Good morning, everyone, and welcome back. Welcome to the eighth meeting of the Health and Sport Committee in the Scottish Parliament's fifth session. I would like to ask everyone in the room to ensure that the mobile phones are switched to silent. Of course, we can use them for social media, but please don't take calls, photographs or film proceedings if you are ever so inclined. The first item on today's agenda is subordinate legislation. This is consideration of an affirmative instrument. As usual, with an affirmative instrument, we will have an evidence-taking session with the cabinet secretary and our officials on the instrument. Once we have had all our questions answered, we will have a formal debate on the motion. The instrument before us today is the smoking prohibition children in Motor Vehicles Scotland Act 2016, fixed penalty notices, regulations and the 2016 draft. We welcome to the committee Shona Robison, the Cabinet Secretary for Health and Sport, Fraser Morris, team leader, health improvement, tobacco control policy and Joanna Irvin, principal legal officer of the Scottish Government. I would invite a brief opening statement from the cabinet secretary. Thanks very much, convener, and thanks for the invitation to give evidence to the committee on the draft smoking prohibition children in Motor Vehicles Scotland Act 2016, fixed penalty notices, regulations, 2016. The approval of these regulations will allow for the full implementation in December. Following that, anyone caught smoking in a car with someone under 18 could face prosecution and a fine of up to £1,000 or pay a fixed penalty of £100 to the local authority. The act was passed by unanimous vote, in part because it builds on and mirrors the successful 2006 smoking ban in enclosed public places. As was the case in 2005, we again require secondary legislation to set out two practical details. These are that firstly the number of days within which a fixed penalty notice must be issued should be 21 days to give police and councils sufficient time to coordinate and secondly local authorities must keep accounts and use any revenue raised through penalties to improve local amenities. These details have been agreed with police and councils who will be enforcing the law. Evidence on the harmful effects of second hand smoke is clear and children are especially vulnerable. This government's commitment to protecting children from the impact of smoke led us in 2014 to announce the target of reducing the proportion of young people exposed in the home from 11% to 6% by 2020, potentially protecting 50,000 children and last month's Scottish Health Survey revealed that we'd met this target five years early. However, smoking prevalence remains higher in Scotland than elsewhere in the UK. The ban on smoking in public places, the display ban and our commitment to a tobacco free generation all contribute to the culture and behavioural change needed to improve public health. The ban on smoking in cars with children will do likewise. Thank you very much, convener. Do we have cabinet secretary? Do we have any questions, Richard? Good morning, cabinet secretary. When we brought in the no smoking ban in pubs and clubs, everyone thought that it wouldn't work but it has. In the last session I supported Jim Hume and his member's bill to bring in non-smoking in cars even though I am a smoker but I took the decision a number of years ago because of having grandchildren that I would no longer smoke in my car and I find that my car smells better. My grandkids enjoy being in the car better but the point is many people who would be against this have to know when it's coming in what we're going to be doing so my question is what steps are we taking to advertise this law where I think the English law came in and there was quite heavy advertising on the television could I ask what steps we're taking to inform the public in order to ensure that people realise that they no longer should smoke in their car? There is going to be a public awareness campaign that's going to run ahead of the legislation coming in to force and it will involve various media including TV, radio, social media and website information so I think you make an important point. The whole rationale here I think is behavioural change so as we've seen with I suppose seat belt and mobile phones using legislation it's designed to safeguard good behaviour and change behaviour so this is very much in that same sphere so it is important to know that people know the information and as I said earlier there will be a full public awareness campaign to make sure that everyone knows that the law is changing. I'm just wondering what the view of Police Scotland is in terms of how they intend to police this particularly in the sort of introductory months whether that's going to be spot checks or pulling cars over use of cameras that kind of thing. Of course they've been fully involved in the discussions and implementation which is why of course there has been the time taken to get the enforcement issues in place. I will ask the officials to say a little bit more. I think initially there's intention to have a softly softly approach so that people while the law is changing as we've done in previous cases there's a soft landing and people may be warned and so on and so forth. Do you want to say a little bit more about that? Yes we've had quite intense negotiations with the police just looking at what's happened in England and Wales where they've had this for a year and Police Scotland are going to be doing the same so as Cabinet Secretary says I like to touch it first just more of an education than a criminalisation. After all if there were no fines issued it would mean that people were adhering to the principle and it's the culture change we're looking for not the criminalisation so initially it would mean just the education. Can I just pick up on the point that you made there Mr Morris about similar legislation already being in place in England and have we had any feedback from our colleagues south of the border about how efficient this has been in terms of reducing smoking in cars how the public have taken to it and how effective it's been? We have in health surveys we've collected even in Scotland even since the ban came in England we've noticed in Scotland there's been a reduction in the reporting here of people of children saying that they're being exposed to smoke in cars and while there's no official stats yet from England on on actual car use the stats on the health survey would suggest that it's definitely having an effect and even here as well. Can I ask you how many people you would expect to have been caught by the offence in say the first year? When the act was going forward we thought as many as 100 but that was just a small part figure in England and Wales the number of prosecutions has only in a year been only about six or seven but the reduction in incidents of people smoking in cars shows that the legislation there has worked as a deterrent rather than something that we count prosecutions on. So if there were none that would be really good and as I say for the first six months or so we don't think the police will be doing anything you know to draconian unless there's something particularly a bad offender. I can just pick up there you were talking about the police but obviously councils have a role in enforcing this is there going to be a similar softly softly approach from councils? Very much so. The smoking ban also has police and council officials enforcing that but in fact it's almost completely the council officer to enforce that. With this one both have the powers but it will almost wholly be the police who enforce this one. They after all have the power to stop a car and local authorities only have the power to enter a car which is a race not so so that they can do roadside campaigns along with the police perhaps but again they're of the same mind that this is about an education and not a criminalisation. Anyone else? Okay thank you very much. We now move on to agenda item two, the sport and that legislation which is the formal debate on the affirmative instrument that we've just taken evidence on. Can I ask the cabinet secretary to move the motion formally? Okay and any members wish to contribute to any debating points? As I've already said I think it's a very worthwhile law and something which we all should support and that includes smokers and I believe that it will be a better health situation for children in cars and that's it when we support this item. I'd just like to add my support too. As was mentioned in opening remarks smoking prevalence remains higher in Scotland and I think if children grow up in an environment where it's not normalised you know that will enable us to to proceed on a healthier footing in the future. Thank you. You've crossed party unanimous support in Parliament's weeks volumes and I think it would be certainly remiss of myself not to be tribute to my predecessor Jim Hume, both my party colleague but also the former Liberal Democrat health spokesperson who brought this forward. Anyone else? Okay I think we would all agree with that and commend Mr Hume for his initiative. I think there's widespread support for this move across the Parliament. Okay cabinet secretary would you like to sum up and respond to any of the issues that have been raised? I just agree I think it's all part of the, as Alison Johnson said, denormalising smoking and normalising not smoking and children not being exposed to smoke. That's a critical point and also finally just to also pay tribute to Jim Hume. I think it is a good example of cross party working where someone comes forward with a good idea and it seemed to be so and that we were found it a very good and worthwhile experience in working with Jim Hume to get the legislation to the point that it is now. Okay thank you very much. The question is now that the motion S5M-01593 be approved. Are we all agreed? That's agreed. Thank you very much. I thank the officials for attending today. The cabinet secretary is of course staying with us for the next item of business and will suspend briefly for the next set of officials to come in. The third item on the agenda today is an evidence session on health and social care integration budgets. I would like to welcome to the committee Shona Robison, cabinet secretary for health and sport, Jeff Huggins, director of health and social care integration and Christine McLaughlin, director of health finance, Scottish Government. I invite the cabinet secretary to make an opening statement. Thanks convener. I certainly welcome the committee's on-going interest in the integration of health and social care and the opportunity to discuss budgets in more detail. As you know the number of older people in Scotland is increasing and by 2037 those aged 75 or over is projected to increase by 360,000. The people are living longer is of course something to be celebrated but it does present real challenges for us in how we design and deliver health and social care services as the population ages, the demand on the health service in particular grows and the nature complexity and acuity of that demand grows as well. These changes mean that delivering even