 Felly nid i weithio ein dess, maid i caberwyr. Mae'r dweud erbyn yn cwrsadefyd yn dda nhw'n ddull iawn, i ddatganidol i ddweud o diwgfawr S5M-14717 yn ddull iawn, i ddweud i'r ddweud yn gyffin o Gwylwyr, i ddweud y ddweud, i ddweud i'r ddweud i'r ddweud, i ddweud i ddweud i goddol i'r ddeud. Felly rwy'n cwrsadefyd o ddull iawn i ddweud, i ddweud, maid i ddweud i ddweud i ddweud. Lebrelwr Chinese has brought forward a motion for debate in order to highlight what we see as some of the challenges that have been faced by providers of health and social care. Our have always been supportive of the integration of health and social care services, young people and services, and setting up the joint integration boards, which was clear that community care must never be seen as care with the teeth and, therefore, must be funded to ensure the highest level of quality and support to meet individuals' needs. Age Scotland state that a lack of social care has a direct impact on other vital services such as the NHS. In September 2018, figures showed that four in 10 people who were ready to leave hospital waited more than a month to do so. That's too many older people at risk of losing their mobility and independence putting their health and wellbeing at risk. Age Scotland go on to say that the Scottish Government must urgently take action to reduce that and ensure that health and social care is adequately funded for every older person who needs it. The Labour leader of COSLA councillor David Ross of Fife Council has called on the Government to recognise the key role that social care plays in the health system and bring forward additional funding to support it. He states, and I quote, that if spending on the NHS continues to be protected, then social care is spending and he continues to expect the NHS to transfer adequate funding into social care from acute lack transparency and is unrealistic. He goes on, there is a concern that in the past additional funding for social care has been channeled through the NHS and some of that has been creamed off before reaching social care services. Therefore, I would suggest that there needs to be clearer transparency around funding for health and social care. I am grateful to Mr Rowley for taking the intervention. I am sure that he will recognise that I have heard similar comments from the health service about local government. That is why, for example, it is really important that the jointly run review that is currently going on between COSLA and ourselves on how well we have progressed so far on integration includes in it strands around governance and finance, precisely to address those issues. Therefore, we know exactly what is going on and not just what one group of people says versus what another group of people says. Alex Rowley. Another way of doing that, we would suggest, would be to look at the Scottish Government directly funding the IGBs. However, another main point and air motion is that there needs to be discussion between the key partners around a financial model that will provide long-term stability for both health and social care in Scotland. I think that the cabinet secretary makes a point herself where she says they are blaming each other. Why not direct the funding directly from the Scottish Government into the IGBs and then we will have clear transparency? The reality is that moving resources from health to social care is proving challenging and progress is not fast enough. Realistically, shifting the balance of care will require investment in social care services if real improvements are to be made. SCVO also raised an important issue around the commissioning of social care services and pointed out that the sustainability issues are coming up to the forward duty factors such as the low early rates and the lack of resources. We have to realise that driving down the cost of social care is in the main achieve by driving down the pay and conditions of care workers. My experience and my personal experience of home care was when my dad was ill before he died. He had a full care package which was four times a day visits and as we got to speak with the carers we discovered that two of the visits were from carers employed by the council and two visits were from carers employed by an agency. All the carers were brilliant and we could never repay the amazing care and support that they provided to my dad. However, the only difference therefore at the end of the day was that some were paid a lot less than others, had poorer terms in condition than others and did not have the same job security as others. Surely that cannot be right. Surely we should be promoting a more sustainable model of care, one that aims to get the maximum social value from public funds. That should include more in-house provision so that the public funding for care is not being used to drive the profits of large-scale commercial providers. Where contracting is still necessary, more effort should be made to break contracts up into smaller units. That gives locally-based providers a meaningful chance of bidding for that work rather than large commercial chains that are increasingly financially unstable. In a survey of carers almost half of carers said that they were limited to specific times with clients. One and two workers are not reimbursed for travelling between client visits, while three and four said that they expected the situation to get much worse in the coming year. They also revealed that one in 10 were on zero-hours contracts. I do not know how many members read the briefing that came in from Enable Scotland, but I thought that they made a very important point about the treatment of social care workers when they said, and I quote, that the Joseph Rowntree Foundation reported in 2016 that 15 per cent of social care workers are in work poverty. That means that we have Scotland's most vulnerable people being cared by Scotland's most vulnerable workforce. The introduction of the living wage was meant to improve that, but I would ask the Government to look at some of the claims that are being made that some organisations are still not paying the living wage and therefore carers are still being paid poverty wages. However, I would go further and point out that most politicians here in this Parliament were keen up to offer their support to mostly women who, in Glasgow, went on strike quite rightly for equal pay a few weeks ago. That begs the question, should we not be supporting equal pay for all workers in the care sector? Poor pay, poor terms and conditions leads to higher turnover, increased recruitment and training challenges and is a false economy. We know that caring for people in their own home or if indeed they need it in a care home is far less costly than a hospital, so why would we not spend the money that is needed to build a high-quality social care sector that pays well, employs local people and puts care at the forefront of its activities? That requires a significant shift in thinking from where we are right now and that is what Labour is calling for. We will work with the Government if the Government is willing to make that radical transformation in social care. I would finish by saying to the Cabinet Secretary right across Scotland that local authorities are reporting that there are massive overspends in the IGBs. We do have a problem, we want to work with you on that but we have to face the reality of the situation out there right now. In that role, I have the privilege to meet people who both benefit from and provide social care. While those I have met and heard from have been resoundingly positive about many aspects of the service that they receive or the work that they do, it is not the universal experience. I welcome the opportunity to have this debate in this Parliament to hear what members have to say, and I am grateful to Mr Rowley for the motion that he has brought. I know that we need to continue to make improvements, but I also know that that does not sit with Government alone, but with the partnerships that we have and we nurture with local authorities, with the NHS, with integrated joint boards to harness our collective experience and efforts and to make the improvements where they are needed. In the health and social care financial framework that I brought before this chamber in October, we recognised that services needed to change, particularly as we enjoy longer lives but with more complex needs. A key component of that change is the delivery of integration in health and social care. Integration is the most significant