 Bless you, and I'm so glad to welcome everyone to this 7th meeting of the Public Audit Committee in 2022. Before we begin, I remind members, witnesses and staff that social distancing rules are still in place. Respect those. If you are moving around the room or entering or exiting in the room if you could wear a face covering but while you're sat at the table you can remove your face covering. The first item for the committee is to consider whether to take agenda item 3 and 4 in private. Is that agreed? Yes, it is agreed. Thank you. Agenda item 2 is to consider the social care briefing which was brought out at the end of January by the Auditor General along with the Accounts Commission and I'm delighted to welcome with us this morning. First of all remotely committee member Willie Coffey is joining us but in the committee room is the Auditor General Stephen Boyle welcome Auditor General and your team this morning who are joining us remotely are Anthony Clark who's the interim director of performance audit and best value at Audit Scotland and Sheila Stewart who's audit manager performance audit and best value at Audit Scotland you're both welcome and can I say to Anthony and Sheila and to Willie if at any point you want to come in please just put R in the chat box function and we will endeavour to take you in and I'm quite sure in Anthony and Sheila's case the Auditor General may well defer to you to pick up some of the evidence that we will be looking for but can I begin Auditor General by inviting you to make an opening statement? Many thanks, convener. Good morning everybody. I am bringing to the committee this morning our briefing on social care. It draws on findings from our earlier reporting on health and social care integration, people's experiences of social care services together with public sector reform. We have previously reported on the challenges within social care including aspects on the fragility of the workforce, tensions between cost and quality in commissioning services, lack of progress in shifting resources to preventative approaches and gaps in key data needed to inform decision making. Unfortunately these challenges along with others continue to threaten the sustainability of social care services and are having a huge impact on the people who rely on them. My joint briefing with the Accounts Commission sets out the key challenges, some recent progress, what needs to happen urgently and not wait for reform. People should be at the heart of social care services but we know that service users and carers do not always have a say or choice about what support works best for them. People have described the struggle that they go through trying to receive appropriate services but have also described the huge impact on their ability to live independently when it works well and when they get the support that they need. It is paramount that the Scottish Government embeds the voice of people with personal experience in all aspects of developing, planning and delivering improvements to social care. This is essential to deliver the aspiration of a preventative human rights-based approach. We know that the social care workforce has been under immense pressure both before and during the pandemic. The predominantly female workforce does not feel adequately rewarded or valued. There are also major problems with recruitment and retention. Both the fair work convention and fair work in social care group have made recommendations. The Scottish Government now needs to take action to improve working conditions for this vitally important workforce, otherwise it will not be able to deliver its ambitions for social care. Our briefing also notes the challenges with social care commissioning system. It tends to focus on costs rather than quality or outcomes and this creates wider structural problems. The current method of competitive tendering, based on framework agreements with unspecified hours, can pass risk on to staff and results in zero hours or seasonal contracts. Our briefing refers to surveys that highlight staff do not always feel that they have the necessary time to deliver person-centred care. This is another key area that the Scottish Government needs to focus on as it takes forward its plans with local government partners and those in the private and third sectors. Pressures from increasing demand and demographic changes are growing. That has led to tighter eligibility criteria being applied for accessing care and increasing levels of unmet need. There are also major gaps in the data and the true picture of demand and unmet need is unclear. That needs to improve to inform decision making. Confer to conclude, some things cannot wait for the establishment of a national care service. Stakeholders have told us about services in near crisis and that a lack of ambition now presents serious risks to the delivery of care services for individuals. The Scottish Government needs to take a pragmatic approach and set out what can be improved now without legislation while also taking time to determine where the national care service can add most value. As ever, convener, Anthony, Sheila and myself will do our utmost to answer the committee's questions this morning. We will have questions covering the whole range of issues raised in the briefing, which I think is extensive and raises some matters of concern, not least about the fact that £5.2 billion of public expenditure is currently invested in social care and yet there are some things highlighted in the report that draw us towards them, which are of some concern. You say that there is increasing demand and demographic changes and still a lot of unmet need. I suppose that the issue for us that we want to begin with looking at is that whole question of the sustainability of the social care system. You have made it clear from the report that while the Parliament in this session is legislating for the creation of a national care service, there is a degree of urgency around the action that is needed to tackle some of those unmet needs and some of those challenges that social care and social care providers and the social care workforce face. In fact, at one point you described in the briefing that it is at near crisis. Do you think that the Scottish Government is putting sufficient resources into social care? It is a variety of components. One of the aspects, perhaps two things to touch on, and I might ask Sheila to elaborate on both of those, is the pay and reward that the workforce and the conditions that they operate in. The nature of the service is very person dependent on both the experience that people who are in receipt of care receive and those who are delivering care services. As ever, you mentioned that resources are significant, but that the resources that we are currently putting into the social care services have still led us to a point that users of the service and those at work are telling us about the difficult experiences that they have. Pay and reward is a very clear component, as well as the working conditions of the workforce. The representative groups in the sector have talked about it, that pay and reward is not just about those who are delivering front-line services, but is the whole structure of pay and reward across all aspects of the social care system. That is one point that I would make convenient. The second, as we touched on in the introductory remarks, is the nature of the competitive tendering structure that we have that focuses more on cost, as opposed to quality and the experience of people who are using the social care services. Both of those factors may result in additional resources being put into the sector. We would recognise, as we touched on in the briefing, that there are plans to significantly increase further the resources into the sector, the Government's own plans and then what may come from the additional national endurance contributions as those come to the Scottish Government. Both of those are significant in terms of additional resources into the system, but in terms of where we are currently, convener, urgent action is needed to resolve some of those challenges. If I may, I will pause and perhaps turn to Sheila if anything she wishes to add. I think that that really covers a lot the main points that we have raised. I will maybe just put some of the detail around the sort of systemic problems, as the Auditor General has read in the introduction to the briefing and the fair work convention concluded. There is something about the commissioning system and how it then leads to risk the unspecified contractual arrangement. That risk gets moved down to staff being asked to work