Report on Draft Budget 2015-16

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Report on Draft Budget 2015-16

CONTENTS

Introduction

Evidence taking
Approach to scrutiny

Cross-cutting themes
Younger people

Support for young people with additional support needs
Factors influencing successful transitions from School to post-16 destinations
Partnership Working and Engagement with the Third Sector
Data Sharing
Meeting demand within the budgetary restrictions of the Employability Fund
Funding for Skills Development Scotland and the Modern Apprenticeships Scheme
Delivering support in rural settings

Older people

Older people, changing patterns of health and health inequalities
Service re-design and shifting the balance of care
Driving Change, National Targets and Evaluation of Integration Funding
Primary Care and the relationship to Integrated Partnerships
Delivering services in rural settings
Work with the Third Sector
Evaluating outcomes and learning for the future

Conclusion on other Committees’ scrutiny of the Draft Budget 2015-16

Annexe A: Extracts from the minutes of the Equal Opportunities Committee

Annexe B: Evidence – Equal Opportunties Committee

Report on Draft Budget 2015-16

The Committee reports to the Finance Committee as follows—

INTRODUCTION

1. Throughout this session, our scrutiny of the Draft Budget has included, in addition to consideration of equality issues in general, an emphasis on specific protected characteristics. In 2012-13, the Equal Opportunities Committee scrutiny process focused on race and religion; in 2013-14 the focus was on women and employment; in 2014-15, the focus was on disability.

2. We agreed to focus the approach to scrutiny of the Scottish Government’s Draft Budget 2015-16 (the Draft Budget) within a broad focus of age transitions in relation to older and younger people. To refine this broad approach further, we agreed to narrow the focus to equality issues for vulnerable groups within the two broader age categories. This was agreed taking account of the Government’s priority policy areas and in the context of the proposals contained within the draft budget 2015-16. We appointed as our adviser Barrie Levine, lecturer in Social Work at Glasgow Caledonian University.

Evidence taking

3. Written evidence was sought from stakeholders. We received six submissions, and held three oral evidence sessions.

4. The first evidence session was held on 6 November and we heard oral evidence on young people with additional support needs from two groups of witnesses in separate sessions.

The 1st panel comprised of policy makers—

  • Clare Fraser, Equality, Diversity and Inclusion Manager, West College Scotland
  • Jim Gray, Head of Democratic Services, Glasgow City Council
  • Dr Kate Hannah, Sector Lead Officer for Additional Support Needs and Special Schools, Education Scotland
  • Scott Read, Scottish Transitions Forum
  • Mike O’Donnell ,Skills Development Scotland

The 2nd panel comprised of service providers and one service user—

  • Fraser McCowan, Director of Argyll Training and representing Scottish Training Federation/Support Training Action Group
  • Brian Webb and Sandy Stark, Station House Media Unit, Aberdeen
  • Lorna Trainer, Director of L & G Learning (Scotland)and representing Scottish Training Federation/Support Training Action Group

5. The second evidence session, on the needs of older people in the context of shifting the balance of care towards community supports, was held on 13 November and we heard oral evidence from—

  • Iona Colvin, Director, North Ayrshire Health and Social Care Partnership
  • Joe McElholm, Manager of Older People’s Services, North Lanarkshire Council
  • Professor Stewart Mercer, Professor of primary care research, University of Glasgow

6. The third evidence session was held on 20 November and we heard oral evidence from—

  • John Swinney, Cabinet Secretary for Finance, Employment and Sustainable Growth
  • Shona Robison, Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights
  • Yvonne Strachan, Head of Equality, Human Rights and the Third Sector division, Scottish Government
  • Alison Taylor, Head of Integration of Health and Social Care division, Scottish Government

7. At the request of other committees, we have taken into account specific issues as part of our scrutiny. We received a request from the Welfare Reform Committee who asked that we explore the impact welfare reform will have on different groups and the impact of Universal Credit. The Cabinet Secretary highlighted that “The challenges in the budget are in its focus on addressing some of the issues of economic recovery and on tackling the consequences of welfare reform. The Government has set out a range of measures to ensure that those are adequately and fully taken into account.”1

8. In scrutinising the Draft Budget, all committees are also asked to take into consideration equalities issues. A summary of other committees’ consideration of equality issues is included in this report at paragraphs 146-150.

Approach to scrutiny

9. In relation to the Draft Budget we focused our approach to scrutiny around the guidance provided by the Finance Committee2 which in relation to Prioritisation identified the following areas—

  • The extent to which the Scottish Government and other public bodies have moved towards a priority based budgeting approach.
  • Whether spending priorities support the Scottish Government’s Purpose.
  • Whether current performance informs the choices about where to allocate resource.

10. Further to the issue of Prioritisation and in line with Finance Committee Guidance in relation to Value for Money3 we also integrated a focus on Outcomes as part of our scrutiny. Of the five identified areas for scrutiny, we agreed to focus particularly on—

  • The extent to which public bodies are spending their allocations well and achieving outcomes.
  • The extent to which the public services are using performance data to ensure value for money.
  • The progress of public bodies in moving towards a more outcomes based approach to public service management.

CROSS-CUTTING THEMES

11. Scrutiny of issues impacting on both younger and older people was a necessarily complex process and we heard a broad range of evidence on both issues. We identified a number of cross-cutting themes in addition to identifying issues specific to each group. Cross-cutting themes are identified below and are pertinent to both clients groups explored as part of the scrutiny process. These themes are addressed throughout the report in the Committee's examination of the issues affecting both older and younger people.

  • The long-term impact of deprivation and inequality leading to poorer life outcomes.

  • The enduring nature of poverty on the lives of vulnerable people facing life-stage transitions.

  • The need for holistic and individual person-centred support to assist people with identified support needs.

  • The complex nature of health and social care systems and the consequent need for long-term continuing funding streams to achieve improvement in service provision.

  • The need for effective joint working between agencies through integration and planning processes.

  • The importance of data sharing between agencies to ensure seamless service provision.

  • The additional cost of providing services in rural areas and the need for funding to take account.

  • Lack of detail within the budget enabling full interrogation of figures provided.

YOUNGER PEOPLE

Support for young people with additional support needs

12. We heard evidence about the extent of the number of young people there are with additional support needs and the issues this gives rise to. Witnesses gave an overview of the number of young people with additional support needs. Scott Read (Scottish Transitions Forum) explained that, as schools had become better at identifying additional support needs, the figures had doubled since 2010 and that “school pupils with additional support needs now represent one fifth of the pupil population”4

13. In terms of the impact this has on young people achieving positive destinations, he went on to state that young people were often not being successfully supported in this respect, with consequent implications for employment, education and training. He explained—

“Only 8 per cent of those without additional support needs fail to achieve a positive destination but, across the range of additional support needs, we see that those at the top of the failure rate for achieving positive destinations are looked-after children, those whose learning has been interrupted, those with social, emotional and behavioural difficulties and those with learning disabilities. For those groups, the rate of 40 per cent is almost five times that of those without additional support needs”5

14. Lorna Trainer of the Scottish Training Federation/Support Training Action Group (STAG) explained how additional support needs could affect young people, and how they can be supported—

“A lot of youngsters experience huge barriers, whether that is because of learning disabilities, physical disabilities or mental health problems, which are often unrecognised. Poverty often leads to difficulties too, and youngsters can be excluded from classes and activities. We have a number of youngsters who have left school and still do not know how to work a computer. That is inexplicable in today’s society, but we support youngsters like that on a daily basis.

“Under the additional support legislation, youngsters in school have an individual learning plan that follows them through, but often it is dropped and left once they leave school, and I am slightly worried about the transition from school to post-16 learning and development. We support a lot of youngsters who have no information and no support plan, and we are left to work around that and somehow or other support their additional needs without the infrastructure that they may have had at school.”6

15. Recognising the issues in relation to young people with additional support needs and the enhanced cost of delivering support to these young people, we asked whether priority is being given in budget terms to support these processes.

16. There is considerable evidence about the scale of the population of young people with additional support needs leaving school and making the transition to training, education or employment. It is also evident that persistent difficulties exist for young people with additional support needs and that costs for supporting these young people are higher. At the same time we heard that local authorities are facing budget restrictions and that in any event local authorities are entitled to make their own decisions about the allocation of resources. As Scott Read commented—

“…we consider transitions as a whole process that happens in the round. As other budgets are reduced the impact on young people with additional support needs will be greater. Our concern is that they will be squeezed out and will not be able to reach a positive destination.

“In terms of budgetary constraints and changes, transitions is a concern not just in relation to education, but also for healthcare and social care budgets. The Public Bodies (Joint Working) (Scotland) Act 2014 and the Children and Young People (Scotland) Act 2014 contain duties for things such as continuing care for looked-after children; I believe that there is a limited budget for that already.”7

Scottish Government

17. In response, the Cabinet Secretary for Finance, Employment and Sustainable Growth indicated that—

“I think that that is the case. I acknowledge your fundamental point, which is that the cost of supporting young people with additional support needs is higher. That must be and is reflected in local authority decisions. Local authorities must put in place support packages that cost significantly more than support for young people who do not have additional support needs. The same maxim applies in relation to opportunities for all and to the support that is delivered through the budget for the college sector.”8

Conclusion

18. We are concerned that there should be equality of opportunity for young people with additional support needs and that sufficient funding is available to support them through post-school transitions. We therefore ask the Government to consider whether the budget allocation is sufficient to achieve these aims and to continue efforts to work with local authorities towards ensuring enhanced support packages are available to all young people with additional support needs.

