 Good morning and welcome to the 20th meeting in 2022 of the Finance and Public Administration Committee. The first item on our agenda is an evidence session on the financial memorandum to the National Care Service Scotland Bill. I therefore welcome to the meeting Mark Taylor, Audit director, Audit Scotland, Emma Cunn Grif, Knowledge Exchange Fellow, Fraser Valder Institute, Hannah Tweed, Senior Policy Officer at the Health and Social Care Alliance Scotland, which will be known throughout this morning's sessions as the Alliance, and Ray Roberts, chief executive of NHS Borders, NHS Scotland. I would like to thank everyone for your written submissions, and, obviously, we will be questioning those this morning, and, indeed, for joining us today. We will move straight to questions, and I think I'll kick off with yourself, Mark. What I would really like from you, Mark, is an explanation of what you mean by the word significant, because, throughout your submission, you talk about things, for example, that there will be a likely to be a significant degree of variation in the treatment of centre support services and other overheads, and you talk about the significant this and the significant that, so in order that we can engage a wee bit more of what you're actually talking about, you know, such, for example, significant amounts of uncertainty in the financial memorandum. Can you give us a wee bit more information on what you really mean by that? Try my best, convener. I guess the starting point for that is a recognition that, by its nature, financial memorandum is an estimate and contains a whole number of estimates, and I guess what we're looking to do is recognise, given that there is a high degree of estimation, particularly in these circumstances where the bill itself is a framework bill and there's much still to be worked through, to really emphasise the areas that we felt, that the Accounts Commission felt, that the Auditor General felt, were likely to make an impact on the numbers and the spending quoted throughout the document. So, the phrase significant is to indicate that it matters, essentially, and has the potential to change the numbers that are quoted as those numbers are developed and worked through. Yeah, I mean, my only concern is the range of numbers, because obviously significant to some people means different than it is to other people, so it was just to see if I could pin you down a wee bit more on that. Hannah, in your submission you've said that you suggest that financial memorandum does not provide sufficient detail on funding plans to assure the sector of sufficient investment to see the proposals implemented, particularly given the significant impact of the cost of living crisis on the third and independent sectors as evidenced by recent work by SCVO. So, obviously, you have also significant concerns, so if there is a shortfall in terms of what the financial memorandum hopes to deliver, have you got any idea of what that shortfall might be? I won't have figures to bring off the tough on my head for you on that, but the key concern that we have heard from across our membership is that this is a financial memorandum that is responding to a framework bill, and we understand that, but there's very little detail even within that context on what parts of the costings provided are acknowledging the role of the third sector and of the really varied and deep services and provision that they provide, and I include volunteering work within that. And without acknowledgement of investment within that sphere as well as within the various extremely complicated movements that are proposed between health and social care boards, that has real concerns for us and for our membership. I mean, what I found was interesting was that, you know, when asked if I applicable, do you believe your comments on the financial assumption of an accurate effect on a financial memorandum, you basically said, well, no, you didn't really, but Fraser Vallander, Emma, you basically thought that they were. You took the view that the analysis provided by the Scottish Government is reasoned and logical, so I'm just wondering if you can explain your thinking on that. Yeah, so it's been a tricky one to analyse. We came at this looking at the whole of the NCS in terms of the work we did and looking at the costs and the benefits of that as a whole, but clearly for scrutiny of the bill, we are just talking about what's in the legislation, which is limited, and we're not here to talk about that, but potentially too limited, given the scale of the national care service going forward. But in terms of the detail of what was in the financial memorandum relating to specifically what was in the legislation, it took a long time for us to work through and we required additional information from the Government in order to be able to understand what they'd done. We did note that there were some gaps, but where we got to was basically what comes across most in this. A large amount of money will need to be spent on the set-up of the national care service, which is what the bill is about, and there's a lot of uncertainty within that number. There's a big range in terms of the recurring costs even once it's been set up. That's the implication that we got from the financial memorandum. As going through all the costs, when we did get the right amount of detail, we could see how the estimates had been put together and where other evidence had been used to be brought into that. We did think that they did a reasonable job at being transparent and talking through the range of uncertainties that they knew were there, but they were never going to be able to do a full and proper job given where we are and when the bill has been introduced before a lot of the detail has been worked through on some of the uncertainties. I have to say that I've been very neglectful this morning. I haven't given the apologies of my colleagues, John Mason and Ross Greer, who are coming to the meeting this morning, but unfortunately they've been held up by trained difficulties coming through from Glasgow, so I apologise for not seeing that earlier on. Back to where we were, Raythe, in your submission, Emma has just mentioned a gap. You said in your submission that there's no detail about which community and mental health services were included within the financial memorandum, so that's a gap that concerns you. Maybe just before I start, I should be absolutely clear that I am the chief executive of NHS Borders, but I'm also chair of the NHS Board chief executives group, and I'm, in a sense, representing that group here today as well. I suppose that's one of the fundamental questions around doing a financial memorandum for a framework bill, because the Government have been clear and I understand and welcome the sense that, as this develops, that will be done through co-design, and that then means that an awful lot of the detail is still to be worked through. We recognise that there are costs identified for community health and mental health within the financial memorandum, but we are not absolutely clear what they exactly relate to, and so that will need to be worked through once we get into the co-design and understand whether or what services are being put into the national care service from a health perspective. There's a different set of questions that's separate to the financial memorandum about whether or not we think that that is the right thing to do or not, which you may or may not wish to get into, but from the financial memorandum perspective until we've actually understood exactly what those services are and how they would be going in and then what the relationship would be between the care boards and health boards in terms of the way they would work. It's very difficult to get to the detail of the costs, both in terms of the current cost of delivering the services, but also the indirect costs and the support costs that are associated with us delivering those services, so if I put that in the context of NHS Borders, community health, primary care, mental health is about 50 per cent of NHS Borders' budget, so if that money doesn't come directly to the health board in the future and goes direct to the care boards and then those services are commissioned from the health board, that is a very significant impact on our support structure and so how you release those costs, whether you can release those costs or whether, as an organisation, you still need to retain a significant portion of those from the point of view of economies of scale, hasn't been worked through and will need to be worked through. Thank you for that and the same with you, Ruth. You said in your submission that what could be the most significant, that great word, significant again, public sector organisational change in recent memory must not be underestimated in both time, unnecessary distractions and increased costs. What do you mean by unnecessary distractions? There are two points around that. One is the impact of organisational change at any point and what that means and the second point is recognising where we currently are. The fundamental point about we need to improve social care, we need to improve outcomes and wellbeing absolutely, I don't think anybody would disagree with. In the context of where we currently are, the focus on organisational change when the organisations are under more pressure today than we have been at any point in the last two years and the impact that would then require on staff to engage with the co-design process does give us significant concerns at this point. I recognise this disguised a process over the lifetime of the Parliament but even so that is an awful lot of organisational focus that needs to be put in place to understand the implications on staff and buildings and etc. So that is a concern and then the other bit is the fundamental point about is organisational change the right thing to do to improve social care and I think that financial memorandum makes the point that it doesn't include the cost associated with other social care improvements that we need to make but I would make the proposition that if we have a proportion of resource to invest in social care would I choose, was it my money to put that into organisational change or would I choose to put that into developing the workforce, developing standards etc. I think I would be very thoughtful about putting the money into organisational change. Okay, thank you. In terms of Fraser Vander's analysis, you know, I find it quite interesting in terms of your discussions about table 3 where he said, decisions relating to the number of care boards have not yet been made and the figures on table 3 assume 32 are created, one for each local authority area. So does that seem efficient to you to have 32, so from 32 local authorities to 32 boards? What impact would that have in terms of being able to deliver what the bill sets out to do ultimately which is to ensure that we have high levels of standard of quality of care consistent like our Scotland? We were looking at it just in terms of whether the financial memorandum kind of made sense in terms of how they put those figures together, so if you have to come up with an assumption and then that seemed like a reasonable assumption to be making