 Good morning and welcome to the 31st meeting of the Public Audit and Post Legislative Scrutiny Committee in 2017. Could everybody in the gallery switch off mobile phones so it doesn't interfere with the committee's work this morning? The first item is a decision on taking business in private. Can I get members' agreement to take items 3 and 4 in private? Thank you very much. Let me move on to the substantive item, which is item 2, and we'll now take evidence on self-directed support. I welcome to the committee this morning, Paul Gray, Director General Health and Social Care of the Scottish Government, and with your second title, Chief Executive of NHS Scotland, Jeff Huggins, Director for Health and Social Care Integration, and Iona Colvin, Chief Social Work Advisor, both from the Scottish Government. Last but not least, Paul McClay, Chief Officer for Health and Social Care, and Beth Hall, Policy Manager at COSLA. I understand that the Scottish Government doesn't want to make an opening statement this morning, and could I invite an opening statement from Beth Hall? You don't need to provide one if you don't. No, sorry, we didn't intend to. That's great. No opening statements from him, but more time for questions from the committee. What joy can I move first to Colin Beattie? This is probably addressed more to Mr Gray. You're seven years into, what's basically a 10-year project. Have you got a formal evaluation as to how it's going across Scotland? Oh, we have followed Scotland's report, but we also have work that we have done based on the data that's under development, so we have a report which, in large part, coincides with what Audit Scotland is saying, and we have further work in hand to evaluate what we're doing. So the answer to that is we have a report which was produced relating to 2015-16, and we have another such report that will be produced next year. We've also commissioned work on evaluation, so yes, we are evaluating. It doesn't seem to be going very well. So one of the aspects of this is that the data that we have suggests at the top line that if you look at 208,000 people who are engaged in this system, it would appear that 26 per cent of that number are making a choice. In fact, within that 208,000, there are about 100,000 who are receiving services such as a home alarm or who have a support worker, and if you exclude them from that 208,000, it would suggest that over 50 per cent of people are making a choice. The other part of this, of course, is, and I recently went to Midlothian to sample some of this, that it is sometimes regarded as not being a choice when someone elects to have the services provided by the local authority, but in fact, they are explicitly making that choice. So because they're not choosing one of the other options on the menu of four, it doesn't mean that they're not making a choice. We're also in close touch with the authorities responsible for delivering self-directed support, and the management information that we have suggests that the position on choice continues to improve, so that would be my response, Mr Beattie. Clearly, self-directed care is bound up in the larger picture of moving resources into primary care. If that is successful, then it follows to some extent that self-directed care as part of that will also be successful. Looking at the Auditor General's report, there seems to be significant gaps right the way across the board. Coesla says that in paragraph 18, page 12 of the papers in front of you, that bridging finance is a significant issue. £70 million was put into this and spent, and you've detailed where it's spent. Now, I assume from what Coesla is saying, that wasn't enough, or they're asking for more. How are we going to move this forward? I'm happy to bring Coesla in. I won't attempt to speak on their behalf, and Mr Huggins will be able to give us some detail on how we're moving this forward. A point that I would want to make, Mr Beattie, given that you've referred to the Audit Scotland report, in terms of the recommendations that the Audit Scotland makes as to what we ought to be doing, and that's the recommendations for the Scottish Government, Coesla and partners working together, I'm not in any sense disputing these recommendations. There is more to be done, so I'm not presenting to a proposition that says there isn't more to be done. Whether more money will be the answer to that is a separate question, but we are taking forward action in response to the recommendations, and I'm happy if you would like Mr Huggins to give you more detail on that. I'm certainly happy to. I suppose that there are two issues here. First of all, to understand where we are in the programme. As you've said, we're seven years into a 10-year programme, but we have to understand the different stages that we've gone through. The programme begins with the framing of the intention to legislate in this space, the consultation, the engagement, and the process by which we act. We're seven years into a 10-year programme. The end date was 10 years. Is it still 10 years? There's been no change to the end date. I was just trying to set out what was within that 10-year programme so that we could say and talk about the progress that we've made through the programme. The initial period of time was around the framing of what we would do, how we would take forward the intention to bring into place self-directed support. Within the second stage of the work that you then have, the period that the Parliament itself spent in framing the legislation—a legislation that was taken forward successfully—with good support within the Parliament for the legislation. We're now effectively in the third phase of implementation within that 10 years, which is to begin to pilot, roll out and embed the approach within the system. The Audit Scotland report is largely on that third phase, but it's important to understand that we didn't start 10 years ago with legislation in place and the frameworks in place. That 10-year programme has also encompassed the need to bring forward the policy proposals and the legislation. I think that it's important also to understand what the £70 million is for. The £70 million isn't for new services. The £70 million is for advocacy and advice. It's for support to local systems to create the mechanisms that they need to take forward. Self-directed support applies to the £3 billion that we spend on adult social care and other social care budgets. In terms of the application of the resource, the self-directed support is the mechanism by which we use the resource that is in the system already. The £70 million that is allocated is basically for the transitional support—the advocacy, the advice, the support to third sector organisations to be able to adopt the process. That's been used across the 10-year period. We can say more about that, but the £70 million is not buying new services. The services are funded through the general allocations from GIE and through the resources that are in integration authorities transferred from the NHS. If I look at the care and spectra submission, they say that their findings are that self-directed support has not yet had the impact across the country that it aims to achieve. It cites various things such as the lack of training, poor engagement, lack of advocacy and support for older people, overly cumbersome systems and tools. They say that the self-directed support is less well-developed in relation to children and young people, and this has not been an area of priority focus. What's happening? Are you really going to fix all this in the next three years? I think that you have to see this as working through a process. We have a number of things happening in parallel here. The Audit Scotland report and other reports reflect on that. In parallel with introducing self-directed support, we've introduced health and social care integration. The consequence of that is that we have significant change happening across the system in parallel. What we can see when we look at those areas that are working better and are reflected in the data as well is that some areas have moved quickly to adopt new approaches around commissioning that embed the idea of self-directed support. Other areas have sought to continue with the historic ways in which they commission and allocate care and have found it more difficult in that context to embed self-directed support. However, what we have is a common process, which is that some areas tend to make progress faster than others, and it's not always the same areas. The Scottish Government team, the team from COSLA, the SSCCC, the Care Inspectorate and others are working with partnerships with local authorities to effectively take it forward. In terms of the implementation phase, we're about halfway through the implementation phase. What we're seeing is good progress in some areas. We're seeing probably some of the things that we might have anticipated, so greater use of the option one for the under 65s with disabilities, less use of option one for the over 65s with frailty. You're beginning to see it fall into place in terms of what's going on. It's designed as a learning process. I don't think that we would have known or could have understood all of the complexity going into the process, and that's where we are now. Do you agree with the statement from COSLA in its paragraph 11? Questions have arisen over the extent to which NHS boards are meaningfully transferring their unscheduled care hospital budgets to integration authorities. I'll bring Jeff in on that. COSLA has raised these questions, so this is to do with what's called the set-aside budget, and that is actually a subject that we are discussing just now. I've discussed this with chief executives twice in the past month. We had a very helpful meeting involving COSLA, chief executive board chairs and chairs of INJBs, and chief executives of local authorities a few weeks ago. That is one of the issues that we are discussing. I accept that it's an issue under discussion. I think that there are differences of view about the extent to which the set-aside budgets can and should be transferred, but we are agreed with COSLA that that's something that we need to resolve. But you are still confident that the 10-year deadline is going to be met? Well, the set-aside budget is perhaps a slightly separate issue, but we are still working towards delivering what we said we would within the 10 years we've got three years to go, and the management information we have does suggest to me that there's progress. Will we be 100 per cent successful within another three years? I'm not about to guarantee that, but we're certainly working towards it. To add to that, one of the things that we've seen during 2017 is that the set-aside budget is the budget for large hospitals, effectively. That's the budget that is supporting the Queen Elizabeth University hospital, the Edinburgh Royal Infirmary. That's what those budgets relate to. I think what's been very interesting this year is that a number of the integration authorities are beginning now to plan across a range of different locations and think about how they provide services for cohorts like older people. We see the Glasgow City integration authority looking at older people's services and picking up both hospital, residential care, care at home, housing support, but also how they're going to have an end-of-life care and also how they'll implement the carers strategy. Instead of looking at all of those separately, which is what would have happened previously, they're actually looking at as a coherent whole and thinking what should the shape of services be for those who are over 65 within Glasgow City. That's a big step forward. In doing that, they're thinking both about the moneys that have been previously spent on primary care and on social care, but also the money that actually is spent within hospital to decide what is the way in which they can deliver the best value for the community from that overall resource, and that's really quite innovative. It's very much the intention of integration to get into the space of thinking