Factors influencing successful transitions from School to post-16 destinations

19. Dr Kate Hannah (Education Scotland), explained that there were several key indicators that would make a positive transition more likely for a young person, including—

“… a whole-school or whole-service approach to transitions at all stages; schools and services having coherent policy and practice; positive relationships with and early involvement of parents and carers; effective partnership working; well-established, clear and transparent communication; ensuring that families are aware of the communication systems and know what the transition process will entail; and effective—by which I mean rigorous and systematic—planning and organisation at an early stage.”9

20. Furthermore, in relation to the statutory duties for Local Authorities, The Education (Additional Support for Learning) (Scotland) Act 2009 has specific provisions on transitions. Authorities have a duty to plan and prepare for transitions for young people from primary to secondary school and from secondary school to post placement. Dr Hannah spoke of the enhanced transitions programmes provided by schools and community planning partnerships, and that, with such programmes in place—

“… children and their families tell us that children form positive relationships, feel more included and are more likely to attend and engage with secondary school. Basically, they are more likely to make a successful transition.”10

21. Developing this theme, Scott Read (Scottish Transitions Forum) spoke about the same legislation, under which there is a duty on the education system to call a transition meeting one year before a pupil is due to leave school with relevant agencies—

“That could include the opportunities for all co-ordinator or Skills Development Scotland. Currently, people are looking at how that fits with the named person or lead professional role in the Children and Young People (Scotland) Act 2014, who will be responsible for calling that transition meeting.

“Some local authorities already have dedicated transitions teams. For people with additional support needs, there is a real difference between the pull and push in the marrying of children and young people’s services to adult services.”11

22. Continuing the theme of a disconnect between child and adult services, Fraser McCowan (Support Training Action Group (STAG)) suggested that training and support providers could find it difficult to use the knowledge of schools to support young people post-education, and that there was often a gap in support between child and adult services—

“Because we are not part of the education system, it is quite difficult for us to engage with schools. For the past 26 years, I have delivered a voluntary industrial awareness day with our local grammar school.”12

23. With reference to the potential role of the Getting it Right for Every Child (GIRFEC) model in bridging the gap between child and adult services, Lorna Trainer (STAG) said—

“Schools should certainly work much more closely with not just colleges but post-education agencies such as ours and social work services. To come back to the spirit of GIRFEC, I am very much aware that things are not working.”13

24. In relation to the critical role schools have in the transition process, Dr Hannah spoke of the potential for secondary schools, through the Curriculum for Excellence, to encourage positive transitions. She explained—

“We would encourage all young people to stay in learning post 16, as that is the best way of ensuring that they will be employable and able to make a contribution to society in the long term.

“Education Scotland is involved in a number of tasks in transition planning. We are looking at how our community learning and development inspectors work with secondary schools to support young people to have high-quality work experience placements and college placements.”14

Scottish Government

25. In response to questions about the transition process from school to post-16 destinations, the Cabinet Secretary for Finance, Employment and Sustainable Growth commented on the Opportunities for All commitment—

“…we have a commitment to ensure that every young person has a proper guarantee of support as they make their journey into the labour market. Some of that is done through schools and colleges and some is done through other Government programmes. That is an indication of the practical support that we make available to young people in that context.”15

26. Questioned further about the transition from child to adult services and the possible role GIRFEC could have with appropriate funding being in place to extend the support process, the Cabinet Secretary for Finance, Employment and Sustainable Growth said—

“There is likely to be an on-going requirement for public authorities—principally local authorities—to put in place support mechanisms for young people as they become older, which will be tailored to their requirements. The obligations in the Government’s approach to care and those that relate to the pursuit of better outcomes for all citizens will mean that public authorities will have to ensure that people’s individual needs are properly and fully reflected in the spending decisions that we make.”16

27. In relation to discussion about the format of the draft budget, the Cabinet Secretary for Finance, Employment and Sustainable Growth made the point that—

“We set out information in various ways, consistent with our agreements with the Finance Committee, but perhaps a different configuration would make the budget slightly more obvious to committees. Indeed, other committees make that point to me as I discuss budget issues with them.”17

28. Developing the theme of transitions, we asked whether the move from pre-16 to post-16 services was, on the whole, working for young people with additional needs. The Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights replied that—

“There are challenges when young people who use health services and care services—young people with disabilities—and who attend mainstream or special schools move away from that support and into adult services. A lot of work has been done on that, but it is still challenging and can be scary for parents when they feel that there is a danger of their child losing the support package that they have had, which involves a clear routine for the day, and moving into assessment for adult services.

“A lot of work has been carried out on transition. Have we got it perfectly right? There is probably still some work to be done on ensuring that all local authorities and health boards work together closely on making it happen.

“A lot of the focus around integration has been on older adults but, without a doubt, there are opportunities to get it right for younger adults who are moving into the system by ensuring that there is far better and earlier communication on not just the budgets, but the support mechanism and even the people who support a family, who may change. The budget is an important element of that, without a doubt.”18

29. Developing the discussion on the theme of the need for effective joint working between agencies we raised the difficulty of establishing where and how budget allocations are applied across the sectors and what influence the Government can have on this process. In response, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights replied that—

“Maybe more work could be done—we could look into this—on how we pool resources, using case studies to give examples of best practice and which budgets are supporting the young person in transition who is moving from one service to another. Like John Swinney, I understand that it is not easy for the committee to see all the different budgets that impact on the young person’s life. We could maybe do some work to make that more transparent, but it is quite challenging. As you have identified, that support sits within various budgets—local authority budgets, health board budgets and budgets that we hold directly—and the issue is how all that support sits around the individual young person. A case study model might be a good way of illustrating that.”19

Conclusion

30. There are numerous factors that impact on a young person’s ability to make a successful transition from pre-16 to post-16 destinations with much emphasis on the central role of the education sector in facilitating effective transition planning. These issues are compounded when young people have additional support needs with evidence that the transition from child to adult services can be problematic. The application of GIRFEC principles and the availability of tailored services for young people can be effective pre-16 but tend to be less apparent post-16. This can lead to young people and their families becoming disengaged from services, not feeling supported and poorer outcomes. Addressing these issues requires good joint working, effective partnership arrangements and robust systems in and between agencies. Further, when scrutinising the budget allocations available to support these processes for young people with complex needs, the way the draft budget is set out does not allow for transparent identification of global budgets across the various sectors.

31. We recognise the centrality of good transition planning in allowing young people to move from pre-16 to post-16 destinations. We are concerned about the impact of the move from child to adult services has on young people with additional support needs particularly. We would ask the Scottish Government to review the relationship between child and adult services for this group of young people and identify measures to improve the transition process. We acknowledge the complexity of pooling budget information to identify the range of resource inputs brought to bear round young people with additional support needs. We support the suggestion made about developing a case-study approach to this and request that the Scottish Government develops appropriate models to make this available. We further recommend that the Scottish Government should consider how to publish budget information in this area to enable in-depth scrutiny. We request that the Scottish Government responds to the Committee on this issue with specific proposals.

Partnership Working and Engagement with the Third Sector

32. Mike O’Donnell (Skills Development Scotland (SDS)) explained that SDS was keen to recreate the softer support approach given in schools when helping young people transition to other forms of education and training, and highlighted the importance of partnership working.20 He explained that SDS were working with Enable Scotland to tailor certain products, such as the certificate of work readiness, towards young people who have learning disabilities “so that they can progress in the same way as people who traditionally progress under that programme do.”21 He also emphasised the importance of conducting risk assessments on the potential delivery model. “…to allow us to tailor the products for individuals.”22

33. Mike O’Donnell also discussed the 32 local employability partnerships throughout Scotland—

“They are called different things, but in the context of community planning they are charged with taking a coherent approach to employability locally. As you would expect, there is a mixed picture because some areas have progressed more quickly than other areas. However, the direction of travel across Scotland from where we started seven or eight years ago is certainly very encouraging.”23

34. Lorna Trainer (STAG) suggested that the local employability partnership in Glasgow had not yet involved training partners in its meetings.24 She felt that—

“We are failing in terms of multi-organisational working.”25

35. Clare Fraser (West College Scotland), when asked about the effectiveness of partnership working arrangements, admitted—

“There is no definitive responsibility between, say, a local authority, the social support, the health and care services and the further education sector. Different practices are going on in different colleges, and the system sometimes does not work so well.”26

36. Scott Read (Scottish Transitions Forum) explained the work of the Scottish Transitions Forum which aimed to bring together multiple agencies in the context of transitions. He said—

“We are starting to get really good at attendance across the board by the different professions such as education, health and social work, and we are looking at local models of supportive transitions forums in local authorities to allow bespoke solutions to work within those authorities.”27

37. Brian Webb (SHMU) explained that SHMU worked closely with “loads of organisations” and emphasised the importance of being able to learn from other projects and have strong contact networks.28 Lorna Trainer explained that—

“Service providers do not necessarily know about what else is out there, so there is a bit of a disconnect. They scramble about trying to do the best that they can, but I am not sure that that is good enough. There should be more of a connection, an understanding and an acceptance that it is not just about the general terms of partnerships—people do not always understand what partnership working means—but about the learner’s journey, first and foremost.”29

38. Sandy Stark (SHMU), a young person who had benefitted from extra support, suggested that a central record of different organisations in the field and their specialities may help individual organisations to find the right contacts and expertise.30

39. Witnesses explained that third-sector service providers were often able to step in and provide the more in-depth support that statutory agencies could not provide, but that funding was a key element in delivering services. Clare Fraser (West College Scotland) explained—

“We have worked with a project called the moving on transition service, which offers the softer support that students need. That has been a successful partnership… It is funded through a range of bodies, including the Big Lottery Fund, Share Scotland and Cornerstone.”31

40. Clare Fraser said that she welcomed opportunities to work with the third sector to offer supported employment opportunities to groups that face barriers to employment. She said—

“… the problems that we have are in finding work placements for students with additional needs and what they do after college. It is not just about getting a job; we have to address life skills and independence. Those students want to be able to contribute—they want to be involved and do something after college—so I am interested to see that point in the budget change.”32

41. Mike O’Donnell agreed that working with the third-sector was valuable, but expressed concerns about the short-term nature of funding for the third sector. He argued that “many of the services that we are talking about are not discretionary services; they are key to any community in Scotland”33 and explained—

“… Skills Development Scotland has been asked to lead the development of a third sector employability fund for European challenge funding. I am currently working with colleagues from the third sector to shape the fund. It will be strongly focused on young people who find it difficult to find their way into mainstream services and on doing more in relation to integration and bespoke services for people who have additional support needs.”34

Scottish Government

42. In discussing issues facing the Third Sector we asked the Government what progress had been made on moving to three year contracts or longer in line with the committee’s request on the same issue during the budget scrutiny in 2014-15. The Cabinet Secretary for Finance, Employment and Sustainable Growth responded that—

“We have made quite a bit of progress on that. As members will recall, some time ago, we had a Conservative Party debate in Parliament on three-year funding for third sector organisations. During the debate, I agreed that the Scottish Government would lead a process of discussion with the third sector and local government, given that we and local government represent such a comprehensive part of the contracting approach.

