 Felly, mae'n ddannig o bwyllfa ni, ac mae hi ddim yn gynghoeddiol. Fe fydd urch yn cfreidio'r mater i gael gyda'r? The minister will take questions at the end of his statement, so there should be no interventions or interruptions. Kev honestly, up to ten minutes minister. Thank you very much, Presiding Officer. I want to start by making my and the Scottish Government's position on this matter clear. longer un hospital, than medically necessary. For every day spent in hospital, that person loses part of their connection with their community, their family, and their friends. If everyone has the right to a home and an independent life, Scotland is not protecting the rights of people with learning disabilities in complex needs if we have to keep people in hospital when they should be living at home or in a homely environment with That is an absolute priority for me and that is why I am pleased to have this opportunity today to update Parliament on the action that the Scottish Government is taking to make change. Members may already be aware that earlier this month I welcomed the publication of the coming home implementation report, drafted by the working group that is established by the Scottish Government, to look into the issues of delayed discharge and out of area placements of people with complex needs. It sets out a clear vision that by March 2024, out-of-area residential placements and inappropriate hospital stays should be greatly reduced. Ultimately we want to be in a position where out-of-area residential placements are only made through individual or family choices and people are only in hospital for as long as they require assessment and treatment. The report sets out a number of key recommendations that I will ensure are taken forward at speed. Implementing those recommendations is an essential next step in improving the care and support that people with learning disabilities receive in Scotland. The report highlighted that one of the biggest challenges is around visibility and accountability. Too often people end up hidden in the current reporting and coding system, and I want to ensure that people are visible within the data and move to an approach where we use data to drive person-centred responses. The Government will work with experts in this field, including individuals with lived experience, clinicians, social workers, commissioners and providers, to develop and establish a national register for people who are either currently admitted to hospital-based assessment and treatment units or living in an unsuitable or inappropriate out-of-area placement, or are at risk of a placement breakdown. The register will highlight to local and national Government those individuals who need dedicated and focused attention to ensure their receiving support that works for them. The register will both improve monitoring at a local level and nationally, and support local areas to effectively measure their own progress on reducing delayed discharges and out-of-area placements. Improved data will also provide a rich intelligence about how we can continue to work to improve people's lives and best meet people's needs. This is something that countries internationally struggle to get right, and I want Scotland to lead the way on providing suitable and appropriate care in the community for people with complex care needs. The register will be supported with new bespoke guidance written collaboratively with professionals and experts specialising in complex care to ensure local areas of the right information and guidance to help in those complex cases. The guidance will ensure that we have a consistent approach across Scotland to end the postcode lottery of provision. It will also ensure that the register remains dynamic, regularly updated to provide live information on people's current circumstances so that services can respond rapidly and effectively. That will provide the basis for a new national standard to make sure that everyone across Scotland is treated fairly and equally. To further support swift and effective action, a national support panel will bring sector expertise together to provide an open collaborative forum that can troubleshoot individual cases in partnership with local areas. The panel will assess progress against the register and identify those most at need of bespoke interventions, discussing cases directly with the staff involved to provide advice and support to progress action to return the individual home. The expertise that is available via the panel will, for example, help to pool resources across local areas, share existing good practice and solutions and provide additional advice about staffing, training and suitable providers. Finally, a national peer support network will sit alongside that work to support to local areas in planning and delivery of services for individuals with particularly complex care needs. That network of sector experts from commissioning, clinical provider and lived experience backgrounds will also be available to offer support and advice in an informal way to any areas looking for additional help and guidance. That is in the spirit of building upon best practice and allowing space for innovative and bespoke solutions to be explored and created. To deliver on the recommendations that are set out in the report, we know that success will require a high level of collaborative and partnership working. Indeed, I am already aware that colleagues and partner organisations such as the Mental Welfare Commission share my ambition to see delayed discharge in out-of-area placements tackled as a matter of priority. Delivering the recommendations in this report will accelerate the momentum towards making meaningful change in the way that we care for people with complex care needs. We are starting, I would say, from a strong position, as there is a strong desire within the sector to work collaboratively and to see progress on this issue. Enable Scotland and the Scottish Commission