at this stage, I think it's clear that they need to work through a lot more detail to actually understand what they believe is, the Scottish Government believe is the right framework for that in terms of their, you know, the coming forward of a programme business case, I believe they have got, they stated very clearly that they have a lot of work to do. From an efficiency point of view, I think there are 32 care boards replacing what's there before, may not seem the most efficient use of money but you'd expect them to be looking at this from a appraisal point of view in terms of looking at the range of factors that they believe are important in order to meet the aims of the national care service for that consistent and high-quality care, so in terms of how many care boards that will mean, we don't really have a view. The moment what the financial memorandum does is provide a range of assumptions and a range of indicative costs and we're a long way from the decision point on how that should work. I think in making those decisions and some of these themes have already been talked about by colleagues today, it's those decisions can't be made in isolation of the sectors affected whether it's local government or whether that's the health service and there's obviously given the scale of activity, we've had an illustration from NHS boarders equally, the scale of activity of individual councils that are affected here. There obviously needs to be a lot of care for thought as to how that works from a whole system perspective and I think therefore having a full and wide ranging discussion about the different models of where care boards should sit and how they should map against existing geographies is an important part of that. From auditor general's perspective, from the council's perspective, we don't have a view on what the right solution to that is but it's important that those discussions take place in partnership with the people task we provide in the services and managing the services so I think we're a long way from being able to provide a view on that. Yes, I mean you talked obviously in the response to question seven about the volatility of inflation costs not yet assessed and you do talk about the variability of costs of staff harmonisation and rationalisation highlighting Pagor 54 is not reflected in the range quoted and again you went to the word significantly by saying in our view is likely to be significant uncertainty with the cost of harmonisation that goes beyond the extent of services and staff groups involved so again what kind of if it's not in the range quoted what kind of range do you think would be more realistic? Difficult for us to come up with a figure convener and we're not in a position to do that. I think what the what the financial memorandum does has been mentioned by colleagues previously has identified some areas of cost where there is significant uncertainty of those areas but then does not provide any figures in relation to those costs and there's a range of those we've included those in our submission and I know you talked about VAT for example previously as well staff harmonisation costs and a number of other costs potential changes to capital and maintenance and the health and social care information scheme so there's narrative in the financial memorandum about each of those things but there's no numbers attached to any of those things and those are all in addition to the numbers that are quoted in the paper. You were nodding there basically and you quoted a statement from Parger 56 on financial memorandum it's not anticipated the establishment of the NCS and care boards and the transfer of functions bodies will have any financial implications for any other public bodies businesses or third sector organisations or for individuals but you you don't agree with that. Sorry I think that there's areas where the majority of the cost will land with colleagues within health and social care partnerships and within the NHS but there are key areas that are not covered within the financial memorandum which will have an impact should they go ahead with the third sector so an example of that would be proposals around care records have been something that is welcomed by some of our membership as potentially reducing the trauma people have of repeating stories again and again ad infinitum and complexities of you know inefficiencies within accessing care but there's nothing to indicate ongoing training costs to ensure that third sector providers of services and support are accommodated in terms of accessing proposed care records but also in terms of unpaid carers access to such systems and people accessing services so if you are to have a care record system that is citizen focused that enables people to have ownership of their own data records and that is flexible enough to allow both digital and non-digital access as per best practice you need something that is the trade the software access the equipment and the relevant training on an ongoing basis because someone can start to need access to care records that didn't during the transition period outlined in the bill that needs to be considered and no that's probably not a substantial cost in proportion of everything else being talked about for the people delivering and accessing services it really matters and it's that sort of detail that really does need to be considered I think if this is to be sustainable and to reflect the complexity of the social care environment and who delivers and access services does that make sense yeah it does and and and and just to to follow on with yourself hi just to move on a wee bit I mean one of the things in your submission you've also said is that the line says supports volunteer scotland's cost and should the volunteers wear a valuable asset to the health and social care landscape are not expected to substitute for paid care provision is there any indication that that's going to be considered not explicitly in the legislation but functionally the pressures under which systems and people have been operating particularly in the last two two and a half years have meant an increasing reliance on unpaid carers and on community support because I mean I'll defer to colleagues at the table but the the system is under extreme pressure this will not surprise anyone in the room and what I would be really hesitant about is seeing a system that relies on unpaid provision of care without properly supporting those persons and without their agreement and wish to do so that's not to denigrate the significant impact of unpaid carers quite the contrary similarly with volunteers but I do think it's worth tracking how that how that shift is developing particularly with regard to the pressures that the workforce is under and the loss of people within the social care workforce sector we're seeing at the moment you know what patterns are emerging how will that affect the costings how does that affect preventative spend and investment okay I'm gonna let colleagues in in a minute or two because if I've been given quite a barrage of questions there's a huge area areas we haven't touched on so I'm just gonna ask another question to rhaith and mark and then Emma and then I'll open up the session so rhaith one of the things that the that's talked about is potential for efficiency savings but you've said in your response that it would be difficult to find additional efficiencies savings so do you feel therefore that if efficiency savings cannot be met that any gaps must there must be a commitment for those to be met by the Scottish Government or should they be shared or are you hoping that efficiency savings can somehow be found out so where possibly could they be found from I mean I think well first point is all organisations should be and continued to look for efficiency savings at all times and we will continue to do that I don't need to tell this committee where we are as a set of organisations around public sector finance and therefore the need to be finding efficiencies anyway so that there will then at the end of that be a choice about whether those efficiency savings are addressing the underlying gaps in budgets or whether they are available for reinvestment in other services like the development of the national care service so that's the first point the second point is I think we need to be very careful about how we describe the potential for efficiency savings associated with specific proposals in the bill and the ability then to actually drive out efficiency savings so one example would be that there are figures quoted in the financial memorandum around the impact of breaks for carers which we would absolutely support as a really really valuable and important thing to do and it quite rightly references the fact that that has a knock on impact on the rest of the system whether that's in social care or within health with people coming into hospital for periods of time which they probably wouldn't had unpaid carers or being able to get breaks however it then goes on to propel to assume that that resource will then be released from the health budget and I think we have to be very careful about making that assumption those are costs that are embedded in the cost of running hospitals we know we've got a huge backlog in care the more likely reality is that that spare capacity will be taken up with other activity delivering the backlog not least recognising that actually we've got systems that are running at 1995 plus percent occupancy and most efficient health systems would run much closer to 80 percent so while the impact of the breaks for carers would be a good thing in terms of delivering improved outcomes I think you have to be very careful about assuming that that sort of efficiency from that will necessarily be released and be available to help fund that ambition which is a perfectly reasonable ambition to be done I hope that helps yes it does thank you for that and mark you've commented about paragraph 51 saying it provides details of the components of core management costs assessed but the subsequent analysis does not provide any information against these headings what kind of level of cost could we be talking about here first of all just to clarify or correct our comment in relation to paragraph 51 I think what we would recognise is that the subsequent table table 8 does provide that analysis at a high level against those cost headings the point we were looking to make and reflection I've not made as clear as we might in the paper is about the level of detail underpinning that and what the basis of those the make-up of that cost is exactly again it's difficult to put numbers on these things I think that the overriding I guess judgment we made in providing our comments was that there's a range of costs that have been set out there's a degree of analysis underpinning those costs but there's a range of additional areas that are likely to add to those costs that have yet to be assessed and again in this area there's been numbers put on those individual areas but the level of uncertainty is such that the accumulation so it is unlikely that in each of the areas that have been identified as potential additional costs that those will all be nil I think we use the word significant but in a number of