 Good morning, everyone, and welcome to the fourth meeting of the Health and Sport Committee in the Scottish Parliament's fifth session. I could ask everyone in the room to switch off their mobile phones as they can interfere with the sound system. We have apologies from Donald Cameron this morning, who is slightly delayed. I will not tell you why. Well, I will. His daughter is locked to car keys in the car. Just smile when he comes in. The first item on our agenda is evidence on the social and community care workforce. Before we begin, I would like to note that the committee met with front-line social and community care staff earlier this morning. I would like to thank them for taking time out their day to come and meet with us and tell us their experiences working in the sector. It was a very informative and helpful morning. I do not know if any of my colleagues would like to very briefly comment on the meeting this morning. I would like to put on record my thanks to the staff who came along this morning. I thought that they were very frank with us, very open and honest with us, and they were really to be congratulated for coming along and representing their workforce. It was a very good session this morning. We now move on to our evidence session on the social and community care workforce. My name is Neil Findlay. I am the chair of the Health and Sport Committee. I am going to ask people to introduce themselves around the table so that they are clear for us. Hi, I am Clare Haughey. I am the deputy convener of the Health and Sport Committee. Hello, I am Jim Fordice. I am the managing director of a company called Hazelhead Home Care who provides care at home services. My name is Tom Arthur. I am an MSP for Renfrewshire South. Good morning. I am Miles Briggs. I am an MSP for Lothian and a member of the committee. I am Donald McCaskill. I am the chief executive of Scottish Care, which is a national membership organisation of providers of older people's care and support. Good morning, everyone. I am Alex Cole-Hamilton. I am MSP for Edinburgh Wesson. Good morning. I am Doug Watson. I am the head of policy and public affairs at Unison Scotland. We represent care staff. Good morning. I am Richard Lyle. I am MSP for Edinburgh Wesson. I am Nicky Connor. I am an associate director of nursing within the health and social care partnership in Fife. I am Alison Johnstone, MSP for Lothian. Hello, Annie Gunnar Logan. I am from CCPS, the coalition of care and support providers in Scotland, which is the membership association for third or voluntary sector providers. I am also a non-executive director of the Scottish Government, but I am not hearing that capacity today. For the record, I am a Unison member. My name is Mary Todd. I am an MSP for the Highland and Island region. My name is Ian Ramsey. I am from Aberdeenshire Health and Social Care partnership. Good morning. I am Emma Collinsmith. I am an MSP for the South of Scotland. Good morning. I am Anna Fowley. I am the chief executive of the Scottish Social Services Council. We are the regulator for the social care and social workforce and also the lead for workforce development for that sector. Hi. I am Ivan McKee. I am the MSP for Glasgow Provin. Okay. Thanks very much, folks. We want this to be a lively interactive session rather than a formal evidence session, as we usually have. We are happy for people to jump in, but we have about 75 minutes for our session. Brief contributions would be helpful, and not everyone needs to contribute on every topic. For the committee members, if they want to indicate if we want to move on to another topic, that would be helpful. It is fair to say that we all learned a lot this morning hearing direct from those who are working in the delivery of care in our communities. Workforce planning is clearly an issue. I heard from one worker who had undertaken 31 visits to different people on Sunday. Clearly a fairly hefty workload, and I heard a lot of 7am to 10pm shifts. There was a feeling among some organisations that this was due to lack of staff, lots of overtime required and clearly a very responsible task. I would just like to ask what the main barriers are to effective planning of this workforce, because it certainly seems that there are several. I am not sure who to direct that question to in the first instance, convener. Who would like to jump in? Dave Watson has never been shy in his life. Workforce planning within what you describe is something that we look at often. What we particularly do specifically—you are talking about Sunday there—is something that we see quite a lot. What we do personally is an organisation. Our full-time workers work three out of four weekends. Nearly every other organisation we come across work one in every two weekends. I cannot see how, at weekends, it is possible to do that. That is why we have always went shooting forward to make sure that we will get the same number of workforce throughout the week. That is the type of thing that we look at particularly as an organisation. I heard a fair amount, too, that a lot of organisations are relying on agency workers, which obviously has an impact on continuity of care, which can be quite distressing, sometimes perhaps, for those who have dementia. I probably left this morning's session thinking that we do not have enough people working in care, and that there is a variety of training on offer for those who are working in the field. The use of agency staff is a matter of considerable concern for many of our members. Sometimes agency staff are helpful during transition periods at holiday or relief, but this is particularly the case with regard to the use of agency staff to fill nursing posts. We have profound concerns about the lack of the continuity of care, particularly as you have highlighted, with somebody who may be living with dementia. That continuity is fundamentally important. Organisations do not want to use agency staff, not least because they are considerably more expensive. I heard of one provider last week who paid £800 a night for a nursing shift. That is not a good business model. It does not give continuity. It is not good for colleagues to see somebody being brought in. The individual brought in on a short-term basis does not know the individuals that they are supporting. We have a critical shortage in some elements of social care and nursing staff. That is all bound up with our ability to recruit and retain staff, which we are not at the moment able to do in the numbers, which would lead to the reduction of the use of agencies. Can I just ask for a bit of focus there as well on what you see as the main barriers to that recruitment? There are lots of barriers. I took part in a project last year called Voices from the Frontline and I was privileged with colleagues in Scottish Care to interview a number of front-line workers as you have been privileged to meet them this morning. The two, a man and woman, are dedicated individuals who give of their life to the care and support of individuals, but there are things that would make them think about whether they can continue in their job. Terms and conditions is undoubtedly one of those things. The fact that from 1 October in most parts of Scotland we will be able to pay the Scottish living wage will go a long way to meet that particular need, but we have other issues in terms of terms and conditions, which need to be addressed, training, learning and development, but fundamentally we also, and I do not think that we can escape this reality, we also have to accept that for many individuals working in care, working with people is not something that they find attractive. Society Scotland as a whole does not value those who work in the care of older people in my case, but in the care of many other individuals. So even if we attend to the fundamentally important issue of proper terms and conditions, we all collectively need to do a lot more to advance the value of those who care for people and we do not do that. The issue that came up time and time again this morning was about being undervalued and that was repeated time again. Arre, so. Yes, thanks Kevin. The barrier specifically, I might add to what Donald said about recruitment because I think that's an issue. More generally I think that the numbers of people who might be required in the future to make this a sustainable sector is quite challenging. The Scottish Government itself came out at one point and said, you know, it won't be very much longer before every single care leaver, every single school leaver is going to have to go into care in order to kind of keep the thing afloat. And I think one of the things that our members are looking at very carefully in relation to that is service redesign because we can't kind of keep going in and providing care and support in the way that we are so we need to kind of figure out a different way of doing it. Certainly the voluntary sector, we're very interested in the potential of self-directed support around that. But something else that I would want to add to one of the barriers that the member asked about and you'll know, convener, that it doesn't take me long to get around to commissioning and procurement of care and support is the way in which care is commissioned on framework contracts. So, you know, it used to be much more the case that you would, as a provider, you would get a contract for a service with a certain number of hours, with a certain number of people to support and then you could plan your workforce around that. Increasingly, you are then now accepted onto a framework so you have no sense of how many people you might have to provide support to in the future, how many hours of support you might have to provide. So, in that kind of circumstance, it's very, very difficult to do forward planning for the workforce. So, we would like to see not just service redesign but a redesign of the way that care is commissioned because I think that's really quite a significant barrier. Yeah, I mean, a large agreement. If