very flexibly with our contract or low hours chat. That is a big and really difficult thing to grapple with, but, again, something that we feel action needs to be taken on now rather than necessarily waiting for the establishment of a national. Right, thank you. You mentioned points around commissioning and workforce and reward and so on, and we have a series of questions that we are going to come to on that. If I could turn to one of the other striking things about the briefing. That is where you are saying how important it is that service users' perspective and voice is seen and heard, and a suggestion that perhaps it is not being seen and heard as much as it might be at the moment. I guess the question is what work is the Scottish Government carrying out that you are aware of that seeks to bring in the views of service users, their families and those receiving care? What work is being done by the Scottish Government to seek those views so that, in term, that is used to inform its strategic planning of social care in Scotland? Yes, again, it will happily start, convener. Sheila will want to elaborate about the steps that the Government is taking. If I may, there are a couple of points that we know that the Government has involved users and sought the views of representative groups, both in the consultation around the independent review of adult social care and in their consultation on the plans for a national care service, and that is clear. It matters incredibly so. If I draw the committee's attention in the briefing paper, we sought to reflect some of the views of those working in and those in receipt of the service about their current perspective of how that operates, some of the challenges that they and their families are finding with the service, and then particularly aspects of what they would refer to as some of the bureaucracy that exists around the system of where there are both struggles to receive adequate care packages or to make progress with self-directed support, and then along with the challenges of moving between one provider to another or moving area and how challenging all of that has felt for people. In terms of the Government's plans and the importance of that, again, I will pass to Sheila just to update the committee on where the Government is planning to go next. Yes, we absolutely made the point that people in receiving an experience with social care support need to be part of the solution and being involved. We know from the consultation on the NCS that that has been built in. There have been a lot of forums and individual consultation events happening, as well as the opportunity given for people to put in their written submissions. We know about the social covenant group as well that it has been established, so it is heartening to see that more formal mechanism being introduced. There are also fantastic organisations out there that represent the seat of social care. There is the Alliance, which held a conference yesterday morning around the national care service. There is the Equality and Human Rights Commission as well. There are lots of partners that the Scottish Government can work with. In terms of next step in looking forward, the briefing, we recommend that the Scottish Government works in partnership with other stakeholders who have a lot of knowledge and intelligence to bring on that. Right. Thank you, Sheila. I think that Anthony Clark wants to come in on this point as well, so Anthony. Good morning, committee. I just wanted to add a little bit to a couple of the points that the Auditor General and the Stephen have already made. They have already made the point that the Scottish Government is working very hard with service user groups around the consultation and responding to the consultation on the independent review of adult care, the feeling review, as you know. However, it is worth not just drawing out a couple of points that Fili set out in his report, which was about the importance of service users having a voice in the commissioning process. Making sure that users have a much more active role working with providers and commissioners to make sure that, when services are designed for their local area, they reflect the needs of people that will be using those services. One of the constraints that I think hit the two in this area around choice has been a lack of capacity in the system, so this is partly a by-product of the pressure that social care providers and local authorities have faced over a range of choices that have served in the Fili review. I just wanted to make the point around commissioning in the future. My final point, if I may, is a more general point about quality. In his introduction, the Scottish General made the point that commissioning tends to focus on costs rather than on quality. In the Fili review report, there were some very important points being made that might require changes to happen around regulation and inspection of social care services, so that measures of success bring much more to the centre, the lived experience of people as well. That could be a very important development moving forward, as the Scottish Government and others started to develop the national care service. I thought that the old touch on the points that you are asking about can be necessary. Hopefully, that was useful. That is very useful. As I said, we have further questions about commissioning. There is a whole debate about whether the commissioning model is the best model in and of itself and is the current model quite top down, is the way it seems to me. I am not quite sure that the voice of users is heard sufficiently loudly, but that I think is going to be part of the debate that we are going to have in the Parliament about the creation of the national care service, as well as addressing some of the more urgent points that you have asked us to push on. One of the other pieces of legislation that is mentioned in the report is the 2013 act, which provided for self-directed support. I think that we reflect that your predecessor Stephen produced a report in 2017, along with the Accounts Commission, concluding that the vision of self-directed support had not been fully delivered and implemented at that point. The question that we wanted to put to you today was how much further on are we? How would you describe today the status of the implementation of self-directed support? You are quite right. The briefing paper draws on our previous body of work, including the self-directed support paper. I am sure that I want to say a word about perhaps just some of the background to that report and progress. We capture to an extent in this briefing paper, albeit not an audit of self-directed support, the on-going frustration that the sector is experiencing with the progress around self-directed support. That is still too hard for people to make progress with their packages to support independent living, to recruit personal assistance concerns about the sustainability of personal assistance, and then the extent to which it is known and understood of what people can access by way of self-directed support. A real degree of frustration coming through, convener, from the representative bodies individuals who have engaged in the service, is that it has not progressed as initially intended. We have signalled in this paper that it is our intention to return with a further programme of work and look to capture the progress around self-directed support. However, in overall terms, convener, the findings that my predecessor and the Cres Commission highlighted five years ago have not progressed as neither the Government nor the partners would have anticipated in the intervening period. Again, I will pause. I am sure that Anthony will want to say a few words on that as well. Thank you very much, Stephen. That was involved in that 2017 report that was a follow-up to our 2014 report, so I am relatively familiar with the audit approach and the findings. I think that the Auditor General's absolutely right that we set out in the briefing paper confirms that the findings in 2017 have not moved on in the pace and scale that we would have hoped. The feedback from service users, which has been captured in the briefing and which was presented to the independent review of adult social care, makes the point that the Auditor General just made, which is that people are still finding it too difficult to get access to the services that they really want and have the choice and control over their own lives. I think that it is fair to say that the ambition of the legislation is still not being met, and that is definitely something that we will want to follow up on as part of our on-going programme of social care work. Thank you. Thanks, Anthony. That is helpful. I just wanted to go to another piece of legislation that the Parliament has passed, which you also reflect on, which is the 2016 carers Scotland act, which provides for rights for unpaid carers. I think that in the report you reflect on a survey, or admittedly a 2019 survey, that was carried out by the coalition of carers. Bear in mind that there are 700,000 unpaid carers in Scotland, so that is a huge part of the population. Of those 700,000, in this survey of presumably a sample of them, the survey found that only 16 per cent of carers knew of the act and what rights it provided. 