reform to health and social care services since the NHS was created in 1948. However, integration is not an end in and of itself. It is a tool, a means through which we collectively deliver better services for people. Because people do not and should not have to care about whose budget the service or the support they need comes from, they want our collective focus and our work to be driven by their need as a whole person. They want the support they need to be safe and effective, the right support in the right place and at the right time. Integration brings together almost £9 billion, which was previously managed separately in health boards and councils. This year, it includes more than £550 million of NHS front-line investment to support integration and social care. That is a whole-system approach that needs to be focused on safe, effective and crucially person-centred services. It needs whole-system thinking. In that regard, I am as one with Mr Rowley in emphasising the importance of us to look at the system as a whole and to think about the system as a whole. That is radically different and it is challenging. To deliver the significant shift that we need in thinking and delivery as fully as it is needed will of course take time, but we do that together. With COSLA, we are right now reviewing how far we have come, identifying where we are getting at right, working out what we need to do to scale up the good practice that does exist and, crucially, what more we need to do to learn and apply lessons and continue to build the momentum of improvement. With COSLA, we are committed to the delivery and upcoming expansion of free personal care. Scotland continues to be the only country in the UK that provides free personal care. 76,000 people over the age of 65 currently receive that in Scotland and, from April next year, free personal care will be extended to those under 65. The social care workforce provides care to people the length and breadth of our country. We want to help them to develop, which is why we have provided funding for adult social care workers—all adult social care workers—to be paid the real living wage. That has benefited up to 40,000 care workers. Like Mr Rowley, I have heard and have correspondence from individuals and organisations who are adult social care workers who have yet to benefit from the funding that this Government provided. That problem is a shared problem between ourselves and COSLA. With COSLA, we need to look at why those funds are not being passed on to deliver that commitment that I am sure is shared across the chamber. Fixing that does not lie at the hands of Government alone. I am sure that members would be quick to criticise the Government if we got into the business of instructing local authorities what they were to do. Elaine Smith Cabinet Secretary for Education and Skills for taking an intervention. The winter has, the cabinet secretary read the enable briefing, which says that third sector providers like Enable Scotland are forced to either fund uplifts in staff pay from reserves or rather revenue streams or tell our staff that we are simply unable to pay the Scottish living wage for every hour work. How would the cabinet secretary respond to that? I am grateful for the question and I have read the briefing. I have read all of the briefings that have come in for today's debate, as I properly should. My response to enable, whom I expect to meet very shortly along with Sen Scotland, is that this is in the nature of the contract that you have with the local authority. You need to take that up with the local authority because we provide the funds, the contracts are between the local authorities and the providers. If Labour wants us to take those contracts and be responsible as Scottish Government, I wonder if they have had those conversations with COSLA to take those powers away from local authorities. If that is what you want, I will have the discussion. What I will do is that I will work with Enable and Sen Scotland at any other organisation who have not received through the contract part of which we have funded to ensure that there is the real living wage paid. If they have not had that, I will take that up on their behalf alongside them with the local authority. I urge the member and all members here to do precisely that as well. We will publish an integrated health and social care workforce plan for Scotland in the near future. As part of the development of that plan, we have published specific recommendations that cover the social care workforce. Those directly address recruitment challenges, promote career pathways and improve workforce development in social care. That plan, as with others, has been developed alongside our colleagues in local authorities, in the third sector and, indeed, in some instances, in private sector providers and third sector providers, too. However, as we look at our workforce, who they are and how to value them, you really must conclude there. I am terribly sorry, it is a short debate, so I think that you must conclude. I took two interventions, but there you go. Even with that, you have had nearly another minute. Could you please move your amendment? Sorry about that. I move the amendment. These short debates are always awkward for the chair. Can I call on Miles Briggs to speak to move amendment 14717.1? Deputy Presiding Officer, I am pleased to take part in today's debate and thank the Labour Party for bringing forward this important debate. Social care is one of the most important issues that our country faces and is of great concern to so many older and vulnerable people and their families and friends across our country. I would like to pay tribute and thank the organisations that have provided useful briefings for today's debate, including SCVO, Enable and Age Scotland. The SNP Government and the First Minister have said repeatedly that they will get on top of delayed discharge crisis in Scotland, which is clearly one of the clearest indicators of the pressures on social care networks across our country. Indeed, the former health secretary, Shona Robison, promised three years ago that this Government would eradicate the problem today. However, the reality is, as shown by the most recent ISD figures, that the problem is deteriorating and this Government shows no signs of knowing how to turn the situation round. The most recent figures show 1,529 people in September were forced to stay in hospital despite being fit to leave, mostly because of an inability to arrange appropriate at home care packages, but also because of the lack of suitable care home places. That figure has got worse over the past two years. Perhaps most concerning was the recent case highlighted in the Sunday Times newspaper of delayed discharges of individuals of up to four and seven years at some health boards across Scotland. With a patient deemed fit for discharge, by a Scottish health board in 2011, it is still under NHS care, according to the mental health welfare commission. I recently met MND Scotland, who highlighted to me a number of individual cases across Scotland, who, due to their failure in community social care, ended up admitted to hospital and often saw their condition significantly deteriorate. As my amendment points out today, it highlights the real need for a joint working between housing associations to ensure that delays in making necessary home adaptations do not further contribute to delays in being able to get people out of hospital. Deputy Presiding Officer, the delayed discharge crisis is particularly acute here in my own Lothian region, with delayed discharge rates higher here than in any other part of Scotland and accounting now for almost a quarter of all of Scotland's delayed discharge. Edinburgh City has more delayed discharges than any other council in Scotland. I would like to commend newspapers such as the Edinburgh Even News for their on-going care in crisis campaign, which is helping to keep the pressure on the city's health and social care partnership. Not a week goes by that I do not receive correspondence from constituents and families who come to ask for help because of the clear breakdown in our social care system here in the capital, and those situations and cases are not being able to be resolved. The inability of local health and social care partnerships to provide sustainable care packages is in large part due to the recruitment crisis in the social care sector today. Edinburgh's health and social care partnership has said that local contracted providers have