you looked at a chance to read our later survey of care staff, I would guess some of the pretty similar things you have heard this morning. The report we care, do you, essentially takes the voices of our front line care workers and explains what their concerns are. Fundamentally, there simply aren't enough staff, it's a bottom line, is that staff tell you that even when they finish their shift, they get a phone call saying, can you do another case? Can you do another one? And that's difficult itself, or can you squeeze another one in? In other words, bluntly, people who are supposed to get a 30-minute visit, get a 20-minute visit because you've got to try and squeeze another visit in that's not being scheduled. Linked very closely to that is the fact that, I agree with you, a lot of travel time is not taken into account in a lot of the programmes so that, in theory, a person is getting a 30-minute visit actually to allow the time to travel, they're actually only getting a 20-minute visit. The other big problem is that because of the perceived lack of attractive job prospects in the sector, pay and et cetera, the turnover is very high in this sector. Even among better employers, and I'm not just talking about the worst in the sector, I've seen turnover rates in some of our better employers are nearly 25%. Now, that's call centre standards to give you a sort of idea which is notorious for having high turnover rates. Now, you cannot provide continuity care particularly for elderly people if you're seeing a different carer almost every week and that is the case. Barriers, paying additions are important but we do need to see this as an all workforce issue. One of the points that we made, the Scottish Government's guidance on procurement makes it clear that local authorities should be procuring on all workforce issues, so that's pay, conditions, travelling time, training, all of those things should be taken into account. Frankly, they're not. We also need to remember we need to attract about another 60,000 care workers into the sector in the coming years. Now, if we can't recruit at the moment, where's the next 60,000? I won't dare mention Brexit if you want to get onto that later because a lot of these workers are EU nationals so we've got another issue to face up there but the reality is that if you talk to people face to face and I've done a number of focus groups with our members in this area, the older staffs tend to say well I'll probably hang on till retirement. The younger staff and there are spikes in the sector. There is a group in the late 40s, early 50s and a late 20s, early 30s group. The late 20s, early 30s group say this is not an attractive job Dave. If I can get better money stacking shelves in the supermarket that's where I'm going. Things that have been drawn out there, colleagues earlier referenced nursing and in quality and continuity of care and there's a huge amount of work happening nationally around the review of district nursing, around the hours review, around the development of clusters, locality, working in general practice and I absolutely agree with what colleagues said around this being a whole workforce issue, around how we will work together, how do we create and make the best use of the skills that everybody has so that we're making the best value of the contribution of everybody to meet the needs of people within the community setting. Just on this there was a couple of things that were one thing that was raised this morning which was interesting for me. One of the care workers said that part of the problem is you can be on for a 12 or a 13 hour day but you're only working for seven or eight hours of those perhaps. So that does a number of things. It discourages people from staying in the profession when they realise that they could go into a 12 hour shift in Asda and they get paid for every one of those hours compared to the situation they're in in the care home. Clearly it's a logistics planning issue which I know can be challenging but also it says there's unused capacity there if people are in that situation so I just wonder if we want to comment on that and the on this was on the self-directed support which I don't know a lot about and it's interesting that you mentioned that but if you look at that at a macro level are you not just in a position where you're saying yeah we've got a problem let's move the problem somewhere else because at the end of the day if the individual patient goes and hire somebody to do that job they're still hiring from the same pool of people that exist to do that kind of work so you're not actually fixing the root cause of the problem maybe just moving it to somebody else. Now even he's just raised there just to say no come to you next I'll like okay. I think it's a fair point to understand about self-directed support is it's not necessarily an individual hiring their own personal assistant there are other things that you can do you can buy in care from an agency you can be much more flexible about it. I think where self-directed support starts to raise some questions for me around the issue that you're addressing there is how you can provide personalised care for people who will want to choose when they want support and at what time and it won't necessarily be at the time that the council wants to send somebody around and how as an employer you can employ people on fair work principles at the same time as being completely responsive to individuals who don't want it nine to five who don't want it Monday to Friday who might want support at odd times and then not others. The committee will be aware I'm sure of the Fair Work Convention which has been established to advise the government on on fair work principles and my understanding is that they want to look at this issue very very specifically around social care personalisation and fair work and how we actually manage that so that might be one to watch. My question is very much to explore further the issues of self-directed support. I think that the vision of STS was something that gathered cross-party support in terms of service redesign in answering the very real and present sort of threat of the perfect storm if you like of the aging demographic, the decline in the workforce and all the issues we've heard about this morning. I wonder if people around the table colleagues around the table could explore how they think STS is working out in particular the impact on the commissioning environment because we heard at the NHS Lothian briefing on Friday that some providers have aggressively gone after recruiting their patients into STS to avoid commissioning but also that there is a mixed picture out there as to what's available so that you may have the choice to take on full control of your budget but if you've only got a sole provider in a rural region there's no real point because you'll get the service that you are being provided already. Can I make an observation? I think that you're right and the committee will know that STS did have cross-party support. I personally believe that it has the potential to be amongst the most innovative answers to some of the particular challenges that we're facing but we're not maximising the opportunities that that legislation gives to us. I think that one of the problems is that we talk about STS here and we talk about social care assessment over there but there is only one type of assessment for somebody who requires social care support and that is under the self-directed support legislation. Are we maximising the opportunities of all the four options? No and is there a piecemeal approach in different parts of the country? Certainly and for those who I support what we are seeing is an under-use of self-directed support by our older citizens. There's almost the presumption that what might be additional engagement through planning your own support and life is something for those under the age of 65. That's a very false assumption. We and our members know that lots of older people would like much greater control over the personal budgets which would enable them to lead increasingly independent lives so real potential which we haven't maximised and it necessitates us as Annie has said looking at the way in which we commission and procure services because if you commission an organisation to provide a 15-minute or a half hour support to an individual that is not going to enable the holistic person-centred approach which the act envisaged. Stask in relation to self-directed support whether you think it will close the gap in health inequality or widen the gap because my view is the potential to widen the gap and that for certain people they wouldn't know how to organise that, they wouldn't have the support, the family support or the framework around them to organise that therefore they're not going to do that, they're not going to get that self-directed support advantage that other people may. I suppose in essence that self-directed support legislation was actually the reverse, it was about creating a quality of opportunity so those who were articulate who had family connection weren't those who were going to be most advantaged but if you had a system where people had increased choice, had information around that choice, had support to be able to make that choice then actually it would lead to better personal outcomes so I hope I'm not dreaming when I think that it is possible for this legislation to reduce health inequality by giving people the sort of service and support that they really need and which clinically and personally will achieve better outcomes for them. We've got a long way to go and I think at the moment we've so focused on getting the system of integration right that we've taken our eye off the potential of self-directed support. We need to refocus that attention. Colin Beattie. Can I come back to the issue of recruitment retention? It was actually the point that Dr McCaskill made earlier about the fact that the Scottish living wage obviously kicks in from the 