beyond the individual silos and services, but understanding how you can take best value from public money across the piece. A set-aside is within that, in that the resource that relates to the large hospitals is within the control of the Glasgow City integration authority. Where the money actually sits is probably less important, but in that context they are actually able to consider that as part of the bigger picture, rather than have that bracketed off and left as a sort of separate entity. People go through transitions, people certainly as part of the Glasgow City approach their intention is to reduce falls, to provide better support at home, to reduce unscheduled admissions, to reduce occupied bed days, to reduce delayed discharge, and they've been very effective on that over the last two years, but they were only able to do that by being able to look across the whole picture, rather than seeing this as individual service areas. So I think when we read the comments in the COSLA submission, I think we acknowledge the significance of them, but we are also seeing progress on the ground in terms of how resource is being used. I wonder whether COSLA might want to comment on what they've heard. I saw you trying to indicate to get in, so is there anything you want to say at this stage? I think maybe just to pick up on the points that were initially made, it's really important to be clear that SDS requires major disinvestment in services in order to be able to reinvest in new models of support. So transformation funding was mentioned, that incurs dual running costs and when you take that coupled with increased public expectations and the difficulties in making some of the shifts in resource within integration authorities that we've just talked about, because not everywhere is experiencing the picture that Geoff's just outlined, it perhaps becomes unsurprising that we're facing difficulties with implementation. I think Audit Scotland also found that the scale of the challenge was underestimated and we're there for facing a longer programme of support, but without the resources to make those transformations. Basically resource and the adequacy of resource to allow you to make that transformation is a key issue for COSLA. I think somebody else will explore that later. I wonder whether I can go back to something that Mr Huggins said that left me slightly perplexed, because I don't think legislation has ever been described to me as a learning process. Legislation in my view is a decision then implementation. Yet you seem to suggest that this was the case for SDS. No, I think what I was saying was that we've gone through, we're in the third phase and the third phase is the implementation phase where we're actually seeing this now apply within localities, within commissioning systems and for individuals. That implementation phase is the point at which we need to see what is going on, learn from what's going on, make adjustments and move on. The legislation is completed and I guess we're here today because you're considering both the adequacy of the legislation and the adequacy of implementation of it, but we see the legislation as a completed process. We are in the learning process about how to implement the legislation. The legislation and the rhetoric around that promise transformational change, yet you will have read the transcript from people at a round table here a few weeks ago that suggested that service user organisations were disappointed. So what do you say to them and with all due respect, if they were happy then that would underline the point that you made about it not being recorded properly? They're not happy, so you cannot blame recording systems for what is a quite low, shamingly low uptake in SDS. I think that there's two or three things around that, first of all, as is reported in the Audit Scotland report, at the moment we've had data problems in terms of understanding what's going on, which we are addressing. A component of how we're addressing that is through the move from the snapshot survey and additional survey work to bringing the data in respect of social care and SDS into source, which enables us to link the data to other data in terms of understanding what's going on within the system. The source data is the data that we largely use to support integration authorities, so we're addressing issues around the data. So we think that the position has been better and indeed when we see the data again next year will be better again in terms of implementation. I think that the other element though to understand is, and again this is reported on and noted, is the complexity of trying to do two things at the same time. One of those is to offer choice and control to individuals, which is a clear objective of the legislation, while at the same time asking integration authorities to plan for populations. Trying to find that the fit between planning for populations and providing choice and control to individuals is really quite complex. Again, as I said earlier, what we see is that those areas that have addressed it through how they approach commissioning have done better in that area, whereas other areas have not moved so quickly into that space. However, it is the challenge between how you are able to meet the needs of individuals within a system but also to meet the needs of a whole population. That's really quite a hard ask. Surely you should have thought that before passing the legislation and raising expectations? Legislation is always framed with a high objective in mind. I think that what we're seeing through and the case studies that we've seen, the examples that we've seen, the work that we're seeing in some areas, particularly like highland, remote and rural areas, we're seeing self-directed support as being a key mechanism by which we deliver care. I think that the fact that something is going to be difficult and hard doesn't mean that we shouldn't do it. No, I'm not suggesting that, but you maybe should have thought about it in advance. Alex Neil? Can I start with the cosla, please? Reading both your original response and the supplementary, you get the feeling that you're putting up the white flag. It's all the fault of the Scottish Government, not enough resources. It's all part of the underfunding of local government. We're in the blame culture here, rather than trying to address some of the key issues. The front line is an MSP. I find that the awareness, for example, among end-users of their rights and obligations is very often zilch when they come to the social work department in the first place. I get the feeling from cosla that this is all about blame, rather than how do we sort this? How do we address the issues? Why have we got so many authorities performing so poorly compared to some of the better ones? What's cosla doing about it? There's a difference between holding up a white flag and blaming people and stating some facts about the difficulty of the task ahead of us. We have a task for transformational change to deliver SDS. That is not an easy thing to deliver for local government and to do it, we need adequate support and transitional funding. I think our assessment of the situation is that the funding, the transformational funding, hasn't been adequate to meet the scale of the challenge. That's a fact from our perspective. It's not blaming, but it is a fact. You couple that with the implementation of the Public Bodies Act, the initiatives that we've had, new initiatives, new legislation placed on local government, all of which require evolution and transformation of services, change investment, behavioural change. There is a reality on the ground as to what the pressures that local authorities are facing to try and deliver for people in that environment. We would be remiss not to identify it thoroughly in our evidence to this committee. What we are doing is not just saying it's not our fault, just give us some money and that will fix it. We need money, but we also need to ensure that we are working with the Scottish Government and we are on the improvement plans, on the future implementation, on how we leverage the system within the resources that we've got and what is realistic to expect. We know that that is an improvement journey. We are working to support local authorities to step up to that and to implement the changes required and we're working with Scottish Government on how we support that nationally. So I think it's a tale of two stories here. We will continue to work with Scottish Government and with local authorities and with the third sector to ensure that the legislation, as it was envisaged, is successfully delivered. However, there is a reality on the ground of what is required and the environment that we're in that also needs to be acknowledged. Obviously, in terms of resources, that's a big issue that you've highlighted. What's the cause of the estimate of the additional resources that you need to make this happen and get it back on track? I think when you're asked to, and I had this experience earlier in the week when talking about care home sustainability, when you're asked to pluck a figure of what would it take for the whole of local government to deliver one particular policy and the transformational change that that requires, I think that's a very difficult thing to deliver on the day, a specific estimate. What we do need to do and what we are saying we need to do is look at the whole pressure on social care, look at all the initiatives that we've got and the resources we've got to deliver them and say together is that sustainable and are those expectations realistic and I think there's a piece of work there to do in the round. What you can't do and what we're increasingly finding is dealing with the social care budget on an individual and incremental basis is a very difficult place to be for local government and for Scottish Government so you can adequately say the carers bill might cost x, free personal care to under 65 will cost y, transformational change for SDS will cost another amount. We need to look at the overall budget and the pressures on it and we need to make some choices about where we're prioritising our spend and what it will take. But surely I mean when the legislation went through a financial memorandum it was attached to the legislation which gave estimated cost of implementing the legislation, what Cosley is saying is- At the time we said that the transformational funding had been underestimated. Right by how much? I think that we didn't give an amount, I think there's an issue in you. I think we know it's underestimated because that's been borne out by the fact that we've had 70 million and actually that has not leveraged the change. We haven't been able to deliver it. I realise dealing with 32 local authorities you can't give me a very precise figure but obviously you refer to the 70 million. Should that 70 million have been 80 million, 90 million, 100 million, 150 million, what's the order of magnitude? I think it needs to be significant. When you look at what local government got out of that money, what was it, 17 million in total over? Yeah, 17, I haven't done the same, it's six plus 11 plus three. But that is not even 50% of the transformational money that went in to deliver this legislation. That is not adequate to deliver the cultural and behavioural change. I'm more than happy to go away and look with Scottish Government at the additional resource that we need. I think the conversation has always been here's the resource we've got, how do we deliver it within that. We've argued long and hard that that's not going to be enough and it's borne out now through the Audit Scotland report. There are two issues. One is the overall amount needed to make it work right across the board and I understand why COSLA would find it difficult to give that because that involves the third sector, it involves the Scottish Government's responsibilities and so on. The second part of the argument is what do local authorities themselves need to make this work. I mean, as we've heard, we're nearly three quarters of the way through the