33 per cent had heard of it but did not know what it was about, and 51 per cent had never heard of the act and the rights it bestowed. So there is an issue there, which clearly needs to be addressed. Again, Auditor General, can you tell us what, as far as you are aware, the Government is doing to address the fact that here we have an act of Parliament that gives unpaid carers rights, yet many of them are ignorant of the rights that they have? Some of the statistics in that paragraph, Paragraph 9, are quite stark. The rights of 700,000 or so estimated unpaid carers in Scotland, their familiarity with the act and their associated rights suggest, for all that we set out in the paper, that there are real gaps in the support that is being offered to unpaid carers, as well as their understanding about how to access support. All of those points to aspects that we touched on in the report, some of the gender inequality concerns of the predominantly female workforce, but female unpaid carers as well, that are not being adequately supported or given or helpfully directed to where they can access support, breaks in caring responsibilities and so forth. We draw the conclusion that we touched on this morning about the near crisis and real challenge, and all of this is a key plank of that judgment. It is not just the Scottish Government, I would say. There is also a very clear responsibility of local authorities for how they understand the role of unpaid carers in their communities. That is also where the solutions lie, as well. Taking some of the time to progress towards the national care service rightly, but also some of the interventions that can be made now, and it goes back to some of the questions that you started with this morning, but yes, there is additional funding going in. Can steps be taken now to address some of the commissioning models, some of the rates of care and some of the additional support that can be provided to unpaid carers? Again, I am happy to pause and maybe turn to Sheila. I think that it is probably best to come in at this point. Sheila, do you want to add anything? I want to echo what the auditor general has said. It is really stark those statistics in our briefing. We really are not in a position to be able to give an update on the Scottish Government's intention to address that. As the auditor general said, there are other partners that are part of the solution for this. That is all I want to go through. I hope that that was helpful. That is fine, Sheila. Thank you very much. We have already mentioned a few times the social care workforce. Willie Coffey, who is joining us virtually, has got some questions to put to you about the workforce. Willie Coffey. Thanks very much, convener, and good morning to everyone in the panel. First, before I come to the workforce issues, I wonder if I could just ask the auditor general to say something about how his briefing complements, reflects, mirrors or otherwise, the FELE report that was commissioned and released about a year ago. How much does it find itself in harmony with what was being recommended in there, Steve? What progress has been made, do you say? Good morning, Mr Coffey. I think that that is a very clear read across between the findings of the FELE report and our own briefing that the committee has this morning. I think that that sense of reform being needed concerns about the sustainability of the sector, the need to incorporate the human rights-based approach for people who are receiving care packages, and the need for a change in thinking about people who work in the sector. We are adequately addressing concerns about the sustainability of addressing recruitment and retention issues, offering fair work so that we move the sector on from some of the sustainability issues that are set out in both FELE's report and our briefing. Although FELE does not cover all the aspects that are set out in the national care service plans of the Scottish Government, it sufficiently tackles some of the urgent concerns at present. In the round, we agree that there is a parallelism read across between FELE's report and our own briefing. Thank you. Turning to some of the issues in your briefing around workforce, it tells us about the difficult environment paid social care workforce that is operating within. It talks about an increasing demand for social care coupled with a wide range of recruitment and retention challenges. What do you think that the Government is doing or has been doing to respond to that challenge and to make sure that we increase the number of people who are getting the social care service? There are a couple of points to address. We set out that there are around 210,000 people who are paid employees in the social care sector. The report recognises that the Government has taken steps to bring in the living wage for people who work in the sector. Paragraph 11 is the correct paragraph reference. Paragraph 26 is the report. We set out some of the Government's plans for additional investment. 25 per cent cash terms increase in the sector over the life of this parliamentary term, around £800 million of additional funding. There are clear plans for investment, Mr Coffey, no doubt, but in terms of the life of the parliamentary term and the living wage, it has not addressed the very specific challenges that the sector is facing in terms of very high vacancy rates in the sector and the overall attractability of people wanting to come into a very responsible demanding role. Concerns about career progression, stress, anxiety and the burden that has been placed upon people who have worked in the sector, particularly during the course of the pandemic, and that there are other options for people to deploy their career choices. It is not that the sector or the Government has not offered support, but in terms of reforming and rethinking the sector, those are the challenges to be addressed. I think that Anthony wants to come in on this point as well. So, Willie, before you ask your next question, I'll invite Anthony to give some views. Thanks very much. Willie, I just want to take up a couple of other things as well. If you look at paragraph 14 of the briefing paper, we set out the developments that have taken place around the living wage, which is obviously a positive development that's happening recently to try and make working in social care more attractive. Committee members might remember that there was a relatively big advertising campaign fairly recently to try and attract people into the social care workforce, but it just feels as though there's a bigger challenge there, which is about public perceptions of social care. It feels as though we value nursing and medical support, and yet we don't seem to really value social care supporting quite the same way. I think that that's been well recognised by people in the sector as well. I think that the recommendations are partly about trying to make that shift, and there's also a big issue in the Feeley report, as you all know, Mr Coffey, which is around career pathways and development, so that people care be modest level, entry level, but then think that this might be a job for life. There's quite a job of work to do, I think, nationally and locally around career progression and development opportunities, which are recognised in the proposals for the national care service. That kind of leads us, convener, into my next question, really, when we considered the report on Scotland's colleges, the principle that Edinburgh College bribed some of the more innovative approaches that that college was taking to address this increasing demand for social care workforce, that included neighbouring students studying social care, this was to undertake a mixture of studies, skills development and work based opportunities, and even a dual qualification in childcare and social care. Is that kind of thinking being reflected across Scotland, and is it having any positive impact? I'm not sure we have a definitive