1st of October and I'm keen to get any observations on that process and in particular how that process I've introduced in the Scottish living wage has actually gone because obviously there's a big requirement for negotiations of commissions and contracts there so I'm keen to know it has that process gone smoothly, has the allocation of resources to deliver the Scottish living wage being sufficient for providers and looking beyond the living wage what other ways or specific measures do you think could be introduced to boost recruitment and retention? I don't think there's a one answer to that range of questions in terms of how is it going that depends on which part of the country you're in. If we can deal with in for my sector two different groups the care home sector as a result of the national care home contract every care home in Scotland that certainly who has signed up to the contract will be in a position from the 1st of October to pay staff the Scottish living wage that's been part of that national negotiation process there are been challenges in that sector the settlement did not allocate some monies to take account of differentials and that's critically important because if as you will have heard this morning we are wanting to create social care as a pathway as a career of choice then simply paying and allocating monies to pay the Scottish living wage to those at entry level doesn't enable that career to be established so if you are as a provider having to eat into your assets your training budget your reserves which might have gone for further service development if you're having to eat into that as they are now in order to pay enhanced rates to a supervisor or a manager that's a short term fix for a fairly fundamental problem on the other hand we've got the care at home and housing support sector because we are in that system of local commissioning and procurement the answer to your question depends on which part of the country that you're in we I think in Scottish care have significant concerns that in a good number of areas in Scotland we will be in a position in the 1st of October of providers on the one hand having to make a choice of reducing terms and conditions just in order to pay the baseline Scottish living wage and in other parts of the country not being able to pay the Scottish living wage because the offer from the local authority and the IJB is such that they will be unsustainable and non viable and my concern as a membership organisation is that that challenge is particularly faced for the majority of small medium enterprise family run businesses in Scotland if you only operate in one area if your staff based is only in one area you don't have the economy of scale to balance one area against another an area which may give you a better package and deal and we have lastly concerns about approaches which are introducing a percentage uplift percentage uplift sound and look as if they are fair but they're only equitable if you start from an equal baseline so if I'm a provider in one local authority area being paid 11 pounds an hour for caring support and somebody else is being paid 15 pounds an hour the guy at 15 pounds an hour with a two or three percent uplift will be able to pay the living wage without restricting staff conditions in a viable way but the person at 11 pound will not and those 11 pound folks are our small medium high quality organisations and I'm profoundly concerned in some parts of Scotland though negotiations are on going that that will not be achieved. The issue of personal assistance which as Annie pointed out is only one aspect of the self-directed support legislation but it's in the context of fair work that group of people if we are hanging a lot on growing the capacity that we have in personal assistance then we really have to look at them in the context of fair work because those people are very very vulnerable they're working with people who are vulnerable yes the service users are vulnerable however the workers themselves are very very much they're not subject to the living wage agreement as many people across I mean it's a myth to say it's social services workers are getting the living wage it's not it's very specific workers who are getting the living wage anyone working in adult daycare for example working with children they don't get it or they're not part of this commitment and personal assistance I feel will probably be last in the queue because they're not organised their individuals they're not well like much of the workforce they're not unionised and therefore they're very vulnerable so I would worry about them in this context but also on the question of the living wage I think that what the point that Donald made earlier about not valuing the workers I think it's we don't value people who work in care we don't regard them in the same way that we do teachers or nurses or you know other other workers footballers even how shocking is that but we we also don't value the people that they work with and I think that's a knock-on effect we don't value old people particularly in this country we don't value children particularly in this country and I think that that's a real indictment on our society but until we can change that we we need we will not manage to recognise and get people working in the sector because they need to feel like they're doing a valuable thing the thing the view from here work that Iris did last year with The Guardian newspaper was the only time that The Guardian had heard the words joy mentioned in one of their surveys of staff because the staff that they talked to loved what they did but they felt exploited the only people they felt valued by were the people that used their services and the people they worked with but that brought them joy but how so how do we kind of harness that and make that more recognised as part of society I suppose you see that very much reflects what we heard this morning um Ian and then Marie forgive me but I can only speak on behalf of Aberdeenshire so it will be a quite a parochial approach that I'll take in terms of the challenges around about the original question about workforce I think it has a different dynamic in on almost every part of Scotland and I would like to reflect in terms of Aberdeenshire you know we have a very rural geography in Aberdeenshire and it is incredibly difficult to to recruit all types of health and social care staff to to that to a rural environment and I think the economics of the northeast also play into it we have still a buoyant oil and gas industry which in house prices are still relatively high as well so it is difficult to to attract I think one of the one of the key points and this is round about how we value staff across health and social care partnerships and I think that that is a fundamental aspect that over over a period of time hasn't been addressed properly we we are developing through health and social care integration integrated properly integrated teams one team approach so that health and social care staff including gps actually feel part of a team and I think for for a long period of time home carers support workers these people have been seen out with that team and I think it's absolutely now the opportunity that we have in Aberdeenshire to draw those individuals into the team and make them feel valued and respected within that environment yeah I would just say that I heard that from some of the people who we spoke to this morning said exactly that point and that that part of the value was relationships so I'm glad you're doing it that way in Aberdeenshire and we should all I keep saying this we should be looking north I just wanted to ask about in terms of valuing staff I think that I got a sense that that in the caring environment there's probably more value placed in caring in child care there's more training available available there's more regulation there's more obvious career paths is that something that you guys would agree with and would say was was an issue as well and I think in terms of valuing people like I think providing training is one of the main ways that you invest in staff so you know I'm interested to hear what you think about training and career progression I mean I'm a care at home provider a care at home employer as a managing director I actually take two days a week to interview frontline care workers it's the most important part of my job it's what I spend most of my time doing and you asked what's at the back was asked earlier on about the barriers to entry and a lot of the things regarding the acceptance and the importance of the jobs have been discussed but there's some there's some sort of for care at home providers people who are flexible that are mobile particularly car drivers interestingly enough there's one of the huge barriers to entry for us is people that don't drive now I know it seems like a funny thing right but I need people who can drive cars also need people who can work what we would term as on social hours for weekends and for evenings what I tell people interview is we need to provide services when people want services not when we want to provide services so there is a limited because even you look at what we actually need to provide services it actually starts to limit irrespective of whether people are actually physically able to do the job but it actually limits the choices that you have in a profession in the care of home setting other things is a sort of as barriers is we live in a sort of society where is acceptable to a certain extent especially in a home setting where female workers can provide personal care which is a huge part of our job to both male and female service users that's not the case necessarily for male workers so there is an imbalance built into the numbers in absolute terms so it's not like I when I look at my workforce plan I will take on 50-50 particularly it would be a much higher amount of women entering the workforce so you can see the types of whittling down of the people that we can actually