implementation period and we're, I think, way behind of where we expected to be. And we can spend a lot of time going over spilt milk for the last seven years, but really what's more important is how do we catch up? Because at the end of the day, this is about the end users. So in order to catch up and in order to provide on a permanent basis the levelling quality of service that's envisaged in the legislation, how much more money for this area does local government need order of magnitude? Okay. Do you? You can write that to us once you have an opportunity to consider this. I would be happy to go back to local authorities and look at exactly how much we need. I think the other issue in this though, in the money, is when you get transformational funding, it's been, I don't want to say eaked out, but it's been year on year and actually this change is significant and I think we need that to be prioritised in one year to leverage the change rather than incrementally delivered year on year. That's not going to help us to leverage system change. I think the two or three things, one of the things you take from both presentations is that there's a lot of pretty small funds instead of, you know, it doesn't seem to be a big picture and I accept personally what you say about one year budgets. Can I ask both the Scottish Government and COSLA? The debate so far and the discussion and your submissions have been primarily about inputs, but what outcomes do we want? I mean, obviously, an outcome in a sense is the percentage of people who are actually on self-directed support as envisaged, but the whole purpose of self-directed support was to improve the outcomes for the end-users. So, who's measuring that and what improvements have there been? Is there evidence of where self-directed support has been working and has been more effective? Has it made the material difference to the outcomes and the quality of life for the people who are trying to help? I think the reference to outcomes is incredibly helpful and that's where we need to be focusing. I think Paula mentioned some points about the need for us to collectively challenge the continued focus on initiative-led budgets and input-focused policy initiatives. So, the Public Bodies Act set out national health and wellbeing outcomes and put them on a statutory futang. Those are therefore jointly owned by local government, Scottish Government and, indeed, the Parliament. I think that we all have a joint responsibility to ensuring that the fiscal and legislative policy landscape function to support the delivery of those outcomes. We accept all that, but what I want to know is from local government and the Scottish Government, what evidence do you have? Historically, since the SDS was implemented, the SDS is achieving where it's been implemented properly. Is it achieving the outcomes and visits? I think that I would refer you to the work that Audit Scotland has done in that respect. There's plenty of evidence in there around where areas are making real progress, where they're innovating, and there's positive feedback from service users. I accept that there's also some more negative stuff in there as well. There's a range of research that's been done by people like self-directed support Scotland. I've been in discussions with them where they've acknowledged that they've found high levels of satisfaction with the services that people were being provided. We have the social care survey reporting that 81 per cent of people are satisfied with the services that they're receiving. I think that the problem that we have is that, when we talk about SDS implementation, we start focusing on stats around option choice and attempting to make some kind of value judgment on people's choice and using high levels of option 3 as a proxy for poor implementation. That isn't the case. Choosing to continue with council-arranged services is a valid choice. It's not for us. I think that the problem on Beth is that there's clear evidence that people are not being fully explained the choices. Therefore, one of the reasons—I'm not saying the main or the only reason, but clearly I know from my own experience as an MSP—one of the reasons why option 3 is so high is because people aren't getting the other options explained to them properly. I think that we need to be careful around anecdotal evidence. It has a role. It's not anecdotal. I've seen it. It's evidential. I mean, I've seen it. I've got a whole case load of people who come into that category. The same is true of other—I mean, I live in South Asia and the same is true there of the people I speak to in the third sector there, for example. I'm not attacking local government. I'm just saying it's not working at the grassroots always the way it should be. Returning to the data—I was drawing a contrast there between research that we have, scrutiny reports that we have that are reporting about that qualitative experience, which in 81 per cent of cases is positive according to the social care survey data. What we have when we look at SDS implementation is that we focus on the four options and use that as a proxy for implementation or compliance. I think that we just need to be really clear and careful as well. Some of the percentages that have been discussed today and in other sessions were in year 4 of implementation of the legislation. The data that we're looking at is for year 2, so it by no means represents the most recent picture. Recording option choice was new for councils. That comes at a cost when you have to change your IT systems and councils without sufficient transformation funding. We would have had to make a choice about where we put that investment. Do we go for the IT systems and the finance systems or do we invest it in changing services and improving support to people? We just need to be really careful when we're thinking about implementation, compliance and what evidence we have. There's quite a lot of caveats around that. I think that the Scottish Government is aware of that and we're working together to support improvement. Jeff mentioned the source work that links health and social care data. We're also working within the context of integration to improve wider social care data, including data about personal outcomes, which is quite expensive to capture that kind of information well. We tend to rely on care inspectorate reports in the interim. We're also working to improve data that's collected about carers. There's a new data specification just been issued earlier this year. We're continuing to talk with Government about the costs of making changes to systems, but what we've seen from councils, if you look at the data that we've been referring to today, is in year one of implementation we had 10 councils that weren't able to break things down into options that dropped to four in year two. As I said, we're currently in year four. We won't know what the picture is until a year and a half from now, because of the data cycles. Can I go back to Paul? I want to clarify two figures. First of all, the 70 million transitional figure, or bridging finance, is purely for SDS. That doesn't include bridging finance for integration. That was aimed at SDS. Purely SDS. The 70 covers some of the implementation costs to local government. It covers the costs of providing advice and support locally to individuals. It's purely about the mechanics and purely about SDS. What's the bridging funding for integration? I don't think we've offered bridging funding. What we have offered, and it's been through each of the last two spending reviews, have been additional resources into integration authorities from the NHS budget to support integrated care. The figure that, up to 17, 18 the year that we're currently in was an additional £357 million transferred from the NHS into the integration authorities to support integration. That's in addition to the historic figure of the £100 million, which is the reshaping care for older people resource and the additional 30 that was also there for delay discharge. As you begin to look through the additional resources that have gone in over the last three, four years, they've been quite significant. I'm picking up the best point of SDS, which also applies to integration. You've got this period of transition where you're effectively funding two systems running in parallel because you've got to disinvest in the old system. You can't disinvest until people go into the new system. That £300 million is that including funding for that kind of to fund that double run until you can make the transfer? It's been important to think about what the different funding streams are supporting. That's what I'm asking. Does that funding stream... Straightforward answer, Geoff. Does that funding stream of £300 million support the bridging aspect of running two services at once in effect? You're setting up the new service, but you can't get people all that quickly, sometimes off the old service, so the £300 million for integration does that include effectively bridge financing to run two services until you can switch to one? The additional transfers that have gone into integration budgets are largely for the costs of direct service provision, so that's the cost of packages. That's somebody who goes into your house or that's the cost of a residential care package. The resource that's associated to 70 is largely about the mechanisms by which people would access a package, so the process of assessment, the advice that might be offered to the individual, but also some of the work that is related to the process. The resource that's in the integration authorities, the almost half a billion that's been allocated there, is largely for the provision of direct care. I think that what you're seeing, and again, this is one of the broader questions that comes into this, is as you're seeing new approaches being developed, such as the work in the carers legislation as well, the support that's in place for that, one of the things that we would expect to see is a transition from old systems to new systems. Part of the challenge that we find is that quite often it's being presented as the need to continue to run the old system and have the new system, and I think that we need to get beyond that mindset. You need to actually see the full transition. If I can draw Paul, I think once. Sorry, I was wondering whether the committee wanted a response from us on outcomes. Yes, yes, please. I'm happy to continue on this or to go to outcomes as the committee wishes. I think that the line of questioning to be concluded, and I think that Paul McClay wanted it in his hand. Yes, sorry. If I go back to the switch-over from the old Victorian mental health institutions to care in the community 20, 30 years ago, one of the reasons why that was handled so successfully over a five-year period or so was that bridging finance was provided by the Scottish Office to the relevant authorities to cover the period where you had to run two systems effectively in parallel until you made the transition. You couldn't empty the hospitals in day one any more than you could empty the acute services of people who don't need to be there in day one. You end up having to fund the existing system until you create the facilities in this case in the community to allow you to empty the hospitals. My question is, is that £300 million, including effectively the equivalent of bridging finance? It's important to think about what happens at the point at which somebody exercises choice in respect of SDS, because that's the intention. Previously, if we take the example that an individual may have been receiving care as part of a care-at-home package in the context of the council having made an assessment of their needs and then provided them with a number of hours each week, if they then, having taken advice using the resource that's supported in respect of advice, have been assessed through the SDS mechanisms and decided instead they wanted to exercise option 1 and that they themselves wanted to take on the budget and commission their own care, what would then happen is that they would then be given