answer to that, Mr Coffey. I remember the session well and the contributions from the principle and the evidence and the conviction with which they spoke about the impact that that was having, and having listened carefully to see the progress that that made, to tackle some of the problems about the sustainability of the workforce, as Anthony mentioned, to have that move the profession on to a different setting to give it absolute due parity with the national health service, and some of the steps that are able to be taken. I think that it may be something that we need to come back to the committee in writing if we have any more detail on it, or perhaps something that the committee wishes to explore directly with some of the college sector. Your brief, Stephen, also talks about the commitment made by the Government to pay annual social care staff real living wage, so we're talking about wages and money now, but it might not still not be enough to attract people into the sector. What would you say to that, and the issues about career progression? It's not just coming in at the entry level, and that's you for ever more. Do we need to be thinking about career progression and opportunities to improve not only pay, but their prospects too? That's one of the key findings from the briefing, and also listening to some of the contributions from representative groups, and watching some of the evidence that was given to the health, social care and sport committee last week. That comes through really clearly, actually. The living wage in itself is welcome and a step forward, but in order to support the sustainability of this workforce, it is about making it an attractive, long-term place that people will want to stay, work and develop their careers. One of the things that I can hear clearly in some of those voices is that it matters not just at the entry level points of people joining the social care sector, but throughout the various grades that there's adequate training, support, supervision managers in the sector to oversee training, development needs and all of those factors. It's a question of parity as well, Mr Coffey, that too often the concerns of the sector is seen as somehow not as important, doesn't enjoy the profile that the NHS enjoys, and to shift on some of that thinking that this is seen as a valued profession for people to work in and hard work that it is to and to reap the right level of respect and fair work that goes alongside that. Turning to retention issues, Stephen Year's report gives us a worrying one in four, 25 per cent of staff leave within the first three months. That must be quite a worry. Can you maybe give us some more information on why that is a pandemic-related term, is it happening before the pandemic, and what can we possibly do to turn that around? You're right, Mr Coffey. I'll turn to Sheila again in a moment or two, but a paragraph 15 we set out some of the statistics of the challenges in the sector. As you say, a quarter of staff leave within three months nearly 90 per cent of social care providers say that recruitment and retention is problematic and that some of the representative bodies have had to reduce the volume of care as a consequence of some of the recruitment and retention issues that they've experienced. I think that for the reasons that we set out in the briefing paper that these factors existed before the pandemic but that were exacerbated by it, it's hard work, as we know, convener, that these are difficult, demanding, responsible jobs. As I'm sure we'll come on to over the course of the discussion this morning, one of the other factors is about the transfer of risk to people who work in the sector, aspects of zero-hours contracts, sectional contracts, not necessarily being given the right time that people would want to spend in providing care, concerns about travelling between different locations and who owns that risk, and, too often, we're seeing in the evidence in our gathering that the transfer of risk is on to the people who are working in the sector. All of those factors are undoubtedly components of where we've arrived at in terms of recruitment and retention, Mr Coffey. Again, I'll pause. I'm sure she'll want to add. That was a really comprehensive answer there. I think that it's very difficult for us to be able to say if it was the additional pressures of working through the pandemic that's impacted on the statistics that people seem to leave the profession or at least the place of work within three months. Again, it's a mirror that they need to make it an attractive career and that people are feeling valued from a monetary perspective, but also just that they're able to spend time building relationships and investing in the care of the people that they are working with. Thanks for that, Sheila Stevens. I wonder if I could just turn now to commissioning issues, commissioning services and issues. Your brief also tells us that we tend to focus on costs rather than on quality or outcomes, despite spending £5 billion on the overall service. Do you think that there's a case for those who are involved in commissioning services to get them in at an early stage so that that tension between cost and outcome could to some degree be avoided? I think that—Antoniel will want to come in on this, I'm sure, as well. That's a fair conclusion about moving towards a more collaborative approach for commissioning of social care services. As opposed to what we are being told, it feels like a very competitive environment and all the instability that that can lead to providers, particularly small providers, and the doubt about the sustainability of their business model if they are unable to secure contracts. We've touched already in previous answers about the transfer of risk to people who are working in the sector and the unsustainable sense of employment that exists as a consequence of that. Antony, I'm sure that I want to say more, but a collaborative approach to commissioning feels like a more sustainable model than we currently have in Scotland. Again, Antony, you can say a bit more, Mr Coffin. Just to completely agree with the auditor general, Mr Coffin, in fact, we made in 2016 in the social work in Scotland report that there should be earlier engagement between providers and commissioners as part of the development of commissioning strategies and commissioning processes. You do see some good examples of that, where local authorities and IJBs are working constructively and productively with local providers, both private and third sector providers, in understanding the needs of their local area and developing innovative solutions and services. However, I think that it's probably the exception rather than the role, and that's certainly the feedback that we've heard from people that are representatives of provided bodies, such as the SSC and the Alliance. What the proposal that you put for Mr Coffin, and it's something that we said earlier in a previous report. Thank you. Auditor General, your report also reminds us that there was £500 million extra awarded to the Government in 1920, but the big question, of course, is, do you know how much of that funding was used for social care commissioning purposes or did it find its way elsewhere? I'm not sure. I think that Antony is probably best placed to answer that question in terms of his more familiarity with the work of local government. I can't give you a clear answer at the moment, Mr Coffin. We're quite interested in that question, though. We're currently working our way through all of the annual audits of integration joint boards. We might give us some insights, but I'm afraid I'm not able at the moment to give you a clear answer to that question. Okay. My final question, convener, is just really about the competition issue that the Auditor General raised there, but I think that you've adequately covered that, Stephen, that if we have more of a collaborative approach and people are involved at an earlier stage, we might gain more rather than focus on in-cost, we might actually focus on quality. I think that I'll just hand back to yourself, convener, and allow the other members to come in now. Thank you. Thanks, Willie. That's much appreciated. I'm going to turn now to Colin Beattie, who's got a series of questions on leadership and culture and some of the other big issues raised in the report. Colin. Thank you, convener, or general, it's not the first time we've seen adverse comments about leadership in your reports, and you do mention this in paragraph 20 of your report. I mean, you call for stable and collaborative leadership, and that sounds fairly basic thing that you would