“The third sector has been involved in all the processes as we move towards a greater presumption in favour of longer-term funding. As you will appreciate, such funding can only be deployed on a case-by-case basis. However, our objective is to move more of our contracts to that longer-term period.

“That also involves us in the crucial challenge that I responded to you about a moment ago: we must maintain very strong scrutiny of value over the length of the contracts. Those considerations are being progressed in the contracting structures that we take forward as a Government.”35

43. Further to this, and in recognition of the core role the Third Sector plays in supporting young people with additional support needs, we sought information on the adequacy of funding for the Third Sector and how this was split between central contracts and the local government settlement. The Cabinet Secretary for Finance, Employment and Sustainable Growth indicated that—

“Some funding elements for the third sector and the opportunities for all programme will come out of some of the programmes over which the Government presides, and others will come out of the wider local government settlement.

“For the Government’s part, we have maintained funding for the third sector. That is part of the Cabinet’s long-term commitment to ensure that third sector organisations are properly and fully supported, recognising the strategic role that we expect—indeed, require—the third sector to perform in the delivery of public services, in articulating on behalf of groups with particular needs and requirements, but also in finding new ways of working to improve outcomes for citizens. Our support has been very strong there.

“Local government has to make its own decisions. I have worked strenuously to ensure that it gives adequate and due priority to the third sector’s needs.”36

Conclusion

44. There is variable evidence as to the effectiveness of partnership working at a local level and indications that some inconsistencies exist in these arrangements. The Third Sector is a key player in these partnerships although there is evidence that stability in long-term funding remains an issue.

45. In relation to local partnership arrangements, we recommend that the Scottish Government reviews its monitoring arrangements and ensures with local partners that effective local systems which link into measurable outcomes are maintained. In relation to funding for the Third Sector, we reiterate our view that subject to contract monitoring and value for money, further efforts are made to move beyond annual budget allocation to longer term funding approaches.

Data sharing

46. Further to the issue of partnership working and developing effective, seamless support services for young people with additional support needs, we heard evidence about problems associated with agencies sharing data between them about young people.

47. Jim Gray (Glasgow City Council) explained the importance of data sharing between agencies. He said—

“We still need to tackle certain big issues in data sharing, particularly with regard to the older age group. Things have become a bit easier for the under-19s, but we are still struggling—that is partly to do with data protection legislation, which is only right.”37

48. A number of witnesses expressed similar concerns38 and suggested that schools, Jobcentre Plus and Skills Development Scotland should be sharing information on young people, such as learning plans, with organisations particularly at the post-secondary stage. Brian Webb (SHMU) explained—

“Our projects are playing catch-up, and we have to try to figure out the best way to address a young person’s needs. If they came in with a learning plan that addressed those issues, we still might not be 100 per cent ready to work with them, but we would have a good starting block from which to begin that work.”39

“If we had a starting block, with the information already in front of us, we could cut down the two or three months’ lead-in time in which we try to get to know the young person, and they could physically get on with the work. The valuable time between getting a young person and getting them moved on could be halved, if not quartered, if we had the right information.”40

49. Lorna Trainer (STAG) suggested that data protection and trust issues were one of the reasons that agencies may be wary about sharing data.41 Brian Webb (SHMU) felt that the GIRFEC agenda should support data-sharing but that it did “not seem to work once the young person leaves school.”42

50. Sandy Stark (SHMU) spoke of his own experiences, in which his personal learning plan and details of his additional support needs were not passed from his school to his college, something which he felt should have happened. He explained that because of this—

“… I had to start all over again on things that I had already learned at school. I told the college that I had already learned about IT, cooking and things like that, but it did the basic stuff again that I had already learned at school. I did not learn anything new. I was told that I had to do things, because the college did not have a record of what I had done. If people’s support plans went along with them, I would not have sat there wasting my time redoing things that I had already done at school.”43

Scottish Government

51. Discussion and responses on issues to do with data sharing tended to focus on the new Integration Authorities and their role in relation to older people rather than transition for younger people specifically; although there is a degree of cross over, particularly in relation to health and local government. In this context, the Cabinet Secretary for Finance, Employment and Sustainable Growth stated that—

“There is a much greater degree of alignment of public expenditure to support the priorities and objectives of Government. I would not for a moment say that the situation is perfect—it will never be perfect—but that expenditure is a great deal more aligned than it has ever been in the past. Our strategic agreement with local government to work on shared priorities has enabled us to do that. As a consequence, ministers have been able to direct, for example, the health service and public bodies, and we have the agreement of local government to work on a broadly shared agenda of what we are trying to achieve collectively with the public expenditure at our disposal. A lot of that is assessed and considered within the national performance framework, but we now have a much more integrated policy framework that enables us to work in broadly the same direction.”44

52. Responding to the issue about data sharing, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights explained that—

“The new integration authorities will gather a lot of data, which should allow them to identify more clearly where the spend is and, in more detail, how that resource is being spent across those two large spending organisations. That might help to provide more detail, particularly at local level.”45

Conclusion

53. The new Integration bodies will have a role in relation to children’s services as well as older people’s services which may improve data sharing arrangements. However, in relation to the specific issue of young people making the transition to education, training or employment there are identified issues of sharing data between secondary education, colleges, Jobcentre Plus, SDS, training providers, social work and health services.

54. To address the issue of improving data sharing we ask the Government to explore the issue further and in the context of the new Integration Authorities determine what additional protocols could be put in place to improve data sharing between relevant agencies.

Meeting demand within the budgetary restrictions of the Employability Fund

55. We heard evidence from witnesses about the impact of restricted funding in providing appropriate support for young people with additional support needs. Witnesses who provided training and support spoke about the employability fund, suggesting that this was the primary source of funding for helping young people with additional support needs to access the workplace.

56. The employability fund generally covers eight-to-12 weeks of support46 at £55 per person per week, described by witnesses as a “shoestring budget”.47 Fraser McCowan (STAG) explained that the funding—

“… has changed quite markedly from what it was in the previous programme for young people, which allowed time. We used to engage with many other services that could provide support, but the programme now is quite short. If people are not ready to hit the ground running, things are more difficult. We find that quite challenging.”48

57. Lorna Trainer (STAG) described the previous model of funding and gradual reduction from 26 weeks to eight weeks, suggesting that there was little consultation prior to the changes.49 She suggested that this made service delivery inflexible50 and that it was becoming harder to meet the demand for services.51 Brian Webb suggested that, in contrast, places were not being filled because organisations relied on Skills Development Scotland to pass on the details of young people52, suggesting a mixed picture across Scotland.

58. Fraser McCowan explained—

“We previously had in place a system whereby we would decide at the start how long a person’s period of training would be. We would go back and agree that with the careers service, and that would go into the person’s training plan. At that point, the training could vary from 12 weeks to a maximum of 22 weeks. The period was reducing, but at least we had flexibility. The way the system works now, we run a 12-week programme and, beyond that, it is not viable to continue.”53

Scottish Government

59. Commenting on the budget resources available for supporting young people, the Cabinet Secretary for Finance, Employment and Sustainable Growth stated that—

“We face a strategic budget challenge, but we are trying to protect the resources that are available to support people to make that journey back into employment, because we believe that that journey into employment is the best route for all individuals. I also make the point that, in the sums that I have talked about, we have additional investment to support the implementation of Sir Ian Wood’s report on developing Scotland’s young workforce.

“When members consider the elements in the round—SDS, the efforts around developing Scotland’s young workforce and the youth employment Scotland budget—they will see that there is a strong level of support available. Of course, into the bargain, the college sector budget is going from £522 million to £526 million in 2015-16. Those are areas that are well supported by public expenditure.”54

60. Additionally, the Cabinet Secretary for Finance, Employment and Sustainable Growth also commented that—

“For every young person whom we are unable to support or engage with properly—as we all know, school does not suit every young person, so other interventions will be made available that are designed to be appropriate to the needs of young people—the longer-term costs on the public purse will be even greater. Without wishing to be depressing about it, I can imagine that there would probably be poorer outcomes further down the track and, therefore, greater demands on public services and public expenditure. Getting that support for young people correct is very important.”55

Conclusion

61. There is evident commitment to supporting young people with additional support needs to access appropriate support and assist them to develop the necessary skills to enter the labour market. However, for young people with complex needs and who require to develop the soft skills necessary to move towards employment, available funding through the Employability Fund appears restrictive and in some instances inadequate to meeting needs.

62. We recognise the budgetary constraints facing the Government and the challenges of delivering tailored support to young people within available resources. However, taking account of the desirability of early intervention and preventing more costly outcomes, we would ask the Government to consider a review of the Employability Fund and associated budget allocations to enable a greater level of support for those young people with higher needs.