reported high turnover rates of staff in the region of 30 to 50 per cent. The cabinet secretary has no time in hand. You have to absorb it. Very quickly, will the member recognise that in Edinburgh there is a particular pressure in terms of the labour market, which is why both the local authority and NHS Lothian have jointly contributed additional funds to meet that? I have been calling for that for two years and met with the health board to say that that needs to be put in place. We have an overheated market here in Edinburgh that is contributing to that factor. I agree with what Alex Rowley said specifically, and I think that it is important that our social care workers and the need for us to support them and value them are also recognised and encouraged in that they are fulfilling a vital role and should be held in the same regard as clinical and other NHS workers. While investment in extra childcare is, of course, welcome, the impact that this is going to have on the adult and elderly care workforce and the additional staff that we need may also be something that the Government needs to be incredibly aware of as well. The Scottish Government will need to address those concerns without delay and look to how we make those social care workforce plans be brought forward quicker. The Parliament's health and support committee, for example, undertook an inquiry into social care workforce and made an important number of recommendations that, to date, we have not seen progress in implementing, and some of those were highlighted by Alex Rowley. A national social care internship programme, for example, I think merits consideration and could be a good opportunity to give students studying relevant courses, practical experience in the field, and I hope that some in the Scottish Government will agree to explore. Such a scheme can be taken forward by colleges, universities and social care providers. I think that it is important to meet what is now a real demand of additional staff across Scotland for the social care workforce. The Parliament's health and support committee in its recent report also looked ahead to this year's budget, expressing serious concerns about the leadership in some of our local health and social care partnerships, and the fact that too many partnerships are failing to deliver the transformational change that is required. I am afraid that you must conclude. I have to be just the same with her. I am sorry about that. No, you must conclude. Oh, I beg your pardon. No, you've got five minutes. So, to conclude, Deputy Presiding Officer. Your five minutes. Sorry, Mr Blake, it's five minutes. You must sit down. I have no time in hand. I'm pleased to move your amendment. Move my amendment, my name. I call Alison Johnstone. I'll take four minutes, please. Thank you, Presiding Officer. I thank Labour for bringing this debate to the chamber this afternoon, and I welcome the opportunity to discuss the future of social care in Scotland. I'm heartened by the progress that has been made in making personal care and nursing care free to all who need it, regardless of age or condition. It was deeply unfair that free care was limited by age, and I believe that this change was won because the Government listened to voices across parties, constituencies and communities. I think that we all understand how integral high-quality social care is to our entire health and social care system and how that should be reflected in housing and in our fair work practices, too. I hope that this afternoon allows us to make further progress in agreeing shared priorities for social care. Of course, no discussion of care should fail to recognise the incredible contribution unpaid carers make. Health and social care budgets are stretched. We can only imagine how much worse that would be without their incredible contribution, that incredible contribution of unpaid carers. A contribution that we should better recognise through a more generous and more widely available Scottish carers assistance. However, returning to pay, I wholeheartedly agree with the point made in Labour's motion that there is still a disparity between the value of social care to society and the staff's level of pay and working conditions. Investment that the Scottish Government has made in the living wage for social care workers has been welcome. Clearly, there are problems and not all workers are receiving that yet. We can and mustn't stop there. The Scottish Greens have long called for a living wage plus for social care staff. A rate of £10 per hour for social care staff would reflect how important their work is to our communities and public services. That's £10 per hour at least. Showing the high regard that we have for this specialised caring role, such investment would be a significant boost to women's pay, given that around 85 per cent of social services workforce are women. I would also like to see the Scottish Government committing specific resources towards delivering meaningful paid differentials among staff building careers in this sector. That kind of direct support would encourage staff to develop into specialised, senior and management roles with increased responsibility and would help to address the serious staff shortages in the sector and the high turnover within it. Scottish Care indicates that average turnover figure in care homes is 22 per cent. As Age Scotland points out, that is only likely to be further compounded by Brexit. At least 6 per cent of our social care staff are likely to be EEA nationals, as are around 8 per cent of nurses in the sector. With more EU nurses leaving than joining the nursery and midwifery councils UK register, enough damage has been done already. The BMA and the RCN are campaigning for a people's vote. Reflecting on Labour's motion on social care today, I urge my colleagues on those benches to join them. To ensure that social care services are sustainable in the future, an increase in resources is necessary, as well as efforts to safeguard existing staffing levels in the face of Brexit and improve workforce planning. However, there does not yet seem to be a very strong consensus as to how increased resources should be directed to front-line social care services. The motion calls for a financial model developed in partnership, I think, to address this issue. It is fair to recognise that the Government has worked on going in this regard, since Audit Scotland has welcomed the medium-term financial framework for health and social care. I… Greens will support the Labour motion today, but I would point out that the Fraser of Allander Institute's budget report also stresses, and I quote, spending choices shouldn't just be viewed as a trade-off between local government and health. When the aim of integration is for spending on health and social care to support each other, we must move away from considering one budget protected at the expense of another. Both need to be properly funded. Half a million bed days are lost to the NHS every year because of delayed discharge. That was supposed to be an issue that was resolved coming up for three years now, because the previous health secretary had given that commitment. I am not pretending that this is an easy problem to solve, but it does show the difference between the rhetoric of three years ago and the reality of today. My concern about the integrated authorities is that we have not created integration, we have created a separate third body that is junior to both the council and the NHS bodies in each area. When there is difficulty, those two bodies are nowhere to be seen. That is one of the challenges that we have. We have not created that integrated body that we need. The high turnover of leadership within integrated authorities is of grave concern. Seven out of the 31 authorities have had new chief officers within the past two years. The lack of long-term financial planning, the lack of data sharing, and we know the problems of the different languages that the different professionals in each half of the organisation speak. The lack of collaboration between the bodies, the confused accountability and all of that has led to this half a million bed days lost to the NHS every year. It does indicate the health of a hospital because it is the flow through the hospital as the number of bed days indicates. As much as the waiting times are important, that is probably a greater indicator of how well a hospital is performing. That is why it is really important that we get on top of those particular problems. If I am allowed to give