the current levels of service in the same way as being done in the past is not sustainable. Radical service we design including the integration of health and social care is required to meet these challenges. Our legislation to integrate health and social care is one of the most ambitious programmes of work this government has ever undertaken and all health and social care partnerships are now fully operational. Whilst these are in many ways still early days these new arrangements are already having an impact on our health and social care services. One of the most significant changes which have occurred as a result of integration is regards budgets. Integration authorities are now responsible for managing more than 8 billion pounds of resources that NHS boards and local authorities previously managed separately. Planning, designing and commissioning services in an integrated way from a single budget allows partnerships to take a more joined up approach more easily shifting resources to target preventative activity and that as with any programme of public service reform we expect efficiencies to be made which can be reinvested in services. However integration is more than about budgets about putting people at the centre of the care that they need. We're supporting these changes through significant additional funding we've already provided a further 250 million pounds from the NHS to health and social care partnerships to protect and expand social care services and deliver our shared priorities this is the first part of fulfilling the commitment from our programme for government to invest £1.3 billion over the life of the parliament from the NHS to integrated partnerships to build up social care capacity. Whilst the new budget arrangements under integration are key to delivering change and I welcome the opportunity to discuss this with the committee today it is important to remember that at its core integration is not just about budget is about putting people at the centre of the care that they need. Thank you very much for that. You said that when you came in to post that you would eradicate delayed discharge social care is central to that have you succeeded or failed? Well it's work in progress I'll admit that it's tough it's very difficult to change something that has essentially been part of the system for a long time however what I would say is I am absolutely optimistic and as committed as I was previously to eradicating it we need to eradicate it. One of the biggest changes has been the move to the 3-day discharge standard so instead of the assumption that people will be delayed in the system being part of the if you remember the six week then the four week target so there was already an assumption of delay being built in to the system the 3-day standard has done away with that thinking and it gets people immediately thinking about the discharge of the person rather than a delay in their care being put together and if you look at what Glasgow have done around that they have working to the 3-day standard have managed to dramatically reduce the number of delays that they have in their system other partnerships have been slower to do that and we through Jeff and his team have been working very closely with those partnerships that need to deliver the same performance if all partnerships were delivering the performance of the top 25% we would half the number of delays straight away now I want all partnerships to be working to the best there's no reason why they can't deliver that same performance but we need to work with them to overcome any hurdles and I'm doing that to deliver best practice to do the things that we know work and if we get all of that right then we will eradicate delay out of the system and now having said that there are complexities around code 9s and we're working through the adults within capacity issue because you know that is difficult to resolve because you've got court proceedings which means that people are stuck in hospital which is no fault of either the health system or the social care system and that accounts for about a third I think of all delays so there are those complexities as well but we know I am absolutely determined to work through all of that to get us to a position where delay is no longer an acceptable part of our system. In relation to that do you think the social care system as it stands is fit for purpose? I think it needs reformed and COSLA and local authorities are up for reforming that has to be done in partnership I think we need to look at different ways of delivering social care I'm very keen on some of the models we've seen which are essentially if you boil it down about empowering frontline staff if you look at it we've talked before I think about the bootsoig model from the Netherlands which can be applied to social care or nursing and it has at its core the empowerment of frontline staff working with patients or clients, servants users whatever the terminology to be able to manage better the people under their care without the need to constantly report back to structures and bureaucracy now we're testing that out here in Scotland and I do think ideas like that are the way forward for not just social care but potentially nursing and community health as well I think it shows that staff get a lot more pleasure and fulfillment in their job but also more importantly those receiving the services get a better service and indeed most often it's more efficient too. Well come on to some of those issues as we go into your discussion and I'll invite some other members to come in at this stage Alex. Thank you convener one of the key responsibilities of the iJBs particularly given that the weight of the money they now control is the delivery of the eradication of health inequalities one of the biggest ones is alcohol and drugs misuse and we heard from Rob McCulloch-Graham who is the chair of the iJB in Lothian that that budget for ADP funding will reduce by 1.3 million across Lothians that's part of the 20% cut that was delivered to ADP budgets in the last financial settlement I wonder if the cabinet secretary can tell me whether you think that the iJBs have the tools they need to deliver these reductions in health inequalities and in particular what we're going to do about drug and alcohol funding. Well I think the first thing to say is that actually the delivery of the outcomes that we've asked partnerships to deliver in terms of the the number of beef interventions and the delivery of services they are delivering that and more so and actually some partnerships are going well beyond what they've been asked to deliver in terms of targets. We asked as part of the financial settlement for for boards to to deliver resources to ensure the continuation of levels of funding previously. I'm aware some have others have not now we're obviously monitoring that and Christine is in discussion with boards around that. We've also said we want to review generally the the the makeup and delivery and the funding of ADPs I think to make sure that we are getting the the right structures, the right focus, the right targets and resources will be part of that going forward so I'm aware of some of the localities expressing some concern others less so and Christine might want to say a little bit more about some of the detailed discussions that you've had with partnerships. Yeah I think we've been keen to look at the the service delivery rather than just focusing on the on the financial position and asking partnerships to look at the extent to which they felt they could provide the services that they needed to in more innovative more efficient ways and I think that's what we're seeing happening. I think where it falls down is if somebody just looks at it as a a cut to the amount of money that you have and still providing the same exact trying trying to look at providing the same services without changing and I think some of the challenge has been a time that it needs to allow partnerships to look at different models with reductions in funding so in some instances what we've seen is boards looking to maintain the levels of funding by the same time giving a timeframe within which the expect to see changes happen with service delivery I think that's where it's where it's working well so we'll be looking at that very closely as part of the budget setting process for next year to understand what can actually what types of models partnerships have been looking at putting in place but the underlying position that was said with boards is that funding should be maintained within this financial year that we expect to see efficiencies developed through the year. Just to add to that because I think when Rob gave evidence as part of his answer he also talked about his ability to use resource flexibly across the piece to secure the outcomes and that was one of the funding principles of integration that instead of handing the money out in small bundles and expecting it to be used in the way that was directed nationally that the expectation nationally was that we would achieve the outcomes that we'd be able to evidence those through the indicators over time and that in that context that we would expect people like Rob and his colleagues chief officers across the country not just to be thinking about how this money supports drug and alcohol outcomes but be thinking across the piece about how the overall service supports drug and alcohol outcomes so I think we're in a slightly different space and if we continue to simply to follow each point based on how it was historically spent and expected to be spent in the same way then we probably won't take the benefit from integration that we're looking for okay thank you for that and I think that point about outcomes is well made I'm sure everybody around this table agrees that you know that's the priority it doesn't really matter what resource we put behind it as long as those outcomes are delivered however I don't think we'll see the actual payoff or the or the um the reaction to that reduction in funding until further down the track as we see outcomes drop off as a result of the 1.3 million lost to ADP services in Lothian. My anxiety about the terminology here is that we keep using the word efficiencies and I think everybody accepts that we need to make efficiencies but when you talk about efficiencies to my mind that means maybe a cut of two or three or four percent and that's you know we've seen that year on year but when you're talking about 20 percent of funding that's a cut that's not an efficiency that is an absolute slash to the budget and I know having spoken to people who work in the ADP workforce that they are up and honest about this is a real anxiety they won't be able to deliver these outcomes regardless of how well intentioned that proposal is and and I'm not sure that we're ever going to be able to achieve those outcomes without a sufficient degree of funding. Well I think that's why we need to interrogate that more closely about whether or not outcomes can be achieved clearly some partnerships are saying they can and in fact some have maintained the level of funding so it is a mixed picture I think where we need to spend more time will be with those partnerships that say they