for People with Learning Disabilities have both welcomed the publication of this report, with Enable calling this a landmark moment for the human rights of people who have a learning disability in Scotland. Although this details the next steps that the Scottish Government will be taking, it builds on action already underway to address the issue of inappropriate out-of-area placements and delayed discharge of people with complex needs. I would like to highlight some of that now. In 2021, the Government provided an additional £20 million to integration authorities across Scotland when we distributed the new community living change fund. The money is available to integration authorities for use now. I expect that integration authorities are utilising the spend to drive the redesign of services for people with learning disabilities and complex care needs now, in the here and now. We must not be complacent about the urgent needs to provide appropriate local care and services for all individuals. That is complemented by our wider package of dedicated work to address the inequalities faced by autistic people and people with learning disabilities. In March 2021, the Government published our learning disabilities and Autism Towards Transformation Plan. That plan looks at the actions needed to shape support services and attitudes across the whole life to ensure that the human rights of autistic people and people with learning disabilities are respected, protected and empowered so that they can live their lives the same as everyone else. Members may already be aware of the Scottish Government's commitment to introduce the Learning Disability Autism and Neuridiversity Bill to this Parliament to strengthen and uphold rights. That will include provision for a Learning Disability's Autism and Neuridiversity Commissioner, an independent advocate to ensure that people can secure the protection of those rights. Members will also be aware of our commitment to bring a new human rights bill to Parliament as part of taking forward the 30 progressive bold and ambitious recommendations from the National Task Force for Human Rights Leadership. That bill will provide a new human rights framework for Scotland, incorporating, as far as possible, within devolved competence for UN human rights treaties into Scots law, including the international convention on the rights of persons with disabilities. I expect those measures to deliver improved community-based support for people with complex care needs and a significant reduction on delayed discharge and out-of-area placements by March 2024. I am confident that members will support those actions across the floor as we work collectively to ensure that people with complex care needs are being cared for appropriately right across Scotland. I commit now to update members on progress with this important issue and the immediate measures that we are taking forward to provide the additional tools, the new guidance and the support and help to local areas so that they can implement the best solutions possible locally to ensure that we do our level best for people right across our country. Thank you. The minister will now take questions on the issues raised in his statement. I intend to allow around 20 minutes for questions after which we will move on to the next item of business, and I would be grateful if members would wish to ask a question where to press their request to speak buttons now. I call Sandesh Gilhani. In 2015, the former health secretary, Shona Robison, said that the Scottish Government would eradicate delayed discharge in a year. Seven years later, the Scottish Government is creating a register whilst patients have been suffering. As a junior doctor, I had a patient suffer for eight months whilst waiting in hospital to be moved due to complex needs, and he suffered multiple hospital-acquired infections and was distraught because he couldn't sleep in hospital environments. Either the Scottish Government for seven years do not know the extent of the problem or the Scottish Government has ignored the problem, which is worse. How confident is the minister that the register will be in place by March 2024 and cases greatly reduced? Why has there been a shift in ambition from eradicate delayed discharge to greatly reduce, and does that mean that the Scottish Government accepts that it is unable to deal with the problem? The Scottish Government and COSLA jointly recognise that we need to progress in this area, and that is why we have agreed to take forward the actions that are highlighted in the report at PACE. Mr Gohani is right to point out that, in some regards, over the peace when it comes to learning disabilities, we have not got that right. That is one of the reasons why we will bring forward all the recommendations of the report at PACE, as I have said. Beyond that, we will eradicate the postcode lotteries that exist in certain parts of the country through our plans, not only in terms of making sure that those recommendations are implemented, but through our plans for the national care service, which aims to eradicate postcode lotteries and bring in high-quality care standards for all across the board. It is absolutely essential that we get it right for people with learning disabilities, autism and people who are neurodiverse. As I have said, I am more than happy to work across this Parliament to get that right. I know that Mr O'Kane, who is on the Labour front bench at the moment, is the new convener of the cross-party group in learning disabilities, and I am more than willing to engage and collaborate with groups right across Parliament in order that we do our best for people across the country. I thank the minister for advance sight of the statement, and I agree that it is completely unacceptable that people who have learning disabilities and complex needs are still being forced to live far away from home or are stuck in hospital. Indeed, it has been described by people who have