the budget to do that and that the care package that was being provided by the council would simply stop. So there isn't a period in which they'd both be receiving the service from the council and also receiving the SDS. My question was about integration. That's why I was making the distinction between the £70 million for SDS and the issue, because the £70 million and the issue was raised by COSLA on SDS about bridge funding, but there's also related here is integration. For the third time, can I ask the question, is the figure that you referred to, is that including effectively what is bridging finance for integration? No, the resource that's been allocated to integration authorities is additional resource to meet the costs of policies such as the living wage but also demographic change and to provide additional service. So my next question then is part of the pressure that COSLA referred to in their evidence, could be addressed by the need for bridging finance for integration, given that you do effectively run two systems until you make the final switch over to the new system? I'm not sure what the two systems are here, I'm sorry. Well the two systems are, we're trying to empty the acute hospitals so we reckon about a third of the people in acute hospitals don't need to be there. One of the main purposes of integration, you may remember Jeff, was to get those third out of the acute sector into the community. You can't empty the hospitals in day one, it will take a period of years to do that, but before you create the facilities in the community, you need the money, so you need the money to create the facilities before you can empty the hospitals. Is there not a need for bridging finance to do that? It's a simple question. So I understand that and I suppose that it's quite an interesting analysis and an interesting question and there are different views on it. Our experience where we create additional services within the community is that people access those services and if we do that while we continue to have hospitals, people continue to access hospitals. So what effectively we do is we increase the overall service provision that is available within a locality. I'm not sure exactly within that how it is that having decided to increase the amount of primary care and social care which is now being taken up by the community, how that takes us to a point at which we are then able to close our hospitals which continue to be full. So the model of bridging finance, I think, works very well where you're able to identify a clear closure plan for a learning-to-be closure. It's about, you know, the hospitals are under huge pressure. I mean, that's the reason why COSLA signed up to this in the first place. One of the driving forces was to get people out of hospital who don't need to be there, but maybe Paul wants to answer the question. So part of the proposition that lies behind integration, and I do want to be respectful of my COSLA colleagues and let them give their own view on this, is that the demographic trends, trends in multimorbidity, trends in the ageing population mean that the demand on hospitals continues to grow. So this is more, I would, my judgment would be that this is more about ensuring that we can meet the demographic trends by having services elsewhere that mean that people who don't need to be in hospital can be cared for elsewhere. There is significant investment, as the committee will know in primary care, and that is intended over time to build up the general practice function, but there is a contract being considered just now by the BMA, and they'll be voting on it. All that is part of the progress we're seeking to make in shifting the balance of care. I understand, Mr Neil, your point clearly made about bridging funding. At the moment, the money that is being put in through the processes that Jeff has described is not being described as bridging funding. Is that clear enough? My question was, in top of all that money that is going in, both to the additional money into primary care and the additional money, a lot of which is going to meet the living wage, not in primary care, but in social care, to meet the living wage commitment, which is quite right. My question is, on top of all that additional money, is there still a need for bridging finance, for integration? Well, I suspect that COSLA would argue that there is. I would also point out that, in terms of the overall transformation that we're seeking to do, there is over 100 million assigned to transformation. The budget will be published later today, and it will be a Parliament with an opportunity to see what is being proposed for that in the future year. We are putting money into transformation. I am not claiming what is describing it as bridging funding, but we are putting money into transformation. Maybe we could hear from Paul McClay before we move on to our next member. In terms of budgets, all the money that is currently being put into integration is to pay for services. It doesn't account for demand, it accounts for spend on services, so the living wage provision of care at home is to stand still. To be very clear on that, there is no transformational funding in, and no transformational funding has been provided for integration. Neither has there been provided money to support the shift in the balance of care. The purpose of integration is to shift the balance of care, it is to shift the balance of resource, and we have not seen that happen. There is a question to answer here about how you support people to invest in community and social care and move the money and the people from acute into those preventative services. We are very clear on that. There are two ways to do that. You can manage the change with additional resource, or you can have some fairly brutal choices about shutting one end of the system in order to immediately invest in the other. Those are choices that we can make. At present, there is no money for managing the transitional shift. I want to stick with the evaluation side for a wee minute or so. Paul, in your paper, he tells that we are appointing an independent evaluator to lead research work and so on and so forth. I am reading this. It says that we are gathering evidence to tell us how to then evaluate the impact of self-directed support. Does that mean that we are not evaluating the impact now, we are finding out how to evaluate it as a result of this piece of work? Have you understood that? There are three parts to the research. Do you want me to go over that? I can read it. It says that we are gathering evidence to allow us to evaluate the impact. That tells me that we are actually not evaluating the impact at the moment. We will do that at a later stage. Could you explain that, please? In response to the earlier points that have been made about outcomes, part of this is designing a process whereby we can work with people who use the support and the people who care for them. That is why we have now appointed the organisation that will support us on that. We are working with particularly disabled people's organisations so that we can tailor the evaluation in a way that produces results that are meaningful to the service users. That is why we are doing it in the way that we are doing it. When will we know that? We are seven years into the programme, are we not? I know that you cannot evaluate the minute that we set up the scheme, but seven years, possibly eight years, and we might get an idea of the impacts positive for other ones? I would like to bring Iona Colvin in on the positive impacts point. In specific answer to your point, I think that the committee may already be aware, but we are going to have progress reports in February, April and June 2018 in a final report by all of us. That is not something that is going to happen far away in the future. I know that local authorities already evaluate for themselves the impact of what they are doing and I know that we have been reminded that anecdote is not evidence, but nevertheless, I do myself take time to go and meet people who benefit from the service. I also accept the points that the convener made earlier that some individuals and organisations remain disappointed with the uptake and the provision of self-directed support, but perhaps Iona could say something about impact and outcomes. I do not want to go back over the issue about the options, but I suppose that I have been in this role now for the last nine months and part of that nine months has been around the country in talking to colleagues about what is happening across the country. It is a very mixed picture, but I know that a lot of authorities feel that we should not judge them just by the issues around the options and the numbers of options and the numbers that choose option 1 or option 2. I think that the key to that is how well some authorities have embedded that in their assessment, so their assessment is not an assessment there and then a self-directed assessment over there is all one. It is one process. Midlothian, Highland and North Lanarkshire particularly have been really, and East Ayrshire is the other one, have been really pretty successful at that. I think that that is part of the key to it, is that we do not have two assessment processes. We have one assessment process in which people's individual needs look at the outcomes that they would like to see. It is about working with people, which is something that social workers are very much trained in and used to doing. I think that it has been difficult to gather that evidence because it is based not just on how many people take the different options but on individual experiences of care and whether or not their outcomes have been differently articulated and whether or not they feel that they have met those outcomes. There is a lot of individual evidence and a lot of all the authorities are looking at that within their own authorities, so they will have an assessment. I think that the job that we are trying to do is how do we pull that together in a meaningful way that reflects that people are having better outcomes because there is more focus on talking to people about what outcomes they are looking for and more focus on achieving those outcomes. I was recently talking at a conference in North Lanarkshire, in fact, in Ayrdrait, about being human. It was the title of the conference, a conference that is very interesting. I have seen and spoken to many people in North Lanarkshire about their experience of self-directed support. I could see clearly the difference between a traditional care package where somebody would have come into your house four times a day and somebody has an individual carer and where they direct when they have the contact. There were a number of service users of people who have lived experience talking at the conference about the difference that that has made to their lives. It is a fundamental difference in terms of the quality of their life and the outcomes. We are trying to work on how we capture that and feed that in, as well as how we assure you that we are having a consistent approach across the country. I acknowledge the point that was made earlier about that people need to be offered that as part of an option. Sometimes that is not happening. That is the bit where we need to focus together on. We are working together with COSLA in terms of looking at how we improve the current situation and the understanding of the process and making sure that people are aware of it and that it is discussed absolutely appropriately with them. How do we gather the evidence to show you that, in actual fact, people have a different experience of care? There are lots of things going on across the country and that is a general experience. There are lots of really good things going on across the country. The problem is how we get to a point where it is consistent. We learn from each other collaboratively and improve the processes, practice and outcomes for people. That is part of the discussion that is going on just now. I have also been working on the workforce, which we will begin to look at. What are the skills