Review of adult social care: speech by Cabinet Secretary for Health and Sport 1 September, 2020

Cabinet Secretary for Health and Sport Jeane Freeman's speech on the independent review of adult social care to the Scottish Parliament on Tuesday, 1 September 2020.

Presiding officer,

We have discussed and debated the situation in our care homes over the months of the COVID-19 pandemic many times – and rightly so. 

From the outset of the COVID-19 update statements to parliament from the First Minister and from me, we set out the plan we were putting in place to prepare our NHS in the face of the evidence at that time of significant hospitalisation and intensive care demand.  We set out our intention amongst other work underway and at pace, to ask Health & Social Care Partnership’s to focus on reducing the level of delayed discharge, a long ambition of this and other governments.  Over the weeks and months since then we have updated the initial guidance to Care Homes, strengthened the primary care support and increased testing.

But there have been many deaths in our care homes and it is right that we and this Parliament use accurate data and analysis to look at the decisions taken and the actions that followed to see – with the increased knowledge we have now – what more could be done.  Not only for the rightful purpose of scrutiny but critically to aid our planning for the weeks and months ahead.

The loss of a loved one is a weight that stays with any one of us for the rest of our lives. It is a loss that is made heavier if we have not been able to be beside our loved one in their final hours.  And one of the deep cruelties of Covid-19 is that at a time we would look to friends and family to help shoulder the weight of grief, we were forced to stay apart.

The weight of the loss of so many of our fellow citizens to this brutal virus will never leave me and I know, many others.

As I set out last month, I have commissioned Public Health Scotland to report on discharges from hospital to care homes, and what the COVID-19 status was for those who were discharged, at the time of their discharge. This should also include information on the outcomes experienced by those patients and this work should be ready to be published by the end of this month.

As I set out in this parliament in March and April, we gave a clear goal of reducing delayed discharges. And as we have considered many times, the guidance made clear any such discharges should continue to be subject to clinical risk assessment.

The UK Coronavirus Act 2020 allows Local Authorities to undertake partial needs assessments by dispensing with particular social care assessment duties, but only where it would not be practical to do so or where to do so would cause unnecessary delay in providing community care services to any person.

The powers are designed to allow Local Authorities to provide urgent care without delay, protecting the lives of those who are most vulnerable, while also ensuring effective safeguards are in place. I gave evidence to the H&S Committee on the Legislative Consent Motion and the regulations came into force on 5 April.

These powers have not been widely used in Scotland. In the monitoring periods to the 2 July, 7 out of 32 Local Authorities have used the powers in the specific type of circumstances I have described.

In recent days we have seen reports of delays in the care home testing carried out through the UK Government’s testing portal.  There have been issues with the UK’s 3 Lighthouse Lab network and we are in daily contact with the DHSC to address these and ensure we can continue to access the capacity we need at the same time as we continue the work to bring more NHS Scotland processing capacity on stream to increase resilience and mitigate any issues with the UK Government portal.  Those recent challenges have seen some test results delayed but having looked in detail, I am pleased to advise the chamber that these delays have not been as extensive as recent reporting suggests.  Even so, delay beyond 48 hours must be minimised and we are working with our UK colleagues to improve this even more.

I well understand the upset and dismay caused to both residents and families of the restrictions on visiting and I hope that the steps taken since early July to return visiting in a phased way both indoors and outdoors have been helpful.  We are now finalising guidance for care homes to support the return of in-reach health and care services and the safe reopening of communal areas.  Caveats apply here as you would expect in terms of the care home being free of COVID-19 and fully participating in the testing programme, but with that proviso and the necessary health and safety measures in place these activities should be able to return and I hope to publish the relevant guidance shortly.  

It will however remain the case – as we have seen in Aberdeen and in Tayside – that where we have a higher prevalence of the virus in an area that may necessitate the restriction of Care Home visiting in order to protect residents while an outbreak is brought under control.

The pandemic has seen a pace of change in the delivery of many aspects of our healthcare service that was previously unimaginable. It is a pace of change that is necessary for our adult care sector.

As the First Minister set out in our Programme for Government I have commissioned an independent review to examine how adult social care can be most effectively reformed to deliver a national approach to care and support services.  I’ve made no secret of my sympathy for a national care service, and this will be part of the considerations of the review.

The scope of this review will include how adult social care is organised, commissioned, regulated and funded.

I am pleased to inform the chamber that Derek Feeley has accepted my invitation to chair the independent review.

Many will know Derek from his time as our Director General for Health and Social Care and Chief Executive of NHS Scotland. He will be ably supported by an advisory panel drawing on expertise from Scotland and beyond:

  • Caroline Gardner, who was until very recently Scotland’s Auditor General;
  • Malcolm Chisholm, a former Minister for Health and Community Care, and former member of this parliament;
  • Anna Dixon, the Chief Executive at the Centre for Better Ageing;
  • Göran Henriks, Chief Executive of Learning and Innovation in Jönköping County, Sweden;
  • Cllr Stuart Currie, of East Lothian Council and Cosla, and
  • Ian Welsh OBE, Chief Executive of the Health and Social Care Alliance Scotland – and also a former member of this parliament.

Their task is not an easy one, and I am very grateful to each of them for agreeing to be involved in and lead this vital work.

The review will build upon the reform of adult social care work that was underway in conjunction with COSLA before the pandemic and had at its core the views of those receiving social care, and had been examined by the health and sport committee at that time.

I believe that across this chamber we have a shared view  that we need both to improve outcomes for people who use services and also ensure a good working environment for a key workforce whose criticality has been emphasised in recent months.

I have agreed with the independent chair that the review will take a human-rights based approach, with a strong emphasis placed on the needs, rights and preferences of people of those who use services, their carers and families.

Social care services and supports are enormously varied – covering everything from care homes and care-at-home to day services, befriending and supported employment.

These are services that touch the lives of a very wide huge range of people: disabled people, older people, people with mental health problems and people with drug and alcohol problems.

We must consider the needs of all of them equitably, fairly and respectfully.  People using services and supports should be consistently and routinely informing this process of improvement and be involved in co-designing services.

Derek Feeley and his colleagues are ready to begin immediately and will report in January 2021. This is a very tight timescale but it will ensure that the next parliament has the options before them straight away so they can take any steps necessary - legislative or otherwise - to put in place the reforms our adult care sector needs.

I know that the care many people receive is already good and that people who work in care in Scotland are beginning to feel more valued and certainly more recognised for the work that they do.

But, not enough - yet.  I am determined that we go further so that positive experiences are the norm, happening consistently: by design and with intent.

My hope is that the outcome of the review will give us a blueprint for the future that can secure consensus across this chamber.

Presiding Officer,

Our adult social care sector is a vital service for very many people – helping them live as independently as they want and as well as they can.  Those who work there are every bit as caring, compassionate and dedicated as those who work in our NHS.  The experience of the pandemic shows us that very clearly.  But it has also shone a light on the pressing work we need to do to improve those services and support those who need them and those who work in them.  The Independent Review will offer us real solutions – and I suspect difficult choices.  But its work is vital. 

But right now as the Review begins its work, there is more for us to do – learning and applying the lessons so far from the pandemic in our mobilisation plans, in support for the sector and in co-operative working and fast responses to problems and issues that arise.  This chamber has my commitment to continue to do just that.

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