learning disabilities and their families as a human rights scandal. Action has been too slow and the situation has worsened. I want to speak tributes to the campaigning of organisations such as Enable Scotland and the Scottish Commission for Learning Disability in campaigning on those issues for many years, and indeed for most recently launching My Own Front Door, the campaign that is called for delivery on five key actions. I know that the minister has announced that recommendations will be taken forward to deliver a national register, national support panel and specialist peer network, but My Own Front Door has also called for the closure of assessment and treatment units, and the end of the practice of Scottish citizens being sent out of the country, and indeed the immediate implementation of a community first principle for support of adults and children who have a learning disability in Scotland, ending the commissioning of multi-bed units. How does the minister intend to make swift progress in those areas that the campaign has called for by next year, rather than the 2024 timescale that he has set out? Specifically, on delayed discharge, we know that more than 120,000 bed days were occupied in 2020-21 due to code 9 reasons. That works out at 34 per cent of all bed days occupied. Many of those people died whilst in hospital and not in their own community. What direct and swift action will be taken to ensure that people who have learning disabilities can live in their communities with those that they love, where they have every right to be? Thank you very much, Presiding Officer. There was a lot in there, and I may not be able to cover it all in the short period of time, but while I do not cover, I will certainly write to Mr O'Cain about. First of all, he asked about assessment and treatment units, and I know that some have called for a moratorium in their use. I fully agree that those places should not be a place where folk with learning disabilities have long stays, but they have a use in terms of short term placements for assessment and for treatment where appropriate. I think that we should recognise that but also fully recognise that those are not places that people should be living in for a long period of time. I recognise Mr O'Cain's call for swifter action in a greater timescale. I think that we have to be realistic here in terms of getting this absolutely right. I want to move at pace, but I also do not want to set any targets that are unachievable, and I am sure that folk feel likewise, but I want to see change and quick change, but I also have to persuade other partners that that change is required to happen at pace. I want to see the investment that we have put in utilised quickly, and I want to see the right places for people who are established right across the country. He talked about multi-bed units. I have to say that having seen from one integrated authority the use of the language of multi-bed units, I do not want to see that again. What we must be doing is providing folks with homes. That may be shared homes where that is appropriate and where people and their families want that. I am quite sure that many of us in the chamber could give examples of where that works. We must get away from the institutionalisation and the institutional language that is used still by a small minority of people in the country, but that is unacceptable. We will do our best to make sure that that culture changes dramatically over the next period of time. There is a lot of interest in the statement, and I would be grateful if we could shorten questions and responses. I call Emma Harper to be followed by Craig Hoy. The minister touched on the community living change fund. Can the minister expand on what steps will be taken to ensure best practices adhered to in the design of community-based support for people with complex needs so that we can end the postcode lottery for access to high-quality services, particularly across rural areas such as Dumfries and Galloway, but more widely across Scotland as well? There is best practice out there, and we must ensure that that best practice is exported. I am not convinced at the moment that that is happening to the degree that it should be. Emma Harper is right to talk about postcode lotteries, because in many places we see person-centred services that work well for people, their families and for the communities that they are taking place in, not so much in others. I would say to Emma Harper that we must ensure that that best practice is in place. The guidance and the standards that we set should help to eradicate postcode lotteries so that we are doing our best for everyone, no matter where they stay in Scotland. Today's statement confirms that, since 2018, the Government has failed to make meaningful progress towards properly supporting those with learning disabilities to live independently in their communities. I listened closely to what the minister just said to Mr O'Kane, but will he now look seriously at calls for an end to the construction of further multibed units for those with learning disabilities? Does he agree with Enable Scotland? I heard what he said that those solutions are sadly no longer part of the solution, but could now be perpetuating the problem in many instances. Let me make it quite clear if I did not make it clear enough in my answer to Paul O'Kane. I do not want any of the money that we are investing to put into multibed units. I do not want the use of the terminology multibed units. What we should be doing is creating homes for people. We will lay that out very clearly in the guidance. There are homes out there, and I have said that already, where a number of tenants are in those homes. Residents are quite happy with those homes and the support that is provided there. I would not class them as multibed units, and I hope that nobody else would because they are homes. Anyone who thinks that they can go back to the same old will not be happening, and