that we require? What does the future workforce look like in that respect? How do we make sure that we have a workforce that is fit for the future? I was going to ask our COSLA colleagues about that. You mentioned East Ayrshire. We have taken some evidence from East Ayrshire and it is my authority. I know what they are doing down there and I am pretty impressed with what they are doing. What is the picture across the local authority landscape to Pola and Beth? One of the issues was raised by Audit Scotland in its work on what is being done locally. What is the picture across Scotland in terms of data gathering to tell us what the impact of that is? How does that work feed into the independent review that Pola is carrying out? I presume that it will join up. I highlighted some of the things that we know are going on with data at the local level when I spoke earlier about councils improving their systems and increasingly being able to record whether someone has chosen option 1, 2, 3 or indeed 4. Where we want to make further improvements are around the impact that that choice is having in terms of whether personal outcomes are achieved. That is the area that is more difficult for a number of different reasons. It is very qualitative. It is an output of a conversation between a service user and their care manager. In terms of how you measure whether an outcome has been achieved or not, what we absolutely want to avoid is some kind of tick box approach that does not really capture what is going on. For example, if I was a young person with learning disabilities and one of my personal outcomes was to improve my social circle, how do we measure that? How do we capture it? How do I, as a council, commission an IT provider, make my data capture system capable of doing that? Over what time period would it be reasonable to expect that personal outcome to have been met? How would we ensure that those very nuanced things were being dealt with in the same way in every single area so that we can then sit at the national level with comparable data? I think that, while we have all got this ambition around personal outcomes, there is a lot sitting underneath that. That is not to say that we are shying away from it or saying that this is too difficult. It is just around the scale and the length of time that would take. Are all the health and social care parts doing the same thing here, basically, in how they evaluate it? Are they doing 32 different things? No. We have work that we do jointly with the Scottish Government in the integration space, which is looking at having a core set of consistent data that can tell us about what is going on in the system, if you like. Our recent focus there has been around social care data. We feel that there is a gap there, and that is something that we are working together to address. I think that we need to challenge ourselves and ask a more complicated question than what is the data on SDS implementation. Are we halfway there or are we three quarters of the way there? SDS is an approach to delivering social care, as I own or stated. It is not a separate thing. For me, SDS is about the whole system and what we know about the whole system. The way that we need to approach that is to challenge ourselves to look at inspection evidence around how their personal outcomes are being achieved. Scrutiny reports such as Audit Scotland, the integration data that I just mentioned, social care survey data that we also have, and developments such as the new national care standards, which are much more person-centred and outcome-focused. It is really about how we look across that whole system. That gives us plenty of work to be getting on with. There are two points that I would add to that in terms of outcomes. The first one is the extent to which the implementation of SDS and the outcomes that it can achieve is being merged with an overall dissatisfaction of how much resource there is to meet people's needs in the system, because we have raised expectations and we have done it in a period of austerity. It is to what extent those things on the ground are being felt by individuals and transferred on to whether or not SDS is being successful for them. The other thing I would say just in the round is that we are not as good as we would want to be as a country at measuring outcomes. We are still measuring inputs. We have had a review of targets and indicators across health and social care that did indicate that we are still measuring inputs and we are measuring them without any counterbalance in that measurement and performance system, which balances whether they are achieving things for people and how we articulate that. There is an issue in there that we collectively recognise and want to address, but it is not easy. Maybe we will also make the connection to what Paul has said in respect to the Sahari Burns review, because I think that it is very interesting. Mr Neil earlier on asked about the issue in respect to outcomes, are outcomes getting better? It is difficult to say whether outcomes are getting better because historically we did not track outcomes. If we are looking to make a comparative between what is going on in 2017 and 2010, the data for 2010 that we would want to compare is not there. We have not looked at it in that way. We are also asking different sorts of questions. The questions that we are asking now are ones that we would not have asked in 2010. SDS is one of the key components of SDS around personal control, the idea that I would have the ability to determine how my care would be delivered, and that I would take a personal benefit from that sense of control in my life. I would not feel that I was subject to some arbitrary or external system making decisions about how I live my life and how you actually measure control and people's sense of control, which is a key component of their wellbeing, of their quality of life. It is a whole new idea, not just within Scotland, but more generally. At the moment, we are doing work within Dumfries and Galloway on the implementation of the dementia outcomes work, the work that we have done with Michael Porter's international consortium on health outcome measures. That takes you into questions around sense of safety, sense of control and beginning to use that within local health and care systems to understand how those systems can understand whether they are producing benefit. It is remarkably hard work. It is easy for us to know how many people went through hospital door. It is a lot more difficult to know how their experience was going through that hospital door, maybe not just at the point at which they might press a button that says, was your experience good today, but also how they maybe think about it two days later or how it has actually affected the rest of their week. These are really quite big issues because ultimately they are about how we feel about ourselves and how we live our lives. Building new systems in this space to actually be able to track whether these more human outcomes rather than clinical outcomes are achieved is a whole new challenge. I think that it is one of the really exciting parts of Sir Harry Burns' review in that it basically maps out that that is the direction that we need to go alongside activity data and some of the population data. You also now need to be able to understand people's experience of care but also the degree to which it supports them in things such as, as I have said, sense of safety, sense of control, sense of wellbeing, things that historically health systems would not have seen themselves as being about. So when you ask about why is it taking so long to develop an evaluation strategy, part of the challenge around that is while we can look at different tools that people use to say, have you achieved your personal outcomes, simply aggregating that up and saying 74% of people achieved their personal outcomes, does not really tell us whether this process is given generally to people exercising option 1 or option 2 or option 3, a greater sense of control over their health and wellbeing. There are some really quite deep questions that we need to answer. As Pauler reflects, it also is happening in the context of a range of other changes happening within the system and also changes happening to people's lives more generally in terms of expectations and experience, issues around social isolation but also the change in demographics in society. You are not just tracking a single thing moving through time, you are tracking that while other things are changing and that takes you into some very complex evaluation as to how you attribute benefit or disbenefit to any particular intervention within that space. That is why you need to move away from simple, it used to be 74%, now it is 76%, there is just so much more going on here. My last point, convener, is to the final point that Audit Scotland made. It is about that, in a joined-up nature. Jeff, how do we try and make sure that we have a picture of what the whole service looks like, particularly all the way, where SDS fits within the whole health and social care integration side? There was a chance to somewhere, sure, GPs last week in relation to the new GP contract and they were bemoaning the fact that you have got multiple integrated joint boards even within a single health board, such as SDS3, so there are multiple joint boards all over the place within health boards and they were finding it difficult to deal with that kind of situation. How on earth do we ensure or try to make sure that this whole system joins up and fits as correctly and appropriately as we want it to? It is a really interesting question because general practice is a really good example of a very local service. As you begin to build and think about the new contract and the wider primary care team connection to social care, we are beginning to see better connections to social care. Also looking at the issues around palliative and end-of-life, as you are making the connections across the piece, those happen within very local systems of care. They are in the framework of a national contract, but you are actually, and we see this when we look at the data in respect of activity and how people actually engage with services, you are actually looking at really quite localised systems of care where people's experience is related to maybe two or three particular services. GPs will tap into voluntary or other statutory services based on proximity as well. That means again in terms of understanding local care systems, a lot of the work that we have been doing around data through the list of services and through source, tracking how people actually move through the system becomes really quite significant. We can now, using the data within source, understand the different pathways of people that people go through the system to actually understand what that means for service configuration. Some of the work that we have done has been in Airsharp, so we have looked at the path by which people, over 65s who are high users of service, go through the system. That has given us a lot of knowledge about basically the two tracks that they follow, one that is a frailty and full track and one that is a dementia and psychogeriatric track. Until we actually had that data, which enabled us to understand how they were going through the system, it just looked like a lot of episodic care. Again, this is part of the challenge for the clinician within the system, is that they see the person in front of them, but they may not recognise that across this area of Ayrshire, East Ayrshire or North Ayrshire, there have been 20 people like that this month. That enables you then to think differently about how you approach that as a cohort in terms of the connection to hospital services to specialist services, but also the support that you offer to primary care. I think that the size of integration authorities varies quite considerably across the country, from 22,000 in Orkney to somewhere around half a million in Glasgow City. Within that, you then have the 100 odd localities, which is where a lot of this very local