those areas those are likely to accumulate what we don't know and what we're not able to tell is is how that affects the overall the overall assessment of the amount involved the reason why that's important to fold one is part of the job of government I guess the job of parliament the job of audit scotland is to help that assessment of affordability and sustainability and where government is embarking on this bill and embarking on this policy to have that overall sense of what the cost is likely to be and at the moment we feel that's likely to be understated and how that cost sits alongside the cost of other commitments around social security around funding for the health service in a very challenging fiscal environment and I don't need to share the details of that with committee members at the moment and therefore to get that greater visibility as soon as it's possible to do that and we recognise the process that's gone through here and that this is part of a wider set of financial planning that needs to take place but as soon as there needs to be that overall sense of what what are we what are we taking on here from a cost perspective and how does that sit alongside the wider financial environment that government's facing at the moment yeah I mean we're not looking for specific pensions and pens costs at this stage but it's looking to see where the parameters obviously you know correct and whether or not best estimates have actually been delivered by this financial memorandum that's the kind of thing that we're looking for I think obviously cost and underpinnings are important because to my mind we're looking at structural changes and we're you know there's seems to be colossal sums involved you know it's not as if they're building new headquarters for each of these boards or anything like that we're still talking about hundreds of millions of pounds and it's important about how we actually how these figures are obviously arrived at how accurate they are etc and I mean do you feel have best estimates are I think I think we're not in a position to say I think I think we're not in a position to say because of the level of detail that's been provided around that there's been a degree of narrative but but there is there are a series of numbers that are provided without the basis of those numbers having been established really being demonstrated we've done a bit of analysis around some of the staffing costs which seem reasonable in terms of cost per head but in terms of the numbers that are expected in difficulty in particular areas it's difficult to get handle on the the the rigor of the assessment that's underpinning that in saying that we recognise that financial memorandum particularly in this type of bill it's at an early stage of the process and I think what's really important is the government proceeds they are able to keep parliament up to date about what that aggregate is and what the components of that aggregate are and find mechanisms to enable that to be scrutinised as decisions are made and things move on. I think the closest example to point to which which is not the same as this but is a similar scale of project is introduction of social security in Scotland and one of the things that we reported on throughout that introduction was it took a long time for government to get to a position where it was able to say with a degree of clarity what the total costs of the change project were around of that and we reported a number of occasions that they need to have much more clarity about that and even at this stage there's still uncertainty about where although it's much clearer where that's likely to finish in terms of the overall cost I think those same lessons need to be applied in this case and government needs to be able to be much clearer a much earlier stage about its financial plans of course there's uncertainty in there about co-creation and the way that that works but that that can't happen in a vacuum it needs to be related to some wider underpinning some wider plans about the financial aspects of all of this. Okay thank you and Emma I'll just finish my questioning with this. I mean you've said in your response that the creation of an electronic integrated health and social care record is in the legislation but no costing has been produced. The reason given is that the work is at two or less staged estimate costs but will be provided in the programme business case due in autumn 2022 and we're now in the autumn and you have been advised as to when these figures will be provided if they've not been already. Yeah so this is based on our conversations with officials that we informed that the programme business case was under development and hoped to be available in autumn 2022. I'm not sure what the position is now. The health and social care record it is an obvious gap in the financial memorandum although I note that the legislation isn't specific on exactly what the programme will be in terms of moving forward the details not there so potentially it's too early stage to do any costings on that but it's the magnitude of such a change a big IT project we know how expensive they can be but we also know how important they are so to actually be able to get a really good understanding of the potential costs at a really early stage feels important otherwise it's not going to be started at from the you know the ambition is potentially going to be too limited at the start which kind of sets it up for difficulties further down the line. I mean I think overall the health and social care record is a good example of the just we're just feeling that we are very early on in the process and the the scale of costs that will come not just from the operational setup for what's in the legislation but from the transfer of duties in terms of the ongoing costs of providing care and then the improvements to social care that are envisaged through the to come through the co-production process it's just at the moment we have very little understanding of the some of those costs and it makes it very difficult to then to be sure that the right scrutiny is going to take place at the right time and I would agree remark and saying that we need to think about how those costs can be brought forward for scrutiny at appropriate times so that these things can be kind of aired and we can see the workings behind the scenes. I think so far I found that the Scottish Government officials have been very willing and able to explain what's going on and they've been very transparent in in how they've you know taught us through and I think just giving those opportunities to ensure that that can continue to happen is really important and I'm not not sure what the best way to do that is but I feel there's a lot more that needs to come out into public scrutiny over the course of this Parliament as plans are developed. Just briefly do you have any fears about slippage in terms of cost provision so that you know for example I'll indicate that that provided in the autumn we haven't obviously seen those figures yet they may or may not be available but is that a worry that you know that we make it slippage in costs and then the whole delivery starts to. It's a concern with any project of this nature and when you build programme business cases and appraisals it's really important that those contingencies are built in. I think over the last year we've we've seen some slippage in terms of when we thought statements were going to come out ahead of the bill being laid in Parliament we have seen you know promises of things going to be released or not promises but kind of you know discussions and being informed that plans were ready to be published and then not being and have and therefore we've had this squeezed period over the summer once the legislation has come out and I think there is a worry that that indicates that things are slipping already so yes it is a concern. Okay thank you very much I'm now going to open out the session. Daniel, a deputy convener, will be first to be followed by Liz. Thank you so I'd like to begin by asking questions to both Emma Congreaf and Mark Taylor. Emma, you were just saying that you think the government has been transparent but it strikes me that they're only transparent after you've asked questions in terms of what's set out in the financial memorandum and indeed I find that quite difficult to actually understand what the numbers are telling me so first of all I'd just like to ask you both I mean do you think there's actually in terms of what is published sufficient clarity in order for us to essentially commit to what you know potentially allows ministers to create quite significant financial liabilities for the government especially given that you who has asked the clarity and then specifically in terms of how to understand the numbers you know again I don't thank Fraser of Allander for their summary tables because I find them easier to follow than the ones in the memorandum but is it correct to say that there's the £527 million figure that's a recurring cost for the additional resource and an effort for running the system and actually if you look is it would it also be correct to say that at the high end of the estimates at the establishment phase there's 300 million of non-recurring one-off costs but that's but the other the other key thing is the assumption is is that 8.9 billion of identified costs in social care will essentially just carry over a new regime and there won't won't be savings essentially assuming that all that administrative costs that's in there essentially will need to continue and this is all all the additional cost is that is that the right way so do we have enough transparency is the documentation enough to make that sort of decision and is that the right way to interpret the numbers on the last question you asked your explanation there is my understanding of the figures so there's an the additional set up costs are large and that 500 or so million pounds I believe is a recurring top-end estimate once we're in the steady state after it's all been set up but then there is the money carried across that's currently goes through the local government settlement and some other sources in order to pay for social care but that figure in itself you know it's it could be very different by the time we get to that money being transferred over and on the transparency point I do I do concede that the transparency was out was there once we asked the questions and the what was originally published in the financial memorandum for us at the Fraser Valendure there wasn't enough information there for us to work through the figures and understand how they'd they'd been put together but our conversations with officials once we found the right officials and was very constructive and you know it was clear they were clearly very willing and able to explain them quite why that information wasn't all in the financial memorandum I can't I can't tell you but it's not my understanding that they were trying to hide any of it it was to just have been in how it was put together essentially you're saying in order to understand these numbers and the financial implications of just what's involved with setting up the new organisation you needed to in your own words find the right officials and