expect to be in place. You particularly mentioned that councils and integration authorities are experiencing high turnover of senior staff, and you previously said that it's the same situation in the NHS. Why is there such a high turnover of senior staff across the public sector? In my memory, until a few years ago, that was, generally speaking, not the case. So what has triggered this? I think that I need to check, Mr Beattie, on the trend of turnover, but you're right that we are experiencing that not just in one sector but, as you mentioned, in the NHS and local government, too. The predecessor committee took evidence on the impact of the NHS and the turnover of leadership and the various factors behind that about the demands of their role, the attractiveness of it, and some of the accountability arrangements, no doubt, too. However, we are in a challenging set of circumstances. I'll say a few more about the NHS, and I'll turn to Anthony, who wants to comment about local government and IJBs. However, some of the nature of turnover is not just confined to chief executives but to some of the other key leadership roles in that. I think that it comes back to the attractiveness of the role and the alternatives that are on offer to senior officials. The stability of leadership is key to moving away and addressing some of the challenges that we set out in the report, tackling the sustainability of the sector and the collaboration between local authorities, NHS and third sector providers. All of that has to happen to move this sector on to a more sustainable footing. Is it about money? Is it simply the job-hopping for more money? I think that that's a factor but not as simple as that. We do see people who will move from one sector to the next who will have career progression aspirations met from moving from an integrated joint board into a council or NHS board. Those things happen, and that's perfectly legitimate for individuals. Where the concern raises is the volume of change, learning new roles, a time of real challenge and the need for all the points of stable leadership produces better outcomes. All those factors are noted, but I think that we're talking about more structural issues. Leadership is one component of it, but the overriding concerns are more about the attractiveness of the roles at different levels across the organisation and some of the commissioning context, but that absolutely needs tackling. I'm sorry if you're content. Just to add one thing, which maybe if Anthony is coming in after or however. I can understand where there's an issue about stability if there is a turnover of senior staff, a churn there. It does create that almost a vacuum until the person moving in has come up to speed with the job and got a grip of it and so on. What I don't understand is the lack of collaboration, because collaboration should be fundamental and it should be embedded there regardless of stability or whatever. That collaboration should exist. Why doesn't it exist? That's a really important question. We refer to cultural differences in the report, Mr Beattie. It's not for the first time, even referencing the reporting that we have done on health and social care integration, that cultural differences between local government, the NHS and the Scottish Government have all been noted and played a part in the experience that people ultimately get, whether it's a lack of collaboration between leaders, differences of views on budgets, different systems, how they're integrating. All are noted and haven't moved on for the best part of 10 years that we've sought to move to a more preventative agenda for health and social care, providing care closer to people's homes. All of those factors haven't been addressed sufficiently to lead to better experience of people that are using and relying on the provision of health and social care. We've said over many years and probably frustratingly so that some of these cultural differences need to be addressed to move to that more collaborative approach, but yet we're still here reporting concerns that culture is still getting in the way of better outcomes for people. Who needs to knock the heads together to make this happen? We've all got a responsibility, which is clear, so local government, the NHS and the partners to take steps and move on from some of the issues that are known. It's not a universal picture, I think that some of the additional frustration must have been to that there are many examples across the country of where cultural differences have been overcome, some real examples of progress, particularly over the course of the pandemic where issues that I felt intractable for many years were set aside and progress towards better outcomes have been delivered. Perhaps that's the opportunity now that we all need to reflect on that when it had to happen progress was made and to build on some of those innovations, but I see Anthony is keen to come in at this point. I think that it would be useful to hear from him on the role that local government is playing and also some of the innovations that we've seen if he wants to comment on that too. Thank you very much, Mr General. If I might just quickly turn to Mr Beattie's question about turnover in local government, there's always been turnover every local government at the senior level, as we'd expect, both at the chief executive and executive director level as well. I think that it's noticeable that over the last year or so we have seen in many ways a changing of the guard. Many of the chief executives that came in to senior around the time with local government reorganisation in 2006, we've seen a whole tranche of those people leaving. That's created quite a big shift, a generational shift in local government leadership. That's not necessarily a bad thing, it's a thing. It does mean that new people are coming in with fresh ideas, but it does mean that there's been a big change of thinking in the local government sector. There's always been shifts in IJBs as well. I think that's often been about career progression. People are moving from smaller IJBs to larger IJBs to move forward in their career, but more recently we have seen some IJB chief officers moving into local authority chief executive roles as well, and I'm thinking of the chief executive of Inverclyde. I think that in some way that's quite a welcome development. People are being able to demonstrate that they can move across different bits of the public sector, and that does in many ways support the collaborative leadership that I think you were wanting to see, Mr Beattie. The collaborative leadership question, which we've talked about many times in many of our audit reports, still feels vexed and problematic. I think that the Auditor General is right that we've seen great joint working during the period of the pandemic, because people have had a singular and shared goal, and everyone was clear what it is that they needed to focus on, which was dealing with the immediate pressing impacts of the Covid-19 pandemic on jobs, health and communities. I think that the danger is that, as we move from recovery to response and renewal, people might then retreat back into their more professional health, police and fire, local government. I think that there is a risk around that that we need to be all alert to, but I'm optimistic that what we've seen in the pandemic hopefully will be sustained moving forward, but hopefully that's helpful, Mr Beattie. I'm very conscious, as the Auditor General has mentioned, of the fact that the question of collaboration at the local level has been raised in this committee several times in your reports. Yet nothing seems to progress. You say that some places are better than others, but all places should have that level of collaboration that allows the outcomes that the Government and everybody else is hoping to be achieved. What has to happen? It can't go on that you churn out a report saying that there's a lack of collaboration locally, which is impairing progress. It can't go on like that, but it has. How do we break that? In Audit Scotland, both myself and the Accounts Commission reflected on the 10-year anniversary of the Christy report towards the end of last year, which touches on many of the aspects of why we haven't progressed with the level of collaboration leading to better outcomes in Scotland. We identified, in the round, an implementation gap between policy ambitions and what happens next. The committee has also heard in previous sessions about some of the performance measures, the incentives, that we are providing to support better outcomes and those not always being sufficiently clear