planning needs to take place. Most people's experience of healthcare services is local. It is very helpful. Beth Hall, do you want to say something there that you looked as though you wanted to come in? If I could, thank you. It is just to pick up on some of the points that Geoff was making there. We need to be really clear that integration is about more than just IJBs. There are services sitting out with the IJBs in local government and in community planning. That can act to support the success of integration or not. I am thinking that community justice and children's services are not always integrated. Housing has a huge role to play. If you look at the other local government services such as leisure environment, they have a massive contribution to make towards the prevention agenda. When we are talking about shifting the balance of care and early intervention and prevention, we can easily take quite a narrow focus. It is not just about shifting from acute to community health and social care. It is also about a shift further upstream to preventative services that are sitting with local government. The reason that I mentioned is that it is relevant to SDS. Geoff talked about control and empowerment. We need to remember that, at its core, SDS is about more than services to meet needs. It is about moving away from that deficit model, so it is not about needs and services to meet them. It is about assets and outcomes and how we achieve them. That means that we are into the space that is around building individual and community assets. A good SDS conversation is about the outcomes that we want to achieve and all the resources that might be available to help to meet them. That includes individual strengths, carers, family and the wider community. I think that we will not be genuinely successful in delivering the original vision of SDS unless we can move into that space. You can imagine what I am going to say next, which is about concerns about all that councils do to tackle inequalities to build stronger communities. It is becoming harder and harder because, while we are seeing some money going into health and social care, which allows us to stand still, as Paula highlighted, we are seeing a corresponding reduction in the wider local government stuff. I worry that we have very narrow conversations about the shifts that are required. If we are thinking about sustainability over the longer term, I worry that that is a real mistake. I am going to come back to that exact point very briefly. Paul Gray, Willie Coffey was asking some questions around data capture. We heard from Inclusion Scotland in a previous session that different local authorities captured data in different ways, and now it is coming together and we are trying to sort it out. Why was that not done at the start? Why did no one plan properly? First of all, Mr Kerr, if we wait until everything is perfect, we will not do anything at all, but a more perhaps constructive answer to your question. Is that an acceptance that there was a failure to plan, Mr Gray? No, I think that we started with what we had. That is a key tenet of improvement. You have to start with what you have. If that runs through our improvement science approach, you have to start with what you have, otherwise you never start anything. I am not saying that there was a failure to plan. What I am saying is that we have based on experience and learning built the systems and made them better. We have improved the data collection, and it has improved to give us a set of data on 2015 and 2016, which we were able to put out as data and development. We have developed it further and we are continuing to develop it. Also, as COSLA colleagues have said, are choices that local authorities still have to be allowed to make about where they make investment. They incur costs, so we talked about the IT system. That has a cost attached. If, as the system develops, the local authority says, hang on, we need a whole new IT system, that has a cost attached. That takes us back to the point that Alex Neil was making. I would like to ask Paul McClay. You were asked by Alex Neil about the financial memorandum and how much more money is needed to make things work. You were fairly clear that £70 million was not enough. Alex Neil pressed you and said how much would be enough, and you did not seem to be able to answer that. Being fair to the Scottish Government, at some point, they are going to say that we think that you need £70 million. You say that we need more. The logical question is how much, and you do not seem to be able to answer that. Is that correct? £70 million was done incrementally, so we never looked at IT systems if we want to refresh them, how much is the cost and when to ask that. That is something that we could do, and we can go and ask that. Who did not look at that? As part of the financial memorandum, I do not think that we looked at it. When you say we, that is COSLA, or who was the onus on to make that judgment? I think everybody. It is on the Parliament, it is on the Scottish Government and it is on ourselves, so we would accept that we did not at the outset look at totally refreshing our IT systems and what it would cost. We do have in terms of data, and I did not want to go into this, because again, I think that if you pick off one element of it, you miss the fact that the funding in the round is really challenging in terms of social care. Audit Scotland's recent report on social care said, in order to stand still, if we stand in still, you need 16% to 21% more in social care budgets by 2020. That does give a ballpark figure for what you would require. What we have not done is broken that down and had a system-wide look at whether historic statutory pressures have kept pace, the spending on that has kept pace with demand, whether the individual additional policy requirements and pressures put on us are sufficient, and whether the overall prioritisation we give across a shrinking budget is able to deliver on expectations. We have not done that, and we do need to do it. I would accept that we need to do it and we need to be able to put more robust figures on it. Audit Scotland has had a look at what it would take to stand still. Obviously, we want to evolve. We want new models of care. We are looking at the integration part of the purposes to be more sustainable, not just to keep growing our services more and more to meet the demand as it is, but bearing all of that in mind, it puts a figure of 16% to 21% by 2020. I think that that is useful. Personally, I have a degree of sympathy and what may happen later today may be more challenging. However, it is a fair point that the Scottish Government would say, well, how much do you need to make this work? To my mind, they need to be presented with a figure, but then that begs the question, Paul Gray. Do you accept that there is not enough money going in at this stage? Do you accept that the financial memorandum was wrong? If so, who got it wrong? No, the financial memorandum is necessarily an estimate made at the time. I am never resistant to the argument that more money would help, but then that would be true of almost anything in the world. I would certainly welcome any more detailed proposition from COSLA about what they think would help at what rate and to what specification. However, we have put £70 million into this, and I am not going to sit and read out my submission to you, but I do invite the committee to look at the submission which sets out where that money has gone, how it has been distributed and what it has produced. If part of this learning is to suggest that we need to make some choices, because that is the issue and Paula has fairly stated it. This is about choices. If we choose to put something further into self-directed support, we will be choosing not to spend it on something else. We would have to decide that that was more of a priority. The panel has been fairly clear that what I am hearing from COSLA is that we do not have enough resource here. I am generalising, obviously, but we do not have enough resource. Paul Gray, you were very clear earlier on that you doubt whether more money is the solution and paraphrase slightly. As you have just done, there may be other things that need to happen. So, who is right and what is the solution? There are many components to the solution, but let me try to keep it relatively short and simple. The work that Iona, chief social adviser and our workforce colleagues are doing on workforce is part of the solution. Education is part of the solution. Again, I am not going to read it out to you, Mr Kerr, but support in the right direction annual report tells us how many people were supported. The innovation fund tells us about people who had improved knowledge and awareness of approaches and so on and so forth. Those investments in helping people to understand the system and what it can do are important. Investments in workforce are important. The data that we gather from our evaluation will help us also to decide what to do next. What we are clear about from the report and from the evidence that we have gathered and from the visits that we have done is that there are still people who are not clear enough about the choices that are available to them and the basis on which they might make them. That is partly about helping the workforce to explain the choices, but partly about making the choices more clear. That sounds like a resource issue. That sounds like some cash will need to be injected into the system to deliver the various things that you have just talked about. If that is so, is the Scottish Government making an assessment of what needs to be done and how much that is going to cost and how much more needs to go into the system? It is largely an issue of explaining and educating, but we are also, as I have said in response to Mr Coffey, carrying out an evaluation. We will reflect on what that evaluation tells us, but I would like to have it before I decide what to do about it. I suppose the point I have been making is that if there is not more money, then we need to make some choices and those are political choices, but at present we have got legislative pressures and I will just list them for accuracy. We have got SDS, we have got legislative pressures on children and young people, the Public Bodies Act, CARERS legislation, Community Justice, Community Empowerment Act, we have got early years expansion, we have got Scottish living wage, we have got additional mental commitments to 800 additional mental health workers, we have got nursing and social care staffing pressures coming our way, we have got free personal care for under 65s and we have got the extension implementation of the living wage to sleepovers. At some point we have to make some choices about what we are prioritising in this system and what we are deprioritising. What we cannot continue to do is keep adding more on with shrinking budgets and expecting the ends to meet. What that means is reduced eligibility, reduced numbers of people getting services and reduced, eventually, consequence of that is reduced quality of care. We want to work against that, we want to deliver improved outcomes, we want to be in partnership to deliver integration, the shift in the balance of care and health and wellbeing outcomes, but there is a stark reality about continuing to load a system with new and more commitments when the overall resource is shrinking. That is a persuasive argument, Paul Gray. How do you answer that? I answer that by seeing how we cause the proposition. I wonder whether I could ask something before I bring in Monica Lennon. In your paper, submission to the committee on page 3, you talk about distributing 40% of the funding over 2010-2018 of £26 million, but the £70 million actually started when? Was that in line with the legislation so that that would be 2013? So are you counting funding against that total that arose much earlier? Yes, convener, I want to give you a precise answer, but I'll give you that and write to me. Okay, I'm happy for you to write back to me. Whilst you're writing back to me, if you