some quick examples in Fife of where I think that that is not working, we have a proposal to close the GP out of our facility in St Andrews, our responsibility of the integrated authority. The NHS in Fife has distanced itself from that decision. The council tells me that the individual councillors on the integrated joint board are there in their own right, not as on behalf of the council. If this is an integrated body, a joint body, both should be responsible for the decisions of the integrated joint board, but both are distanced in themselves. Even though the co-leader voted for the proposal to close the St Andrews facility, even though he is in the leadership of Fife council that is supposed to be part of the integrated body, the whole thing is a shambles, and that is why people in Fife are very confused about who is responsible for any of that. The turbulent leadership is also an example in Fife. Michael Kellett, who is a very good officer and the chief officer, is relatively new within the organisation. We have just lost Simon Little, who is the immediate past chair from the body, prematurely removed from the board. Again, removing continuity that I think we need is part of the wider concerns that I have raised about the performance of NHS Fife and its leadership with four departures from the senior positions within the body within the past few years. It is something that I hope that the Scottish Government commissioned an investigation into. However, the other fundamental weaknesses that we have within the integrated authorities are fundamental to the whole organisation, the shortage of workers, particularly in rural areas, where workers are not paid to travel between homes to care for individuals. No wonder that we are finding it difficult to get carers to cover rural homes and rural patients. Brexit, of course, is compounding the problem, which is why we need that people's vote that Alison Johnstone was talking about. Robert Kilgower has talked about the impact of Brexit in this perfect storm, a combination of different issues that are impacting on the care service. Finally, the removal by build of 12 of its care homes surely is another indicator that this sector has serious problems. We move to the open debate. We are already behind time, so under four minutes would be useful. Elaine Smith, followed by Emma Harper. On many occasions in this Parliament, members have commended the skills and the professionalism of those working in the social care sector. For so many families across Scotland, a good quality of life and engagement with the wider community is entirely dependent on the support of social care services. Investing in the social care sector also contributes to the preventative spend agenda by keeping people healthier and active in their own home, and, as we have heard in other speeches, releasing hospital beds for those who need them most. Social care sector workers, mostly women, make a significant contribution to the local economy, earning and spending in our communities. I am sure that there will be agreement across the chamber that the essential work should be valued accordingly. As such, the targets set on the payment of the living wage across the sector are to be welcomed, and the progress that has made has improved the earnings, I am sure, of many households. However, too many of the children who are living in poverty in Scotland are living in households where at least one and often two adults are in work, so we should be asking if simply delivering on the living wage alone is adequate for meeting the needs of families or, indeed, in this instance, recognises the value of the social care sector. Implementation costs for the payment of the living wage as a minimum across the sector appear to be unclear. Last week, the Coalition of Care and Support Providers in Scotland commented in two recent research reports. In surveying the experience of their own membership, providers have, in the name, kept up with living wage increases. However, the reality is that less than a third of the organisation has secured sufficient funding from living wage earmarked sources to cover the costs. That must mean that other aspects of the service suffer. Staff recruitment and retention is known to be a problem already. If overall staffing capacity has to be reduced, then there is more pressure on existing staff to do the work, sickness and absence levels increase and job satisfaction decreases. There really is no way to run a service on which so many of our citizens depend. The recent Strathclyde university research also looked at the experiences of those involved in delivering the payment of the living wage across the sector. While recognising some of the progress made, the research report highlights almost 32 different approaches to implementation across local authorities, with time and resources wasted and undue strain placed on some organisations and departments. Looking to the future, the social care sector, including the voluntary sector providers, who work in partnership with the local authorities, need the financial support to bring in new staff. That means younger staff, a more diverse workforce, staff who may also be starting or bringing up a family, staff who need well-funded maternity and paternity leave, sick pay, pension rights and good terms of employment, meeting the aspirations of the fair work framework set out by the Government. Annie Gunnar Logan, CPS director, said that the findings outlined in the report suggest that the delivery of the living wage in social care has made a practical reality, at least in part, by a significant transfer of financial responsibility and risk to the voluntary sector, with concomitant pressure on the sector to bail out the policy with a pretty whopping level of subsidy. The First Minister has made a commitment to extend fair work, including the living wage, to as many funding streams as possible through public procurement. We warmly welcome that commitment and want to see it happen as soon as possible, but this new research shows clearly that the implementation process needs a complete overhaul if this policy is to have a positive lasting legacy. Both of those reports raised serious questions about a longer-term commitment to improving pay and conditions across the sector, and our social care workers deserve far better. The Scottish Government, Presiding Officer, must indicate how it intends to address the specific concerns and take seriously the need for more investment in this key employment sector in Scotland. Emma Harper, followed by Nichelle Ballantyne. The motion today on investing in social care in Scotland's future states that the health and social care system is based on human rights, where people receive care according to their need and not their ability to pay. Presiding Officer, I absolutely agree with that statement. A key priority for the Scottish Government is ensuring that the needs of people who are experiencing care comes first and that their rights and choices are respected. I, like many in the chamber, recognise immediate and long-term challenges to the delivery of care in people's homes and indeed in the community. I also recognise that there are challenges to demonstrating and elevating the value of people who chose to look after those who need care. In preparation for this debate today, I was reminded of my nurse training, and I remind members that I am a registered nurse. When I started my training, I learned about Abraham Maslow and his theory of the hierarchy of psychological health needs. His paper, published way back in 1943, is still relevant today. His hierarchy of needs described basic needs of survival, food and water, shelter, warmth and safety. Carers provide a level of support and care that achieves the basic needs that human beings require, and often, while engaging in their care duties, they support clients and service users in many ways. Maslow's hierarchy of needs is as relevant today as it was in 1943. I agree that attracting and retaining the right people to become carers and raising the status of social care as a profession is key to delivering quality care. The SNP Government has taken action to protect our social care services. It has taken action to ensure that adult social care workers are paid the living wage. This move has benefited up to 40,000 carers, many of whom are women, which Elaine Smith has already highlighted. I am sorry, I am not taking an intervention because time is tight. In addition, the SNP Scottish Government has ensured that this year