can't and we need to understand why that is and why others can as I said some are actually in the moment over like delivering more than they've been asked to deliver which is not a bad thing and we need to get the targets right and of course there's the more general review of targets about what we measure and why and that applies as much to alcohol and drugs as as any other area and you know we need to make sure that as Jeff's point was if we stick rigidly to you know this is funding for this this this and this then nothing will change which is why we try to remove some of the restrictions on what can be spent on what to allow partnerships to be more flexible and and where they spend their money to get the outcomes and if we focus on that and achieving the outcomes then hopefully we can work through some of these issues but we will be keeping a very close eye on those partnerships that are telling us that they have problems and obviously the one you've cited is one in particular. Thank you. Thank you cabinet secretary. I'd like to ask you a bit of a wider question if you like about budget setting timelines and one of the issues that has been raised by iGIVs through the interrogation of this committee consistently whether we orally or in written answers is about the misalignment if you like of timelines of budget setting which then has an impact on on iGIVs setting the budgets and councils set the budgets at a different time of year to the NHS and subsequently then that has an opcon effect. Is there any scope for looking at timings of setting budgets and if so what sort of work is the Scottish Government looking at doing on this? I think you raise an important issue. There is quite a challenge. Obviously local authorities have a statutory obligation to set their budget before the first of April whereas some health boards set theirs in the first quarter of the new year and obviously the challenge of the spending review constraints as well that played into quite a difficult situation. What we're doing is working with health boards and local authority directors of finance and integration authority chief finance officers to pull together guidance on good practice for budget setting so that the processes will be better aligned for 2017-18. I also it's important to bear in mind that the statutory guidance stipulates that budget setting for year 2 onwards should be a process based on negotiation about the level of funding performance associated risks rather than a roll forward of individual service budgets used for initial allocations. It comes back to the point Jeff was making earlier on that if all that happens is that there's the same things the same resources are spent on the same things just in an integrated fashion and nothing changes and I think that's the point about year 2 onwards that the expectation is quite a different process based on negotiation and looking at change. So I think it's not unexpected that year 1 was going to be challenging in that respect but we will expect to see more of that in year 2 onwards. I think that it's an area that you should expect to see a lot of improvement on next year. We're having working quite closely. I think that we knew that the first year was going to be one of transition. We had made a decision with the NHS to allow an extended period for the financial plans which took them into June of this year and that was to recognise the need to be working with IGB. From that very start you had local authorities setting their budgets by normally mid-March and normally we would require NHS boards to have their delivery plans and their financial plans signed off by 31 March as well so we had allowed that period of time but that did mean obviously for IGBs we're starting the year without a firm plan in place. I think it's really fair to say that there was a level of strategic financial plans in place but they didn't have the bottom-up detail that you'd like to see in your budgets. So there's a lot of work going on just now. There are boards that are working to a December position to have indicative budgets in place for IGBs so I think between December, January I would expect to see much greater clarity about budgets for next year but what we're also definitely seeing on the ground is much greater involvement of chief officers, chief finance officers in that planning process and I think some of the good examples are where you've actually got local government, NHS and IGBs working collectively as part of that influencing the level of budgets for IGBs whereas I think in year one it was very much handing a budget over to the IGB, much greater engagement all the way through. That being said I think we need to recognise that we're boards are starting the year without a balanced position and we've got three boards this year. Clearly the IGB is part of the solution as well on how they look to recover that so I think I would probably want to manage an expectation that there will still be an element of decisions that will be taken in some cases after the financial year into next year but that's part of I think what would be the IGB influencing the position rather than waiting to see what their budget is going to be. Thank you for that. I'm some reassurance there that there is work being done behind the scenes in terms of trying to have a budget that is more aligned. Are there specifically plans for having budgets at the same time because the budgets seem to have been off-kilter? The local authorities work to mid-march to set their budgets. The NHS does work to 31 March. I don't envisage that we would have that three-month extension again for next year so all things being equal we would expect it to be at the same time. I've spoken to a couple of the NHS directors of finance just this week to check and they are saying to me that they expect to give high-level budgetary figures that are negotiated with the IGBs roundabout in December-January. I think that's a much improved position, probably bringing the process back by about three or four months. In summary, yes, I think that you should see alignment between the two. A lot of the evidence that the committee has looked at around this has shown the difficulties in trying to get resources out of the acute setting and into the community. So, as the policy goes forward, how do you see a successful outcome looking in terms of the share of budgets between community and also institutional care? Secondly, you touched upon the overspends. How do you think that's going to be impacting in terms of taking this policy forward within health boards? I think that it is difficult to, and it always has been, to release resources from the acute setting. That is no different than under the world of integration from the hospital set-aside budgets. However, if you look at some of the examples, I know that one of the examples used where integration authorities were asked to bring forward specific examples of their plans. One, of course, was Edinburgh City's closure of Liberton hospital and the reprovision of services within the community. I think that where the opportunity lies is through the development of alternative services for that balance to be struck in a better way, but, of course, it's a chicken and egg situation. The services have to be developed in order to reduce pressure for then the acute service to be able to release that resource. So, getting that into the right order is not easy, and I don't think anyone ever said it would be. The integrated care fund was, which is 300 million over three years, was put in place to help the transition period, if you like, so that services could be built up, which could relieve pressure and potentially release resources from the acute sector. Now, there are lots of good examples around the country of it being used to good effect, and we would expect to see more of that in the use of some of those resources. Thank you. Maybe one of the interesting examples that we are in the process of coming into this winter is the different approach that the airshers are taking to winter. The airshers are going into year two of integration. They launched on 1 April 2015, whereas in previous years part of the planning process for winter would have been to make provision for additional wards and additional beds within the hospital so that, as demand went up, they would then open those. Our experience has been that those are very difficult to close, and we experience the challenge of still having winter wards open in June, July and August, and that's a significant financial burden and also means that people are in hospital who otherwise might be elsewhere. So, the plans that they've brought forward based on the experience that they were able to work through during last winter largely are built around the addition of extra community capacity to absorb the further demand as they go into winter. Now, they're being careful about this, so they're building it also in a contingency should they require additional hospital capacity that it is still available for them, but their first line of planning is that they will build the community service. That's not the closure of a hospital, it's not the closure of a ward, but it's saying that, instead of doing what we used to do, we will now find a different solution. So, we're beginning to see that appear across the country, particularly as partnerships mature into using the integrated space differently, and I think that that's really quite exciting. Overspend, so we're seeing, for instance, I think about NHS Fife that's one of the boards that's working through a recovery plan, that their chief officer is working as part of that senior team in looking at what the options are, because in the best situation, your recovery plan financially will be something that supports your operational plan, and what you see is the chief officer being round the table, and when I'm having discussions with that board about their plan, the chief officer just feels like part of the team in working out what those plans are, so it's not something that's just given to the IGB as a target to deliver, they're actually looking at the plans and what they can contribute towards it, and I think that that's a positive step that they would like to see replicated across the country. Thank you, Cyneddina. I had the honour to be on the last health committee, and we looked at this bill and basically what was put across was, one of the reasons was to get rid of, delayed discharge, but also was mentioned in that, the Piamble at the time was about 140 million pounds worth of savings. I don't see those savings coming through now. Concern I have is that some joint boards are taking on more than we envisaged that they would do, it's becoming arms and legs, one council, I'll not name them, is now nine months down the road of not setting a budget, and we're now going into 2017. Do you have any concerns about what some boards are taking on board, and I'll be another question in regards to that, and do you have any concerns about whether they will make these savings, which we intended would be reinvested in putting better care out there? I think we want integrated authorities to be ambitious in what they're doing, but we want them to be clear about how they're going to