could break the £70 million down, because what I heard from Paula McLean, I may be wrong, was you seem to think that you got money from the £70 million in tranches of £3.116 million? Yes, it was £11 million the year before implementation, £6 million in year one, £3.52 million thereafter, and now we've got resources that covers one staff member and a development budget of a few thousand pounds depending on the size of the authority. What I'm keen to do, because just adding that up didn't get me to the figure that was in this paper, but that might be my maths. You're saying that you've distributed £35.5 million to local government, so just a clarity round about the distribution of the £70 million and over what years and to where would be very helpful, and I'm happy to have it in writing. Onika Lennon. Good morning. Can I start with Jeff Huggins earlier on in response to a question that you mentioned, rural areas? I can't recall exactly what you said. Can you just remind the committee? One of the things that we've seen is in some areas where it's been quite difficult to provide social care because of workforce issues and workforce challenges, what we've seen is quite creative and innovative uses of self-directed support as mechanisms to enable people to secure care. One of the examples that we would see of that would be Balesgan care in the Highlands, where the health board who's the provider of social care in the area was finding it difficult to recruit, they were able to work with the people who required care in that area, and they were then able to access and buy care from others who lived within the community, so it enabled them to bring the component of control but to address the question of supply. It's one of the issues that in those areas where it's been quite challenging to provide care in traditional ways has been a mechanism that has enabled people to secure care, which otherwise would have been difficult to deliver. We're seeing aspects of that. It also, I guess, shows the degree of customisation that you can allow and also the degree to which it reflects people's lifestyles and work patterns within localities. You get to a situation where somebody who may also be the postman is doing four hours of care a week as part of a portfolio career within the locality where they work. I guess it's just that that enables people to maintain their lives within the communities where they want to live rather than actually have to move elsewhere to receive care. We think that that's really valuable and really important. We think that it's the sort of creativity that we want to see generally, and we're beginning to see more generally, but it's there come about because of a series of very particular pressures. It's good to hear about innovative approaches, but I mean, I don't represent a rural area predominantly urban, but Jess Wade was here a couple of weeks ago from self-direct support Scotland. She did talk about rural areas and some of the challenges that you have acknowledged. From what she was telling us about what her members have reported back, it didn't sound like a great picture on the ground. She said that a lot of rural areas that are no service providers are very few and that people are being directed to option one when it might not be appropriate or they don't want that. Is that something that you recognise and what has been done about that? A genuine challenge is that all the facilities that we want aren't available everywhere. In that context, trying to find creative solutions is certainly part of the way forward. There is the challenge, and we see it across the country. Perhaps more in rural areas than others, that a supply of a workforce that is available to offer care, including personal care, is not always available. Our objective is to be able to support councils and integration authorities to secure that, but, ultimately, we cannot compel people to work as social care workers. There is a genuine challenge there. The examples that we have seen are quite creative. We use our facilities, our engagement with integration authorities to share those examples, to talk about them with people in Argyll and Bute or people in Dumfries and Galloway, so that they are aware of what is happening. Other areas are equally challenging, particularly in areas that are rural, but which have high employment, such as Orkney, where it is difficult to secure people to work in the area. I can acknowledge that there is a genuine challenge there, but we are looking to work with providers and commissioners to find ways through that. I will probably come back to best practice, but sticking with self-directed support, Scotland evidence, Jess Wood said that there is a disconnect around the implementation between central government and local government. She believes that the legislation is sound, but she questions to what extent it is being followed. Is that the frustration that the Scottish Government shares? In my earlier response, one of the things that I talked about was the challenge that we have of both providing individual support based on choice and control, alongside commissioning for populations. I think that that is a genuine issue, and that is not a make-up issue. If I am to think about what the care needs are for the people of East Ayrshire, I need to be thinking about what the overall workforce needs are, what the pattern of care might be, what the residential care needs are, how we are offering what the facilities might be around end-of-life and palliative. If I am then also trying to answer the question what I do for particular individuals to support them to exercise their control within that, that is quite a complicated picture. I do not think that we are seeing a disinclination to take the work forward. We are seeing the genuine challenge of trying to do both of those things at the same time. It is a real challenge. Effectively, you are thinking at the whole population level but also at the individual level. There are really good reasons to do that, increasingly the work that we do under integration, and the data work tells us about the interaction between a relatively small group of individuals around 100,000 people within Scotland and their interaction with the whole health and care system. That 100,000 people are using roughly half of all the resources that are used in health and care. Offering them choice and control to support them to live independently and safely is really valuable at a system level, but that is a difficult balance to bring in when there are expectations of standardisation and uniformity. Many of the questions that we get asked are why can't we say everything is the same everywhere or why can't we guarantee that things are happening in the same way? However, one of the expectations around SDS is that it will happen in very different ways to reflect what people request. That is an on-going challenge. We have heard a lot today about challenges. Sticking with SDS, its perspective is that it is really difficult for the Scottish Government to give strong direction to local authorities on what needs to change and what needs to improve. Paul Gray has talked about issues around explaining and educating. Is there a leadership problem? Is the Government fit to address that challenge? One of the key focal points for leadership around self-directed support within local systems is integration authorities in their commissioning role in setting the framework. My team and I meet with each of the integration authorities at least once a year—some of them we meet more frequently. We meet with the chief officers regularly. As part of that process, particularly around some particular challenges in respect of social care delivery delay and preventing admissions, one of the areas that we are identifying with chief officers in both the local meetings and the national meetings is the opportunities that self-directed support offers within that. We are very much working with key leaders. Can I ask at those meetings, given that the evidence shows that provision is really patchy? Do you ask those chief officers why good referral pathways are not consistent? Yes, we address the issues that come out of the data. What do they say in response? They identify the degree to which they are doing work in those spaces to make improvement. This is an improvement story. This is a story where you start from where you are and you make improvement to deliver better quality outcomes. So, if there were top three reasons given as to why provision is patchy and why good referral pathways are not always in place, what would those top three answers be? Generally, what comes out of the conversations is how they have prioritised different parts of their activity over the recent years. They will have been doing different things that, as Paul McLeod has identified, there are a range of expectations in terms of improvement that are in place. What we have seen within systems is those systems addressing those different improvement expectations in different orders. What we tend to do is to identify why it would be that, around both, and carers is another good example, providing better support to carers at an early stage will help them achieve their overarching broader strategic outcome objectives in terms of sustainability and quality. If we can pause for a second, because Paul McLeod ran through a long list of legislative requirements, statutory duties, and she talked about there may be a need to de-prioritise, is the Scottish Government giving any direction to local authorities that there are some areas of delivery that can be given lower priority? I think that it comes back to what is going on within local systems in terms of the different degree of maturity that they have in those areas. In some areas, the work that we did around implementing living wage was significantly more straightforward because of existing work that had happened, so it becomes less of a burden for that work to be taken forward. Some areas have significantly more developed engagement with carers and better supports for carers within their areas. What you find is that, as you work across the country, not everyone is doing everything really well, nobody is doing everything really badly, and the work is about how you are looking to see how those things fit together. The other element that is important to think about in this way is that not all of those are intended to produce additional resourcing burdens and that the intention to provide good quality support to carers is to enable carers to feel more safe and secure, to provide the care that they want to offer to their loved ones for a longer period of time, and that has benefits both to the carer and to the individual, but also to wider sustainability. I know that we are probably running out of time this morning. You have clearly got in mind examples of innovation in good practice. We know that good practice exists. Why is there no urgency between Scottish Government and local authorities to do more to shine a light on that good practice and to ask other people to have a pull up their socks and get on with it? If you know that good practice exists, why has that not become in the standard everywhere? I think that, again, it comes back to the situational nature. We identify the example that I gave of Bleskin care is a great example within that area. At the same time, I would not expect to see that same service delivered in the centre of Edinburgh. I would expect to see something that is appropriate to the locality. I guess that is the improvement challenge in that you are looking to use the facility and the framework that is there under the carers legislation or under SDS or in different areas, different improvement areas, but it needs to be very much localised. The knowledge that you get that others have done innovative things does not mean that you simply drag and drop what they have done to your locality. People are expecting, and also individuals are expecting, individual care. The fact that the people in the Bleskin example have found that to be very valuable does not mean that people in another area of