for people working and leading in the sectors to deliver it. I think that that is one aspect of it. We also reflected on our own role about audit and scrutiny, which is also directed towards improved outcomes. There is no single answer, Mr Beattie, because as we touch on towards the end of the report and reflecting on what might come next through a national care service and learning some of the lessons from previous significant aspects of public sector reform in Scotland that haven't produced the intended outcomes at the pace that was originally anticipated, the place on fire reform and some of the colleges reforms. We have made a number of recommendations for Scotland, as we anticipate, and as the convener mentioned, the pending scrutiny of the national care service, about some of the points that policy makers will want to reflect on as we move towards that. There are clear milestones, clear intended outcomes and that we are able to measure that. However, I don't think that that sets aside the need for effective collaboration and to make some of the changes now. One thing that I haven't mentioned, the committee may want to explore this morning, is about the data. The quality of data and metrics across different organisations also needs to move on. As I'm sure the committee will fair again a frustratingly recurring theme through audit reporting that data isn't sufficient, it's not readable, it's not transferable in the way that it needs to be to deliver better outcomes for people. I'll come back to data in just a second. I'm going to ask you an unfair question, which you may or may not be able to answer. Looking at social care in the public sector versus the private sector, how significant a difference is there in quality of leadership or isn't there? I'm grateful for you recognising that I may not be able to answer that, Mr Beattie. That's probably where I'm at. I'm not sure that we have done enough audit work or even that we have necessary scope or remit to make that definitive judgment. As Anthony has mentioned and we touched on in the report, we are looking to recognise that stable collaborative leadership is a key component of better outcomes for people, whether it's in the private sector or the public sector. There are no differences of experience that users of social care will have depending on whether they are receiving care from a local authority provider or a third sector or private sector provider. However, as you suggested, I'm not sure that we have done enough audit work to have a clear position on that. Auditor General Anthony has indicated that he wants to come in. Perhaps he's going to answer the question that Colin Beattie has put. I'm sorry to disappoint you, convener. I'm not going to answer your question, but I'm going to point you to someone who I think can answer the question, which is the caring spectrum. The caring spectrum inspects and regulates all the services that Mr Beattie has on interest engines and quality that they talk about his leadership. I do recollect that I think that they have done some analysis comparing private third sector and local authority provision. I'm hesitant to offer what might be a hazy recollection of what that said. I think that my recollection was that it didn't demonstrate a clear pattern in terms of quality of leadership across sectors, that there was variability, but it is wanted to the caring spectrum. I'm sure that we'll be pursuing issues around collaboration and so on as we go forward. You very correctly raised the questions of data, and this is not a new issue in front of this committee. I can't remember ever sitting there saying that the data collection in any particular area was exemplary or particularly good. In paragraph 23, no individual social care record is taken in the same way that each member of society has a different NHS record. There is obviously some comparison difficulties there. No consistent method for recording unmet need, no co-ordinated approach to anticipating future demand for and costs of delivering services, which is pretty fundamental. Are we saying that each individual area is collecting data in one form or another with a view to meeting that data need, but simply they are not doing it on a basis that it is comparable with other areas, or is it that they are just not bothering? There are some quite stark comments in this section of the briefing paper. Mr Beattie, Sheila can come in and say a bit more about how it operates in different parts of the country, but the overall implications that we are noting here is that there is an inability or unwillingness to share health and social care data where it is collected across different providers. Significant implications arise from that. As you mentioned in your question, there is not a comparable data record between social care compared to NHS. We all have individual NHS records that follow us if we move from one area to another or across our lives. That is not the case with social care. Implications of that, as we touched on in the briefing paper, are some of the direct experiences that deter people from moving house, moving local authorities, some of the challenges that they have had in building a care package around them. Then, as we mentioned in paragraph 23, there is not a consistent method of recording unmet need. There is a real lack of information about the demand for services and the experiences that people are therefore having. Although assessments will be carried out of people's social care requirements, that is applied against an eligibility criteria of whether people are met. If they are not therefore met, there is no consistent method of recording what alternatives might be available for people. There are some very significant implications, ultimately, for the quality of social care that people will receive currently and for anticipating what demand will be on social care in the future. All of those issues really need to be tackled in again. Come back to that theme of urgency. This is one of the things that ought to be done now, to look at the need for data to be consistent, usable, transferable and based around people's needs as opposed to some of the concerns of the organisations that are involved in the sector. You asked specifically about what is happening in different areas and I think that it might be useful to bring Sheila in at this point. Thank you. Start off with the point that there is not an individual record the same way, so being able to take that with you is not in place. We know that there are different systems happening in different integration authority areas. That is not necessarily a bad thing because organisations have different individual requirements. However, what is missing is the ability to take it up a level so that you can pull together what that means for demand, for unneed and for the demographic pressures going forward so that there is a more strategic approach to using the data. That makes sense. Just one last question. We are quite correctly looking at a national care service, which, hopefully, will provide a uniform standard of care across all of Scotland. Without that data, how successful can that be? That is a very clear answer to that, Mr Beattie. If I may highlight to the committee, we have, at Paragra 38 to do the briefing paper, set out some of the points that need to be in place to ensure that public sector reform, whether it is a national care service or elsewhere, is successfully delivered. One of the components of that is clear business case anticipated outcomes and transferable, measurable, consistent data is a key component of that. The national care service really needs, as part of the process of formulating it and getting it in place, good data behind it to ensure that it is going to be effective. Would that be correct? Absolutely correct. As I mentioned a moment or two ago about our reflections on Christie, that policy to be implemented successfully is subject to effective scrutiny and evaluation reflecting the experiences of users of any system. There has to be clear milestones, data points and consistent high-quality data throughout. The briefing states that Scotland's ageing population will inevitably result in an increasing demand for social care services and resources. Paragraph 25 outlines that, by 2038, nearly 25 per cent of the population will be over the age of 65. To what extent is the increased funding from the Scottish Government over the current parliamentary term likely to meet the needs of the growing ageing population in Scotland? Both of those things are true. We set out in this section of the briefing paper that about a quarter of people by 2038, as you