achieve what they've set out to achieve, and for that to be realistic and to then be delivered. The efficiency savings are to be reinvested. What we would expect, whether that's the health boards or through the integration authorities, is to be ensuring that the resources and the priorities and the resources aligned to those priorities deliver some of the changes that Jeff has just outlined, a very good example in Ayrshire about where resources are aligned to really begin to make the difference and begin to shift the balance of care. I'm probably a bit more optimistic than that. I think we are seeing some really, really good examples of integration working as was intended. However, I think there are some who have got further to travel, and this is ever the case in this world. There will always be those who fire on ahead and get the benefits very quickly, and those who need more support. Sometimes that's an issue of leadership locally. Sometimes there are other challenges that get in the way. Jeff and his team spend a lot of time, and as does Christine working with individual partnerships that perhaps have more of those challenges, and that's why that's right and proper. I was involved in the figures that were in the financial memorandum at the time. I think that the principle in there was showing that we should expect a reduction in occupied bed days, whether that was through reduction variations that we mentioned earlier to lead discharges, but that's what we expected to see. I think that if you actually look at what's happening even just this year in the first full year, the efficiency savings that IGBs require to make to balance the overall bottom line is in the region of about £225 million. That will be a combination of efficiencies. As you mentioned earlier, an efficiency can come in different forms, but part of that is the focus on the lead discharge. More than that, I think is the extent to which partnerships can achieve a reduction in variation that improves clinical outcomes, but also is more efficient as we were headed. The analysis that was in the financial memorandum was about indicative costs. It was on a cost per bed day, so we know that in order to make an actual saving, you need to take out costs, which is either areas like reducing nursing agency and bank costs, or ultimately taking out the equivalent of a ward that didn't feel like it was necessary with its winter bed along those lines. I think that partnerships are very focused on what translates into a cash-releasing saving, as much as a productivity saving as we go through, but if you just think about that target of £225 million for this financial year, it's already above that indicative figure that was in the financial memorandum, and that's an amount that's required in cash rather than productivity in this year. I think that what will be important is for us to be able to look at what it's meant in terms of reduction in occupied bed days, so that they were felt to be areas where the service has been provided in the community rather than in the acute setting. I can't give you an absolute figure on that yet, because I think that we need to get through this first year to see what that looks like, but if the partnerships achieve somewhere in the region of 3 per cent, which is what they're targeting, that gives us a good basis for delivering those efficiencies with the IGBs. I agree with Geoff Huggins. Ayrshire impressed me, because they showed where their savings were coming and how they were coming, and maybe it's been counters. I don't know, but can I move on, because there are other members who have good questions? One concern that I have is again the point of taking on too much. I was surprised this week when I contacted the social work department in relation to a house extension for a physically challenged young constituent, that that is now under the joint integration board, which totally astounded me. Maybe it's the care and the community part that they're putting in, but I thought that when I want to talk about getting an extension for somebody in the house at the cost of £25,000, I'm now getting referred to the joint integrated board manager, which totally foxed me. Do you believe that those sort of things should be under joint integrated board? I can see the logic, given that housing adaptations are quite often the barrier to someone remaining at home or being delayed in hospital because of adaptations pending or being delayed, so I can see why the housing element, and remember there was a long discussion about the housing element of integration, and a recognition that actually things like aids and adaptations are actually quite fundamental often to moving and ensuring someone can remain living in their own home or be returned home. To say something about a number of the housing examples that are out there, so the Highland Lead Agency at the moment is doing work around housing options, particularly to address some of the challenges of offering residential care in more rural and remote settings, so they're saying housing is a key component of the work. Similarly, Murray about five or six weeks ago just began the process of creating 13 tenancies to replace a previous residential setting, which will offer a higher quality, broadly for people with challenges around capacity and dementia, but which will effectively offer closer to independent living for that group. In five, they've done an extensive piece of work to bring together all of the equipment and aids and adaptations work and bring together a series of different stores which sat between the social work department and the health department to get better value, but also faster access to things. Again, looking at Ayrshire and East Ayrshire in Kilmarnock, the Lilyhill development, which they actually developed as part of a broader social housing development, so this wasn't a particular health and care but was a health and care component to a housing redevelopment in the town centre has built award-winning accommodation for people, particularly with learning disabilities, which enables them to be more included in the community than they would have been before in individual tenancies or in residential. So we're seeing housing as being one of the areas where it was perhaps a bit further behind two or three years ago, but a lot of the options that are coming forward are coming forward in that space. So everything that basically is keeping people in their home, caring the community, all that basically will come under a joint integrated board and they have to, from the health and from the council, be funded for that. So they've fitted the mandatory list of things which they must bring into the integration area and then beyond that they can think within local circumstances as to what makes sense to add to it. We're seeing housing developing quite quickly, we're seeing more areas also bring in children's social work services, most children's health services are already integrated, so we're seeing that become part of the story as well, thinking again across the life course, and we're also seeing in a number of areas criminal justice social work and that's got the linkages both to mental health and addiction, so people are trying to find ways of bundling together and thinking across the needs of the individual rather than the needs of the individual services and you know that's very progressive. Thank you, Cymru. Thank you very much, convener. I'm actually really heartened to hear that housing is being viewed in that way, the longest delayed discharge case I've dealt with was, you know, it was a family person that had a stroke, couldn't return to his tenement flat and and we had quite a long wait, so I think it's heartening to hear that there's such good work happening certainly in parts of the country. You mentioned the Highland model there briefly and when we heard from Nick Kenton of NHS Highland a couple of weeks ago, he stated that what makes the lead agency model powerful is that operational budgets, management and governance are entirely integrated into one body. Now Audit Scotland have noted potentially confusing lines of accountability around IGBs and a lack of clarity about who is ultimately responsible for quality of care and I'd just be interested in your views about whether that lead agency model offers advantages and whether there's a feeling that perhaps the Government, the Government, the governance arrangements of IGBs are making autonomy difficult particularly in terms of budget setting. I think Highland will be a good way of interrogating that over time because of course Highland covers both the lead agency and the IGB model in terms of the areas that they cover, so even within that one area you're going to have lead agency for part and then IGB for other parts of NHS Highland. So I think that will be an interesting contrast. I am probably less convinced that it's about the structure and whether or not the lead agency model offers up better governance and accountability solutions than the IGBs. I think leadership is the most important thing here and rather than it necessarily being about the structure I think where we've seen the most progress being made is where local leadership is strong and the ideas are flowing, they're ambitious to change things and we see some really, really, really good results out of that. So I don't know, Geoff, would you? I suppose Highland is quite an interesting example reading forward from the housing discussion because of course housing isn't part of the responsibility of the lead agency. So certainly what we've seen over the last two or three years is greater engagement with the council in terms of the functions that still sit with the council as part of the process because there you have a delegation to have a function so the council still retains a responsibility for the functions which are discharged by the health board. I think the challenge on this is that part of the intention of integration is to tie together a wider range of organisations and individuals to secure better outcomes for people and finding simpler ways to do that to reduce complexity and reduce the degree to which people are involved probably doesn't take us there. So I think I would agree entirely with the cabinet secretary that we see those areas moving fastest and doing best where they show the greatest leadership. So it is ultimately about leadership but also that interdependence, that integration is intended to build. If you look at the first 18 months or so of that lead agency model there was a number of budgetary issues so although it was in some way simpler there was a lack of understanding about the budget that was transferring from the local authority to the health board in particular and it probably did take them about 18 months before they really fully understood the scope of services within that. So there were a different set of transitional issues which are now very much in the past and it's working much better so I think there is something that may be accepting that first year of something that is so different like this will have some degree of turbulence in the system so I'm not sure that one isn't necessarily shown to be a smoother initial process in that first year. Okay thank you