there is still uncertainties I've got within it as we've built the range but I'm a lot more comfortable under the shared accountability assumptions partly because they're less obviously now we'll always have these variabilities but will they be reduced by the time we get to stage one or we'll be still looking at these figures I think but we'll hopefully firm up on the cost I'm not anticipating a massive change in terms of what we're looking at for the national board we may have a wee bit of variability in the integration authorities as we work through that way because of the NHS but I'm not anticipating a massive swing back. Incidentally are we query here why carers breaks in the financial memorandum classed as service strategy in order for carers breaks were doing a much easier way to actually explain it so that anyone looking at that lay person would understand a wee bit more about what that was actually being spent on. I think that I was just down to our lawyer's drafting. All right okay now digital in the business case says new technology were required to deliver the integrated social care and health and social care record and we need to invest in the sector of the significant what already underway to ensure that NHS the capability and capacity support the interaction record significant can mean anything of course so what are we looking at in terms of course for this and when will this work conclude? I think I'll ask Richard to come in on that and this is his area of expertise. Yeah so we are working through the care record and we're seeing that in the context of the wider digital strategy across health and care and we expect that to kind of be taken forward over the course of the current year so over course of 2024. We are working through at the moment the detail of the care record and building up a business case which when that's developed we'd be very happy to share with the committee so that you've got that detail as well. Okay thanks just one final point Minister you've talked about how about the 36,000 people potentially with regard to admit need you've also talked about the many excellent people that we have working in the sector you've talked about need to improve quality pay conditions etc but how many additional people are we going to need to actually deliver the service on the ground because if we're improving the the care that people receive the quality of that care that takes time it takes people there are chronic recruitment challenges I mean in some of the islands I mean obviously Jamie's Menched Islands but I've got an island in my constituency over 6,000 people and I've been trying to get care staff as a nightmare and even if you were to increase hourly wages to 15, 16, 17 pound an hour I'd really struggle to get because the demand is high we've got a demographic challenge you know we're looking at a financial memorandum of 2% inflation and 3% real terms increase but some of that 30% real terms increase will be absorbed by the increasing number of people receiving care so how many additional staff are we going to need and where are we going to get them from and what kind of recruitment and training programmes are going to be you know introduced in order to to find these people so representing a rural area I've absolutely recognised that it's not in my part of the country it's not about money it's about a lack of people and the aging demographic in some of parts of rural Scotland means that it's very hard to find young people of working age to take on these roles I think that I don't have a quantification of that but I suppose I would point to some of the work that's going on across the board it's not just about improving pay it is about improving terms and conditions as well the ethical commissioning there is work going on outside of the bill on fair work and there is very close working with the sector in terms of improving recruitment advertising marketing and farming up on pipelines making sure that it is simple for people to get qualification and registration when they come into the sector making sure that they are supported when they come into the sector making sure that there are pathways to qualification for professions for people who are working in the sector who might for example like to study for the regulated professions that require degree level education like nursing and social work so we recognise that there is a lot to be done to support the workforce and much of that work is happening outside of the national care service bill in terms of what the bill will deliver for the workforce and I think that the ethical commissioning is a real step forward I think from that ethical commissioning we will deliver better pay and conditions for the workforce and I think there will be an increase in status for the workforce as well undoubtedly I mean I suppose collectively I think I think the bill I know that each individual aspect of it I mean I suppose we're very very fixated on the on the costs and the economic benefits and I suppose what I would put back to the committees can we afford not to do it can we we're spending a great time against this so I don't like to interrupt but times against really obviously general questions starting in less than 20 minutes and I do want to you've kind of body swear the question I mean I'm you've got costs built into this bill and we're now putting it down in the new revised bill never mind all the old whatever was proposed it over a year ago 6 3 1 9 1 6 million surely an element of that the costing must be the additional staff component required to deliver on the ground taking into account the improvements and conditions and status that you've mentioned so I'm just asking straightforward how many additional people are we going to need and I do appreciate you were talking about four years before you implemented but how many additional people are we going to need in a workforce which is aging itself rapidly I don't know what we do if you know women over 45 were you know when they get to retirement age in 15 20 years because I'm not seeing young people coming in the numbers we require so how many additional people are we going to need to deliver this bill as envisaged and because it's one thing to develop a wonderful bill but you've got to the full to deliver it and how are they going to be recruited and trained so so I suppose the first thing to say is that these are not direct costs from the bill in a way these are not our workforce these are not people that that will be employed most of these costs must be staff there must be staff I mean no you have to the money you pay that the bill cost goes in people wages I mean for example we mentioned earlier that the 10 million pounds spent on 170 civil servants so if this 631 916 million a colossal proportion that has to be on staff surely so that clearly tells us that okay wages will improve but numbers must improve if we're talking about 36,000 people we're unmet need to mean so that's what I'm saying what numbers do we have for people to deliver this bill whether we're recruited may not be recruited with the Scottish Government but you know the Scottish government's putting money into this bill to ensure