Funding for Skills Development Scotland and the Modern Apprenticeships Scheme

63. Within the Draft Budget an additional £16.6 million has been allocated to the training, youth and women’s employment portfolio. Mike O’Donnell (SDS) confirmed that some of this had been allocated to SDS. He explained—

“The commission for developing Scotland’s young workforce asked us to look at increasing the number of modern apprenticeships that we deliver. We are keen to look at supply and demand and to use this opportunity to do some research that will begin to tell us what some of the traditional and non-traditional barriers are for young people, so that we can attract mainly young people who might not hitherto have had the opportunity to do a modern apprenticeship.”56

64. Scott Read (Scottish Transitions Forum) welcomed this funding, but expressed concerns over whether the funding allocation had been, or would be, subject to an equality impact assessment to ensure that people with disabilities would benefit from the resulting activities.57 He spoke of projects that would benefit from access to such funding, giving the example of Project Search—

“… which helps to support people with autism, primarily, into the workplace. It is a kind of intern project. The people work as interns in different organisations throughout a year and, I believe, are guaranteed a job from their last placement.”58

65. Jim Gray (Glasgow City Council) also welcomed the additional funding, but agreed with Scott Read that there was a need for tailored interventions, for instance to address the under representation of disadvantaged groups in the Greater Glasgow region.59 Brian Webb (SHMU) spoke of specific funding to reach areas of regeneration and deprivation in the Aberdeen area.60

66. Providing more information on the changes to Modern Apprenticeship funding, Mike O’Donnell (SDS) confirmed that by 2020, the number of Modern Apprenticeships would rise by 5000 from 25,000 to 30,000,61 and that the opportunities for all commitment for young people with additional support needs goes up to their 25th birthday.62 He explained that, despite SDS receiving recent additional funding from the developing Scotland’s young workforce initiative—

“Any budget cut means that we have to consider the service that we offer. Like other public sector organisations, we need continually to refine what we are doing. We need to get smarter with regard to how we deliver services, while protecting front-line service delivery across the school community and other communities throughout Scotland.”63

Scottish Government

67. On being asked to clarify the detail of the additional £16.6 million to training, youth and women’s employment and how this is broken down, the Cabinet Secretary for Finance, Employment and Sustainable Growth responded that—

“That mainly relates to the uplift that has been put in place for the work to implement Sir Ian Wood’s recommendations on developing Scotland’s young workforce.

“In the 2014-15 budget, we allocated £12 million; we have now increased that by 38 per cent to £16.6 million. That will be focused on expanding the apprenticeship programme, on encouraging more vocational learning opportunities for young people while in school, and on the establishment of better integration between schools and colleges in preparing young people for work…”64

68. Asked to comment whether an impact assessment had been carried out of how this allocation might help people with disabilities and additional support needs to access the workplace, the Cabinet Secretary for Finance, Employment and Sustainable Growth replied that—

“As part of the equalities assessment, we are testing portfolios’ budget propositions to ensure that they support the process of improving outcomes for all individuals. Young people with disabilities will have been considered as part of that process. I come back to our obligations to improve outcomes for individuals, which are reflected in the budget choices that we make.

“Those issues are tested in the equalities budget statement in the budget process that the cabinet secretary, Shona Robison, and I preside over to ensure that individuals’ wider expectations of the effect of the Government’s programme are fulfilled by the spending choices that we make.”65

69. On being asked to further clarify the role of the allocation of £12.7 million to a new budget line of youth employment within the overall £16.6 million, the Cabinet Secretary for Finance, Employment and Sustainable Growth replied that—

“It will support the principle of early intervention to support young people in securing worthwhile employment. As I said to the convener, for every moment that a young person is not supported, encouraged and nurtured to enter the labour market or head towards a good destination through education, we are in danger of walking into a worse outcome and further demand on public services.

“Youth employment Scotland is designed to try to ensure that that journey is made as smooth as possible and is as well supported as possible so that individuals’ needs are met. For some young people, staying at school can be a negative outcome. The early intervention is designed to make, as quickly as possible, the judgment that a different approach or setting might benefit a young person. That is a crucial judgment that, in the long term, will deliver better outcomes for the individual and for society.”66

70. In responding to the issue of the low participation by women, people with disabilities and other protected groups in the modern apprenticeship scheme, the Cabinet Secretary for Finance, Employment and Sustainable Growth replied that—

“On the sourcing of data, I am happy to ensure that the Government takes as much action as it can to address the committee’s aspiration of getting more detailed statistics on this area of activity. The committee might wish to consider making a specific proposition about what information it would be helpful to collect, and the Government could respond to that. […] there is no shortage of Government-collected statistics; whether they are all useful and up to date enough for our current needs is a completely different question. If the committee wished to set out a framework of statistical information that it considered would be helpful, I would be happy to look at that and to establish what was required.”67

71. The Cabinet Secretary for Finance, Employment and Sustainable Growth indicated that the reduction in the SDS budget was 0.3%.68 At the same time, the Government has announced an additional £16.6 million to training, youth and women’s employment which is partially designed to increase provision within the Modern Apprenticeship Scheme.

Conclusion

72. Despite the increase in funding and the announced expansion of modern apprenticeships to 30,000 from 25,000 currently by 2020, there are acknowledged problems in the uptake of apprenticeships by young people from protected groups. This remains a matter of concern. The issue has also been referred to in written submissions to the committee.69

73. We welcome the additional funding for youth employment. We seek reassurances that the needs of young people with additional support needs or those who belong to protected groups are not being met, and that these groups are underrepresented in the scheme. We therefore recommend that the Scottish Government reviews measures in place to ensure that young people from protected groups are positively encouraged to take up modern apprenticeships and develop an action plan to this effect. Further, in relation to the take-up of modern apprenticeships, we ask the Scottish Government to provide statistical information on an annual basis on all of the protected groups, review existing targets for relevant agencies and enhance current monitoring of this process.

Delivering support in rural settings

74. Witnesses spoke of the additional challenges facing support providers in rural settings. Fraser McCowan (STAG), speaking about the Argyll region, explained that there could be “huge distances between where the young person is and where support can be found” and that there “was not always funding or flexibility in the programmes to match things up.”70 Both Fraser McCowan 71 and Sandy Stark (SHMU) called for more funding for transport to help agencies deliver service in rural areas and to help young people to access education, training and the workplace.72 Lorna Trainer (STAG) explained—

“We have been established in the area for 23 years and have always supported the rural and remote areas, but that is becoming more difficult in the new funding regime.

“We now need to take some tough decisions. Even though we are a charitable organisation, we still have to cover our costs, so we are probably coming to the point at which we will not be able to support some of the young people in such areas because it is no longer viable to do so. It is very difficult.”73

75. Fraser McCowan also expressed concerns about the allocation of funding to rural areas—

“There is less flexibility now in the programmes. We do stages 2, 3, and 4—stage 2 with the 45 different age categories. If you bust one part of that, but you have demand, you cannot transfer across within your own contract; everything has to go back into a central pot. I fear that areas such as ours will miss out because there will be pressure for more places for some of the big providers in the central belt.”74

Scottish Government

76. Subsequent to the evidence from witnesses, and prior to the evidence session with the Cabinet Secretaries, committee member John Finnie asked a number of written questions on the subject of rural training delivery challenges.75 The indications from the written answers suggest that aspects of this issue are under review by the Government.

77. In response to a question about the additional costs providers experience in rural and island settings, and whether this has been factored into the draft budget, the Cabinet Secretary for Finance, Employment and Sustainable Growth responded that—

“Some of the judgments in that regard are reflected in the decisions that Skills Development Scotland makes about the delivery of contractual arrangements in remote areas. In the local government settlement, provision is made to enable authorities to take due account of rurality and remoteness. The additional costs that are incurred in delivering services to island communities are reflected in the element of the local government settlement that is influenced by the special islands supplement.”76

78. He went on to state—

“I give the committee a wider reassurance, in that the Government’s purpose is to ensure that there are opportunities for all in Scotland—I stress “all”—to flourish, through sustainable economic growth. That means that whether someone lives in central Edinburgh or the Western Isles they are entitled to have access to opportunities. Therefore, the funding support and the way in which we deliver services are designed to address that requirement.”77

Conclusion

79. From evidence heard there is considerable financial strain on providers delivering employment services in rural and island settings. The issue has also been raised in parliamentary written questions78 and in a written submission from Argyll Training Ltd.79

80. We are concerned that equity is needed in the provision of employment services across Scotland and are of the view that additional supports are required by providers in rural and island settings to achieve this aim. We welcome the response from Government and note that the issue is under review. We recommend that the Government review the relevant budget allocation and contracting arrangements through SDS to ensure that the balance between rural and urban funding is equitable.

OLDER PEOPLE

Older people, changing patterns of health and health inequalities

81. We heard evidence on the changing demographics of health and that a focus on purely chronological age factors is not adequate to understanding and responding to the health and care needs of older people. In this respect Professor Stewart Mercer (Glasgow University) indicated that—

“The problem of the elderly is largely to do with their having multiple complex conditions. Older people increasingly have a mixture of multiple physical and mental health problems, such as dementia, heart disease, diabetes and osteoporosis”80

82. When discussing the pressures on primary care resulting from this change in population health, Professor Mercer went on to elaborate—

“The problem is compounded by deprivation, because we know that multiple morbidity happens much earlier—10 to 15 years earlier—in deprived areas, so when we talk about people being elderly it does not necessarily mean an age cut-off. There is a biological phenomenon here.”81

83. In this context Professor Mercer raised concerns about enduring health inequalities, suggesting that those from deprived areas may “at the age of 50, have the same amount of multiple morbidity as somebody in one of the most affluent areas who is 70”82. He went on to say—

“We have a huge problem with health inequalities in Scotland—the worst in western Europe—and multiple morbidity is compounding that, because need is not matched by resource, particularly in deprived areas. The distribution of general practitioners is flat across different deciles and different places in Scotland, but healthcare need and the problems of multiple morbidity are not flat, as there is a twofold to threefold increase between the most deprived areas and the most affluent. GPs working in those deprived areas have formed a powerful advocacy group—the general practitioners at the deep end group, about which my colleague Graham Watt from the University of Glasgow has presented evidence to other committees. We cannot possibly expect general practitioners at the deep end to be able to cope in the same way as if they were working in a more affluent area, because it is not a level playing field. That has been called the inverse care law.”83

84. When asked about pressures on acute care, Joe McElholm (North Lanarkshire Council), confirmed that older people can have complex multiple needs, but “It is not necessarily age related; it is about multiple morbidities and the complexity of the person’s needs.”84

85. Iona Colvin (North Ayrshire Health and Social Care Partnership) expanded on the impact of health inequalities and stated that—

“We think that about a third of the people who turn up at hospital do not need to be there. However, two thirds of them do, which relates very clearly to the impact of deprivation on people’s health and to the fact that we have an older population.”85