if I might ask another question convener. I mean obviously we're faced with increasing demand on our services, we have an ageing population, an ageing growing population and rising costs so there are clear challenges here but they're not all financial some of them are about a cultural change if we're really going to to see this shift from you know acute to real community care and I just wondered in our earliest evidence sessions we heard about a bit of risk aversion that perhaps those in certain services weren't aware about the community offering and Mr Huggins you were speaking there about the need to tie together a range of services I just wonder what's going on behind the scenes there to make sure that professionals in all areas are aware of one another's work and the opportunities that there are in you know transferring people at an appropriate time back to to a home setting or a different care setting. I think one of the strengths of Glasgow is very much around the operational managers being empowered to make some of those operational decisions and to get on with change and I think that has resulted in the ability of something's not working to do things differently and change things and speaking to the managers and staff in Glasgow they pinpointed that as probably being the key to the success and being able to address some of the issues around delayed discharge. I think your your issue about being risk averses I think that's that is an issue change is difficult doing things differently is always a risk I think though you can the evidence that is emerging around what works and works well should help to minimise that so there are great examples of what has been done that has led to a better service for people and sometimes a more efficient better service for people and in the context of increasing demands and aging population and you know resource constraints always being there it is important that things are done differently but that does mean sometimes change the public has a view on some of those changes I think that it's also about making sure that when change does happen or is proposed that the benefits of what new services are and they're going to be are clear and you know that we've had debates in in this place about some of those changes and you know I think that's upon all of us as politicians to yes interrogate some proposals for change but I think also to accept that you know we do need to see change if we carry on as we are spending money in the same things then we'll get the same results and we've got to change because the population is changing their needs are changing and the services that we have need to evolve if we're going to not just meet the needs of today but 10 15 years down the line that's not going to be easy and we need to support local leaders in in driving forward some of those changes if you look at the example Jeff raised around the winter beds there's a risk there and of course there's always a contingency plan so that you know if it does it doesn't work then there always there needs to be a management of that risk but to not open masses of acute beds in the winter as it's always been done is doing things differently and carries a degree of risk however if it leads to the sustainable avoidance of people going into hospital that don't need to be there then surely that's a better way of providing services than just opening winter beds because that's what's always been done. There's a few things which are beginning to come onto the table around the cultural and behavioral change so one of the conversations which has emerged in the last three or four months from the chief officer group is a conversation about acute commissioning and it's the question about whether in terms of the structure of the unscheduled care service which is currently provided by hospitals is that the service that they would want to buy and part of that's come out of experience where as they've addressed delayed discharge what they've seen is that the hospital has still been challenging as an environment and they've simply seen in some cases additional admissions take up the space created by additional discharges so they're now having a conversation about how it is that they actually engage in terms of the hospital environment. You know the group of chief officers around half of them come from local authority backgrounds around half of them come from health backgrounds but in health backgrounds they tend to be more in planning or in community settings so you know this is a group of people who are now becoming engaged with what goes on within the hospital in a new way and from that are beginning to ask questions about whether they would if they were setting out the specification for the service they would specify it differently to work better as part of a integrated system so we're beginning to see that quite that arise. We're seeing quite a cultural bias towards greater use of data and so people are both tracking activity and financial data in a way in which they hadn't before they're using the analysis that we've done around the you know the 2% of people using around 50% of the resources so that they're using that data to better understand where to actually use their resource and the choices that they might make differently so they're an interesting group you know they meet monthly we meet with them monthly as well and so they're also engaged in conversations between each other about what they find is working but also how they're working within the broader environment so you know I'm expecting to see that change process accelerate you know as they see more opportunity and as they gain more confidence but it is quite a quickly transforming space. Thank you, thank you, convener. Missy McLaughlin, what was the percentage increase that health and social care received across the piece for this year? The uplift for this year was 5.5% on average for territorial boards. If that answers your question. 5.5% of an uplift. That's not what they tell us. So I mean I can give you the breakdown of that. If that's the case then you know for example why is NHS Lothian cut in £90 million? Well within the allure the allocations are as Christine said. Can the Secretary could ask Missy McLaughlin first? Yes of course. So just to be factual right it's so £474 million was the value of that uplift to boards and the breakdown within it is that there was a real terms uplift which so last year real terms were 1.7%. It was funding for social care £250 million and then it was a combination of other things such as additional enrack funding for boards that were below parity and delayed discharges so that's what made up the total of the uplift. See that's what NHS Lothian, they tell me that they got 1%. So 1.7% was the real terms uplifting. And they tell me that health inflation is 6%. So if I can just take you through that. So the uplift was 1.7% for all territorial boards as a minimum for real terms uplift. NHS Lothian received additional funding for being below parity in their funding. What the board obviously has to do like all boards is be able to balance off the inflationary pressures that they have as well and that's why you see boards on average where about just under 5% efficiency savings this year which are recycled within your system. Right so can we stop there because you're getting into accountancy speak that I do not understand and do not wish to understand but so they got 1.7%? That's correct. Does that take account of the 6% health inflation? 6% health inflation isn't a figure that I would recognise. That's what they tell me. The inflation that boards will talk about will be the combination of pay inflation and drugs inflation. And so if you look at pay it's been running about 1% of inflation prescribing I think Lothian will have been in 10 to 12% region in terms of prescribing inflation. So across the board they tell me that across the board it's 6% that they regard as being health inflation? Well I think probably the way I would try to put that in simplest terms if I can do would be what's the total level of efficiency savings that boards require to generate in order to break even because that should by and large be the figure that you're talking about albeit it will include things like developments to services as well and Lothian would have had some of them within the plans. So they have in effect a 5% cut to make? It's not a cut it's the level to which you need to create efficiencies within your system in order to? That comes to the next question then because I've heard this for all my time in either local government or in this place that efficiency is the word that gets up. I've heard it probably 20 times this morning. It then leads me to a question as to why have we been paying some very senior manager lots of money to be running such inefficient services? If that's what's, I mean that'd be, if you were dropping someone in Femmars just now who hadn't listened to the background of this they would be saying hold a minute these people have been running services for so long if they're so inefficient why we continue to employ them? I don't believe that for one second but that's the inference in what you're saying? It's certainly not the inference that I would put on it generating efficiencies is a combination of things and all boards will look at the extent to which services that the provider could be provided in the same way but more efficiently or the extent to which they can do things differently. I don't think for a second that that implies that they are being inherently inefficient in the way that they're doing but they need to continually thrive to live within their means. NHS Lodian's efficiency savings target she says is around 6% savings but that is not all about cost inflation in things like pay and drugs it's also about developments that Lodian are putting in place within their boards so I think I would disagree with the fact with any implication that boards are being inefficient in what they're doing so I would agree with your analysis on that. Are there any cuts being made? So boards are looking at a number of things this year so within that overall just under 5% savings some of the things that they're doing will be savings that they'll make this year. Are there any cuts being made to services? So the savings that they'll make this year will sometimes be things that they'll not be able to do on a recurring basis if I can put it that way. Is that yes then? So I guess it depends what you mean by a cut in services board. Are there services being cut in your opinion? In my opinion what boards are looking to do is to provide the best outcomes they can with the funding they've got and it's a whole dangerous service that's within them. That's not good. Are there cuts being made to services? I'm asking Mrs McLaughlin in her experience because she's a finance person. So if I can answer it from my experience what I see boards looking to do is to take an approach to that which is a way to identify savings to their baseline that don't impact on clinical outcomes. It's not a language that I would typically use with boards nor is it a language that directors of finance would use? I know it's not a language that they would use and it might not be the