that will be spelt out very clearly in the guidance. One of the visions of the coming home implementation is that all adults with complex needs of choice and control over the care and support that they receive. As the new adult disability payment rolls out this week, can the minister tell us what effect it will foresee on that ability of adults with complex needs to have that choice and control? When we are talking about making this person's centre, we have also got the census. What support has been given to people with complex needs to access the census, and why is it important that they do so? Presiding Officer, I will have to write to Ms Martin around the census aspect of her question, and I will do so. I do not have the detail of that to hand. The adult disability payment is designed to make things as straight forward as possible. In all of that, we will always start from a position of trust when it comes to the adult disability payment. Of course, it will have dignity, fairness and respect at its heart. However, it is not just the adult disability payment in terms of getting it right, in terms of income and support for folks with a learning disability. We also should ensure that folks are able to access self-directed support when that is required. At this moment in time, we are updating the guidance on self-directed support to make it easier for folks to access that support. Often, that has been difficult again in some parts of the country. We are doing our level best to ensure that that guidance is clear, and the maximum amount of people can access that support too. Jackie Baillie to be followed by Jackie Dunbar. Ending out-of-area placements was a priority in 2016, six years ago. The coming home report was then published in 2018. It is disappointing that, after all these years, there has been so little improvement in out-of-area placements. For the past six years, I have been trying to help families in Helensburg and Lomond to have their loved ones living closer to home, not hundreds of miles away. The key constraint has been a lack of suitable supported accommodation. There is not one single mention of housing in the minister's statement. What specific action will be taken and when to improve the provision of supported accommodation in local authority areas so that the practice of out-of-area placements can finally end? I would say to Ms Baillie that the £20 million of support should be helpful to integration authorities to ensure that the right housing is put in place. That £20 million alone should also be backed by the substantial amounts of money that local authorities have through the resource planning assumptions for the housing programme that the Government has. I have had regular discussions with Shona Robison since taking over this post and, as Ms Baillie knows, I have quite an interest in housing. I have to say that local authorities should be using their strategic housing investment plans and their housing needs and demand assessments to look carefully at what is required in their area and to lever in the investment that is needed to bring back folk to their places. I should say to the chamber when I was in administration in Aberdeen city, we made a major effort and some real gains in bringing folk home from out-of-authority placements. That was in the days before there was the amount of housing money that is available now. That is not beyond the wit of anyone. What we need to do is make sure that folk work in tandem to get that right for people right across our country. One of the main barriers outlined in the report is a lack of visibility of the population of people with learning disabilities. Can the minister set out how the lived experience of complex care needs, including individuals and their families, will factor into the creation of a new national care service? Thank you very much, Presiding Officer. Ms Dunbar recognises that, in everything that we do in relation to the work and the formation of the national care service, we have to ensure that the voices of lived experiences are at the very heart of all of that. Many of the stakeholders that we are talking about today are the people and the people that represent them. We are involved in the review conducted by Derek Thiele and, of course, the consultation since then. That includes the likes of PAMIS, Enable and others. We are continuing to maintain all of those links as we ensure that NCS moves forward. We have to ensure that those folks with complex needs, that their voices are heard, that their voices of their families and their voices of their carers, and that we will ensure close collaboration as we move forward, as we co-design the national care service. Alex Cole-Hamilton, to be followed by Fergus Ewing. Thank you very much, Presiding Officer. Can I commend Enable Scotland's efforts to highlight the cases of people who have lived in hospital for years who have been offered care placement miles and miles from home? The Scottish Government is now promising, quote, a significant reduction on delayed discharge and out-of-area placements by March 2024, but it has been declaring this as a priority for years. Let me get this straight. The new plan is to continue routinely breaching people's rights for yet another two years. Why is it taking the Scottish Government so long to make these critical changes? As I have said, I have made no bones about it today. It is not good enough and this has persisted for too long. We are going to build on the recommendations of the working group, which has put in a lot of work. Beyond that, we are going to improve data through the register, which will allow us to track much more what is happening to people. That will give us the ability to ensure that we take the necessary steps to get this right when we are not doing well. That is backed, as I said, by the resource that we have put in, £20 million. We will continue to look at that as we move forward. However, the key thing in all of that is