Service re-design and shifting the balance of care

86. Witnesses were asked to speak about shifting the balance of care towards home-based services in the context of only 7% of the expenditure on health and social care being on home care.86 Witnesses confirmed that the majority of health spending went towards acute and secondary services and hospitals in particular.87 Iona Colvin (North Ayrshire Health and Social Care Partnership) explained that there would be challenges in freeing up funds from large hospitals88, but that—

“We have grown some elements of care at home through the reshaping care for older people fund, but I do not think that that fund managed to influence the main stream of funding as much as it should have done. We are considering seriously how to grow the community infrastructure. That is not just about care at home; it is about district nursing, community psychiatric nursing and building services around general practice, which is fundamental.”89

87. Joe McElholm (North Lanarkshire Council) highlighted the prescribing budget for older people—

“The 7 per cent figure is stark. We spend the same proportion of the health budget, or slightly more, on prescribing for older people, and we would like some change in that regard.”90

88. Joe McElholm went on to discuss the approach to reshaping care in North Lanarkshire specifically the focus on redesign towards reablement and working with people at the early stages of using a home support service to help people move back out of services. He pointed out that it—

“can require an intensive use of resource in the early stages, but it represents spending to save, because over time supporting people back out of the services frees up resource to support people who have much higher levels of support need to remain in their own communities.”91

89. Joe McElholm also discussed developments in North Lanarkshire where services have “moved away from providing residential care within a traditional long-term local authority model. Our care homes are now focused on intermediate care. Two of them operate fully on intermediate care and two are moving towards doing so. We have divested from the long-term residential care model without there being an increase in the use of independent sector care homes, so it is possible to make such shifts in the balance of care through a process of redesign.”92

90. When asked to give details on the barriers to shifting the balance of care, Iona Colvin explained that the number of admissions to accident and emergency services was increasing year on year93, as was the demand for care home places94, and that there was a need for such issues to be considered by both health and social care services in tandem.95 She suggested that there needed to be an emphasis on community services so that people did not see A&E as their only option96 and stated that—

“We still have a culture, particularly when older people are in hospital, of deciding that they are going down either the get home quickly to care at home route or the care home route. That is one of the things that we need to change. We need to change the options that are available for older people and we need to change that culture.”97

91. Professor Stewart Mercer, (University of Glasgow) said—

“A lot of it is about having systems that enable people to work better together and at least to share knowledge, but I think that there is a fundamental problem of the relative balance of the budget between acute and primary care.”98

92. Witnesses were also asked whether self-directed support would help to shift the balance of care. Joe McElholm felt that it would, saying that it would “give some people options to manage their support in ways that have not been available to them prior to the new legislation”99, but that—

“The change funds do not change the fundamentals of the budget; they provide an opportunity to reshape, to redesign and to take a step back. Delivering within the current budget is a really big challenge, and the coming years will be harder still.”100

Scottish Government

93. Shona Robison MSP, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights, commented on the issue of shifting the balance of care stressing the centrality of the core joint budget—

“The question is how we keep people at home for longer. Some of the £173.5 million will build on the resource for how to do that, which the change fund was very useful at doing. However, we should keep our eyes on the £7.6 billion. If we can unlock that resource, that will bring real change in how people receive services at local level.”101

94. The Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights went on to say—

“Will the unlocking of that £7.6 billion happen and bring sweeping change overnight? No, but the gradual shift of that resource has a strong chance of happening because of the accountability for the joint budget, which will be the catalyst for change. We will be pushing from the centre and ensuring that there is momentum locally. In many areas of the country, a lot of good work is being done that recognises that this is a once-in-a-lifetime opportunity for substantial change. All areas will make those changes; some areas are getting on and doing it quicker than others, but they will all do it.”102

95. John Swinney MSP, the Cabinet Secretary for Finance, Employment and Sustainable Growth, stressed that shifting the balance of care was “…an absolutely fundamental question…which is at the heart of the Government’s agenda for what needs to be addressed.”103 He made the point that—

“…it costs £4,000 a week to support and care for an individual in an acute hospital, whereas it costs £400 if they are in their own home. It does not take an awful lot to work out what the finance secretary thinks is the preferable approach. However, I accept that the Government has to drive the process relentlessly in association with our local authority partners, and that is exactly what ministers are focused on doing.”104

96. He went on to comment—

“Crucial to the journey of shifting the balance from dependence on acute care, for example, to supporting people more effectively in their homes is the contribution and performance of the third sector, and its ability to be a big player in that journey. That is a major theme of what the Government is trying to achieve."105

Conclusion

97. We note that shifting the balance of care from acute hospital and residential services to care at home is a central plank of the Integration agenda and fundamental to improving outcomes for older people. Evidence suggests that some limited progress is being made in this respect, but the challenges are significant. Re-designing services to achieve this aim is a major undertaking and will involve concerted effort from central government and local partners. It is evident that the process will necessarily be long-term and will involve significant changes in structures, culture and practice.

98. We recognise the challenges involved in shifting the balance of care and commend local initiatives that are making progress in this respect. We recommend that the Scottish Government maintains its focus on driving this approach and develops a mechanism within future budgets which provides financial information on progress towards this objective.

Driving Change, National Targets and Evaluation of Integration Funding

99. When asked whether the impetus to deliver services differently should come from central government, Iona Colvin (North Ayrshire Health and Social Care Partnership) explained that reablement and care in the community was already a big focus for most local authorities106. She said—

“Integration gives us a better opportunity to use the resources that we have across the NHS and the council to do that and to work on maximising independence but also getting people into better care and into a position where they live more happily in the future.

“We are looking at how we work with the care home sector and how we commission services in the future.”107

100. Iona Colvin went on to talk about the importance of local authorities sharing examples of best practice—

“We look at the best examples of practice across different authorities and try to learn from them. Some of the things that have been achieved in moving people out of residential care and into extra care housing have been remarkable. The opportunity that that model provides is that we are not moving individuals but are able to have much more flexible support and health services round about them. We need to define and look at how care should be delivered in the future.108

101. Joe McElholm (North Lanarkshire Council) suggested that there was—

“… scope to improve how we direct the Scottish Government’s national level input around the performance regime, which can, perhaps unintentionally militate against effective transitions and the achievement of some of the outcomes.”109

102. Witnesses spoke about the restriction fixed targets could have on care, and pointed out that the four-hour target for accident and emergency services was proving increasingly challenging110. Joe McElholm explained—

“We are moving towards the implementation next April of a target of two weeks from clinical readiness for discharge to the person leaving. We currently report on a target of four weeks, so there is a risk of the new target generating a pressure. During that period of transition in the hospital, the patient and the team that is supporting them may need longer than two weeks. Driving performance is a laudable thing to do if we are trying to ensure the most efficient and effective use of the acute resource, but if we drive performance too hard on the basis of a regime of time targets, we risk driving more institutionalisation and premature declarations of the need for people to move to a care home when, with a different approach, we might be able to support them to go home again.

“We need to look at how the Scottish Government can work more subtly with the local partnerships to achieve the desired outcomes. It is less about whether there can be more straightforward direction than about whether the Government can work more subtly in partnership to find the best way to manage performance.”111

103. Witnesses were asked to comment on the national outcome focused on helping older people to maintain independence. Iona Colvin suggested that, in the context of the 2020 vision statement “fundamentally, the funding is going in one direction and the policy is going in another direction”.112 She said—

“… Reshaping care for older people got about 1 per cent of investment, and we need to shift the 99 per cent that is currently invested in health and social work. That is what we are grappling with at the moment—that is what we need to do.

“We are consulting just now on our future model. My view is that we all need to begin the shift to building the model around primary care, particularly general practice, which some areas have done.”113

104. When asked whether the amount set aside in the budget for the integration fund was sufficient, Iona Colvin said—

“It is not enough to make the big shift, as we have said, but we need to use the resources to begin to make inroads towards making the big shift. Because we have been guaranteed money for only a year—we understand why that is—it is not enough to set up a whole lot of new services. We have to change the way in which we use the services”114

Scottish Government

105. The cabinet secretaries were asked about how funding would support the development of change. In this context, reference was made to the cessation of the Change Fund for Older People and the introduction of the new Integrated Care Fund which totals £173.5 million for 2015-16.

106. Shona Robison MSP, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights, responded that—

“The new integrated care fund builds on the change fund that preceded it, and it will have £173.5 million for 2015-16. However, the important thing to say about that is that the integrated partnerships will have scope to look at joint budgets of around £7.6 billion. The £173.5 million will be used to continue some of the groundbreaking work of redesigning services to showcase what can work, with the expectation that that will be a good model for the practice of all the integrated authorities. That budget is a catalyst for change but the big resource sits within both health and social care, which is why they are being brought together. The integrated partnerships need to focus on the £7.6 billion but use the £173.5 million to unlock some of the resource that is tied up in doing things that we know are not the most effective.”115

107. When asked to specify what the new Integration Fund would do to improve services and outcomes for older people through shifting the balance of care, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights answered that—

“The legislation was put in place to bring together two big-spending organisations…That is why we have reached the point of putting legislation in place to require those organisations to come together and pool their budgets; the pooling of the budgets was always the missing bit. At the end of the day, whether it is human nature or system nature, when there are two separate budgets with two separate responsibilities, there will always be barriers to real change. The legislation that brings together those bodies and budgets will make the difference for service users.”116

108. The Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights was asked further about the scope of the Integration Fund and what the role of central government should be in this process. She considered that—

“The £173.5 million for next year is the budget to help oil the wheels of change. We expect change to happen and we expect the health boards and local authorities to look at how to shift the £7.6 billion resource, and the £173.5 million is to help bits of the system to change.”117

109. With reference to the relationship between central government and local partnerships, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights explained that there would be robust oversight of planning processes, with the strategic plans laying out how it is going to change and what has been done at what stage. She considers that the plans “will be subjected to a great deal of scrutiny, not just by the Government but locally as well.”118

110. When asked about the evaluation process in terms of meeting the nine national outcomes for health and social care partnerships, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights replied that—

“There will be a sharp focus on delivery and evaluation.”119

111. In recognition of the long-term nature of the changes being developed, both cabinet secretaries were asked about the continuation of the funding stream to support integration. The Cabinet Secretary for Finance, Employment and Sustainable Growth replied that—

“We have financial information only up to the financial year 2015-16. We have not been provided with any longer-term information. However, integration is an absolutely strategic priority for the Scottish Government. That is the route to enabling us to create sustainable health and social care services. It has to work and it has to be supported with sufficient political and organisational leadership, as well as with resources to ensure that it can happen.”120

112. The Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights responded that—

“During 2015-16, we will get a far sharper focus on what is working. It will then be a case of driving what works to ensure that change is delivered. That will inevitably influence any future spending decisions.”121

Conclusion

113. We heard evidence from witnesses that local partnerships are working to drive change and identify best practice. There was recognition that the process will be complex and necessarily long term. Witnesses discussed the role of central government in shaping the process and the advantages and potential unforeseen issues that can arise from performance frameworks. Whilst welcome, the new Integration fund does not appear to provide substantial levels of funding at a local level, and appears to be geared towards system change as opposed to fundamental service change, unlike the previous Change Fund. There is no indication that the funding stream will continue in future years, although any decision to this effect this will be subject to evaluation of the impact of the new fund.