language that you would use but it's a language that the public and the people that we represent use. Many of them will understand what you're saying but to cut through that they understand it in those terms to cuts to services or not cuts to services and it appears that you can't answer that question. Maybe I could try and answer the question convener. I think the public understand that record levels of funding have gone in to the NHS. I think the public understand though that demands increase and continue to increase now. We all live within resource constraints even you convener I'm sure would accept that and the NHS has actually got the lion's share of Scottish Government resources for a number of years including this last financial year. Now within that though I have never argued that things are not challenging and boards will require to manage those resources with all of the demands that are being made whether it's inflation, whether it's pay, whether it's demands on services which continue to grow which is why we've just spent the last hour talking about why things need to change and that services need to change and evolve. If we keep doing the same things and not changing services then your constituents will not get the best deal for the public money that goes into it and I would thought that collectively we all have a stake in making sure that money is spent in the most efficient way possible and I think our managers although there are 25% less managers over under this government because we believed that it is right that we don't have a top heavy management structure within the NHS so there's 25% less managers that those managers have a very challenging job to do and Christine and her colleagues work very very closely with them to try and make sure that every public pound that we put into the NHS gets to the front line providing the most efficient service, the best service for the people whether it's of Lothian or any other board area but of course you know that that is challenging which is why we're spending time talking about integration while we're talking about examples of providing services in a better way that's why we're here this morning with with this evidence session. I'm still not sure whether that's saying there aren't cuts to services. Well there'll be changes to services convener I mean I'm sure you wouldn't expect everything to stay in the same way otherwise if we'd taken that approach and there's not going to be any changes we wouldn't be sitting here talking about the world of integration and changing services in the way that we are we want services to be better. Thanks convener. Yeah can I just follow up on that but shift out the focus slightly to talk about outcomes and performance measures and I suppose you're reflecting on that discussion there I mean to my mind efficiency isn't an absolute term it's very much a relative term you should always be able to get more efficient no matter how efficient you are and reflecting on this kind of cuts versus efficiency debate again to my mind it's all about if you're talking about efficiency that's about getting more from less whereas cuts is getting less from less in my mind so I think the direction of efficiency is absolutely where we should go but clearly it's part of that defining what the more is important in terms of your outcomes and I suppose I just want to get your reflection on the performance measures outcomes the indicators we've got in place are they up for the job and I know there's a review coming up and then following on from that again reflecting on some of the discussions with hand with health boards that we're in earlier is there an understanding that the importance of being able to link budgets to outcomes and how that process works because we kind of got the feeling that it was maybe a gap in perception and understanding that and just for a leave that just to reflect on one thing it's come up a couple of times which might be stress is the importance of that the letter we wrote to you in the last couple of weeks following on from the delayed discharge review we had and one of the points we raised there was specifically about Glasgow and delayed discharges and there seems to be a difference in interpretation of the metric in that some health boards include interim care in the delayed discharge and some don't and I'm not saying Glasgow I'm doing a good job but certainly the job there seem to be doing is made a lot better by the fact that they're one of the boards that doesn't include interim care step down beds in their metric but coming back to the main thrust of the question round about performance measures and linking that to budgets where do you see that and how do you see developing well what we measure and why we measure things is important and obviously the review that harry burns has taken forward is geared to try and make sure that we measure the right things which is about outcomes for patients mean we we can talk about money into services we can talk about whether services change whether we we put money into that instead of that but at the end of the day the most important thing in all of that is what the outcomes for people are and the work harry burns is doing across both the health system and the the care system is to look at whether we can get a better set of measurements that better reflect what those outcomes are at the moment we have and we've dramatically reduced them over the years but we have a set of targets that a lot of which are quite input focused so they measure what goes in rather than what comes out and what the outcomes are for people and so did that person end up remaining with a quality of life in their own home for longer because of that intervention now I think we're getting better at that but the work that harry burns is doing will help to make sure that across our whole system where we get those those measurements right and that the investment I guess in the priorities that both the health and care system then prioritises will inevitably shift towards those those outcomes and I mean if we set targets as a government which we would expect boards to deliver then of course resources have followed those targets if those outcomes if those targets have changed to more outcomes based then we would expect the integrated authorities to prioritise the resources to those outcomes which hopefully will help to move shifting the balance of care will help to shift resources into more preventive spend into keeping people out of hospital and avoiding hospital admission so the work that harry burns is undertaking is very very important I think he's the best person for the job he understands the system very very well and I think we'll be able to get us to a place which is going to stand the test of time as well and it will balance the views of the professions who clearly have a a view and will input into but also how it's important to hear the public and the patient view about what's important to them and he he will do all of that through through that piece of work maybe just to say a wee bit more about the where we are with the indicators that sit underneath the outcomes so at the moment we have 23 indicators the first 10 of those are largely evaluative so we get those every two years from the Scottish Health Survey we also will generally get them a number of months after the survey is completed so in terms of the degree to which they can actually be useful to partnerships and reshaping services they're probably not sufficient although the space that they're in which is around people's experience of the healthcare system is a key area where we need to understand more with the second group which are the more numerical at the moment our view is there's there's too much of a focus on the interface between the hospital and community that there's certainly not enough about the quality and experience of primary and community services and there's also very little in there about population health so at the moment the only indicator in that space is premature morbidity so I think the challenge in this is to better reflect the things that we know matter to people and I think the cabinet secretary is right that Sir Harry Burns will do a good piece of work in this but certainly what we're seeing from developments in other systems is an increased focus on items such as isolation and loneliness has been core to people's experience of their health and wellbeing rather than the health and care system but also a move from looking particularly at care failures through safety to people's sense of safety and because that affects the degree to which they'll engage with other things within the community and this is going to take us into the space of needing new ways of measuring what's going on can I respond also to the question and it's left so and we really have to go on to your next point but by all means finish your point yeah well I was going to go on to the second half of the question which was the the question about the dead delayed discharge metrics and I think we have offered an answer on that I think we probably need to understand why it is that we include community hospital beds within the the delay figures and we don't include care home beds within the figures in that even within community hospitals we will only include somebody as a delay if they are ready to go home so it's not all people within community settings in community hospital settings will be considered to be delayed discharge the question is whether there is something which is now preventing them those people who are in step down accommodation in Glasgow will be receiving assessment will be receiving reablement and the assessment is that that is the appropriate place for them to be now it is open to possibility that they may become delayed in that space but if they become delayed in that space then the system as has been built in Glasgow simply doesn't work and it relies on the continued movement of people through the system I think the best evidence of of the impact that that's had and that focus has had is the degree to which people are increasingly going home rather than going on to institutional settings so we're saying that that's been used as part of the the discharge process and isn't a isn't simply a separate place for delay it's a place where something is happening in the budget and is there an understanding there because I absolutely don't you've said it's at the next level and do chief execs understand and people are in that space and it's in a mechanism there to line up what they're spending and what they're delivering from it and I suppose you said flip that the other way around if you rocked up and said you're the hundred million pound to spend extra money or a specific outcome they'd be queuing up to tell you exactly how they were going to take that money and deliver an outcome for it but when you flip it on its head and say right the money you're getting at the moment how is that delivering the outcomes they suddenly find it very very difficult to give clarity there just a point that was a plan okay is anyone else calling thanks thanks very much convener and good morning can I ask a couple of questions just regarding the social care fund that in particular will be