said, will be over the age of 65. Then we will expand that to say about a fifth of the population in Scotland. The find themselves as having a disability, of course, has been more prevalent in older population. Then some of the projected anticipated 80 per cent increase in population of wheelchair users by 2024. All those statistics combine to talk about increasing demand for the service of social care. At the same point, we know in the briefing paper that there is anticipated funding increases over the life of this Parliament by £800 million, together with whichever spending decisions the Parliament chooses to make with the increase in national insurance contributions. However, in and of itself, and I think that it maybe speaks to Anthony's point and he might wish to elaborate further, is that the sustainability of this sector won't be tackled by funding alone. As Scotland emerges from the pandemic, the importance is not to rebuild a system that was already unsustainable but perhaps to use opportunities now for reform of the system that allows it to deliver better outcomes and experience for people who are relying on social care and are working in the sector. Anthony, you wish to come in. Certainly, thank you very much. It's quite right that I'm budget gaps looking forward in terms of the medium to long term. We haven't yet, I think, been able to overlay the predicted expanded funding and whether or not that would actually address the budget gaps. Irrespective of that, as the Auditor General says, what we need to see, and I think that we've been saying this for some time, is change and reform. Simply delivering what we've been delivering here the two is not going to be the right way forward. The whole commitment to more community based provision, more preventative services, we're all framed around trying to develop and implement a more sustainable social care system. We've seen progress in that front, but as the briefing makes clear and as the feeling report makes clear, that change hasn't been quick enough or widespread enough. Therefore, the challenge for the next few years, as you wish, and the challenge for national care service itself, is making sure that we have sustainable models in local areas. That requires changes by health boards, councils and strong leadership by integration joint boards. You mentioned the national insurance contributions, so the increase is set to provide an extra £1.1 billion to Scotland. Has any work been undertaken to establish what proportion of the funding will go towards social care? I'll check with colleagues in the team if we've a site of that analysis. Deputy convener, about the spending plans that the Government has set out. If memory says me correct, there may be references in the medium-term financial strategy, but I apologise, I don't have that detail to hand, but I'll check with the team if we've got any additional comment. If we don't, we can come back to the committee and write them. You mentioned change in reform as well. You've covered that, so I'm going to ask what the required shift is in the delivery of social care services to a preventative approach. Has anything been done about the relative cost effectiveness of investing in preventative care, as opposed to only paying for support when someone is at crisis point? There is a significant body of work, Deputy convener, about the relative cost and also better outcomes from moving to a preventative care model, as opposed to particularly in the health and social care setting about the impact of, typically felt for unscheduled unplanned care presentations at A&E, the duration of stay in hospital, challenges of creating care packages, impact on delayed discharges and the knock-off implication throughout the system of health and social care. We mentioned already this morning about this thinking isn't new. Certainly the Christie commission explored this in detail 10 plus years ago now about both the most cost efficient, not the key driver necessarily, but the better outcomes that people receive from having a preventative approach applied to their social care and health needs. There are some references in our own paper, but we are happy to come back to the committee with additional comments and sources if that would be helpful. Paragraph 28 states that two thirds of integration authorities were unable to achieve a balanced budget in 2018-19 without additional funding from partners. The briefing also highlights that the introduction of free personal and nursing care resulted in the development of eligibility criteria to manage demand for services. That has led to local variations in response to financial pressures across Scotland. Could you provide some further detail on the local variations that exist with regard to the eligibility criteria for free personal and nursing care and the extent to which you believe that there is a postcode lottery for care? If I may invite Anthony to answer that question, given that he is closer than I am to the individual workings of integration joint boards. This is not a new issue. This was an issue that we commented on in the Social Work and Scotland report in 2016, when we saw that the pressures that were faced by local authorities meant that, in many cases, they were having to revisit the eligibility criteria. Previously, they might have been adopting more of a preventative model and the threshold for receiving services was set at a particular level. Many local authorities were moving to place a threshold on accessing to be reading quite a critical need. At that point, we were highlighting the fact that this was running very much counter to the topic that we have just been discussing, which is a shift towards prevention. It really meant that people were only accessing services when the needs were very significant. We will be able to provide a bit more further information for you, Sharon, on that, on the idea of this as well. It is a significant issue. Okay, thank you. Okay, thanks very much indeed. Anthony Clark mentioned about change and reform on the agenda. Craig Hoy has got a final series of questions about what the future holds, Craig. Thank you, convener. Good morning, Mr Boyle. Before we go perhaps into the detail of the proposals for a national care service, I don't want to pre-empt what the Government will finally come forward with. Given that your report identifies that there is an urgent need for actions in relation to the present system, particularly in adult social care, is there a risk that the difficult decisions that need to be taken now could be put on hold, especially given the much wider scope and remit for a possible national care service that goes well beyond that envisaged by the failure review? I think that we've got ourselves the position that there's both these things. So there's a need for some urgency to address the threats, the sustainability of the social care sector that can't wait for a national care service. We've talked this morning about particularly the workforce challenges, recruitment, retention, sickness absence levels, sharing of data, consideration of the commissioning model. All of these things can be thought about and tackled now before the Government takes its time with the discussion with the Parliament about what happens and how the national care service will be structured. The key message from our report today, Mr Boyle, is that there's an urgency to address some of the challenges that the sector is facing that needs to be done alongside some of the thinking that will take place about how the national care service will deliver better outcomes. Do you think, though, that there is a risk—if you look at the consular responses and individual council responses to the consultation—that there is a risk that there will be a period of paralysis as we go through such a huge structural reform, particularly in relation to workforce issues? How should we guard against that now? It's undoubtedly when there is a risk that focus turns to governance and structural matters about how a new system, a very significant plank of public sector reform, will be implemented. There are very many people working in the sector who will all want to have their voice heard about how that looks and what that means. That really takes us back to our key conclusion from today's briefing that, while thinking will no doubt take place to develop a national care service, there is a risk that that pushes out addressing some of the very real challenges that need to be tackled now, many years in advance of we see a national care service and begin to feel its impact. Obviously, you set out on page 19 the timeline for social care reform. One