do the care at the £8.25 minimum wage I see as a start and actually could be transformational within our industry I think it you know as long as that is the starting point in this progression with an organisation I think that that could begin to reflect the importance of the job at the care worker to address your point about the comparative levels of training and regulation there's actually more regulation of workers in the social service workforce than there is in the care sector as we regulate everyone who works in care homes at the moment all the managers across social services are regulated and the care at home workforce is coming on from next year and to be on our register you have to have minimum qualifications so they must and you have time to get the qualifications but over the course of time I am and currently we're going through this with people working in care homes everyone will have to get my minimum qualifications all the managers and they are all they're doing that just now all the managers already have to have management qualifications so I think there's a difference and how people experience the training that they get especially in care at home at the moment is will vary across the country but there are actually minimum standards and minimum requirements that they do have to meet We are increasingly making social care a career of choice and into the future there is absolutely tremendous opportunity if we're going to meet the needs of the national clinical strategy the out of our strategy if we're going to meet all that lies potentially with integration then we're going to have staff needing in the community and in care homes to be upskilled to develop increased capacity and ability so there is a potential for positive careers in care but we need to give all the value both in terms of conditions and other elements of service I think all agree would agree the potentials there but from the evidence that we heard this morning we're a long long way from that Annie to come back on a couple of points the member here I'll lodge with the committee our benchmarking HR report from our from from the voluntary sector providers and one of the encouraging things in that was was that voluntary sector providers are very committed training and development and nearly 70% of the providers we surveyed had actually managed to keep their development and training budgets stable or had increased it and that has been not without its struggles but if you're looking to develop a workforce to make it an attractive career you absolutely have to invest in that and in our sector we've kind of placed quite a high priority on that I just wanted to come back to the living wage question convener for me briefly I mean you'll know that that my organisation has campaigned for this for a very long time I think we've probably led the debate on this over the years by producing evidence about the impact of paying conditions on quality and we were absolutely delighted when this initiative was announced back in February if I'm honest I'd have to say we were less delighted that we read about it in the paper rather than actually being involved in some of the decision making around it so providers weren't involved in the decisions about the amount of resource and we weren't involved in the setting of dates around implementation and so at this point we are struggling to to get over the bar I think a lot of providers are confident that they'll make it but there are some challenges and Donald set them out I mean part of the challenge was that the resource that was allocated didn't it didn't account for differentials within organisations which is huge if you're talking about career progression and development but it also didn't include on-costs for employers so national insurance pension contributions and there was an assumption that providers would would find a contribution to make to this and certainly in the not-for-profit sector that is something which we are really struggling with to be honest we are working through these issues now with partnerships we're working with with Scottish Government Donald and I around the table unison around the table but I wouldn't say that it was easy we took some soundings from our members on the 1st of September kind of with one month to go and the majority of them were thinking really we're struggling to arrive at appropriate funding agreements because as the committee has heard this money was allocated through local authorities and integrated joint boards in order to then to contract locally with providers we certainly advocated a national approach that wasn't taken forward and we advocated an approach which was less about the amount of money that went into staff pockets because that's something that employers need to deal with we advocated an approach which was about how much we pay for public services and therefore what is the enabling factor that allows providers to pay the living wage and that wasn't taken forward either so there are some hurdles to overcome I think we will be taking some more soundings over the coming weeks but we're hopeful and yet cautious. A couple of questions right firstly on training I think it's absolutely right that's key I'd have to say our experiences it's a bit patchy in places I'm particularly concerned about induction training in home care areas I frequently get examples frankly institutions ringing up when their daughter or sons have been started work and are not given adequate induction before being sent out into fairly complicated care areas also refresher training ongoing training CPD very often staff tell us that they're told to do that in their day off which is not in fact the way it should happen so there are issues there I think the point about rural areas is well made I was talking to social worker last week who said she rang five providers to try and provide a package for an elderly person needing hospital and several of the providers said we don't do villages um as a response um and I should say this was a rather rural local authority um so she wasn't much impressed by by that either but I think it does reflect some of the challenges in fairness to providers in terms of getting people out and of course travelling time is a huge issue there if I can address Colin's question um I largely agree with with Anne's response um let's be very clear we welcome the Scottish Government's commitment to the 825 living wage from the 1st of October I think it's absolutely the right policy um I think the difficulties has been in the delivery of that um we were told £250 million was allocated in the budget for social care difficulty we weren't told how that's broken down how much was for living wage how much was for building capacity and so forth so I think there was that problem the other concern we have is if you put too much focus on the Scottish living wage then frankly some of the bada the worst providers in the area will try and cut other terms and conditions to do that so they'll meet the headline yes minister we're paying 825 an hour uh but they'll cut travelling time they'll charge your mobile phones they'll they'll they won't pay holders they pay properly sleepovers a whole range of issues where they'll they'll cut current terms and conditions and frankly our survey our FOI in our latest survey to councils indicate they didn't even most of them were admitted they weren't following the Scottish Government's statutory guidance in this area just said oh um no we're not following it um so that's a real area of concern the solution frankly uh if the government had said look we accept government in the current climate is not going to have all the money to solve all the problems in the social care sector but if they've come say in april and said and got ourselves the providers cosler and everyone else around the table and said look this is the money will be absolutely transpired what it is this is what we want to deliver let's have a discussion about how to deliver that we would have all played ball with that we wouldn't be in this are we going to make it by by the first of october situation that everybody is in in at present and i do think that involves a national rate for home care we've got one for the residential sector i think we should have one for the home care sector as well so that requires early engagement transparency about funding and it and it also means recognising as unison's ethical care charter which a number of authorities are now picking up recognise you've got to do a range of things pay is very important but there are other things you've got to do as well so i think if we had a national forum to do this that would allow local authorities the integrated joint boards remember the money didn't go to councils it went into health service and then into ijbs and then into councils which seems the most bizarre way of funding anything um so if we actually had that transparent system i think that would allow the ijbs to focus on designing the best system the best service delivery service design issues locally without having to worry about the key issues in terms of contractual rights yeah just to go back in touch on the the integration aspect of it one of the things that was raised this morning by the care workers was the difficulty they found in coordinating and getting responses from other people that were involved in the process one example was a doctor will come in and make an assessment right up some notes but they never tell us so we have no idea what the status of the patient is or getting a hold of other staff in other parts so that's clearly an issue they identified i don't know if you wanted to comment on that and i don't know if there's an issue there about different types of provider be it local authority or alley or voluntary sector or private sector that i don't know if that makes a difference in that in that that if you're not the other thing just to put in there a different question was just inquire about measures of patient satisfaction that are in operation