spricing all the living to wage on friday I met with Margaret Patterson who's the Dumfries and Alwey Brands rep on the Scottish Care National Committee and also my director of office to care a local care provider and Margaret obviously described it that the somewhat fraught process that took place in and up to the first of October to get agreement between IJBs and social care providers to deliver the living wage and it's a process that's also been described as by a number of people that have came to this committee it's obviously clear that IJBs and providers don't want to see a repeat of that process next year presuming the government obviously continue the commitment to pay the living wage beyond this year so can I ask what lessons have been learned from the process and what improvements do you see coming next year in particular first of all how will the living wage actually be funded beyond this year and secondly will we actually get for example proper costings for the living wage so we don't have that sort of disconnect that we had this year between what the government's original estimates were and what the reality has turned out to be for social care providers and I suppose the third point is will we build on the living wage by guaranteeing that it will be paid to staff that carry out sleep over shifts next year okay well first of all it's a good thing though isn't it that we're on the track to deliver the living wage and that staff working in the social care sector who previously didn't get the living wage will get the living wage from the first of October and I'm sure that is something collectively that we all support the process has been difficult I think by its nature the fact that what has had to be delivered is a series of local negotiations that was never going to be easy and Jeff and his team have very much supported those local partnerships in being able to get to the place they've got you now and Jeff will be able to give you the latest update on where we have got to and of course any providers where there has been a delay there will of course be back it will their pay the individuals pay will be back dated to the first of October so no one will lose out because of any delay on agreement and the issue of sleepovers has been a challenging one and because of the views of providers the very people that you've just been talking about in saying that there needed to be more time in order to ensure that services weren't withdrawn from vulnerable people at which I'm sure nobody around this table would want and to make sure that the issues that needed to be resolved were resolved and the unions that have indeed supported that position that there's now a process being put in place to resolve the position of sleepovers I've been very clear that I want people who are being paid for sleepovers to to be paid at the living wage rate and that's the ambition to get there but I do understand some of the complexities of that and that's why we listened to what providers and indeed the unions were saying and that's why more time has been taken to ensure that we get that right in a way that doesn't undermine and doesn't pull the rug from under vulnerable people getting services. Jeff, do you want to give the latest on where we are? Yeah, we met with the provider organisation Scottish Care CCPS, the unions in Coasley yesterday and I've been meeting with them about once every two weeks or more frequently alongside telephone calls and emails over the period since probably the beginning of August you know this has been a testing process effectively we have negotiated with 32 local authorities we've then seen 32 local authorities negotiate with somewhere north of 500 providers and ultimately the benefit will be felt in changes to around 100,000 employment contracts and that's not insignificant you know that's two to three percent of all the employment contracts in the country so we have tested the current system to destruction in terms of processes which would normally have gone through cyclically over three to four years through councils we've basically worked through those over a six month period um you know from that there is there are a number of elements of learning and we talked yesterday and particularly yesterday the second half of yesterday's meeting was focused on what does this mean for 17 18 and on the basis of this what would we do differently so we're looking at the particular challenges around providers who provide services across a number of authority areas particularly those likely to be delivering either mental health or learning disability or more high tariff services and how we can think differently about that in future years because part of the challenge this year has been having for some providers having to reach in agreements with 23 or 24 different authorities before they can make it reach an agreement with their staff we're working through some of the challenges of procurement as well and again what we've seen in some areas is that the the the amount of resource that councils have within their system to take through the procurement has has been limited so we need we need further work there we also i think are looking at some components in terms of the cost structure of services in that we've been surprised that while in many cases that the living wage can be delivered at 15 or 16 pounds an hour in some cases we're being told by providers that they can't deliver it for 20 pounds an hour and when the wage we're talking about is eight pounds 25 we're we're we're we're looking again to see how it is that we understand why it is more difficult to provide the living wage by some providers than by others even when there's already differentials in in in in the space. Scottish Care have raised with us the issue of differentials and on costs and again we've said that we would look at those although i think to be fair in terms of what we're seeing in terms of the resource that have gone in from the 250 million is it's broadly comparable to what we anticipated that this would cost so you know the the figures that we offered through SPICE last year are not that far away from what we're actually seeing in practice. I think the distribution of those figures perhaps has been different in how those have impacted on different local authority areas has been variable but also the degree to which partnerships in looking at what it's costing them have also included some of the costs of their staff for in-house services as well as services which are being provided through the private and voluntary sector and that's particularly where the additional resource was offered on the basis that councils were already in the place of saying that there were living wage employers coming into 1617. So it continues, you know, we will meet again three to four times between now and Christmas with the other stakeholders and we do, you know, we are putting together an event towards the end of November beginning of December to think through and work through the issues of state sleepovers because at the moment what we're seeing is a number of areas where they are offering enhanced wages to sleepovers on the basis of the progress that they felt that they could make within this year but also looking to see how we can best use sleepovers and the degree to which there are other ways in which we can structure services to give better people better outcomes. I apologise for the situation from the green party there but Colin. A couple of points raised them and I come back to the original question which was how will the living wage be funded next year, presuming that there will be a commitment there to pay that living wage and I'll be keen to know that that commitment is there and how it will be funded. You made the point that the figure, the Government's estimate and the actual reality were pretty similar but the information that we've got back from IGBs is when 20 completed a survey to this committee and from those 20 the cost of the living wage was about £47.7 million and that was just from 20 but your estimate was £37 million so I'm not entirely clear how that's close when actually the actual cost is significantly more than the estimate based on the information we've been given by IGBs so I'll come back to the second part of my question as well the Government calculates and publish very clearly what they estimate by IGB what the cost will be going forward when it comes to the living wage in future years. Can I answer the first part of the question that obviously the living wage is a key commitment and one that we want to ensure continues to be delivered. It will be part of the spending review negotiations to make sure that we can do that now we need to obviously look at the real-time information which is still filtering through around what the actual cost of delivering the living wage is from partnership to partnership some have you know and there is a significant variation in that some were further along the road towards that already and therefore the cost is different from those where they would have been further away from that in terms of the amount that they were paying providers to provide services so of course we'll look at all of that and taking forward the negotiations to ensure that we continue to deliver the living wage into the future. I guess just to come back to the difference a good example and when we were looking at the material that you sourced from integration authorities there were a couple that stood out so Dumfries and Galloway I think in the figures that they showed you suggested that they thought the living wage was going to cost them something like four million but that four million includes the resource which is associated with their own council staff as well as the private and voluntary sector services and the as I've said in terms of the commitment that was made for the use of the new and additional money the 250 that was focused on the resource which was in that private and voluntary and didn't include the costs now it's entirely legitimate for partnerships to use some of the 250 million also to support additional wage costs within the council and that's what they've declared to you as they've done but that didn't fall within the data that we provided through Spice at an earlier stage beyond that I think there is also you know the question of the impact of sleepovers within this which I think going into the process neither the providers nor ourselves nor consular nor the unions forecast to be the issue that it was and you know we've had to work through that issue and you know we're not entirely at the most satisfactory place on that but we will work through to to achieve our objective in that space so some of it will be accounted for by the sleepover issue yeah original estimate of 37 million pounds is the cost of the living wage faced by i gbs so the the assessment of the cost within the figures um in respect of the services which were covered by the commitment which are the independent and voluntary sector including those services which are provided through the national care home contract you know our our senses and we've been you know looking at this again over the last few days in the context of looking into next year um our assessment is