of the things that I note with some alarm is that, even before we've got the full scope of the services that might be provided by a national care service, we see that already management consultants are coming in to put in place programme management structures and the operating model. Is there a risk that we put the car before the horse here and that we end up building the bureaucratic system independently of the patient-centred or the resident-centred care system that I think feeling envisaged? It's important that the Government and its partners consult widely about the views of service users and representative bodies in the sector are reflected alongside any expertise that the Government decides that it needs to bring in to create structures. I think that my previous answer goes back to that, although setting up significant plans of public sector reform will require investment and expertise, it doesn't push out the need to address some of the very real challenges that the sector is facing currently. We have many years of consultation and discussion ahead of us in setting up what the national care service looks like. I will perhaps reference back to Mr Beattie's question that, alongside that, we learned some of the lessons from previous public sector reform and addressed some of the recurring themes around particularly data that we are clear on what the outcomes will be. Ultimately, that is the core ambition from this level of investment that people who are using and relying upon social care services in Scotland receive a better outcome than they are currently doing so. Looking at the timetable that you have on page 19, which effectively has the national care service becoming fully operational by 2026, bearing in mind that we are already into the second quarter of 2022 and no legislation has come forward as of yet, do you think that the timetable is reasonable and that any costings that you have seen so far are likely to be deliverable and achievable? I have two things to say. The scale of public sector reform proposed here is the most significant that any of us will have seen in decades. That needs to be accompanied by a very clear timeline of deliverables in order to meet the timeline that is suggested. We touched on the briefing that the scope of the national care service is significant in terms of adult social care, children's services, social work, drugs and alcohol. That needs to be accompanied by detailed costings that have not yet been produced. All that needs to be clear for the Parliament to scrutinise and for users of the service, given that there are many people working in the sector, representing groups and people relying on the service, is that their voices are very clear and play a part in shaping what the national care service looks like to them? We are almost talking about a fundamental structural reform of local government. Mr Clark referred to needing urgent action from local authorities and IJBs in relation to the present demands and needs of the care service. We see local government and IJBs effectively being moved out of the picture, or a rebranding of IJBs through that. As we look at the structures and the ownership of the system, are there going to be risks that we lose accountability at the local level and that we may end up seeing some of the issues that perhaps you have identified in relation to Police Scotland, for example, in the past? As our understanding of the consultation, like everyone else, we are waiting to see more detail, is that there will be changes in some of the accountability arrangements if they are progressed in the way that the consultation suggests with the creation of memory seismic national social care boards. I may have the wrong terminology, but mirroring the role that NHS boards play in an NHS setting and accountability will move from local authorities to the Scottish Parliament and Scottish ministers. All of that is a process of change, the risk. If you are relating to Mr Hoy, during that period of change there is a risk in terms of focus, quality of service and so forth, and we are keen to emphasise that that needs to be addressed. The focus, when any significant plank of public sector reform takes place, is that it is not at the expense of care and the quality of service that people receive. That is a very real component of that that we come back to if I may, just in terms of the overall conclusion that we make in the briefing paper, that some factors have to be addressed now, not wait for a national care service and also guard against the risk that, as we are going through a period of real structural change, that that also brings an additional threat to the quality of care. In relation to Mr Beattie, you talked about the importance of data. The Scottish Government's consultation envisages a single national IT system for patient and resident records. What would be the risks in putting such a huge scheme together, given that we have seen prior public sector IT systems not always running according to plan or budget? There is a combination of risks and benefits. The risks clearly that the system does not deliver what is intended, does not meet the timescales, cost overruns, cyber security threats of any system, and that those risks are known and addressed that they are guarded against. Alongside that, the benefits and opportunities of investing and progressing with IT arrangements are reflected in the outcomes that come from it. We have not done any work on this yet, but very clearly, as we touched on in the paper that I mentioned this morning, it is our intention to undertake more work on social care in Scotland. Very appropriate parallels are that, with the level of reform of this type, we have looked to undertake audit work in recent years alongside the implementation of significant changes in policy, such as police reform. We produced a number of reports and, more recently, in social security reform that audit work and assurance that the Parliament will want does not wait until a system is implemented so that there is an opportunity to audit and comment alongside the development and implementation of policy, and we can anticipate that that is what we will be with the national care service. Just one final question, if I may. The review and the Government's consultation continues to envisage the private sector playing a significant role in the delivery and provision of care. How should the Government go about making sure that it fully engages and keeps the private sector informed and consulted so that it does, in the end, form part of the end solution that we see once there is a national but not a nationalised care service? You touched on your question. We operate a mixed market in Scotland, so that there is a clear role for the private sector currently in the provision of social care, and I am sure that the Government will want to engage widely, consult and inform and listen to the views of providers and recipients of care. Perhaps more a question for the Government themselves about the steps that they are planning to take to ensure that that happens. Thank you very much. I am famous to how you are veering to areas of policy and ideology there, which is certainly not the remit of this committee. However, this is a debate in which the whole Parliament is going to engage in in the next few years. However, I think that the point that you have been making repeatedly this morning, as well as in the briefing, is that there are some urgent issues that need to be addressed alongside the Parliament's deliberation on the reform of the system. You did also mention your interest that is shared with us about what happened to the £500 million cash injection and how much of that went into social care commissioning. If you get to the bottom of that, we would appreciate you sharing that with us, because we are anxious to track where the money has gone. We also heard about skills development and some of the innovative things that Edinburgh College shared with us in a roundtable discussion that this committee held late last year. Next week, we will have the director general education and justice giving evidence on the planning for skills agenda. We have clearly a lot of shared interests and what is going on in the care sector is absolutely central to what is happening in the planning for skills work that the Scottish Government is leading on. I take the opportunity now to thank Anthony Clark and Sheila Stewart, who have joined us online this morning, to you, Auditor General, as always. I thank you for the production of the briefing and for answering our questions on it. I now want to move the committee into private session.