and how those are how those are tracked and what those show and that is that we're continually speaking to staff both in care homes and at care home services who struggle to have that centre comes back to our issue of value if your role and contribution to the health and wellbeing of the individuals you're supporting is not being valued by clinical colleagues in the community whether they're general practitioners, allied health professionals or others then that is going to have a profound impact on the individual who is receiving that care and support and let's be honest we've got a piecemeal level of support particularly for older individuals i've read a brief summary report this morning about how poor post diagnostic support is for individuals with dementia in care homes we've you know we're getting it right in the community we're not getting it right for individuals within the care home sector so we need to if we're serious about integration and about valuing our unique contribution of social care staff as clinical professionals then we need to not just start talking to each other not just be co-located not just have teams networks or whatever but we need to start collaborating around the person who doesn't ultimately care what the colour of the uniform you are wearing is but what difference you make to her life and at the moment because of a lack of inter-professional support that's not happening a question about training because some of the care workers i spoke to this morning were almost saying that they were almost undertaking a community nurse role in in the job they do and with stoma bags feeding and managing medication things like that and i think with an increasing pallative care and end-of-life group of clients how is training being developed ahead of that given the demographic demographics we're going to face as a country i'd be interested to hear any of that ongoing workforce training and upskilling yeah sorry nicky i think that's a really important point i think in terms of joint training there's a lot now happening where people are developing and delivering training together some of what you refer to do not require registered nurses to deliver and i think when we look at delivering more complex care in the community whether it be in place of acute hospital care whether it be pallative care we need to be ensuring that nurses are able to be delivering what only nurses can deliver but actually there's a support network there so that people are not feeling dumped on left or anything else and we are working together i think there's a real role in terms of the development of clusters the development of local teams and what is within a locality and actually what does that mean for nursing for adult health professionals for general practice for our social care workforce and for our voluntary independent agencies in that area some examples of how i have seen that work in practice is a daily huddle where general practice would be saying there's a huge amount of data available to us around people who are at risk that we could be using and actually what does that mean about being a fluid with the workforce that we can have so we can put the care to where people need it most there's examples where a social care member of staff may be delivering and supporting care four times a day who would notice that somebody's pressure areas are becoming red who can then contact the nurse who can get involved earlier so we can really be getting upstream and preventing rather than reacting what's happening but i think there are examples whereby nurses are almost absorbing things that don't require them to do but i absolutely agree there's a training need there's a support need there's a governance need around making that safe for everybody a couple of things we heard this morning we were speaking to some of them we're telling us the new technology that they've been using where they get care plans on a smartphone and all the rest and that's great others are saying that they get a text from a manager that means that they no longer have any interaction with another person in the organisation so there are huge advantages with technology but other disadvantages as well alec then clear i'm not quite sure who's best to answer this but the committee has given itself the task of examining the implications of the brexit vote and i think at this stage it would help to find out what estimate you can put on the percentage of EU nationals working in the social care workforce firstly and secondly is there any great divergence in terms of geography or or the independent or internal structures that would that would help i don't know who can answer this there i know you mentioned it yeah i mean i did mention it it's interesting after the day after the the referendum i thought we better find out how many how many staff we've got who are EU nationals and how many members and so you know i i did i've got my team working on all the usual sources and you very quickly discovered there isn't any data and and and and we don't know there is for example in the nhs a survey of of ethnicity essentially but it's voluntary and large chunks of staff choose not to answer it you might be worried as to why they feel they don't not able to to answer that that survey but the sad fact is that they don't so we don't really know that we've done some work ourselves we reckon we've got about 6000 members in scotland who are EU nationals and they are mostly in the health and and care sector the bulk of them i have to say are largely in the private nursing sector they're mostly don's areas there and we have an overseas nurses group so i meet quite a lot of them doing doing that area so the honest answer is we don't know but we do know is they a large chunk of that group i remember you know working Scottish Government Health Department doing workforce planning the thought that Annie was referring to some years ago and then we were talking about having to essentially bring almost every young person certainly women the girls coming into into into the area didn't happen that's because migration took up the slack the next big jump 60 000 places in health and care it's not just social care that's health care as well um you know they're just not going to be available you know the simple demographics tell us that not enough young people are going to going to be there be want to work in this sector so without that level of migration i just don't know what we're going to do so it's a real concern for us under Brexit that first of all we what we said to the Scottish Government we said to your colleagues on the external relations committee is that we need an absolute commitment from the UK government that existing EU nationals must be allowed to stay unequivocably say it now because otherwise people will start to make alternative plans and go and secondly we need a long term arrangement whereby we can still recruit and retain staff from from overseas because we're going to need them to that because it is predominantly within the independent sector that many of the European nationals are working our last data is about nine months ago we're currently undergoing some research and hopefully that will be available in the next few weeks with a vacancy level of between 18 and 20 percent for nurses in the care set the independent care sector over the last 18 months we've noted that about 55 percent of recruitment has come from the European community we've seen major care home organizations and smaller organizations set up recruitment units in European cities so we have proportionately around about 14 to 16 percent of our workforce of our membership which is the largest social care workforce who would call Europe or who were born in Europe now we are confident because of the hospitality of our country that we will encourage those who are here to stay and to find a place of value and welcome but that as Dave said doesn't answer the question of how are we going to plug the gap which has been in existence already and which will only grow in the future and migration seems to us to be the only answer to that question thank you thank you convener my question speaks to Dave's Dave Watson's very eye-opening anecdote about the we don't do villages comment and it's about the urban rural split in terms of social care provision when I worked for a social care provider before becoming an msp we did a bit of work with Angus and identified that there was only 104 children in the whole of that authority who required who had been assessed to require respite support which if you think about it means that that becomes a very difficult business case for a new provider looking to expand into the area that has a knock-on effect for choice in terms of social self-directed support as we discussed earlier but also it has other implications in terms of travel times around rural areas that you know if you've got a an arrow of window to fill to meet somebody and to support them it may take you 25 minutes half an hour to get there I wonder if our panellists could reflect on that and tell us how if there are solutions to this or how they see that problem developing and I would agree I think we need to look north and in the highlands in particular around Inverness there are some innovative programmes in bulliskin where community groups have with the support of one of our members highland home carers have begun to develop alternative models in that case a workers cooperative and a community led model to provide social care support in some of our more rural and isolated communities and I've been enabled to do so with the support of NHS Highland and Highland council so where there is collective partnership working then we're coming up with the solutions to the challenge where there is not then the challenge has only grow clear thank you convener and I want to declare an interest in that I'm a member of unison one of the issues that was raised with me this morning was the use of zero air contracts within particularly home care and