ask them the right questions do you think all 129 MSPs in the Parliament will necessarily know to do that because essentially we're being asked to approve this on the basis of the documentation not not conversations with officials I mean I don't disagree I mean the reason we we did this work and it was it was the ccps who gave us some funding to do it was to provide that clarity that was missing we felt in the documentation so we were trying to do the job for you essentially so because we saw that there were questions that weren't issues that weren't quite clear in how the figures are worked through so we did that working through the numbers but what you say is correct and that we wouldn't have been able to do that if we hadn't been able to speak to the right officials to get the information and I do think that that is a problem Mark would you agree with that both in terms of my interpretation on numbers and also in what what's all that Scotland's thought around the transparency and whether you know you audit Scotland are experts in looking at management information whether decisions are being made in a you know a robust and repeatable manner do you think the presentation of the information that we have would lend to that sort of itself to that sort of decision making well and fundamentally of course you will be the judge of that I think the things that I would say are I think we're clear that there is limited detail about where the numbers come from in terms of there's narrative and then there's numbers and how the narrative relates to the numbers is not as clear as it might be and and we haven't had the opportunity to speak with government officials to get into the detail of that in the same way as colleagues have but I think that's apparent from reading it I think the broader point is the one we've made before is there's also costs here that have been identified but not costed and therefore the amount and aggregate or the range of the effect of those costs is unknown and we're not able to add detail on to that the third point I'd make and goes back to your last initial question to Emma is one of the points we make in our submission which is perhaps a bit more cryptic than it might be so let me explain it is the relationship between the figures and table two which are the overall spend or what what could potentially transfer and the costs here and a big part of that was that question about are there any efficiencies in here are there any efficiencies that are being assumed that this model will allow that activity to be generated more efficiently either in terms of efficiencies within those cost numbers or restricting the rises of those costs probably more likely in the future and again that whether that's the case or not is not clear the drive of the bill of course is for quality and consistency is a fundamental question is where does efficiency fit in that and does that affect the overall numbers and then that takes us on to whole different discussions around preventative spending models of care reconstruction and the like so I think that that's the question that we had about about that it's a question that I'm about to put to both Hannah and Rafe in a moment because I think you know why are they doing this and what benefits will there be is one that I don't think is properly explained in this but just into those essentially those the the key question areas in terms of things that might have spend or cost that are fully worked through we just recently had a paper a very interesting paper from the fiscal commission looking at Scotland's demographics you know if you if you look at it it is saying that the proportion of people aged over 65 in Scotland is going to go from 20% today to 32% in 2072 now it strikes me that the probably the biggest cost driver and all of this you know setting aside sort of the details around you know the models of care and you know service provision is actually demand and demographics is going to be the single biggest driver of that demand and we're going to have a very substantial increase in that. Do you think that demographics have been properly explored and is the 3% figure seems to sort of cover everything both in terms of service improvement and demographics is that 3% figure sufficient to really cover that I mean so you know has demographics been properly looked at am I right to place that emphasis and is 3% is that is that covering it sort of put that to Emma and Mark in the first instance. The truth of the answer is we don't know there hasn't been as yet and I've assumed the Scottish Government is working on this there hasn't been a detailed analysis of demographic changes that are expected and how that will impact on the cost of care being delivered other than an acknowledgement that there will be an upwards pressure. So the 3% figure is around 3.5% is the figure that's generally used in England from some modelling that LSE do in order looking at the different components of care and it's not just the over 65 age group actually it's the over 80 age group that has you know the biggest sort of most significant impact on the cost of care. So as a yet that analysis from what we've looked at across the literature on this there hasn't been that level of analysis done specifically for Scotland. I know Ireland is another example of where there's recently been a lot of assessment of that so that is something that will be required in order to understand the demand. That isn't as far as I understand it that isn't a core part of the financial memorandum it's not something that has to be scrutinised because the financial memorandum is about the setup of the of the new operational system not about the provision of social care going forward but there is a table in the financial memorandum that talks through it so it has been included but the extent to which that's there for scrutiny at this time is a little unclear. So I mean a 3% it's not it's not a I mean it seems a reasonable estimate but it's not founded on specific evidence of the drivers of social care in Scotland. Would you agree with that? I mean do you think there's sort of sufficient clarity on the impact of demographics? Yeah I'd agree entirely with Emma there. I think two things to say one is that the table is helpful because it sets out the scale and that's the purpose of the table sets out the scale. What's not clear is whether that scale or how that scale matters to the numbers that are part of the financial memorandum and therefore if that scale is bigger or smaller will that affect costs in terms of what's the subject of the financial memorandum. In terms of the numbers on table two and again we make this point in our submission it's unclear where the 3% comes from except the point about it's a kind of standard approach but that doesn't reflect necessarily the expectations in Scotland. I think that you've pointed to the work of the fiscal commission so far and their plans for reporting in the first quarter 2023 I think will help put some additional light around what the implications of demographic change will and it will be and I think it'll be fundamentally important to thinking about the national care service in the round care health services and cost based in the round. In terms of how this paper sits I think it's helpful to have this. I think there are some questions around the 3% and where the numbers have come from. It's set out as being indicative what's less clear is how does it affect things. Just coming to Rafe and Hannah the points already being made by Emma and Mark to an extent about it so the lack of clarity about it actually why this will improve things. Maybe we can just elaborate a little bit. The implication here is that currently decisions around social care services are being made by local authorities and health boards both separately and collectively through iJBs. The implication here is that what's going wrong is that we need an independent decision maker separate from both local authorities and health because otherwise I don't understand how else to you interpret these plans. Do you think that that is the problem with how we are providing health in social care is that we need an independent decision maker separate from those delivering health care and separate from those providing local services. Rafe do you want to? Thanks for that. I mean I think it's important to answer. If you go back to the principles in the bill there's some really good principles in there. There are clearly some elements of the bill like shared information like breaks for carers etc that I would absolutely support. I think I've already said that I don't personally fundamentally believe that significant organisational change is what will add the biggest value at the moment. I think that there are other things that are a higher priority but I do think that there are opportunities for us to continue to improve the way in which the various bodies involved in the health and care system interact and I would certainly like us to continue to take those and work through that. IJBs I think it's been said in various evidence to various committees have been in place for a number of years now but in organisational terms they're still relatively new and are finding their feet and have had to deal over the last couple of years with a very different set of propositions and I think there's certainly learning in that but I think personally I think there is opportunity to address that through the existing legislation and building on that with local partners, understanding how they make decisions better together, addressing some of the cultural and behavioural differences and then building on some of the other aspects that are in the bill. Good question, it's probably slightly unfair but I'm afraid it's a question, I don't know if I can put it this way. Is the problem about where we're making decisions and if you're going to spend £500 million a year in improving social care is it is about creating a separate decision making body or is it elsewhere that you would you think that we need to look at in terms of? I think that there are a range of issues with current delivery of social care and one of the ones that I would highlight that I think steps back from that presentation if that's all right would be that there is little in the current structures despite the best will of many of the people involved within health and social care partnerships and IJBs about the prioritisation of the voices of people who access services and who deliver them at grassroots level and that is something that I don't think is perfect in the NCS bill in our wider response we highlighted that we strongly recommend that while we welcome the mention of lived experience representation and the provision to ensure that they can sit with meaningful voting rights which doesn't happen in current IJB structures they're not even in a large number of IJBs those positions aren't even fillable for a variety of reasons including basic working practices you know off the top of my head nine a and meetings don't tend to suit someone with care responsibilities if we can embed something where co-production happens not just at the stage of consultation and discussion around legislation but on day to day decision making including finances then I think that