114. We commend the progress being made at a local level and welcome the Scottish Government’s introduction of the new additional Integration Fund. We recognise the need for long-term approaches and funding to sustain change and would recommend that the Scottish Government commits to long-term funding of local partnerships to achieve stated objectives and national outcomes that maintain the focus on the needs of individual users of services. We further ask the Scottish Government to publish the evaluation of the Integration Fund in time for scrutiny of the draft budget 2016-17.

Primary Care and the relationship to Integrated Partnerships

115. When asked about the impact of budgetary changes to the provision of care, Professor Stewart Mercer (University of Glasgow) suggested that although different areas develop their own approaches, it is important to consider the wider national picture, in which older people have “multiple complex conditions”122, and that “People with multiple conditions need generalism and holism, not 10 different specialists in 10 different places”123. He explained—

“We have an ageing population with multiple complex problems and 90 per cent of the activity of the NHS is in primary care and general practice, but that is not reflected in the budget that goes into primary care and general practice. In fact, the percentage of the budget going into general practice has decreased over the past 10 years in the United Kingdom and the Royal College of General Practitioners has been calling for a 40 per cent increase in the share.

“… The bigger picture shows a problem of primary care being underresourced for the future, and something has got to change.”124

116. In the context of health and social care services working together, Iona Colvin (North Ayrshire Health and Social Care Partnership) suggested that integration with GP practices was essential because “most people will go to see their GP and it is likely that their GP will be the first person who gets involved.”125

117. Professor Mercer spoke about the deep-end link worker project—

“The cabinet secretary has announced funding for the project for the next two to three years. The project is designed to deal with the situation in which, although there might be a lot of community support in an area, there are people who are isolated and GPs often do not know what is available for them in the community, particularly in deprived areas, because they do not live there.

“The link worker is a fairly highly skilled person, often from a community development background, who is based in the GP practice. When a GP sees a patient and picks up the fact that they are isolated, they can refer the person to the link worker, who will see them the next day. The link worker will go through what is available locally. There is the local information system for Scotland, which is called ALISS. It can be localised for all sorts of things—for example, someone might run a lunch group or a walking group.”126

118. In relation to the additional funding for deep-end services, Professor Mercer added—

“… the cabinet secretary announced an extra £43 million over the next year, part of which will go into deprived areas and general practice in deprived areas. That is welcome. We do not know yet how that money will be spent and it is only for one year, so it will not solve the fundamental problem, but it is certainly a step in the right direction. I do not know of anything that will reverse the inverse care law.”127

119. Following the suggestion that more investment in primary care was needed, witnesses were asked whether the model of GP service provision could be a barrier to reshaping care. Professor Mercer praised the flexibility and reactiveness of GP services,128 but expressed concerns that the quality and outcomes (QOF) used to incentivise GPs was too focussed on single diseases and failed to take due account of patients with multimorbidity.129 He expressed the view that the national health service should be more person-centred.130

120. Joe McElholm (North Lanarkshire Council) suggested that the GP contract was at least moving towards encouraging, more local integration. He said—

“… a small part of the QOF has been allocated to the commitment by the GP practice to engage with their locality partners. That shift is a positive example of how the contract can be used to incentivise engagement in the development of a locality model—in other words, an integrated model. That integrated locality focus is in the legislation, and the GPs will be absolutely central to its successful delivery.”131

121. In response to a question about whether GPs were being fully involved in the integration process, Professor Mercer welcomed the inclusion of GPs in locality planning but did not know how uniform their inclusion is across Scotland and felt that it might be piecemeal.”132

122. In response to the same question, Iona Colvin agreed that it was essential GPs be involved in the integration process but also indicated—

“We have a job to do with GPs, because they feel quite disenfranchised from what has gone before and from the community health partnerships. That will vary across the country, but I know that it is the case in Ayrshire. It is very much a case of talking to GPs and engaging with them, so we are meeting them regularly…We also plan to have GP leadership in our management team.”133

123. In relation to the evidence presented by Professor Mercer regarding the government’s announcement of additional funding for primary care, we asked for clarification about whether the additional funding was part of the £173.5 million Integration Fund allocation previously discussed and this was confirmed by the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights .134

Scottish Government

124. In response to a further question about the purpose and intention of the additional funding, the Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights replied that—

“…when the Cabinet Secretary for Health and Wellbeing, Alex Neil, announced that funding, it was focused particularly on tackling inequality by strengthening primary care services both in urban areas of deprivation and in rural areas where rurality was a significant factor.”135

125. Alison Taylor (Health and Social Care Integration, Scottish Government) provided further detail—

“Discussions are on-going about exactly how to fulfil that aim, which parts of the money to spend in which way, and how to involve professional organisations as well as officials and ministers in due course. …the emphasis is on equalities as they manifest themselves differently in rural and urban areas.”136

126. The Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights indicated that further information would be made available in due course as to which areas the additional funding would be allocated to, and in relation to its specific purposes.137

127. In response to a question about the role of the QOF in providing incentives to general practitioners to involve the third sector, Alison Taylor clarified that—

“We have recently adjusted one aspect of the general medical services contract to include provision to enable every practice to have a link with the integrated partnerships. That is a first step; it does not guarantee that a GP is directly involved in any given discussion. However, it creates a liaison, which is important.”138

Conclusion

128. Evidence from witnesses stressed the importance of primary care as being a core element of future integrated services and that this relationship needed to be developed and strengthened. The needs of the ageing population are also such that holistic responses are required as opposed to a reliance on specialisms. At the same time, funding for primary care is population-based rather than needs-based meaning that primary care services in deprived areas can be over-stretched. It is not yet clear what the additional £40 million allocation will be targeted at, or whether this is a one-off or recurring funding stream. Further, as this additional allocation emanates from the £173.5 million Integration Fund, it is not clear whether the funding will be targeted at integration initiatives specifically.

129. We welcome the announcement of additional funding for primary care by the Scottish Government but are concerned that this may be a one-off allocation and seek clarification on the targeting of this funding. In relation to the evidence heard on the inverse care law and the importance of GP services, we consider funding for primary care needs reviewed in its own right and as part of a wider approach to shifting the balance of care in line with integrated services. We would ask the Scottish Government to consider how funding for primary care can be developed to shift the balance of care, as well as meeting higher needs in particular areas.

Delivering services in rural settings

130. We heard evidence that particular issues exist for older people in rural areas. Professor Stewart Mercer (University of Glasgow) said that—

“… the issue of an ageing population is worse in rural areas. The Highlands and Islands are ageing faster than urban areas. The problems will accelerate. I am not sure whether enough is being done.”139

Scottish Government

131. In this context, a specific question was asked of the Scottish Government regarding the special islands supplement and whether agencies that deliver work on behalf of the Scottish Government take a similar approach.

132. The Cabinet Secretary for Finance, Employment and Sustainable Growth replied that—

“I would have to check particular contractual arrangements to see whether any specific cash factors are taken into account in that respect. I will write to the committee on that point.”

Conclusion

133. We welcome the Cabinet Secretary’s response and await his written communication.

Work with the Third Sector

134. In the context of reshaping care, Joe McElholm (North Lanarkshire Council) explained that people must be given opportunities by investing in the third sector.140 He highlighted the investment North Lanarkshire Council had made in emphasising publicly the role of the third sector in the delivery of services and—

“the importance of the small initiative in a community that builds its capacity. By putting the funding into that, we are sending a message to the community that it is vitally important and not something that we treat as a bolt-on.”141

135. Professor Stewart Mercer (University of Glasgow) suggested that integration between the third sector and primary care was still at a “very early stage”.142 He said—

“The Health and Social Care Alliance Scotland is a big player in this and is doing really good work. However, we should not think that it can be rolled out as a one-size-fits-all process, because it will evolve over time. The deep-end link worker project is an example of a model that might not work across the piece. I think that it will take about five years before we really know how to do this.”143

136. Iona Colvin (North Ayrshire Health and Social Care Partnership) explained that local health and social care partnerships will hold contracts for integrated services, suggesting that this set the scope for working with the third sector in delivering services.144

Scottish Government

137. In response to broader discussion about the role of the third sector in relation to integrated services and primary care specifically, Alison Taylor (Health and Social Care Integration, Scottish Government) indicated that—

“On the subject of building in the third sector, we have requirements within the integrated arrangements for partnerships to establish localities, which are smaller areas within local authority areas. Our emphasis for those localities is that GPs and other local professionals must have a leading role in helping to develop services that are appropriate to the population.

“There is also a guaranteed role for third sector representatives under those arrangements, and there is a guaranteed role for third sector representatives and for primary care around strategic planning tables. We have knitted those arrangements in at various points in the system so as to develop a collective effort behind shifting the balance of care.”145

Conclusion

138. Evidence from witnesses confirms the central role that the third sector has in contributing to shifting the balance of care and in delivering essential services to older people in their communities. The third sector is progressively being involved in the planning and design of services through integration arrangements and in relation to primary care. The majority of third sector services in the field of integrated and community-based care for older people are likely to be commissioned through local authority and health agencies currently, with this progressively coming under the aegis of the new integrated partnerships from April 2015 onwards.