this wasn't a short-term measure for covering holidays or vacancies this was staff who were employed on a continual basis on zero air contracts and who would also expect to do training in their own time unpaid what I would like to ask is how can a social care providers justify this on a long term basis and also what work are the IGIBs at NHS doing to ensure that anyone who is contracted to an IGIB is not using exploitative zero air contracts? Again I personally as an organisation we don't use zero air contracts at all we have 320 staff we contract all our staff it's possible to do there is a price to pay in that and it actually falls on to the question that Ivan had said earlier on about it's spread out during the day and it's a bit about workforce planning as well so when how we're contracted by local authorities they've hollowed out the services a little bit so a lot of services in the morning a lot of services in the evening not so much in the middle so that's changed quite significantly in the last four or five years and that does mean for people to get full time hours people are working split shift now that's a you can explain that's just a fact of life at the moment but you can guarantee hours to do that to your point what you have to do is it does take a lot of planning to do that you have to be confident you're going to get the work you also have to someone mentioned earlier on about attaching certain service users to a particular worker for example we find that difficult to do the way things are contracted at the moment because if somebody goes into hospital somebody loses all their hours so it has to be a little bit more spread out so that if somebody goes in they don't lose all their hours kind of thing so it just takes a little bit of thought a bit of a little bit of a little bit of planning to do but it is possible to do we've done it we've always done it that way and for a lot of people so it is possible to do but it just takes a little bit of time to do that so in relation to that those two issues in relation to zero hours and living wage previously we were told that it was rules euro single market rules that type of thing that was preventing that becoming in as you know a statutory is that the case was that the case and might that change there's two points here firstly i think the if you look at the official statistics it would tell you that there's probably less than 10% in the sector on zero hours contracts actually that grossly underestimates the problem and the reason is because there are a lot of people on what I would call nominal hour contracts in the words which rather are under service not you're on zero hours what you get is a 10 hour contract or a 15 hour contract but actually you regularly work 20 and 25 so and that's equally as big a problem for if for someone in terms of getting your mortgage in terms of getting those sort of working out your career and puts off people working in the sectors no doubt about it that does leave to the point that I've raised about about split shifts you know we do find it's one thing if you've got a three hour split shift in the morning a three hour one in the evening and a big gap in between you can go home you can do other things frankly some of our members even do other jobs in between it's another thing altogether if it drags on till 12 and your next shift inverted commas is at two o'clock you haven't got time to go home so you spend you just walk into cafes and you know all sorts of places around scotland you will see an awful lot of of care workers in fact we even organise and do recruitment exercises in in in supermarkets because you can actually see care workers with their uniforms going around supermarkets in the coffee shops because they're cheap actually actually just wasting time frankly on that basis in terms of procurement there's been lots of myths around this the procurement guidance that we agreed with the Scottish government is actually shows how to do this and it's really disappointing that local authorities seem to struggle to actually follow it it's not idea we'd like it to be very clear specified the living wage and that's it in our view that can be done perfectly legally for all sorts of reasons the law office has felt that wasn't possible it is possible under the new guidance all that simply has to happen is the local authority specifies in its general strategy its policy on on on procurement what it wants to see living wage secure contracts time to care etc etc all of those things you can specify our care charter in there then it can evaluate contracts against it and once you award the contract essentially the contract is agreeing to deliver that so it's a bit messy it's a bit complicated but it's legal and it's doable and it's beyond understanding frankly as to why local authorities say they can't follow it i mean we're not point question is is is a really interesting one i mean i think i think the key to it is exploitative zero house contracts in the kind of sports direct fashion i think there are very few if any voluntary organisations that operate those as a general kind of package of terms and conditions for staff where where zero house contracts can be very useful with the agreement of staff is for relief and sessional staff and a lot of organisations will be operating it in cooperation with their own staff around that but by and large the kind of thing that you're talking about doesn't doesn't really exist in the voluntary sector the the fair work comments that Dave has made are are absolutely crucial i think and to the point what we found in in some tender exercises for social care is that the fair work question is there for bidders to answer and the waiting given to that and the tender evaluation is five percent you know whereas the cost is 30 or 40 percent and i think that's that's where we need to see some change much more weight given to fair work principles and and practice in in tenders and just coming back to donald's point previously about some of the community-based alternatives to getting an infrastructure of a provider into a village which is very difficult and actually very costly the minute you tender for that you'll kill it that's that would be that would be my view and certainly when we started talking about brexit within our own membership it wasn't the national workforce that came up first it was does this mean we can follow different rules around procurement now because people really really want that to happen sorry you've been waiting some time to follow up on a point that was made earlier regarding communication between a GP and a carer just in that instance i think that's a lot of that just based around about the historical construct construct of multidisciplinary teams and in many ways quite silo based and i think we have an opportunity now to and we are pursuing that opportunity to look at why does a carer have to go to their manager then relays information another manager who then relays it to another person and it just doesn't seem that sensible to have that approach so we're moving to a very much a location team approach where carers are part of that team and that that's it's called a virtual community ward so the practitioners gather together every morning with a whiteboard of of folk in their local village or town that they're concerned about and the gps are involved in that as well and they go through that list of people and there's feedback given and they come off the list if need be or they add other people on and it's it's not a health model it's not a social care model it's a joint model everybody's respected within that team and and their views and opinions are all are all exactly equal in there and i think that you know through that approach we break down some of those barriers of elitism that often creeps into the the multidisciplinary way of working in terms of your organisation what are they doing in relation to zero hours and do they operate within your area so i can only speak on behalf of the health and social care partnership in in Aberdeenshire um i think what what broadly happens is that we in the past had very fixed rotas and i think that it didn't necessarily suit many people in terms of a family friendly approach so we have a a range of shift patterns that now operate and a range of contracts that operate as well but most of them are based around about a set number of hours and there is also relief staff as well that are part of that that mix of staff however demand outstrips supply so if people want a certain amount of hours broadly they they are given that number of hours so it's it's it's you know and as i say it's very much based on around about the demand which is increasing all the time um and and we do struggle to meet that demand obviously our 60 of our providers struggle to recruit staff you don't enter into an exploitative situation if you're wanting to recruit staff employers in social care by and large don't establish themselves to be poor employers but it comes completely back to the fair work practice process that both Dave and Annie have talked about we will only ultimately get fair work conditions if we get a fair process of commissioning and procurement and that ultimately involves us all as Dave has suggested sitting around the table and saying what does it cost to give not basic but appropriate high quality care and support to our citizens and that involves a national process and it's about time because the sector the workers in the sector the managers and those who are providers are getting tired of constantly in different parts of the country negotiating a five pence here 10 pence there 16 pence somewhere else it's time for us if we're serious about in my sector older people care and support for us to get round the table within our limited resource and start negotiating about what does that look in practice Richard McLear? Donal McCaskill actually has just touched on the very point I was going to bring and and I do apologize to anyone who may take offense of