changes the dynamic that changes it away from decision makers who are grounded in the health and social care professions although their insight is valuable it should be part of the process and makes it much more of a partnership working process I think one of the things that has come through loud and clear in some of the research the alliance has done I'm thinking of a piece we did with self-directed support Scotland a couple years back my support my choice people's experiences of self-directed support in Scotland does what says in the tin and one of the things came through is when sds works for people it works really well and people actually highlighted the impact that the shift towards greater control and choice of of how to care should be delivered made a really substantial difference to their day to day life to their ability to engage with the community to work at a whole host of things but that is not consistent across the country and that's the challenge that's one of the primary challenges and if we have a system that says decision making across Scotland will involve and embed disabled people people living with long-term conditions and unpaid carers in every care board and in every stage of decision making that's a different beast and that does not happen in the current system it does not happen within the current legislative structure so yeah that's my set piece on that so following on from this I mean this is my final question I mean the OECD have done quite a substantial amount of work around aging population across industrialised economies and having looked at at their reports on that I mean there are that if you look at countries which have undertaken reform you know notably I think Japan the Netherlands and Finland that the approach that they have taken is actually to enhance the powers and municipal level for both configuring and then delivering social care services strikes me that this is taking the opposite approach is is actually you know taking up a layer I mean I was just wondering if either of you understand or or you know whether it's been explained to you why the government have taken the approach of essentially centralising rather than you know pushing down and do you do you think you know what's your reflection about the appropriate level to make these decisions I think that the priority should be improving people's access to good quality social care however that is achieved and that's essentially the the main take home for me and for the alliance and our membership I hesitate with any rhetoric that implies that all we need is more money or investment or slightly more powers for current systems because it implies that what we have works and just needs a bit more investment and I'm not sure that that's true I'm not sure that's evidenced within what we've heard from people with lived experience whether that means this is the right way to go about it I'm thankful that's your job and not mine but I think that there is a great deal of potential in anything that meaningfully prioritises a proper co-production approach that's a great thing we mean we mean would you think that about it's reflecting voters better and I guess the other way of pitching my question is you do you think there's been sufficient international sort of comparison analysis of what has been done elsewhere and what works and what the dynamics are and I think there's always opportunities to learn from elsewhere and you can always say you can do more I would echo Hannah's point about involving people with lived experience into decision making I don't think it's something we do as well as we could and should so I think but we can do that within existing structures I suppose I see this through the lens of going into your point about municipalities in places at one level through that I've always worked in small organisations I've enjoyed working in small organisations and I think there is a power in having that ability to be connected to your community when you're making decisions so I think that is really important if I just look at it through the health lens if I go back in time in the borders we had three health organisations running health in the borders and we've now had for the last 19 nearly 20 years had one and I think that has been very important for having a unified clear set of decision making for health that allows health to be seen in the round over the last you know 10 years that has increasingly linked into social care and that has certainly been to a benefit but I think we have to understand there is a point at which having more too many bodies in a single population trying to make decisions can cause difficulties that aren't helpful and from a health perspective and it goes back maybe to a point alluded to before about why we think this is potentially so significant it could fundamentally change the dynamic around decision making for primary care community health mental health services for health services potentially for example in our context split community mental health services from inpatient mental health services which we run as a collective so how would that work and if that set of services are going to be commissioned in a health sense in the future by a care board which is getting the money directly then we are going to have to put in place a way of commissioning health services in a way that we don't at the moment and that has a potential cost attached to it it has a potential effectiveness of decision making issue and it has a potential for too many people trying to make the same decision so I think we just have to be very thoughtful around it having said that I think and we've seen we've seen this within the health service again you know there are always opportunities or cases where it is actually helpful for there to be collaboration at a bigger a higher level or at a national level we commission very specialist national health services at a national level and I've got examples of individual very complex care cases that we are not big enough or have the skills to necessarily deliver just for our population so I think there is a role for some form of regional national collaboration on particular types of care in Scotland that could be delivered as part of a national care service so I think there are some real strengths in here we within health have done work around international recruitment that we can all have a debate about how effective it is but it has been done collectively and I think that has added value to us as a local health board around what's been done at a national level I would you know suggest that there are opportunities to do that around social care workforce in terms of bringing in social care workers recognizing that workforce is one of our biggest issues so I think there are definitely opportunities at a national level that we can bring together but I fundamentally believe decision making around these sorts of services needs to be embedded in the local communities thank you very much just like the witnesses who attended committee last week you've each cited instances of where you feel that there hasn't been sufficient detail for to make sure that the numbers properly relate to the narrative can I ask you each have you been surprised by the extent of the lack of the detail given that the scale of the change of reform is you know is very significant to use that word it's on the same scale as you know merging the police forces or college regionalization are you surprised about the extent of the lack of detail could I just ask each of you that I mean at a level I'm not in the context of this is a framework legislation and the government understandably being very clear that the detail will come out of co-design and that will be the point at which it will be easier to understand the numbers in detail now that obviously I recognize and from the conversations last week that gives issues for the parliament in terms of scrutiny and decision making and that is obviously your business but but so to that extent I'm not surprised at this stage but I think it is really really important as we go forward that we have the time to understand that to work through it work through the implications some of which I've flagged already from a health perspective before decisions are made so there is clearly an awful lot of work to do but I have no I'm not making any suggestion in that that there isn't the commitment to doing that I would echo many of those comments I think once it became clear that it was a framework bill and knowing the complexity of some of the calculations given what we collect data on in some ways this is a hugely complicated almost impossible task for some elements you will be working off estimates rather than off concrete data and that's the best case scenario for some sections that said we do have reservations about leaving quite as much detail to secondary legislation because there are fewer opportunities for editing proposals and for subsequent transparency about why decisions are made and cross-examination just because of the process parliamentary process and that's where we would like to see very very careful movement through this first stage of legislation to work out even within the framework context what needs to be shifted to ensure I mentioned representation on care boards earlier that's an option at the moment in the legislation rather than necessary for quarit decision making I've got real concerns about watering down of some elements of that element of things like that and other human rights based approaches if it is not in primary legislation and that goes into costings because if something doesn't have to happen and you are under significant financial pressure best well in the world it's the optionals that get cut and I'm not that that is what it is I would also go back to Emma's earlier comments about the need for we also have had very welcome conversations with civil servants so I'm not critiquing colleagues within government for that but there's a difference between the conversation and publicly published information I'm keen to see much more of the working shown not just for transparency although that is extremely important but also because in this intervening period of uncertainty for a lot of people delivering services how do you make your budgetary plans as an organisation if you're not sure whether change will be happening in one two three four five years that's got a knock on impact on a sector that is also in many areas finding continued operations difficult so yeah I don't have a lot to add on that I think given that it's a framework bill and given where we are in the process of some of the additional work that the Scottish Government have promised on co-design and on working through various other parts of it I think as we said in our submission we we do think there's sort of a reason process they've gone through to produce the financial memorandum although I do note my previous comments about there not being all the detail within the documents that we would have liked to have seen and had to go searching for so I think that's a concern I'm not sure it's a surprise but it's a concern I think I add the risk of I guess repeating what I've said previously I think what's important fundamentally is as government goes forward as we