139. We recommend that as part of the evaluation of the new integrated partnerships the Scottish Government provides information on the role of the third sector within the partnerships.

Evaluating outcomes and learning for the future

140. Witnesses were asked to talk about how the outcomes of the reshaping care fund and associated initiatives could be measured, and how lessons could be taken forward to inform future practice. Professor Stewart Mercer (University of Glasgow) expressed frustrations around the lack of evaluation of projects146.

141. Joe McElholm (North Lanarkshire Council) gave an example of how outcomes had been measured in North Lanarkshire—

“… at the beginning of the programme, we decided that 20 per cent of the spend from the reshaping care budget should be spent in the third sector and we established a rigorous evaluation framework around that. A lot of small initiatives were set up on, for example, digital inclusion, such as a small local group that connects young volunteers for whom using an iPad is second nature with older people who want to learn how to use that technology, which is strongly connected with inclusion and combating loneliness, because it gives those people different ways of connecting with their families and so on.

“With each of those projects, we have established a framework whereby there is regular quarterly reporting on what has been achieved with the money that the project got. […] It is labour intensive, but if we do not do that, we will not be able to make the case for the wider transfer of resource that we are talking about from the acute sector to the third sector. It is always going to be difficult to evidence the connection between such work—education around falls, for example—and fewer people being in hospital. However, as long as we can evidence the contributions—we publish a contribution story on a quarterly basis that summarises all the information—we are making the case for the transfer from the acute sector.”147

142. Joe McElholm went on to talk about the importance of highlighting good practice and explaining what services do, and spoke of the positive impact North Lanarkshire Council had seen following the employment of a media-trained communications officer148.

143. Iona Colvin (North Ayrshire Health and Social Care Partnership) suggested that, while there were initial costs in integrating services, ultimately there would be savings, particularly in relation to management structures and eliminating the duplication of work.149 She explained—

“… The challenge for us, first, is how we provide the services and stay within budget or stay at an acceptable level for our elected members. The second part of that—the bit of the model that we want to work through—is how we attach to primary care and particularly to general practice. That is very much to do with the things that Professor Mercer talked about; it is a matter of organising services differently. Thirdly, an innovation fund has been organised by our third sector colleagues, who are looking at innovative approaches that the third and independent sectors want to come up with.

“One of the problems with the reshaping care for older people policy was that it was quite strict and had to be focused on the over-65s. As we have discussed, particularly in areas such as Irvine and the three towns, there are people in their 40s and 50s who are just as sick. We need to consider what we learned from the policy that was good, what we would want to extend and what else we want to do. We have to work hand in hand with the third sector to get its best ideas generated.”150

Conclusion

144. There is considerable evidence of innovative practice which has the potential to influence the development of integrated services and contribute to shifting the balance of care. Evaluation of outcomes needs to be systematised so that learning can be shared across sectors and partnerships.

145. We recommend that in conjunction with the Joint Improvement Team and other relevant bodies, the Scottish Government explores how experience in the integration field, and with particular reference to services for older people, can be widely shared across the sector.

CONCLUSION ON OTHER COMMITTEE'S SCRUNITY OF THE DRAFT BUDGET 2015-16

146. As in previous years, we asked other committees to take into account matters relating to equalities within their own scrutiny of the Draft Budget 2015-16—

  • The Economy, Energy and Tourism, Health and Sport and Rural Affairs, Climate Change and Environment Committees chose to include specific sections relating to equalities.

  • The Education and Culture, Infrastructure and Capital Investment and Welfare Reform Committees included mainstreaming of equalities within the main body of their report.

  • The European and External Relations and Justice Committees did not specifically report any issues relating to equalities but covered subject areas highlighted last year including support for immigrants and workforce balance within Police Scotland..

147. Some Committees heard evidence which linked directly to our focus in scrutiny on age—

  • The Education and Culture Committee heard concerns about the reduction in non-teaching staff and the potential impact on students with additional support needs (ASN), and general concerns about placing children with ASN within mainstream education. The Committee sought additional information from the Scottish Government and COSLA on the concerns raised, and a response as to whether an eight per cent increase of non-teaching staff between 2010 and 2013 was sufficient to cope with the significant increase in children with ASN.151

  • The Health and Sport Committee sought further information from the Scottish Government on how it would prioritise spending within the Integration Fund and asked for reassurance that the funding allocation was sufficiently large to meet demands.152 It also asked for reassurances on how health boards would use funding, and how the Scottish Government planned to monitor the progress of integration.153 The need for budget processes to accurately reflect the restructuring of health and social care was highlighted154 and the Committee expressed a commitment to work with Scottish Government officials and NHS boards to bring more transparency to the budgetary process155.

  • The Rural Affairs, Climate Change and Environment Committee looked specifically at issues relating to rurality in the context of the equality statement, and noted the Scottish Government’s consideration of the impact of rurality on both young people and women accessing employment.156

148. Other issues included—

  • The Economy, Energy and Tourism Committee looked at employment and training for young people and accessible tourism. The importance of both modern apprenticeships and of teachers understanding of different industries was highlighted.157

  • The Health and Sport Committee asked, as it did in its report on the Draft Budget for 2014-15, for the Scottish Government to include more supplementary information with the main Budget document. It specifically noted the need for more details on health inequalities across Scotland, and the resources being dedicated to talking these inequalities.158

  • Whilst the Infrastructure and Capital Investment Committee focused its scrutiny largely on sustainability and climate change, it did touch on areas which connected to equalities issues. Concerns around adequate funding for rural broadband159 and public transport160 link strongly to evidence we heard on access to services for both younger and older people, and consideration of funding for future housing stock161 links into evidence we heard during our 2014 follow-up work on Having and Keeping a Home: steps to improving homelessness among young people162.

  • The Rural Affairs, Climate Change and Environment Committee asked the Scottish Government, to inform future equality statements, to carry out research on the impact of climate change on equalities groups across all portfolios.163 It asked, for the second year running, that the Scottish Government improve details on how indicators within the National Performance Framework link specifically to equalities issues.164

  • In last year’s scrutiny of the Draft Budget we heard concerns about the additional impacts of welfare reform on people with disabilities. The Welfare Reform Committee, in this year’s scrutiny, concluded that funding for welfare reform mitigation was currently sufficient, but that there were a number of issues that may affect this judgement in the future. It also noted the scope for moving past mitigation as further responsibilities were added to the Scottish Government’s current portfolio.165

Conclusion

149. We thank those committees who made specific reference to equalities issues within their scrutiny of the Draft Budget 2015-16, and in particular appreciate those who took our focus on age into consideration alongside general scrutiny. We are concerned that in comparison to previous years the range of equalities issues highlighted this year is limited.

150. We commend the specific recommendations made by the Health and Sport and Rural Affairs, Climate Change and Environment Committees in relation to improving both the transparency of budget documentation and demonstrating the explicit links between National Performance Indicators and equality issues. We urge the Scottish Government to take these recommendations on board and provide an update within its response to the Finance Committee’s report on the Draft Budget 2015-16.

ANNEXE A: EXTRACTS FROM THE MINUTES OF THE EQUAL OPPORTUNITIES COMMITTEE

8th Meeting, 2014 (Session 4) Thursday 24 April 2014

Draft Budget Scrutiny 2015-16 (in private): The Committee considered its approach to the scrutiny of the Scottish Government's Draft Budget 2015-16. It agreed to focus on age and to seek to appoint an adviser.

10th Meeting, 2014 (Session 4) Thursday 15 May 2014

Draft Budget Scrutiny 2015-16 (in private): The Committee further refined its approach to scrutiny of the Scottish Government's Draft Budget 2015-16. It also agreed a response to recent correspondence from the Rural Affairs, Climate Change and Environment Committee regarding climate change mainstreaming.

11th Meeting, 2014 (Session 4) Thursday 5 June 2014

Draft Budget Scrutiny 2015-16 (in private): The Committee considered and agreed its approach to the scrutiny of the Scottish Government’s Draft Budget 2015-16. It also agreed a person specification for an independent adviser, and to seek approval from the SPCB to appoint an adviser.

13th Meeting, 2014 (Session 4) Thursday 14 August 2014

Draft Budget Scrutiny 2015-16 (in private): The Committee agreed a ranked list of candidates for the appointment of adviser on scrutiny of the draft budget 2015 16.

16th Meeting, 2014 (Session 4) Thursday 9 October 2014

Draft Budget Scrutiny 2015-16 (in private): The Committee considered and agreed its approach to evidence taking on the scrutiny of the Scottish Government's Draft Budget 2015-16.

17th Meeting, 2014 (Session 4) Thursday 6 November 2014

Draft Budget Scrutiny 2015-16 - witness expenses: The Committee agreed to delegate to the Convener responsibility for arranging for the SPCB to pay, under Rule 12.4.3, any expenses of witnesses in the inquiry.

Draft Budget Scrutiny 2015-16: The Committee took evidence on the Scottish Government's Draft Budget 2015-16 from—

Jim Gray, Head of Democratic Services, Glasgow City Council;
Clare Fraser, Equality, Diversity and Inclusion Manager, West College Scotland;
Dr Kate Hannah, Sector Lead Officer, Additional Support Needs and Special Schools (Inspection), Education Scotland;
Scott Read, Policy and Development Officer, ARC Scotland – Scottish Transitions Forum;
Mike O'Donnell, Head of National Training Programme Partnerships, Skills Development Scotland;
Fraser McCowan, Managing Director, Argyll Training Limited - Scottish Training Federation/Support Training Action Group;
Lorna Trainer, Director, L&G Learning (Scotland) Ltd - Scottish Training Federation/Support Training Action Group;
Brian Webb, TRAIN Co-ordinator, and Sandy Stark, Station House Media Unit.