there will be more than £550 million of NHS front-line investment in social care and integration. Around 66 million of that £550 million will enable local government to better support social care, including the continued delivery of the living wage for adult care workers, and it will cover the extension of sleep-over hours during 2018-19. Ensuring that the workforce is properly trained, supported and regulated is key to effective, safe and high-quality delivery of services. That is exactly what the Scottish Government is doing and what it will continue to do. Moving and handling is one of the key skills required by both paid and unpaid carers to prevent injury. I have had representations from a constituent in AIR who has asked me to pick that up, and I have already written to the cabinet secretary on that matter. I support the Government's amendment, which includes the addition of increased resources and investment into primary care. In my south Scotland region, there is currently a very active programme working with local people across the rural south west Scotland called Transform and Wigdanshire. I have spoken about Transform and Wigdanshire previously and its goal is to generate ideas in different ways of working so that social care resources can be delivered in the most effective way. The programme is under way and European Union funding has been applied for and is available to investigate how implementing technology can be used to support people in their homes so that people can remain independent and supported and get out of hospital quicker. This technology, called Empower and Co-Sync and now attend anywhere, is being piloted and tested in the area. I look forward to seeing the outcomes as they become available. In conclusion, I support the Scottish Government's motion and I agree that social care must absolutely be a fundamental right and that those working in the sector must be recognised and paid the fair wage. The concept of integrating health and social care has unanimous support from across the spectrum of politics and professions. It is the ultimate no-brainer, a policy that would not only deliver a better care system for the over 65s enabling people to stay in their own homes and communities, a policy that reduces the use of acute health services and improves everyone's quality of life, a policy that ultimately would help address the challenges of our increasing longevity and a policy that, while improving lives, would deliver a more financially sustainable outlook. That view has not changed and the support for Frank's law reinforced the belief that the provision of free personal care for those who need it is an important social principle. However, despite this unanimous support, the delivery of the principle is still facing a number of hurdles, not least of all the conflicting interests of local government and the health service. In the early days, it was a battle of language and understanding between two different cultures. Today, it is more a battle of resources and control. In 2011, the Christie commission into the future delivery of public services identified, in my view, five key issues—that services were provided to individuals rather than designed for and with them, that models of provision had failed to empower and enable people and communities sufficiently to achieve positive outcomes in their own lives, that services often impaired individual incentives and fostered dependencies that created demand, whilst a culture of professional dominance in public bodies had made them unresponsive to changing needs and risk averse about innovation. Finally, procurement was often taken forward on a scale that discriminated against smaller providers and person-centred approaches. I guess that the question is how far have we really gone in addressing those challenges? I believe that there is a real tension between the key partners. The health service needs patients to be able to leave acute care in a timely manner. Delaying discharge is not only an expensive option, it is also a poor option for the patient, particularly the elderly, as people can become institutionalised, losing their independence through reduced movement and risk of infection. Local government, on the other hand, are feeling the strain on their budgets and seeking solutions to the increased pressure to provide more services to a burgeoning elderly population. I do not believe that the competing interests of those two bodies, no matter how united their press releases, serves the best approach to meeting people's needs. There is a clear lack of leadership, as integrated joint board members have half an eye to the interests of the bodies from which they are appointed to the IJB. I say this not to be disparaging of the members of the IJB, but in recognition that this is a difficult balance to get right. The reality on the ground is that people just want good services. They do not care who is in charge, but somebody needs to be. Delivery of a high-quality social care system requires motivated caring staff. Pay certainly has a role in that, but so do conditions of work and most important job satisfaction. Many elderly people develop very positive caring relationships with those who come in to assist them, but there are difficulties. When I speak to care staff, one of the consistent concerns that they raise is the lack of time that they have to deliver the care that they would like to. The 15 minutes, often allocated, is not long enough to support some people effectively. Both the client and the carer struggle with that, and it fails the person-centred care test. We do need transformational change. I am not suggesting that there is not good work being done on the ground, and I certainly welcome the independent inquiry that is now under way. As yet, integration of health and social care is still very much a work in progress. There are two specific issues that I want to cover in the short time available. Both relate to the importance of the social care workforce, and we know that the quality of social care is fundamentally about resources, and the biggest resource of all is the workforce. Without that dedicated workforce, the system would simply collapse. We know the challenges of recruitment and retention in social care. There is no doubt in my mind that that will be exacerbated by Brexit, but there is much that we can do. It is a growing sector. The need for social care is increasing. Whether you are someone with a learning disability, needing support, or an older person requiring a night-time tuck-in service, the care provided is essential to your wellbeing. For the very first time in the Scottish Parliament's history, social care was recognised by the economy committee as a key growth sector that mattered fundamentally to our economy. The committee recommended that it should be treated as such by Scottish Enterprise, but, unfortunately, ministers thought otherwise. I would ask them to think again. Caring and the jobs in that sector make a hugely important contribution to the Scottish economy. It is a predominantly feminised workforce, characterised by low wages and part-time temporary work. That needs to change, and we need to value the service that they provide as a society. One obvious way of doing so is through their pay packet. The Scottish Government allocated additional money for local government to pay the living wage from October 2016 for waking hours, something that Scottish Labour campaigned for, and I welcome very much. During the passage of the procurement bill, the SNP refused our calls to pay the living wage for all employees on public contracts, but I am glad that they have changed their minds and done so for social care staff. I welcome to the announcement by Shona Robison in October 2017 that the living wage would apply to staff providing night-time cover as well. That was to be implemented this year in 2018-19. Additional funds were given by the Scottish Government to health and social care partnerships to do that. The living wage would be in place for all staff, whether day-time or night-time cover, not just for those employed directly by the local authority, but for those employed in the private and voluntary sectors, too. However, the reality on the ground, cabinet secretary, is very different, and we have heard that from speakers today. Let me tell you about the experience of one of the largest third sector providers of social care. They are keen to pay their staff the living wage for sleepover, so too are their trade unions, but the delivery of the policy