go forward through parliament with this legislation that there's an understanding of the full range of cost and the full range of financial benefit there and the thing that would be surprising to me was if decisions were taken to proceed without that full understanding being there now I recognise that given the nature of the bill given the nature of the conversations that are ahead about the design of service and how those take place on a co-creation basis involving individuals effective, involving bodies perfected, all that's if you like appropriate but fundamentally unembarking on this path I think there's that fundamental question about what range of cost are we likely to be incurring here and how can we demonstrate that that's affordable and sustainable on embarking on this path and for me that's that's where my surprise would come if government wasn't able to do that the question is whether the financial memorandum is a device to do that that's I guess a question for you but I think it's fundamentally important that government can do that and embarking on such a forgive me for conveying our significant change to the way that things are running thank you these are very helpful Ms Congrief can I just refer you to the paper that you sent to us in which you raised some concerns about some of the use of data you say for example when it came to some of the estimates of inflation that the financial memorandum states that these figures are taken from the ons but you understood them to be actually from the bank of england can I just ask whether you got that issue clarified with the Scottish government and also if you asked them why the Scottish fiscal commission forecast hadn't been used by the Scottish government did you get any clarity on that I didn't get any clarity now on why the Scottish fiscal commission forecast hadn't been used I don't believe I asked so that that may be why I think it's it's you would have expected the Scottish fiscal commission forecast to have been used on the question about the inflation I did ask what the source was and was told it was at the bank of england forecast so when s don't forecast inflation which is why it's slightly off would I be right that because you raised this issue that you want to see much more clarity about not only what the statistics are but what the rationale has been for using them is that is that what you're really seeking that would be generally what we would seek on when these types of types of information are used especially when they differ from what you would normally expect to see in scotland because obviously as a committee and eventually as the parliament it's not easy for us to carry out the scrutiny that you all referred to in your first answers and if we're a little bit unsure about the statistical analysis the source of that analysis and then you know the rationale for using it because that makes our job it's just as difficult as yours in many ways and I'm just interested to know if you would if that's the kind of clarity that you're wanting when it comes to a better assessment of the statistics yeah so on on the specific instance you raised I think that citing it as on s rather than bank of england was just a typo I think in terms of them writing it up and given the on s don't do inflation forecasts it would yeah that it kind of made it was obvious that that it was someone else bank of england forecasts for inflation is seen reasonable but yeah I don't think it would make that much difference if you're using Scottish fiscal commission or a forecast that are done for the UK as a whole obviously inflation that forecasts are done as the UK as a whole they just come out at different times depending on which body is forecasting them but there's a lot of uncertainty within those inflation estimates and I think it would be an appropriate time to ask for enough to for those forecasts to be updated in line of the fact that inflation is not quite appropriate that there's a consistency as well because that allows us to measure against a period of time particularly particularly as we've all mentioned today that this will be an on-going process for quite some time and it's surely important to have a consistency of the statistics against which you're measuring yes I would agree that it'd be good to keep that consistency just one more question convener mr Roberts can I just ask you you've been very clear in your own views this morning that while the some of the principles behind this may be laudable it's maybe not what you think is the right thing to do at this particular juncture would that be a view of your colleagues as chief executives of other health boards is there a general feeling that while there may be some things that we'd like to do this huge structural change is not appropriate just now I mean I believe so we we put in a submission as a collective of board chief executives and I think that's the one of the main themes of that which is you know there's some really good work things in here there are definitely we need to improve social care both from the point of view of the importance of that to individuals receiving care but obviously also the knock on impact that has on health and our ability to provide health services so absolutely supportive of that but I think a level of concern about the scale of organisational change and whether that will add the value that we believe is needed to to deliver the improvement in social care that we all want to see obviously the health services under very difficult circumstances just now for lots of different reasons do you think this bill would have merit if the circumstances were a little bit easier in terms of not fighting Covid and not fighting all the difficulties of health issues for cost of all these things do you think this would be the right thing to do I I personally still believe that you have to be very thoughtful about the reason for doing all organizational change and the benefit that will give alongside other things that you can do to improve social care and I will still go back to I think one of the biggest things that we need to do around social care is investing in the workforce and we can see that in terms of the comparatives between health and social care pay you know my daughter is a student works in hospitality gets paid in hospitality for what I think she would accept me saying is a relatively easy job compared to care exactly the same so if we're going to attract people into a career in social care then I think we that is probably where we should be focusing on priorities thank you very much Michelle to be followed by Douglas quite a lot of areas I wanted to probe have already been followed up by my colleagues mark just quickly and I read scan through very quickly the publication that came out today from audit Scotland radical action needed on data just came out this morning so I wondered from the point of view of you know we're taking a kind of top-down approach looking at the financial memorandum of the the national care bill but looking at it from the other side where we know we have some issues around data are there any areas that you'd like to pull out in the light of this report this morning that are more general and pertain to our inquiry thus far I think one of the one of the things that sits alongside of a news that phrase the financial memorandum is the aspiration for effectively service redesign so to introduce this new structure at its heart is a need to do things differently and provide services differently I've heard some of the specifics of that for that to be successful it needs to be informed by data and it needs to be underpinned by data and understanding and our submission on on on the bill what we we identify is some of the the variability in where information comes from and the variability in some of the numbers that come into table two for example that underpins that information that is that that ostensibly because this is the information that's in front of you is informing decisions that have been made here and that variability at its heart is underpinned by problems around data quality and that investment around data quality is a really important way of making sure that from the bottom up is the way that you ask question these decisions are informed so absolutely even when we look at the high level numbers in the financial memorandum for example around table two there's some questions about the quality of the data that goes into that and so that investment in data quality across public services fundamentally important as we set out in our paper today. In terms of that paper can I assume that that you've made that call because I think that as you yourself describe in it there's a variable appetite for the importance of data as a mechanism of driving change in government is that due to constrained resources or lack of understanding of how important data is as enabler what's your sense of that the reason for the paper is across areas of work by both the auditor general and the accounts commission work we do on a behalf a common theme is that data limitation and the questions are about is that because it's not been invested in is that because people don't give it appropriate attention is it because it's just not possible to establish it and I suppose it's that investment and understanding those issues and be able to address that issues fundamental building book to of course evidence-based policy. Hannah I'm saying so you want to come in here. Do you don't mind. I haven't read the paper as it only came out this morning although that's now on my reading list but one thing that has was was definitely part of our wider response and call was to improve our data collection and publication including intersection and intersectional analysis at the moment what we find and is that data around social care particularly data around social people outcomes and experiences of social care is really variable and I don't say that to critique colleagues at public health Scotland who are working with some extremely difficult data sets in terms of comparisons you know no disrespect but we have very different collection across different local authorities there's very little consistency and that means we don't know where social care is working properly for people and where it is not as accurately as we should in order to make informed decision making. I can give specific examples about how we assess for example information about ethnicity which until in recent publications although I understand that there is significant effort to improve this was still classifying as white other and don't know which is not exactly ideal practice in a variety of ways but also means you can't win it you can't get down to the detail of which population groups are receiving better or poorer access to care and that's massively problematic but there's also something about the fact that we don't have any way of assessing unmet need and the numbers and from a financial position that's really concerning so we know the number of people who access different types of SDS options one two three four telecare etc more or less albeit with differences in collection strategies we don't know how many people request access to social care and are told you don't meet the current eligibility