what I'm going to ask but it's a question that's not been asked yet previously all care was done by councils council staff you know people run council homes and we privatised it all and everything supposedly get better we've got private care homes private care at home agency workers we don't get any villages because you know we don't do that have we privatised care too much have we got to a situation where we really need to bring it back under scale and sorry to say it gentlemen and ladies renationalise it bring it back you know because I've watched care workers from different agencies in my street going into different houses different agencies going into the same street you know so you know and with the greatest respect to private providers complaining about wages and conditions and holidays and whatever they make a profit they're in it to make a profit so should we not do what you're saying donal to do away with all these factors of five pence or whatever here and there to bring it back all back under the one umbrella rather than all the separate umbrellas that we presently are can I respond to that given that you know as the representative organisation of the independent which includes private charitable and not for profit I think what we're wanting is a range of choice for citizens so that if I want to choose provider A who's offering a particular skill set or provider B whether that's public private independent or charitable and voluntary so I think that's what we're ultimately a citizen's desiring but have we given sufficient resource to the sector no in the last 10 years year on year in we have reduced per capita the amount of money allocated to the care and support of older citizens and that has a profound impact on the nature and the quality of the services delivered so fundamentally the picture at the question is bigger not who does it but what is it that we want people to do what is the level of care and support that we're requiring because eligibility criteria keep getting higher and the old 20 30 years ago home help who fundamentally connected people up to their communities has gone and now as we've already heard we've got individuals engaged in high intensive emotionally draining work you know I was going to come back on the palliative care comment about are we ready for the palliative end of knife life needs of our community and in some areas yes but in other areas the person who sits with somebody in their last few weeks in life is terrified because she or he is not trained or not resourced because their organisation can't afford it so we do need to get around the table I don't think one answer is going to be the solution but we need at very least to start talking can ask him any providers that have been in the last 20 years has you know have it doubled quadrupled or stayed the same that's roughly when we started and it started there interesting and interesting at that time there was home helps who didn't do much personal care and district nurses just at that time stopped giving things that they called at that time a medical bath and earth and didn't give a social bath but only gave a medical bath and right at that and they asked nursing homes care homes to go out into community and provide medical bath that's actually our social bath sorry that's how a lot of care at home providers including herself started funnily enough around about that time in the mid 90s so that's how that a lot of our industry actually started was was a change in how the nursing in the community did and what the home helps could do at that particular time okay one of the things that we've touched on many many times is how we value our care staff um particular issues have been raised about parity of steam within a steam within the multi discipline environment but it goes deeper um my question sort of very short it concerns the welfare of care staff themselves who cares for carers because it was struck me in the conversations I was very privileged to have this morning the number of carers who just feel on the edge of breaking down overwhelmed so i would just like to ask do we know how many days are lost to stress to depression do we know how many of our carers have been prescribed antidepressants how many are battling with alcohol problems because these are some of the issues that were directly raised to me this morning and I'd like to hear some comments it has over a hundred front line workers they develop their programme and next week we're holding a day in which we will look with them at the emotional personal and physical wellbeing of home care and care at home care home staff because they said just as you have rightly identified that this is a hard joyful job which we enjoy but it's increasingly tiring and draining and all that relates to everything we've talked about this morning we if we're going to hold on to these dedicated individuals do need to attend to their health and wellbeing and we all need to start doing that together next week in Glasgow we're beginning that process difficult to achieve what you're asking for the only way at the moment to do it is to do things like donald's saying where you have focus groups and you have samples and you have surveys and you extrapolate up from that because what you're looking at is a sector with over 7 000 employers so it's not like you can just kind of go out to 32 councils or 14 health boards or whatever and say tell us the stats of your staff there's actually thousands of employers and they are the ones that will hold the information so it's really it's really hard to achieve but you can do it in that kind of sampling type of way. Annette, then, clear. My HR benchmarking survey from the voluntary sector the average number of days lost per employee was 9.9 economy as a whole is 8.3 and actually the figure was lower than the last time we checked it now how much of that is down to the kinds of issues you're talking about I can't I can't say but those has got some sort of stats that I put before the committee. Convenient, can I just come back on the member's point about privatisation? Hesitate to correct a member but I have to say that everything was not always provided by councils a lot of care and support has always been provided by voluntary organisations it's just that the public sector caught up with us eventually and decided to fund it publicly so I think the the issue that we've got here is you know whether things are provided by a mixed economy or not is is a matter of perhaps political taste but what I can tell you is in the voluntary sector the quality of care and support provided by the voluntary sector for adults in Scotland is much higher than either the private or the public sector so if we're actually looking at the service that people get there is a very good justification for actually putting more out into the voluntary sector rather than taking it back in-house again and just quickly to talk about the kinds of support that staff are getting for the sort of issues that you have Donald was talking earlier about the risk of living wage implementation that people will end up with £8.25 in their pocket but other things will be cut in order to pay for it one of the things that we're very very concerned about in relation to that is supervision supervision for staff because this is you know even if you're not doing extra hours or overtime you know it's a very challenging job at the best of times whether you have fair work principles or you don't so the importance of good management and supervisory support is critical and we certainly wouldn't want to see that sacrificed in pursuit of some kind of totemic achievement of a number somewhere. Okay, excellent, Alex. It is very quickly on the back of Annie's point. I should have declared at the start that the social care provider at work was abilar. There is empirical evidence to show that service provision in the voluntary sector can outstrip the statutory provision that we have for example in looked after children. Those who go who are in residential care in the voluntary sector have demonstrably better educational attainment and attendance so I think that rich tapestry of provision is absolutely vital and also in terms of procurement environment when services go out to tender voluntary sector providers often competing against in-house local authority providers who can hide some of their on-costs in terms of the economies of scale they get from being so big so there I would absolutely echo what Annie Gunan-Logwin was saying about the importance of a rich tapestry. Alison, then Dave. I think that this is obviously a very very challenging issue and you know we're learning a great deal this morning about the challenges we face ensuring that we have enough people delivering care and I'd just like to sort of explore. I think Ian you mentioned elitism sometimes, part of a multidisciplinary team. One of the groups I spoke with this morning felt that while GPs may engage well with them on a professional level, often they felt overlooked under value despite the fact they are the person who has spent most time that week with that patient. But the Scottish social services coalition report that there's a steady decline in registration and certification for SPQ health and social care. Apparently the social care sector 2015 report shows that there is a decline in registration for SPQ training. Now obviously if we're looking at a culture here that appreciates and values those working in social care are we investing enough in their training. When I heard from two people who were working for a private provider this morning who said they had three days training and clearly the better training that we can ensure that all those working in this field have the more able they will be to deal with what is clearly a stressful and demanding role. So just like a bit of you know some of your views on how will we're doing training staff in this area? There about the triple SC's data is what we think on that is that it's because most people have got the