that we all need to work together. I do not have all of the levers of power in all of that. We need to have integration authorities, local authorities and others working together to get this right for people. I am very pleased at the way that COSLA has interacted with all of that. I think that we are in a better place than we have ever been before. That, for me, is a priority. It is a priority to ensure that we get this absolutely right. I have a past record of bringing folk back from out-of-authority placements in a council basis, and I want to do that on a national basis. I appreciate the minister's keen to give a fulsome comprehensive response, but we are becoming very tight for time. I call Fergus Ewing to be followed by Gillian Mackay. Of all the tens of thousands of people who, over the past 22 years, have sought my help in one way or another as constituency MSP, it is my impression that those who face the longest, the most painful and gruelling struggle are parents and families of children who have profound special needs, whether in childhood or adulthood or both. Does the minister recognise that, in the Highlands and Islands, there are simply not enough specialist facilities to provide appropriate out-of-area care, and that, in some cases, the children should be referred to specialist facilities out of the area? My concern is that those decisions, whether taken for children by the council or adults by the NHS, are often the subject of financial pressure, which sometimes is perceived by the parents to trump clinical and human considerations. Will the minister review the system of finance so that neither councils nor health boards are in the position of declining such placements for financial reasons and that that should never happen? Mr Ewing has been very vocal on this issue on a number of occasions. I know that he always stands up for his constituents. The national panel has to look at the systemic challenges that exist, the geographical challenges that exist in some cases, and we need to get better at sharing expertise. Beyond that, we also need to lay out clearly what our expectations are but we also need to bring about some cultural change here. In some regards, that is about cost, but it is not about money. Sometimes it costs a hell of a lot to put folk into and out of authority placements and it is not right. However, the human cost of doing that is great. We have to ensure that, when folk are taking decisions, it is not the short-term financial cost that is looked at, it is the human cost of not getting that right. Sometimes in the past we have made mistakes in terms of authority placements. I will give an example from my time in Aberdeen. Could you do so very briefly, minister? When folk were sent to Devon and Cornwall, which was not right for the families, not right for the people themselves and certainly not right for the public purse, either. The coming home report states that everyone should understand their rights and be fully supported to take part in developing policy and practices that affect their lives. We have heard from families that they are not aware of what rights they had when their loved ones are placed outside of their area. What action is the Scottish Government taking to improve rights awareness amongst people with learning disabilities and complex care needs, their families and carers? We need to ensure that everybody's human rights are appell'd. We have a job of work to do in ensuring that everybody knows what their rights are. I spoke in the statement about our plans to embed human rights into legislation, and we will do so. Beyond that, I should say that we need to be much better in terms of advocacy as well, and ensuring that folks have the right to obtain advocacy as we move forward and get the right advice. More work to do there, but it will be done. I refer to the report, and I quote, The framework is designed to ensure that the needs of people with learning disabilities and their families drive the local commissioning strategy. Will those families in the front line in plain speak—that's quite official language—in plain speak, what does that mean and how will it be achieved? Quite simply, in all that we are doing at this moment in terms of social care, I want the voices of lived experience to help to shape services as we move forward. In the case of the national care service in terms of the proposed community health and social care boards, that means that folks with lived experience will sit round the table and have a vote on how things go on. In this area, I have talked to a lot of folks since coming into this job with learning disabilities and with their families. They feel that they are not listening to you enough and that we need to do much more, and we will. Minister's statement rightly points out that improved data is needed to quantify and measure work to improve people's lives, especially those with complex needs who are lost and tied up in hospital. The register will make some progress towards that, but it is concerning that work has not already been undertaken to join up support and care for those vulnerable individuals. Of those in December who had their release from hospital delayed by three days or more, a quarter could be accounted for by people with complex needs and learning disabilities. Is there not a case for an expedited progress and real action rather than more promises? Promises with noble ambitions but with no instinct for delivery? I thought that I made it quite clear in the statement that I want to move at pace here, and to get that absolutely right as we move forward for all the folks in our country with their learning disability, for all of their loved ones and their carers. As we move at pace, I am more than willing to come back to Parliament on a regular basis to update colleagues on how we are progressing with all of that. Thank you. That concludes the ministerial statement. There will be a short pause before the next item of business.