criteria because we are operating under level four you know bath and bed life and limb extent only because of the pressures under which local authorities are under I'm not lessening those but unless we're collecting information about who is being turned away essentially how can we know what early intervention means in terms of estimating the numbers but also estimating the impact of actually earlier intervention and enabling people to live well without reaching the highest point which is generally more expensive as well as huge sort of human rights impacts and impacts on individuals you make clear that your concerns about unmet need in in your submission as I read just to finish off in some of the themes that everybody's brought forward this time I think we all agree that the fact that this is in a framework or an enabling bill and it's a huge transformational project and it's highly complex and there's a huge huge uncertainty in all the variables I suppose and also to add on in legislative terms going through secondary legislation which is something that's been brought out this far but knowing what we know now and setting aside parliamentary processes which we probably want to discuss separately are there any other final things that you want to bring out all of you that you think should have been in the financial memorandum even if they were there with an amber alert in terms of we suspect this we cannot know for extremely good reasons because of what I've set out but have we managed to capture everything thus far either in your submissions or in the questioning thus far from the panel Mark I'll be to kick this one off and thanks for the opportunity to broaden it out a little so it builds on the answer I gave to Daniel Johnson earlier when we were talking about efficiencies is that inherent in what this is about is service redesign and there is an aspiration for improved quality improved consistency in the services that are provided the implication of that is there's a degree an unacceptable degree of variability in services at the moment I think what's not clear is and that that flows from the provisions of the bill I think what's not clear and understandably so but I think what's not clear is the price tag that ultimately we're associated with that so so if that is to be levelling up just to use that politically loaded phrase but if it's to be about areas where where the quality of the consistency of the service falls below a certain standard does that have a price tag attached to it even where it's it and clearly won't be as simple as that we would expect a degree of change in how services are provided because if that doesn't happen what's the point of this therefore what's the price tag what's the cost associated with that service redesign and that reorganisation and I understand at this stage of the process that it's very difficult to get a sense of that but that's if you like the hidden cost here what with financial memorandum is the front line cost but there will be a cost associated with service redesign and changing services both in terms of the transitional costs but the actual underlying cost of those services and I think for Government to be increasingly clear about what that investment what that cost is likely to be will be increasingly important and I know what you're saying about the change itself and the steady state and the breaking down of that cost Emma. I would agree with what Matt said there and also about the points on unmet need I think they are big unknowns as an example we don't even know how many people in Scotland have a learning disability and that's the largest population that takes draws on care for working-age people in Scotland but we have no idea whether who's been turned away from services he would actually really benefit from them and who might fall under future changes in eligibility so I think that's a big area I think one point that's not being raised yet too much is the probable necessity of double running costs during the transition phase in particular and how that might actually be critical for the success of the transition. I was thinking back with someone at CCPS about when there's been big significant change like this before and I thought that of the transition that took place in the early 2000s when the long-stay hospitals were closed and people with learning disabilities and other conditions were moved into the community and when you talked to people that were operating at that time the fact that the two systems ran in parallel for a period of time so that that transition could take place was seen as really critical to its success it wasn't rushed there was enough money in order to ensure that the transition could take place well and that required double running costs for a period of time so I think that would be an area we'd like to see more understanding of what that will mean in financial terms. Any last comments or real from Helen? That I would say it would be really important to draw on the learning around integration and SDS introductions. I think that in particular thinking about on-going training and early training for people delivering services for staff across all levels of decision making if you want to make this meaningfully embedded with human rights-based approaches for example which are very welcome mentioned in the first stage of the bill then that comes with an educational cost and an on-going investment so that people it's not just rhetoric so that it's actually followed through and enabled to inform practice and I'm thinking about the fact that you know best part of 10 years after the SDS legislation come in we're still in a situation where that's not a part of the core curriculum for social workers which are separate around to available on the on-the-crust but what that takes time and it takes investment and that needs to be considered if you are to see it effective running through all of this and I would also tie that into things like the Scottish mental health law review and its recommendations around human rights-based approach budgeting and seeing that threaded through with the wider range of legislation engaging with this at the moment you know how much can this be tied in efficiently to ensure that knowledge basis spread and properly costed three very quick ones one obviously I mean the whole economic fiscal context has changed since this work was you know beginning of the year and that has changed very fast so I think we need to acknowledge that secondly I think we have to be absolutely clear around the opportunity cost of doing this versus that and thirdly I think there is a point in here around the bill is very clear that in terms of the potential changes for children and criminal justice services that that requires further consultation and it also then makes the point about and healthcare services can be delegated to but it doesn't commit to that needing to be consulted on and I think the scale of the impact potential impact on health boards is so significant that it should be an explicit piece that we need to understand the financial implications of that if we talk about it just through the financial lens but the big personally from the bigger organisational sense I think there is a fundamental step that would need to be taken at that point because I think it calls into question fundamentally the structure of health boards that we would have and therefore I think there needs to be some work done on that specifically at the right time. Thank you. I just pick up on that point then so do you feel that in terms of health boards going forward they they may have to radically change as well as the national care service comes into being maybe a reduction on the number of boards do you think or? I mean this is where you begin to get into personal interpretation of and we haven't and the work hasn't been done and it's been quite clear that it hasn't been done yet and that's fine because that's part of the co-design but if you look at this through the lens of borders as I said earlier approximately half of our budget would then presumably go to the care boards and they would be responsible for strategically planning and commissioning primary care services, community services, mental health services and as a health board we would then be left commissioning or planning and delivering all of those services but planning the acute service at that point are we right to have a health board in the borders for an acute service only? Arguably not. I passionately believe having a health board in the borders is the right thing for the population of the borders in terms of local decision making around health services so I would absolutely not advocate for that but we have to understand the potential knock on implications of shifting the balance of responsibility and I know we're an early process of this legislation but obviously NHS being a key partner in the national care service surely there's been some discussions already for the government even to get to the point that they're at just now or is that not being the case? Not at that level of detail and that is part of as recognised is the co-design process. I think the other bit and it goes back to a question that was asked slightly earlier I suppose about timing is you also have to recognise that the bill has been developed and the next stages of the bill will be taken forward at a point when as a health service we have been incredibly focused in a way that we would not normally be purely on operational delivery so our ability to put time and effort at a strategic level into engaging around these things has not been what we would have wanted to do in normal circumstances and that is not a criticism everywhere it's just an observation of where we are and I think we need to recognise that going forward that even at the moment you know our ability to significantly engage in co-design in the next six months is going to be extremely limited so we need to think about timing and process that takes into account and that would apply to social care providers as well. When it comes to the co-design and engagement process you don't have a lot of staff sitting around waiting for that to happen so what's going to be cut for that co-design and engagement to take place? In the short term we will focus on delivering services for our populations working with colleagues about delivering service and we will have to prioritise that as people have said and people recognise the whole system is under a significant level of pressure at the moment and it would be wrong for us not to prioritise that so that is what we will prioritise. To see additional budget coming your way to take part in that co-design and engagement process or will it be something else that will have to be cut? I think that that would be a question that the Scottish Government needs to think about in the context of their broader budget decisions and your deliberations around the budget. Because it's got our demand, it's not going to be an insignificant piece of work that's going to be coming in NHS's way. As I've already alluded to, this is a very potentially very significant change for health systems. A very welcome focus on social care because of the benefit that gives the population and to the health system without a doubt, but