that that's broadly the six months value of the so it's it's in that ballpark I think you know the point jeff has made is that there are some of the returns included the commitment on the councils were funding for their own staff so it would have included the uplift for their own staff rather than the um the commitment to deliver for the independent and voluntary sector so clearly that wasn't in the figures provided to Spice because all we provided to Spice was the estimates of the delivery of the living wage for the private voluntary sector so I think you know we need to having said that we will obviously use the real time information once all of the financial information is available and all the the deals have been completed you know we will have that real time information to inform us of where we go from next year and we're already beginning to have those discussions with with local government on the living wage I think there's no one here would not say that this is very good news however we met with 25 social care workers recently to discuss a whole range of workforce issues and probably the most powerful testimony that I've heard for a long time from witnesses who've spoken to committees and they raised numerous in fact I've got a page full of issues here that they raised in relation to workforce issues about downtime during the day, travelling time, paying for uniforms, paying for phone calls, lack of continuity of care, lack of feeling valued all of those issues that we're all very very familiar with in relation to the social care sector and we'll be writing to the cabinet secretary soon about that but one of the issues that comes across I think very clear and has been reinforced by Mr Huggins evidence this morning where he says that they've been involved in 32 negotiations, 500 providers have been involved and 100,000 staff. In the evidence that we heard before this committee all of those issues have brought together the providers and the trade unions calling for national collective bargaining and I think that is hugely significant that both sides are saying that we need national collective bargaining. Is there a commitment from government to move towards national collective bargaining very soon in this sector because I think personally I think that's the most significant thing that could be done at a governmental level is move towards that to address all of those workforce issues in a systematic manner that makes social care what it has to be and that is a sector that people want to join not that people want to leave. I have never claimed that only addressing pay is going to be the panacea for a change of I guess how we view and value the care sector it's going to require more than than just addressing pay. Having said that pay is important and the principle of the living wage being paid to those who are looking after and most vulnerable I think is a a good signal that we value the care sector and we want to encourage people to come into the care sector and remain working in the care sector but the issues you raise that are in and around the sector beyond pay are legitimate issues absolutely. Career progression is another one and we are looking at how do we create better career opportunities within the care sector to potentially for people to move into the regulated professions if they so wish and so on and to have the opportunity in education and training to do that so these are all issues that we're very much aware of it can't just be the responsibility of government to resolve that though it has to be in partnership with local government and with the sector itself obviously we do have the national care home contract which delivers a national deal for care homes home care care at home has has been different and we have had the numerous negotiations we are now talking to the sector about how we can move forward to perhaps address some of those issues that are common across the sector and perhaps to avoid some of the difficulties we've had. Jeff, you're closer to some of those discussions. Yeah, so I suppose since the summer as I've said we've met face to face five or six times with the unions to discuss where we are on living wage and they've yet to raise with us the suggestion that they would like national collective bargaining on behalf of staff so it may be that that's an issue that they're raising elsewhere but they haven't raised it with us and I'm not aware that they're not aware that they've raised it with COSLA either because of course their negotiation would be with local government it wouldn't be directly with the central government. What we do have though is a conversation which is about in the same way that there is a framework for the provision of residential care through the national care home contract whether there would equally be value in having a framework for care at home and for housing support where that relates to care services which would you know effectively potentially maybe for different sectors and across different geographies set target rates for the hourly rate to be paid to providers with also the expectations that go around that in respect of things such as terms and conditions so that's a conversation which we have been having and I think there are pluses and minuses to it but it's one that we've certainly indicated to the providers and to other partners that we're happy to continue to have so I'm not sure whether those two things have maybe become intertwined but I'm certainly happy to next time I see the STUC asking them what their position is in respect of collective bargaining. Okay thank you. Okay thanks very much everyone for giving me evidence this morning and I'll now suspend briefly to allow the pile change. Thanks very much cabinet secretary and your colleagues. Okay agenda item four is a petition that's been referred to us by the Public Petitions Committee and that we previously discussed on the 13th of December. Can I ask Members for their views on the petition? My view on it is that we keep it open and wait for the results of the information that's coming back to us next year off the work on going. Any other views on what we do with the petition? Happy to support Ivan's position. That agreed? Thank you. As agreed earlier we will now move into private session.


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The following is a production of New Mexico State University. You bought your new home here in the Southwest. Now you need a landscape. You can plant it yourself, but it might be a good idea to hire a landscape designer. But what do you do? What are the questions you ask? Dr. Ralston St. Hilaire teaches landscape design at New Mexico State University and he's gonna give us some pointers today. Ralston, thank you. Good morning, goodness. If you were the landscape designer designing this property, what are the things you would do first? Well, Curtis, one of the first things we want to do is take a side inventory. And that means that we look at our side, look at the potential problems and how we can potentially address those. Have you found any problems? Well, I was catching out a few ideas here and yes, I can point out a few of those for you, for example, Curtis. Right here on this side we could look at a potential erosion problem and that's one of the questions and concerns that a designer would possibly have to address. Well, Ralston, it's flat up here. Do we have any problems up here? Yes, Curtis, there are potential problems and one of the problems that we might want to address here would be the issue of privacy, for example. You've got a porch right here, right next to the house. Right next to the house and that's one of the issues that the landscape designer must address in his design. Is there anything else we need to consider here? One of the issues or features that we need to take into consideration would be the curve on this outside wall. This curve line dominates the landscape and therefore the designer must take into account that this is going to be part of his landscape and therefore he or she has to design for it.  Certainly not, Curtis. Street lines certainly don't have a place in this design because of these curves and also we can notice curves in the garage way, the arch and even on part of the windows. And so therefore an informal design is probably the best way to go. Well, after the site survey, what's next? Curtis, I'll take you to my landscape design lab and show you what happens next. Let's go design. Sure. Do you still design on paper these days? No, Curtis. I actually use the computer. Well, this is a different landscape. What is it showing us? Yeah, this is a typical frontier design that shows some of the principles and elements involved in landscape design. Principles and elements? What does that mean? This is like making a cake. The principles would be the recipe and the elements would be the ingredients that are going to make in that cake. So what are the principles? Well, the principles involved in landscape design include repetition. For example, notice how this group of plants here, the dwarf broom, has been repeated throughout the landscape. We can also see the same thing happening with the gray Crippin gemander, which is also repeated throughout the landscape. The elements? The elements are actually what make up those principles. So in the case of the Crippin gemander, for example, we can look at the texture of the plant or the seasonal color, which would be another element of design. There's color and texture, but are there other elements we should be aware of? Yes, we should also be aware of things like line, for example, as we're going to see in this design. We could see this line in the landscape. Also, line may be brought about by having plant materials create that line for us as we can demonstrate in this design. So when we put these things together, we've made a landscape. Can you show us how the designer addressed the issues in this property? Yes, Curtis. One of the things we can immediately see is that the designer has used curved lines in the design. And that does two things. It accentuates the curved lines on the outside wall, as well it accentuates the curve on the sidewalk. Also notice that the designer has repeated some of the plant materials in the design. For example, those junipers are repeated throughout the landscape, which is a very good idea. Also notice that the designer has repeated some textures in the landscape by the use of those pines. You notice that they're all repeated in the design. So they've done a lot of good things here. Yes, they have, Curtis. I see a problem that's real common in landscapes, and they've used an interesting way to solve that problem. Let's go take a look at that. Utilities and utility easements often cause landscape problems. It looks like the designer has chosen an interesting way to deal with this problem here. Yes, Curtis. The designer has chosen evergreen plants to screen the utilities from the house. Notice that it also curves around and screens this from the view on the house. But also notice that the easement is kept clear, which is required by law, of course. That's an important thing. Well, Rauston, thank you for sharing your insight into the mind of a designer. Thank you, Curtis.