qualification now so the people working in the sector had time to get it so it's not that there's people aren't doing training so they've already met the registration requirements so that will gradually go right back to the beginning again with care at home and we get to opening the register for them in 2017 but for people working in care homes they've had considerable time now to actually achieve those qualifications. Maybe someone as well could pick up on whether or not agency staff are trained to the same specifications? Okay I'm going to take the final two people Dave and Ian and then we'll have a can I sum up? Yeah I mean to pick up on the point about about stress again if you read our later survey there are a number of staff who described in their own words the pressure they feel on the increasingly an awful lot of home care staff also dealing with end-of-life situations for which they're certainly not trained and they've had very little experience in dealing with. I think it's that the response from employers is mixed the best employers we've been working with doing quite a lot of work on on ill health on sickness absence in fact part of the cost reduction has been to try and focus on that and actually been very successful. I have to say in other although the one error actually that this sector is very poor on is dealing with violence at work too many employers I have to say say and I've heard chief executive one of the biggest providers say well that's part of the job I'm sorry it isn't part of the job and so we have a real problem with violence. The other issue in relation to the worst providers is if you talk to care staff they'll say we go to work when we're not well because we feel we will be penalised if we don't and you know obviously going to an elderly person when you're not well is not a clever practice to put it to put it to put it mildly equally you find those particularly those on zero hour contracts or none of our contracts they are the least likely not to go to work when they're not well and I also have to say they're also the least likely to report safety issues and they're also the least likely I'm sad to say and I was shocked when I asked the question I didn't plan to I said well would what about if you saw care abuse in the home would you report that and one member of staff said to me no Dave I would not my manager wouldn't thank me for it because they'd have to do something about it and because of the fragmented market they just feel they just go to a to another another provider so I think there are there are big issues in the sector I think the best employers in the sector are trying to tackle this frankly there are people at the lower end of the market who are not tackling it and there are real problems to be addressed and I would just like to follow up on a really Jim's point about how I suppose health and social care has developed over the last 20 30 years and the demographics show that we there are there are there are a lot of people who are more mature and who are being cared for at home many of these people are receiving end of life care and have conditions such as motor and neurone disease dementia and that place is a huge it puts a lot of pressure on carers practitioners doctors all of the multidisciplinary team and it can be quite it can be quite difficult caring for people in their own environment that's absolutely the right thing to do but in terms of how we support those individuals I think that's absolutely critical and how we support the practitioners and professionals around about that I think we do that through support and supervision we do that through having really a strong team ethos doing debrief these sorts of things but I think if we overlook that part of it we put far too much pressure on the individuals that are out there providing this care okay thanks very much I think maybe just to kind of finish up we might do a quick quiz round our guests this morning and you know we will be producing a reporter a letter to the government on following this short session and our evidence for people this morning so we're kind of looking for your top line on what we should be saying in that and maybe you know I'm sure everybody's got a may not have a different view but you know people will have different views as to what we should be saying in that reporter that letter that we sent for so you've got 30 seconds or a minute or so each to tell us what we should be putting in and if Anna do you want to start thank you for once glad to start because I'm going to say what everyone else probably say which is we need to value we need to value the workforce we need to value them not the living wage can't be our highest aspiration it's got to be a starting point but it's more than money and we have to value the people that those people work with as well. I think it would just be to reinforce that Scotland has a varied geography and we're one of the most rural parts but I don't think it's a one-size-fits-all with us I think integration of whole social care and that that push towards location focus local villages towns communities is absolutely right working alongside community planning is essential and communities and third sector all of these things is is is you know I think is incredibly incredibly important in this and I think ultimately we have to have staff that feel valued that are resilient that are well trained all of these things that have been spoken about already. I think it would be really good for the committee and we've talked about problems this morning but I think it would be good for the committee to look at what people do get out of this area of work because it's very substantial and I think when we we are looking at the problems that we've examined my plea would be that we emphasise that market mechanisms and a buyer supplier relationship for care will not solve our workforce issues and that partnership and getting all partners around the table in the way that Donald and Dave we're talking about will is our best hope. Nicky? I think that it's about valuing and I guess a strength and assets based approach our biggest assets are our workforce is about valuing our workforce as that but also about the diversity of people's needs people don't come in a box they they're not just an older person that they're you know it's not just mental health there's learning disability there's palletive care and frailty and I think it's about that whole team approach and using the assets of everybody within that team to provide support to our workforce and to ensure we're focusing our care on people that need it in the in the place in which they need it. Dave? Unsurprisingly care is not delivered by robots it's delivered by people and therefore workforce is the key to this that means proper pay and conditions it means training and most importantly means giving them the time to care if you read the surveys that's what staff say I want the time to care to get the feedback the organisational thing we'd ask you to say is a national sectoral framework for for for care the fair work convention recommended that we should have more sectoral collected bargaining in Scotland and the Scottish Government accepted that this is the sector where most of the money comes from the Scottish Government so it's easiest to deliver if we did one structural thing going forward is to create that framework. Donald? It's the words of somebody I spoke to a few weeks ago who was brought up in care and she said this is a pure dead brilliant job because I get to give back I love my job I love what I do it's just a pity I get embarrassed when I go out on a Saturday night and I tell people that I work in a care home and I used to work at home care that they feel what does that they don't value me I want a wee bit more money not a lot but I want people to value me for what I do. I think that this is a watershed I'm incredibly positive after all the negative things that I've said I'm incredibly positive this is a watershed moment two things are happening we've got £8.25 over the living wage going to be introduced I see that's a starting point changing from being a job to being a career the registration with the triple sc in early 2017 speaks to getting the qualifications to set the sq2 qualifications within our workforce so those two things going together and my opinion changes the whole dynamics of things going forward and we should celebrate what our industry is the rewards are beginning to get a little bit better for people the training is going to be much more formalised and the feedback we get for people who undertake the sq2 is incredibly positive and empowering for them it gives them a lot more confidence actually so I'm actually really quite positive about it as long as we can build from here okay thanks very much to everybody for coming in this morning greatly appreciated and we'll now suspend the meeting to change the panel okay our second item on the agenda today is consideration of a public petition pe 1477 by jamie rey on behalf of the throat cancer foundation on the human pamploma virus hpv immunisation programme in scotland members are aware of the previous work carried out by the public petitions committee on this petition scotsia government have agreed to implement a targeted extension of the hpv vaccine to include men who are sex with men up to the age of 45 who attend a gum and hiv clinic they have also advised that they would not propose extending the hpv programme to adolescent boys ahead of any recommendation of the gi cvi that the gi cvi may make and this recommendation is expected in 2017 the committee is going to look at the way in which we handle petitions given the number of new members and more experienced members who would like to be involved in that discussion around how the committee handles petitions so with the committee's agreement we will leave the petition sitting with us until we have that further discussion as can we get agreement on that thank you very much and we now move into private session and