we have to understand the context for currently working. Mark, I have a question for yourself. Do you feel that all the risks, even at this early stage, have been identified and quantified accurately enough? I'm thinking of things like VAT, for example, that we're still at large question marks over. Do you feel that there's been enough work done on that so we can actually understand the impact that that may have been done? I can't comment on whether the work has been done because we're not cited on that at this stage. I think that what's evident from the financial memorandum is that there's an understanding of the risks but not yet an articulation of how that understanding might translate both in terms of the financial implications but also in terms of the wider aspects of risk operational implications and the deliverability of that. I think that to exemplify that a little, if I may, one of the underlying issues about the status of care boards as opposed to the status of local government is what comes with that and VAT is an example of that and the ability of local government bodies to borrow for capital purposes and hold reserves whereas central government bodies generally can't is another example of that. There's something about these things at one level are details but they're really important details as to how this will fundamentally function. I can't comment on the extent to which that's been thought through but it's not evident from the materials associated with the bill that a resolution and understanding of the range of that risk and what that means for the deliverability of this that's not yet presented for scrutiny. There's not one place where all the risks have been written down yet that we can all see? So I'm not aware of one place where it's all been written down that you can see because of where we are in the process we've not done audit work around this that would allow me to give you a sense of how that works in government at the moment. Yeah because it seems to be over the from the submissions today and what you've been saying today there is a number of risks you know we've heard transition costs number of boards double running costs uncertainty on VAT uncertainty on pensions uncertainty on staff numbers scope input on the third sector impact on the third sector I should say IT systems records and training so there's a huge amount of unknowns that you know we've covered already today and I guess it's how we keep track of them and how we know what costs are going to be to mitigate some of those risks and I guess is there any other unknowns that you can think of just now that should be added to my list? I think the one thing I would say is that list seems familiar we've also done a list in our paper there so there's the question of keeping track of it so I think it's not it's not a simple question of well once we know what the number is that's the number is that these things will mature and develop through time and I could the scrutiny challenging amongst that is how as a parliament you keep track of those risks if you get to share that phrase and how those are manifesting and how over such a wide-ranging policy area and piece of legislation that will enable those changes how those risks are tracked and monitored through time because they will not even when quantified when reported they will not be static and things will need to be worked out through and those risks will move through time. Jumping off the comment about on-going tracking and this is a risk irrespective of whether or not the NCS goes forward to be honest is we are very aware as you can also see illustrated in the CCCPS business surveys for the last several years of the very significant and I don't use that word lightly impact of the rising cost of living and fuel prices and all sorts of other provisions upon third sector ability to continue providing the services that are much needed within communities to people disabled people and people of all long-term conditions and unpaid carers and a real risk is that if substantial portions of an already strained social care system go under because they cannot afford to keep running we will be in even more of a crisis situation than we risk being at the moment and that has to be tracked and considered as decision making going particularly in environment for 10.1. I've lost track of what inflation is doing frankly I defer to Emma but it's deeply depressing and what does that mean in terms of the knock-on impact for the sector this also relates to workforce concerns about people who cannot afford if they're working in say the children's sector where they don't get the up left to continue in that job if they can earn more working at Tesco's even if they want to remain in care because it is a skilled important job if you can't afford to pay your bills you're not going to be able to continue working there so irrespective of what happens that has to be tracked considered so that we don't end up losing already strained services and then they knock-on impact on individuals. Mark, in terms of the list that Douglas has touched on in your submission you say a number of costs associated with the measures set out in the bill have yet to be assessed. The Scottish Government has recognised this and provided a broad description of the anticipated cost and the difficulty in assessing it at this stage and then you list the areas where cost information is not being provided as including a new list of things ranging from the cost of care boards, transition costs for local authorities and health boards, VAT, pension scheme arrangements, external potential changes to capital investment maintenance and the cost of health and social care information scheme. If the purposes of the financial memorandum are any of those that you believe should have been included in the financial memorandum at this stage or do you think that the Scottish Government got things just right in terms of what was and what was not included? I can't comment on that without a detailed understanding of the information that Government has available to it at the moment and I understand the uncertainties that are inherent in each of these areas. I also recognise in one of the areas around health and social care information that the comments made that the information is not being provided because we can't come up with an exact figure. I think that I would counter that none of those are exact figures and that that is in itself, in my view, not a justification for providing an indication of the range of costs that are likely to be associated with those. Is it the case that Government has not assessed those costs and therefore does not know or is that assessment not available yet because it's not felt solid enough? I think that what's important is that the full range of costs—those are costs that Government has identified that are associated with the bill—are understood, even if the applies to the language around financial memorandums, even if that range of uncertainty needs to be explained. I think that there is something here about putting numbers around that and the Government's responsibility to put numbers around that. Ray, you have said in your response that the purpose of creating the NCS is to improve the delivery of community health and social care together. The clear definition of community health is not evident within the bill and therefore is significantly more challenging to understand the financial implications on service and costs. What impact might that have? I suppose that that takes us back to understanding the organisational impact on the health service but also understanding the exact arrangements that would then be in place for commissioning community health services. I know that there is a process beginning to define exactly what we mean by or is meant by community health in the context of the bill, but that work hasn't been done yet. That then takes you into, for example, does it include community mental health services or are they seen as part of health services in total? Do they include community hospitals in our context or would that be seen as part of the wider unscheduled care acute service? So there's a whole load of variables in there and that's not a criticism to say it hasn't been done yet. It's just a reality that until you actually say when we say community health services will transfer into the national care service we mean this and this and not that and that. It's impossible to understand the basis of the financial implications. Thank you, communities. One supplementary question from Mark Taylor. The IT question is a potentially significant one. If we look at recent projects, Social Security Scotland today has spent £250 million on setting up its IT. We also know that from recent times Police Scotland estimated that they need to spend around £300 million on their computer systems. Those are all essentially record systems, holding information systems. First of all, is that the sort of skill of magnitude that we should be looking at? Are there other recent IT systems that we potentially could be looking at to find analogs that Audit Scotland are aware of? I'm not sure there's the information available yet about what's envisaged around the IT to enable that question to be answered. I think that that would be a helpful question for Government. Is this a big one? Is it a middle-sized one or is it a small one in terms of the scale of IT projects? Even to get that sense to have those sort of comparators to give that sense of scale I think is really important. I don't know if this is helpful for the committee, but we have been doing a piece of work between our Integrated Joint Board, the Council and the Health Board around what an integrated digital offer might look like in the Borders. It's got a range of costs, some of which we will have to do anyway, because they're part of our underlying systems, but they are in the order of magnitude of somewhere between around £20 million. Borders as a health system is 2.2 per cent of the Scottish health budget, so that might give you a bit of context around what those costs might be, but that is very early work, so I wouldn't want to, but I hope that's helpful. I'm not going to say whether from colleagues in various health boards that some are working with extremely old systems that will need replaced anyway, so there would probably be work where you could source information on the proposed costings of similar ones and that, frankly, they absolutely do not function any more. It's part of the problem with data collection, going back to Michelle Thompson's point, is if the system is not sufficiently fluid to allow robust data entry, the best will in the world you're not going to get it. Thank you very much. Our witnesses have been excellent in terms of their contributions. The committee will continue your evidence-taking on the financial memorandum next week, when we will hear from Kevin Stewart, MSP Minister for Mental Health, sorry, mental wellbeing and social care. That concludes the public part of today's meeting. The next item on our agenda, which will be discussed in private, is consideration of a proposed contingent liability. We now move into private session and I'll call a five-minute break to allow our witnesses an official report to leave.