on the ground is patchy. Services commissioned by local authorities for the full year have been commissioned already without payment of the living wage for sleepovers. In fact, some 60 per cent of local authorities who commissioned care services have not provided the living wage for sleepovers for the entirety of 2018-19. I cannot believe that the cabinet secretary would be content with that. Money has been given to pay the living wage, money that is not ending up in the pockets of hard-working care staff, where I know that she wants it to be. We all want it to be there, and I cannot believe that the cabinet secretary is happy that it is not. Will she ensure and help her that, for the remainder of this year, the money is paid so that staff get their rightful pay? Will she give the guarantee now that the policy will be fully funded for 2019-20, and that all staff doing sleepovers will be paid the living wage? Presiding Officer, I know that you will want to know that it is 41 days away from Christmas. The Panto season is upon us. Will Jean Freeman be Santa or Scrooge? Social care workers are watching with interest, and I hope that she is Santa. Fulton MacGregor, followed by Alexander Stewart. Money has been invested in NHS social care integration. Health spending per head is 71 per cent higher than the UK as a whole. That is £850 million more spending in health services in Scotland. Given that Labour has brought this debate to the chamber, it is worth remembering that Labour's spending plans from the last Scottish election for health would see a NHS cut by £360 million. That is equivalent to 9,000 nurses. Rather than deliver the full funding, the UK Government has cut our budget by almost £55 million next year and more than £270 million over its five-year plan. Despite those UK Government cuts to Scotland's budget, an additional £66 million will be provided to local government to support the carers Scotland act. I hope that that will be welcomed by everyone. First and foremost, the Scottish Government's priority is to ensure that the needs of people who experience care come first and that their rights and choices are respected. Within the past decade, a significant amount of work and investment has gone into supporting older people and people with disabilities to live well in their homes for longer. As a population, we are living longer, meaning that demand for support care and support is growing faster than our traditional services were designed for. The challenge, looking after a raging population in the future, is one that we almost face head on. In Scotland, it is the only part of the UK, as others have mentioned, to have implemented free personal care for older people and will be the only part to implement it for people under 65. All in all, we have a system that, although it is not perfect, is much fairer. In general, there has been cross-party political consensus on the issue of integration and, given the importance of that issue, that is right. This is the second time in a week that I have spoken on this issue after contributing to Monica Lennon's member's debate last week. A debate used to criticise decisions of an SNP council to reduce the need for care homes and support independent living decisions, which I pointed out at the time when they were initiated under the Labour administration and, quite rightly, too. Monica Lennon's debate and her colleagues failed to address is the fact that neighbouring North Lanarkshire council, which is under Labour, is now down to just one care home. However, I agree that I am not going to be a hypocrite on this position. I agree that that is the sign that we are supporting people more to live at home. I am not going to get any time for intervention, sorry. The worker's situation is a theme in that debate and this debate where I would find some common ground with Monica Lennon and Alex Rowley mentioning it today as of other speakers. We must work with the social care workforce to find the right employment for everyone. That is why the SNP Government has provided funding to enable adult social care workers to pay the Scottish living wage, and it was the living wage a week just last week. That has benefited up to 40,000 care workers, as Emma Harper pointed out, and average earnings of adult social care workers are higher in Scotland than elsewhere in the UK. However, I think that that point has been talked about a lot in the short time. I just want to welcome the cabinet secretary's remarks earlier that she is willing to address some of the concerns that have been raised in the chamber today about people being paying the living wage when they are employed through third sector organisations. In terms of the system that we have, it is not perfect. In no one's line-up, it is a system that cares for some of her most vulnerable people and needs to be flexible and responsive. Like every MSP in here, I am sure that we have all had queries from people who are unhappy about the level of care that they receive from themselves or from relatives, or they are unhappy about localised decisions such as, for example, reduction in community alarms or reduction to gardening services, and the inoclon effects in personal care. As politicians at all levels of government, we must respond honestly to those issues and learn from them to make the system as effective as we can. I have to mention unpaid carers as well, like Alison Johnstone, the work that they do is absolutely fantastic. We need to work collaboratively on this. It is one of the biggest challenges of her generation. Brevetay and the final two open debate speakers. We appreciate Alexander Stewart, followed by Alex Neil. The decision to integrate health and social care and to see the shift of balance of care out of hospitals into community was fundamentally the right one. Finding that we are putting those ambitions into practice has never been something of a challenge. Having seen, first hand, as a councillor, that the integrated joint boards, when they were first set up, I was acutely aware that councillors, NHS board members and officers from organisations took some time to adapt to the new way of working. Indeed, they must continue to adapt to the new way of working if they are to make progress within social care. At present, the increasing costs that are brought about by the pressures of an ageing population are outpacing the rate of transmissional care that is made in the integrated authorities. In a recent report from the health and sports committee of this Parliament, it suggested that that was due to a lack of leadership within them. That is a real problem and a problem that has to be tackled if we have a leadership issue. The report also highlighted concerns that some senior managers were directly linked to one of the partners and therefore might have a conflict of interest when budget decisions were being made. More concerning, however, was the lack of joint working arrangements between NHS boards and local authorities, which also allowed one manager to have responsibilities to staff in both organisations. While often teams of staffers and partners work together without such formal arrangements, true integration will continue to elude us if we do not tackle that problem. There are still concerns about integrated joint boards' ability to govern and the arrangements that they have when it comes to governance. Although the integrated scheme may allow for things such as overshares and a share of overspends between partners and organisations, it is not necessarily a requirement for that to mean. Local authorities might have to pick up the bill for significant increases in demand pressures that will then particularly take place. The amount of budget that is made to be very careful is very important because we have to ensure that we are not going to have two authorities that have failed and just replacing that with three that might be failing also. We have also seen the need to ensure that a move to improve delays and discharge, including through the improved sharing of information. In my own region and in the council of person can loss, the home assessment recovery team seeks to get people out of hospital and back into their own homes as soon as practically possible by putting in place the necessary adaptations. It also provides temporary care to help them via just to being back in their home before they get the permanent package of care that they require. This model has been very successful in reducing the number of delays that are just charged and is one that could be