18th Meeting, 2014 (Session 4) Thursday 13 November 2014

Draft Budget Scrutiny 2015-16: The Committee took evidence on the Scottish Government's Draft Budget 2015-16 from—

Iona Colvin, Director, North Ayrshire Health and Social Care Partnership;
Joe McElholm, Manager Older Adults Services, Housing and Social Work Service, North Lanarkshire Council;
Professor Stewart Mercer, Professor of Primary Care Research, University of Glasgow.

19th Meeting, 2014 (Session 4) Thursday 20 November 2014

Decision on taking business in private: The Committee agreed to take item 7, on its approach to its report on the Draft Budget 2015-16, in private.

Draft Budget Scrutiny 2015-16: The Committee took evidence on the Scottish Government's Draft Budget 2015-16 from—

John Swinney, Cabinet Secretary for Finance, Employment and Sustainable Growth, Shona Robison, Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights, Yvonne Strachan, Deputy Director for Equality, Human Rights and Third Sector, and Alison Taylor, Health and Social Care Integration Directorate, Scottish Government.

Draft Budget Scrutiny 2015-16 (in private): The Committee considered its approach to its draft report to the Finance Committee on the Scottish Government's Draft Budget 2015-16.

20th Meeting, 2014 (Session 4) Thursday 4 December 2014

Draft Budget Scrutiny 2015-16 (in private): The Committee considered a draft report to the Finance Committee on the Scottish Government's Draft Budget 2015 16. Various changes were agreed to, and the Committee agreed to consider a revised draft, in private, at its next meeting.

21st Meeting, 2014 (Session 4) Thursday 11 December 2014

Draft Budget Scrutiny 2015-16 (in private): The Committee considered a revised draft report to the Finance Committee on the Scottish Government's Draft Budget 2015-16. Various changes were agreed to, and the report was agreed for publication.

ANNEXE B: EVIDENCE – EQUAL OPPORTUNTIES COMMITTEE

Written evidence received in advance of oral evidence

Argyll Training Limited
BEMIS Scotland
The Health and Social Care Alliance Scotland
Inclusion Scotland
North Lanarkshire Health and Care Partnership

Oral evidence

17th Meeting, 2014 (Session 4) Thursday 6 November 2014

Jim Gray, Head of Democratic Services, Glasgow City Council;

Clare Fraser, Equality, Diversity and Inclusion Manager, West College Scotland;

Dr Kate Hannah, Sector Lead Officer, Additional Support Needs and Special Schools (Inspection), Education Scotland;

Scott Read, Policy and Development Officer, ARC Scotland – Scottish Transitions Forum;

Mike O'Donnell, Head of National Training Programme Partnerships, Skills Development Scotland;

Fraser McCowan, Managing Director, Argyll Training Limited - Scottish Training Federation/Support Training Action Group;

Lorna Trainer, Director, L&G Learning (Scotland) Ltd - Scottish Training Federation/Support Training Action Group;

Brian Webb, TRAIN Co-ordinator, and Sandy Stark, Station House Media Unit. 

18th Meeting, 2014 (Session 4) Thursday 13 November 2014 

Iona Colvin, Director, North Ayrshire Health and Social Care Partnership; 

Joe McElholm, Manager Older Adults Services, Housing and Social Work Service, North Lanarkshire Council; 

Professor Stewart Mercer, Professor of Primary Care Research, University of Glasgow. 

19th Meeting, 2014 (Session 4) Thursday 20 November 2014

John Swinney, Cabinet Secretary for Finance, Employment and Sustainable Growth,
Shona Robison, Cabinet Secretary for Commonwealth Games, Sport, Equalities and Pensioners’ Rights, Yvonne Strachan, Deputy Director for Equality, Human Rights and Third Sector, and Alison Taylor, Health and Social Care Integration Directorate, Scottish Government.

SUPPLEMENTARY WRITTEN EVIDENCE 

Scottish Transitions Forum


 

Any links to external websites in this report were working correctly at the time of publication.  However, the Scottish Parliament cannot accept responsibility for content on external websites. 

Footnotes:  

1 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 11 

2 http://www.scottish.parliament.uk/S4_FinanceCommittee/General%20Documents/Guidance_to_subject_committees_-_Draft_Budget_2015-16.pdf 

3 http://www.scotland.gov.uk/About/Review/IndependentBudgetReview/Resources/final-report 

4 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 2 

5 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 2-3 

6 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 22. 

7 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 8. 

8 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 16. 

9 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 3. 

10 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols.4-5. 

11 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 17. 

12 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 33. 

13 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 32. 

14 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 15. 

15 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 17. 

16 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 17. 

17 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 16. 

18 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 20.

19 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Cols. 20-21. 

20 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 5. 

21 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 5 

22 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 5. 

23 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 11. 

24 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 43. 

25 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 22. 

26 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 20. 

27 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 20. 

28 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 28. 

29 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 39 

30 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 40. 

31 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 3-4. 

32 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 7. 

33 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 8. 

34 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 8. 

35 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 15. 

36 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Cols. 15-16. 

37 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 13. 

38 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 41. 

39 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 23 

40 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 25 

41 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 24. 

42 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 24-25. 

43 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 25. 

44 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 21. 

45 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 21. 

46 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 27. 

47 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 26. 

48 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 27. 

49 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 35. 

50 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 35 

51 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 43. 

52 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 42. 

53 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 42. 

54 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 12. 

55 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 13. 

56 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 6. 

57 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 6. 

58 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 6-7. 

59 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 7. 

60 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 38. 

61 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 9. 

62 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 18. 

63 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 9-10.

64 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 18. 

65 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 18. 

66 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 19.

67 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 14. 

68 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 12. 

69 The Health and Social Care Alliance Scotland, written submission, page 1, Inclusion Scotland, written submission, page 3. 

70 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 23. 

71 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Col. 44. 

72 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 30-31. 

73 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 36-37. 

74 Scottish Parliament Equal Opportunities Committee, Official Report 6 November 2014, Cols. 44-45. 

75 S4W-23067; S4W-23068; S4W-23069; S4W-23070; S4W-23071; S4W-23072; S4W-23073 

76 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Cols. 16-17.

77 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 17. 

78 John Finnie MSP, written questions S4W-23067, S4W-23068, S4W-23069, S4W-23070, S4W-23071, S4W-23072 and S4W-23073

79 Argyll Training Ltd, written submission, page 1 and page 2. 

80 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 6. 

81 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 7. 

82 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 7. 

83 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 7.

84 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 8. 

85 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 5. 

86 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 2. 

87 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 2-3. 

88 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 3. 

89 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 2-3. 

90 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 3. 

91 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 3-4. 

92 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 3-4.

93 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 5. 

94 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 6. 

95 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 6. 

96 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 11. 

97 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 5.  

98 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 7-8. 

99 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 21-22. 

100 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 22. 

101 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 23. 

102 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Cols. 23-24.  

103 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 24.  

104 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 24.  

105 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 24. 

106 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 4.

107 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 4.

108 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 5.

109 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 8. 

110 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 8.  

111 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 8-9.  

112 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 9.  

113 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 10.  

114 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 20.  

115 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Cols. 22-23. 

116 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 23. 

117 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 25. 

118 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 26. 

119 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 25.  

120 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 25.  

121 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 25.

122 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 6. 

123 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 7.  

124 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 6-7.  

125 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 19.  

126 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 19. 

127 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 21. 

128 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 12. 

129 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 12.  

130 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 13. 

131 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 13. 

132 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 21.  

133 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 21. 

134 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 26. 

135 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 26. 

136 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 26. 

137 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 26. 

138 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 27.

139 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 24. 

140 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 4. 

141 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 15. 

142 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 24.

143 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 24-25. 

144 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 25.  

145 Scottish Parliament Equal Opportunities Committee, Official Report 20 November 2014, Col. 27.  

146 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 20.  

147 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 14. 

148 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Col. 15.

149 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 22-23. 

150 Scottish Parliament Equal Opportunities Committee, Official Report 13 November 2014, Cols. 22-23. 

151 Scottish Parliament Education and Culture Committee. Report on Draft Budget 2015-16. Paras 18-22.

152 Scottish Parliament Health and Sport Committee. The Scottish Government’s Draft Budget 2015-16. Para 46. 

153 Scottish Parliament Health and Sport Committee. The Scottish Government’s Draft Budget 2015-16. Para 68. 

154 Scottish Parliament Health and Sport Committee. The Scottish Government’s Draft Budget 2015-16. Para 101. 

155 Scottish Parliament Health and Sport Committee. The Scottish Government’s Draft Budget 2015-16. Para 134. 

156 Scottish Parliament Rural Affairs, Climate Change and Environment Committee. Report on the Scottish Government’s Draft Budget 2015-16. Para 141. 

157 Scottish Parliament Economy, Energy and Tourism Committee. Report on the Draft Budget 2015-16. Paras 121-127. 

158 Scottish Parliament Health and Sport Committee. The Scottish Government’s Draft Budget 2015-16. Para 19.

159 Scottish Parliament Infrastructure and Capital Investment Committee. Report on the Scottish Government’s Draft Budget 2015-16. Paras 115-116 and 119. 

160 Scottish Parliament Infrastructure and Capital Investment Committee. Report on the Scottish Government’s Draft Budget 2015-16. Para 61. 

161 Scottish Parliament Infrastructure and Capital Investment Committee. Report on the Scottish Government’s Draft Budget 2015-16. Para 80. 

162 Scottish Parliament Equal Opportunities Committee. Having and Keeping a Home follow-up work. Details available at: http://www.scottish.parliament.uk/parliamentarybusiness/CurrentCommittees/74872.aspx 

163 Scottish Parliament Rural Affairs, Climate Change and Environment Committee. Report on the Scottish Government’s Draft Budget 2015-16. Para 11. 

164, Scottish Parliament Rural Affairs, Climate Change and Environment Committee. Report on the Scottish Government’s Draft Budget 2015-16. Para 149. 

165 Scottish Parliament Welfare Reform Committee. Report on the Scottish Government Draft Budget 2015-16. Paras 2 and 6. 

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