the country will equally find that valuable. I guess that suggests that the degree to which the change process itself is not simple and straightforward. Do you understand why it is quite frustrating for people who do not work in the system, who are not in this political bubble, that quite often best practices appear in a report and it is an example to look at, but that does not seem to be rolled out? Why is there no urgency? I think that there is a very clear urgency around implementing SDS, the Scottish Government's commitment to developing the innovation, to continuing the funding to support the change, the work that we are doing with chief officers, the work that is going on through SDSC, the work that is going on through NES, the work that is going on through the care inspectorate, both directly through ourselves, through COSLA, but also through the national agencies. There is a very clear commitment to promote and take forward SDS. I think that a key component of that will be the improvement of the data, but also the data that begins to demonstrate and show the degree to which outcomes are being improved. However, I think that that is a significant, and as Audit Scotland reflects, a major challenge to implement, and we are working through that. I will bring it back to the experience of service users. We have heard in evidence that reducing levels of service in some authorities is causing anxiety for some service users about how their support will be reviewed. Can I ask COSLA and the Scottish Government what impact diminishing resources within councils and integrated authorities is having on the flexibility and choice that is available to people? Just to focus on, for a moment there, you talked about service users seeing services diminishing, and we spoke earlier about some of the difficulties in disinvesting and reinvesting in new models of support. I certainly picked that up from the Audit Scotland report. What I also noticed was almost a dichotomy and attention in terms of feedback from service users. On the one hand, you had people who were quite anxious about that move away from traditional services, who want to see things like day centres retained, who are nervous of self-directed support because they perceive it as being about a reduction in service, and they are aware that it is being implemented at a time when local government resources have been greatly reduced. On the other hand, you hear from individuals who feel that they have not had the level of choice, control and innovation that they would expect from SDS. You have got those two competing views and competing experiences. What councils will be struggling with, and it is picking up on some of the themes that I mentioned earlier, is where you have people making different choices and coming out of, say, a day centre. Those say to three or four people, for argument's sake, who choose to take a direct payment. The costs of running that day centre do not reduce by the two, three or four individual service fund levels, so you have to meet both those costs. You have to give the direct payment to the people who have come out of the service, but you are still having to meet the service costs. Where that becomes very difficult, councils have to make very difficult choices about whether they are going to close community-based day centres that some people still want to use in order to be able to afford to offer the SDS options that they are required. In terms of their role around engaging with communities, I outlined the two different views that can be at play there, so all of that needs to be reconciled, and all of that will be different from area to area because the configuration of services that we are starting with when we implement SDS are different in different areas. That is some of what you are hearing coming through from Self-Directed Support Scotland. There is quite a lot going on in there. We have started to talk about some of the bigger whole systems issues today. I realise that we do not have masses amounts of additional time, but in order to deal with that, there are some pretty fundamental questions there about how you get the flexible workforce that you need, about how you get the investment to the right place, about how you balance what is going to end up competing priorities. There is not enough resource to deliver all the initiatives that the legislation has outlined, so those are inevitably going to compete over a too small bit of resource. There is a lot going on under that, I think. When there is a competition, there are always winners and losers, so who are going to be the losers? If you are asking me what choices local authorities are going to make, I am not able to answer on their behalf. I would be reluctant to characterise it as winners and losers. We do risk losing sight of the fact that local government has come a long way on self-directed support. The number of people engaged with it is increasing. The self-directed support strategy, which is published, sets out—again, I am not going to read out long extracts from it, but I am going to draw attention to the fact that, over phases 1 and 2 of the self-directed support, it was observed that there is a greater understanding of SDS, greater use of local facilities. There is a list that the committee can read out for itself. There are lists under outcome 2 and outcome 3. All those lists are based on the evidence that we have. The management information that we are seeing, which will form part of what is published in due course, shows that uptake is increasing. I am not diminishing the difficulties or the pressures that COSLA colleagues are describing, but we are seeing a system that is improving where the workforce is gaining improved understanding and where the public, who are really the most important part of all that, although the understanding that they have is not yet as good as we would like it to be, we are improving it. I would want to leave with local government the matter of the choices that they are legitimately entitled to make, but I do not think that I would not like to come away from this conversation with the sense that SDS was somehow failing. It is not. It is improving. I will try to enter a positive point. I ask Paul Gray what more can the Scottish Government do to work with COSLA and to help local authorities to improve and achieve best practice. We know that some of it exists. How can we get that rolled out a bit quicker? I have already indicated that we want to wait for the results of the evaluation. One thing to be clear about that evaluation is being overseen jointly by ourselves, by COSLA, by other local government colleagues, but most importantly by people who represent service users. We want to learn from that. We want to learn from what this committee may say. What can we do? We have resources available through our iHUB programme, which supports improvement. I think that Ms Lennon is the point that you are making. How can we ensure that, where there is good practice, that is spread? Like Jeff Huggins, I hesitate at the word rolled out, because rolling out what happens in the black aisle to Falkirk is never going to work. However, there are components of good practice that we can continue to support. Everyone involved in the system and developing. Another thing that we can do—not in preparation for this committee, but it was helpful as it turned out—is continue to meet the representatives of carer organisations and the people who experience the service. I think that there are powerful testimonies, and they are not all about what is working. I have already acknowledged the convener's point about some who feel quite strongly about what they are not getting from this as well as what they are. We can continue to learn. However, if we adopt a proposition, and it would not be my intention to do this, that we should somehow move into a mode of telling local government what to do, I do not think that that is an effective way to run this. I would like to be clear that that is not what I was recommending. Can I just ask for a clarification? Who is in charge then of the SDS project? Well, local authority or the integration partnerships are in charge of delivering it. I think that to suggest that one person was in charge of it would be— I think that it would be helpful to know who is and who can be interpreted how you like. I asked before in another session about chain of command then. Who is at the top of the chain of command? In that context, Mr Bowman, I am at the top of the chain of command in the sense that the officials in the National Health Service in Scotland—I am the chief executive of the National Health Service in Scotland—are at the top of the chain of command. That is not something that is delivered by a single agency or body. Therefore, let me be quite straight. I could simply say that I am in charge, but it would not be true. I am responsible for—I am the accountable officer for—the budget that comes from the areas that I am responsible for, but there is money that is directly assigned to local government, and therefore each partnership is responsible for the delivery of self-directed support in its area. Does a partnership model work then? Better than almost anything else that you have tried. There are few things that are not delivered better in partnership. I am absolutely fundamentally clear about that. I think that it is not easy. It would be much simpler but much less effective if somebody—and it would not matter too much who, along this row of people here, could just give instructions and say that this is what is going to happen next and in what order. That would completely ignore, however, the fact that, as Jeff Huggins, Pauline McLean and others have explained, those systems are delivered in localities, which are very different. A single all-encompassing edict would simply not work. There is a ministerial steering group that is jointly chaired by Cabinet Secretary for Health and Sport and COSLA's lead spokesperson for Health and Social Care, Councillor Peter Johnston. There is governance in place that oversees integration partnerships, and that is joint governance and deliberately so. I may not be giving you exactly the answer that you are looking for, but that is the answer as it currently is. I would differentiate between giving instructions and leadership. You have heard from COSLA that they are not happy about everything and suggested, for example, that the more money might help and your response was, well, I will awake their submission. Before I have suggested to you that you have a passive management style where you delegate and let things happen, could you not be more proactive in these matters and show a bit more leadership? I do not think that any leader will sign up to a proposition that they have not seen, so I am happy to wait for it and to receive it. I also think that if you have deduced that I have a passive management style, I think that you have not seen it at all. I await that, but I think that being proactive and waiting for something before you act is in different things, but anyway, I think that you have told me what I need to know. Can I just pick up on one very small, very quickly point? You spoke about, I think that it was you that actually raised this amount of money that was spent with 40 per cent. I noticed that you referred to various funds on page, well, that is page 4 to me, maybe page 2 of your submission, supporting the right direction innovation fund. You talked about £2.9 million has been invested, £1.2 million has been invested. What does invested mean? Spent. Can we not just say that? Invested suggests that you are creating something for your balance sheet. Mr Rowan, at the risk of agreeing with you, I agree with you. It is clumsy drafting, it is not a word that I particularly like. I don't think that it is only you that falls into that. I won't say trap. Well, I agree. Okay. Notive agreement. I intend to conclude this evidence session. Can I thank the witnesses for coming along this morning and providing us with some very interesting evidence? I now move this committee into private session.