replicated across other areas. All of those considerations are rather academic, Deputy Presiding Officer, if we are unable to get the staff to provide the services that are required. The care inspectorate recently indicated that 35 per cent of care services in 2015-16 had been unfilled due to staff vacancies and the Scottish care talked about the proportion of homes that required full-time nursing posts that had increased of recently. We need to look at ways that those jobs become more attractive to those who might otherwise be put off by not working in the sector or working in another sector. In conclusion, we have made some real progress along the road to real health and social integration, but there is still much work to be done. We should continue to monitor the public bodies joint working Scotland act that is being implemented and considered how we in the Scottish Parliament can support the development of integrating authorities. If that is achieved, it will go a long way to tackling the many issues in the sector. Deputy Presiding Officer, first of all, I emphasise the fact that we have made significant progress in recent years. I particularly welcome the introduction of Frank's law, the introduction of the living wage and the increase in the carers allowance, all of which are making a substantive contribution to the improvement of social care. However, we all know that there are major challenges still to be faced. However, it is worthwhile to remind ourselves why this is so important. It is very important for the following reason. That is that the policy of integration is driven by the medical and economic evidence, and the medical evidence is that patients are better treated and safer treated at home if they can be than being treated in a hospital setting. Any one time—I remember the statistic—I got it in day 1 when I became the Cabinet Secretary for Health and Any one time in Scotland or in any advanced economy, there is about one third of the patients in hospital who ideally do not need to be there, and it is not to their medical advantage to be there. That is why we have got to transfer and get those people treated in the community rather than in hospital, as they have done most successfully in Alaska. However, there is a very unusual situation here, because not only is treatment at home medically the best way to treat patients, but it is also the least expensive. Usually, in the health service, the best treatment is the most expensive treatment, but, ironically, here it is also the least expensive. It costs nearly, on average, £4,500 a week to keep somebody in an acute hospital. It costs about £2,000 a week to keep them in a community hospital, £700 a week in a nursing home, and £3,000 to £400 a week at home. There is both a medical and a resource issue that should drive integration as fast as possible and as comprehensively as possible. Let me see the core issue here. The same issue was faced when it came to emptying the Victorian asylums and treating people with mental health problems in the community. The core issue is that we have to fund both services to the same level until the transition is actually made. We have to continue to fund acute services, which is what the set-aside money is about—the resources that are allocated there. In the meantime, we have to build up the resources that were not there in the community so that, if we are going to empty the hospitals of those people who do not need to be there, we need to have the facilities in the community for that to happen. We are trying to achieve that against a background of severe budget constraint, which was not one of our making. What the Victorian asylums did was to provide bridge funding, which is the equivalent of the set-aside money. I think that we can learn lessons from how it was done with mental health as to how it can be done with physical health in how we achieve our objective fear. However, we under no misunderstanding—this is a complex issue—and it is one where we have made substantive progress, although there is still a lot of progress to be made. I believe that there is a great pity that the debates are being squeezed by the bureau, because it does no service to the Parliament, no service to the subject of social care and no service to the next debate. I move to the closing speeches. Brian Whittle, no more than four minutes, please. I am delighted to take part in the debate, and I thank Labour for bringing it to the chamber. It has been a really interesting debate this afternoon. A subject that, as Alex Neil just said, has done with more time to develop some of the main points, and I think that the fact that it has been little attempt to leverage any political discourse probably highlights an important subject. Alex Rowley started today's debate highlighting the issues between NHS and social care services that are leading to that delayed discharge. Miles Bigg developed that point, suggesting that delayed discharge indicates the pressure that our current social services are in. We have to highlight that there is much within the Scottish Government's outline vision and objectives that we would agree with. It is entirely right, for example, that we should aim for everyone to live that longer, healthier lives at home or in that homely setting. Alex Neil did focus on the fact that treatment at home is both medically and, from a financial perspective, a much better option, and that it should receive root support from across the house. Central to this vision, of course, is the development of the integrated joint boards. Alan Gander Stewart in his speech highlighted the fact that initiating such a fundamental change will inevitably come across bumps in the road. However, as the health and sport committee reported, plans for the measure of health and social care are being hampered by a lack of leadership, which was a thrust of Michelle Ballantyne's speech. I think that there was certainly a sense there that the process, in that process, no one governing body is steering the ship, and Willie Rennie was keen to develop that. I think that that led to the point where 21 joint authorities are failing to deliver that transformation that is required, and that is after three years. I think that it was further backed up by an oryx Scotland report that stated that the 2020 vision is progressing too slow. In that report, it also mentioned that financial sustainability of the health service in the medium to long-term and recruiting the right number of skill staff is key. I mean that the thrust of today's contributions and in the labour motion has been in workforce planning, or the lack thereof initially. We are looking for this cohesive strategy to alleviate the shortage of trained healthcare professionals. Some of the SNP policy at the top level we are certainly able to support. The issue being that when you look below the surface, the more thought is required to create that sustainable and stable workforce. One of the examples that I would like to highlight is the unintended consequences of a lack of forethought and planning in presenting the 1,140 hours of free childcare for three or four-year-olds. In fact, carers are transferring from social care environment to the childcare environment because it is the same kind of skill sets that are required in both settings. I did hear from nursery owners only a couple of weeks ago that they are recruiting more and more staff from the social care sector, and that has been raised again and again in the chamber. The Government has been slow to react and recognise that all those social care and health policies are interconnected and interdependent. The integration of social care and health is the way to go, and we support that drive to achieve that. However, the implementation of that policy has an issue with governance, according to the Health and Sport Committee investigation. At best, one would say that progress on delivery is patchy, depending on what part of the country you happen to come from. I will leave it there, Deputy Presiding Officer. Jeane Freeman, no more than four minutes, please, Cabinet Secretary. Thank you, Presiding Officer. I will do my best to rattle through this. We are undoubtedly faced with challenges as we seek to properly deliver integrated health and social care, but Alex Neil is absolutely right. We should not set aside our recognition and our credit for the significant achievements that have been made in many authorities and by those social care workers. It is right for people to point to delayed discharge. It is