it's delivered in that much filtered down to staff so we can give you a breakdown of the assumptions in terms of the numbers of staff that we've assumed I think we need to recognise that there will be different roles for the people that we're talking about who are directly related to the delivery of the national care service the national board and local support etc there's also and I think this is what's been referred to more broadly and also by miss todd is the current issues with the workforce for frontline social care delivery and I think they're two slightly the separate things which but we're very happy to give you the breakdowns of the numbers of staff assumed for the delivery of the bill yeah I mean you yourself donna said on at least two occasions on Tuesday that you have pessimistic assumptions so you know I'm trying to be realistic about here I'm not looking for pessimistic assumptions but it's just really about you know how how this can be delivered in reality on the ground with these workforce challenges that we currently have okay we'll see we can bring you back a little bit more detail on that in terms of the workforce that's out there the number of people employed in social care at the moment and how we expect that to change should we have a fully functioning social care board I think that is social care system I think that's what you're asking for of course when we get into that level of detail there are clear areas at the moment for example where agency spend and things is really really high because of the lack of workforce so again with the improvement that we are intending to bring to the system a functioning social care system actually having the workforce in place need not necessarily in every case cost more it may actually cost less to deliver if we've got an appropriate workforce and aren't spending phenomenal sums of money on agency spend but I'll see if I can get you more detail on that prevention of course if that's implemented although I mean myself and John have been on this committee we were discussing this exact same thing in 2011-2012 unfortunately you know everyone talks been talking about prevention but delivery of prevention is a it seems to be a different ballgame from talking about it because it just isn't happening to the... That's a clear economic saving as I said you can literally support twice as many people if you provide an early intervention and prevention package rather than providing a full package of care after crisis is reached which means that you can get support twice as many people with half as many staff. Indeed but I mean what we've found was it's difficult to be able to disengage from existing programmes at the time of financial challenge to say you know if you stop doing x we'll be able to spend more money on wine prevention that that's not being seen unfortunately so again it's well in the world it's been it's difficult. Anyway, Jamie what's going on? Just on the point the convener is making there Micae you're going to come back with figures will councils are you expecting councils to have to take on more staff and are those costs for the additional staff included in the estimates? Could I be offer some context convener? So part of the issue and Ms Todd's reflecting on this already there are some unknowns about unmet need we also don't necessarily have a real time understanding of numbers of staff where those staff are working jobs. So they could be councils could be asked to bring on more stuff are those costs included in the? So note this bill so the provisions within this bill do not require local government to take on any more staff and when I was talking on Tuesday I focused very specifically on the provisions in the bill and the provisions in the financial memorandum so there is no additional cost to local government from this bill separately as part of the deliberations of the national board there may be conclusions reached that additional staff are needed to meet the as yet unknown unmet need and that will be a discussion that takes place at that point and again there are always choices for councils about what they do that is the purpose of the shared accountability arrangement so no they are not included in the bill because they are not a direct result. There could be additional staff or you would expect perhaps there to be additional staff taken on by councils I think councils are already doing that right but that cost wouldn't be a net from this bill no because it's not directly related to the provisions okay or even indirectly actually and I think there are councils in certainly my own local authority has large underspends in this area because they can't recruit workforce so they have the money they can't spend it the core of what we're talking about here is that the hundreds of millions of pounds that you're asking the taxpayers to pay here is for bureaucracy rather than care workers isn't it so at the core of this is what this bill is going to deliver and we've discussed in great detail some aspects of the bill so ethical commissioning undoubtedly bringing in ethical commissioning and procurement will improve pay and it will improve terms and conditions that will make a difference to the people working on the ground the national board which we've discussed in great detail better oversight and governance a system of escalating support that will be welcome to the many people I meet day in day out who work in the system who say who are distressed at the situations that they are exposed to because they really care it distressed at the situations that are exposed to where the system is failing to function at the moment the national and regional work and complex care the national social work agency will undoubtedly improve things for the social work impression I have absolutely no doubt about that at the moment social workers are employed under 32 different sets of paying condition around the country and there is very little in the way of workforce planning there is very little and patchy support for newly qualified practitioners and for practitioners who are following an advanced pathway the national social work agency will undoubtedly improve that so do I believe that collectively this bill will improve things for workers yes are we alongside this bill this government is committed to improving the pay of workers and we have demonstrated that by increasing the pay of social care workers in scotland to 12 pounds an hour from next April which is a 14.9 percent increase over the last two years and whilst I agree we need to go further that does mean that social care workers in scotland are the best paid in the UK and are paid substantially more than their equivalent in either England or in Wales okay thank you very much minister we're going to call a halt there I'd like to thank you and your officials for your evidence this morning that concludes the public part of today's meeting the next item on agenda which will be discussed in private is consideration of our work programme we'll now move into private sessions I'll just call a two minute break because I want this session to finish before chatting questions the two minute break till I'll do it