undoubtedly a challenge, but, as Alex Stewart said, we have integration authorities where there is no delayed discharge, where this is working and his is not the only one. It is not simply about resources, it is also about how we work, which is why I pointed earlier when I spoke to the whole system thinking that is needed. Willie Rennie points to issues of governance and leadership—it was not alone—and, without a specific reference to the situation in Fife, which would not be appropriate, I think that it is right now that the joint review that I mentioned, led by COSLA and ourselves, is actively looking at issues of governance, finance and decision making. The approach is three years old. A lot has been achieved in those three years, but it is still young. I completely appreciate that, if you are waiting for better services, it does not matter how young or old it is that you want those now, but I think that that perspective is one that we should reasonably have and that it is a partnership. It is right that it is a partnership. It is an interesting proposition from Mr Rowley to directly fund—no, I shan't—integrated joint boards. Presumably, that is funding from both the health service and from local authorities. I am happy to discuss that with COSLA and with changes to ensure that our Government procurement framework is applied in local authorities or is at least matched. However, I would certainly welcome Mr Rowley and his colleague's support in doing that, because I do not think that those local authorities would take kindly to that idea where the employment of those that they currently employ is somehow lifted out and moved over. Jackie Baillie offered to help to ensure that the money that the Government has provided to fully fund the real living wage gets to the staff who deserve it, and I welcome that. I would ask her now if she can be Santa with me, work with me to make sure that all councils do precisely that, not only for those that they employ but for those that they contract, including the third sector. Let's together look at lessons in those local authorities who directly employ social care staff, where the terms and conditions, the career opportunities and the real living wage are such that they not only attract staff, but retain them, because in those authorities—no, I shan't—in those authorities, where that is being done, what we see is that the clear guidance that 15-minute visits are only appropriate in certain circumstances—for example, medicine checks—are followed. In those integration authorities, we see them moving away from time and task, moving away to focusing on the individual. The workforce is important. Indeed, I am interested in Miles Briggs' proposition for a social care internship, and I am happy to discuss that with him. However, we cannot, as others have mentioned, talk about the importance of the workforce, the importance to recruit and, importantly, retain them without recognising it. We do that in the context of Brexit. Brexit will take away a significant proportion of our current social care workforce. What we need is not only free movement in order to continue to benefit from those skills and experience, but we also need changes to immigration policy that support the particular needs of Scotland. I commend the debate, Presiding Officer. I am happy to discuss that with others at any point, and I look forward to support for our amendment. Colin David Stewart, to wind up the debate for no more than five minutes, please. Thank you, Presiding Officer. I think that this has been an excellent debate with well-informed and passionate contributions from across the chamber. Many members, such as Alec Rowley, Jackie Baillie and Alec Neill, made powerful statements about the reality of social care by providing vivid examples of vulnerable constituents, many of whom relied on unpaid carers, the backbone of our social care network. Presiding Officer, I suspect that few members here today would disagree with the change in philosophy from hospital-based care to community-based health and social care, but the key issue is a health and social care system based on human rights, where people receive care based on need, not the ability to pay. As we have heard in the debate so far, we have several key challenges, high levels of turnover in the social care sector, exacerbated by low pay and the uncertainty of Brexit. By 2035, a quarter of Scotland's population will be aged 65 or over, up nearly a fifth from 2010. Just over a third of over 85-year-olds receive care at home or as a long-stay resident in a care home hospital. I am really sorry, but I do not have enough time. However, older people are more likely than younger people, as we would expect, to be admitted to hospital in an emergency and have multiple and complex needs. However, let us not forget today that 657,000 unpaid carers in Scotland, half of whom are aged over 65. Technology and innovation are also crucial in my view, and the Health and Sport Committee, of which I am a member, published an excellent report earlier this year. As they say, and I quote, technology presents an opportunity to ensure innovation in health and social care flourishes and that Scotland is a leader and not left behind. Can I give you an example, Presiding Officer, in my own region in the Highlands and Islands? The Inverness City regional deal is developing a very imaginative project called fit homes. Those homes are future proof for changes in the mobility of residents and of a series of sensors that collect data that can be monitored and responded to by agencies such as health and housing. That model is designed to create a viable lower-cost alternative to full-time residential care and prolonged stays in hospital. Hopefully, that best practice will be picked up across Scotland. Of course, it is a truism to say that good homes support good health. I believe that that project could allow people to live independently in their communities for longer. Very much a point that Alex Neil made, I thought, in a very insightful contribution. I would like to say that fit homes won the Salter Award and has been developed by Carbon Dynamic in conjunction with Alvin Housing Society and NHS Scotland. Turning to the debate, I am afraid that I am very constrained in time, so I apologise for those that I am not able to mention. I thought that Alex Rowley made an excellent contribution in the treatment of social care workers and he quoted the Nable Scotland, which I in turn would like to quote, and they say that the Joseph Rowntree Foundation report in 2016 that 15 per cent of the social care workforce are in in-work poverty. That means that we have Scotland's most vulnerable people being cared for by Scotland's most vulnerable workforce. He went on to talk about differential paying conditions that are experienced by care workers and I would highlight to all members the excellent unison study and survey into this area. I thought that Miles Briggs made a very useful point when he talked about delayed discharge being a key factor and he raised the issue that this problem is getting worse. I too would endorse his contribution about social care internships as one factor in trying to reverse the problem of recruitment. Alison Johnstone again made a very useful point. I would particularly stress the point that she made about the important role that we have in Scotland in unpaid carers. I think that Willie Rennie's contribution about 500,000 bed days lost is very insightful indeed. If I can't just move to conclusion in the very brief time that I've got left, so my view is that social care is the very heart of our welfare state. Of course, it embodies the original beverage principles that create the system of welfare protection that looks after our vulnerable, our ill, our old and the sick. However, we need to have a significant shift in resources, as Alex Rowley said, in social care services, so that we can achieve a sustainable financial model that provides long-term stability for health and social care in Scotland. To conclude on time, as the famous American anthropologist Margaret Mead once said, I never believe that a few caring people can't change the world, for indeed that's all whoever has. That concludes the debate on investing in social care for Scotland's future. It's time to move on to the next item of business. Can I ask people to change seats quickly, please, and use that time to tell you that we are already behind time for the next scheduled debate, so it may well be that some speeches will have to be curtailed.