Chamber and committees

I thank Mr Sweeney for his long-standing interest in, and campaigning on, the issue. I will defer to Maggie Page on the detail to ensure that I do not speak out of turn. NHS Scotland Assure is involved, and there have been delays in ensuring that the facility can be operational.

I would very much welcome that interaction. Again, I go back to Ms McNair’s questions on interaction with UK ministers at a minister-to-minister level. Those conversations have not happened, but I would very much welcome them, and I believe that the relevant health and social care partnership—without wanting to speak for it—would welcome them, too.

With regard to the learning from the facility, I expect that a great number of people will have an interest in looking at the success, or otherwise, of the pilot. In Scotland, we have to contend with a specific, and greater, issue with drug-related deaths. The recent statistics show that there has been a rise in the prevalence of drug-related deaths elsewhere in the UK, but it is not on the same scale that we are seeing in Scotland. I do not wish to diminish in any way the challenge that we have in Scotland, but I believe that there is, and there should be, a wider interest in the success, or otherwise, of the pilot at Hunter Street.

I will come back to the first point that Ms McNeill made, and then I will address her second point, on the gendered aspect. I will bring Maggie Page in on both questions, too.

On the first point, constituents have come to me who are in exactly the situation that Ms McNeill has outlined. They believe that residential rehab is right for them, but clinical decisions have been made that make that more challenging.

That touches on some of the work that we are seeking to do to provide clarity and ensure that guidance is in place with regard to people who present with both mental health and substance dependency issues at the same time. I am clear that we must support people to tackle both issues concurrently, as they drive one another—the substance dependency drives the mental health issues, and vice versa. We need to be clear on that, and I certainly believe that we need to support people in both aspects. I would be happy to return to Ms McNeill’s points in that regard.

On the gendered aspect of this issue, Ms McNeill is absolutely right. The figures are clear on the level of drug deaths among men, and indeed on the prevalence of poverty and the correlation between people living in poverty and the impact of that in terms of substance abuse. I will bring in Maggie Page to talk about this, but we have been developing work on how we target men to ensure that they understand what support is available.

Again, that brings us back to the landscape of destigmatisation, which is so important when it comes to men’s interaction with health services. Mr Sweeney and I are currently participating in Movember, because we need to promote greater awareness among, and provide a greater level of comfort for, people with regard to the need to interact with health services, regardless of how uncomfortable it might be to talk about health. Over the past couple of weeks, Chris Hoy has demonstrated the importance of doing that when it comes to prostate cancer, and it is just as important in this area with regard to the drivers of drug dependency among men and the mental health aspects in that respect.

I will bring in Maggie Page to talk about the specific action that we have been taking in that area and the work that is developing there.

I would be very interested in hearing more about the direct experience that you have been able to pick up. I presume that that will come through in the report, but if there is anything that the practitioners in Broadford would be able to feed straight in, I would be keen for us to look at that as part of our reform and improvement work. We are keen to look at how we can blur the lines of health boards and ensure that we maximise the operational capacity through better working arrangements for our staff.

However, I am cognisant of the fact that, although such an arrangement might work for many people, there are others who would prefer to have a fixed-point contract that involves working in a fixed-point place. Therefore, we would need to handle that carefully, but I would be very interested in hearing more about the experience that you picked up in Broadford.

That is a major concern for me. Since coming into post, one of the areas that I have had the greatest concern about is the rise in agency and locum costs. In some areas, that cost is unavoidable, and we need to invest to ensure service continuation. However, I want to take a longer-term approach, and I hope that some of the reform discussion that we will have later this month and, going into the rest of the year, the reform and improvement work can focus on how we make sure that we have the culture and management structures in place that allow greater flexibility for workforce so that we are attracting and retaining staff.

We have a number of areas of intervention including bursaries and golden hellos to try to attract people to rural and island areas in particular on a sustainable basis, so that we can avoid the need for locum and agency cover. That cost increase over recent years is a major concern for me and one that I wish to tackle.

It increasingly sounds as though the session on Skye was incredibly productive, and I am ever more regretful that I was not a part of it so that I could hear directly from the colleagues that Ms Mackay refers to.

We are in a situation where we do not have the luxury—although I do not think that it is a luxury, actually—of being siloed; we cannot afford that. We need to use the capacity that is available, regardless of where it comes from. There must be much greater collaboration between public sector agencies. The integration agenda is about much greater collaboration between our health and social care partnerships, or IJBs, and our statutory partners, as well as the community and the voluntary sector. As Ms Mackay rightly said, that sector often provides services that statutory providers cannot provide to the same level of funding. We have to see much greater collaboration there.

We must also utilise the expertise and innovation that are coming through from the private sector. If we can harness that, we have an opportunity to stay true to the principles of the NHS being publicly owned and free at the point of need and delivery. We need to harness some of the products that are being delivered by the academic and private sector to free up clinical capacity for the care that clinicians and health service staff give. We have an opportunity to take forward much greater collaboration, if we can, to continue to improve and reform our health service for the better.

We are in discussions with NHS Grampian on the point to which Ms White referred and the particular example that she highlighted, which she has also raised in the chamber. We have been working with NHS Grampian to look at what it is doing. That includes work to improve the flow through the hospital so that we are not seeing ambulances stacked up outside.

The national centre for sustainable delivery is doing work to look at how we ensure that those who are in our hospitals actually need to be there and at how we can improve the delayed discharge picture so that we have hospital beds available. Ultimately, that is at the heart of why we have had delays, certainly in Scotland. I cannot speak for the rest of the UK, but that is certainly what I am picking up here. If we are seeing delays in ambulances being able to turn around at hospital, that is largely because of a lack of availability of beds.

We are using the centre for sustainable delivery to identify patients who can be discharged and get them discharged as quickly as possible, and thereby bring down the average hospital occupancy time. We are also working on that with our local government partners. I work closely with Councillor Paul Kelly of the Convention of Scottish Local Authorities, and we have agreed on work that is to be done across Scotland on giving people patient discharge dates, discharging before noon and weekend discharge. We are looking at everything that we possibly can to get people to where they should be, which is either at home or in the community, rather than in hospital.

We are also doing more focused work with our health and social care partners in Grampian on whether anything further can be done to improve the delayed discharge picture and to improve integration in NHS Grampian. I would be happy to update the committee on that work.

That is under active consideration, as Ms White will understand, given what happened on Skye recently. Sir Lewis Ritchie undertook a review of the services on Skye; with him, I met NHS Highland, and I expect to have a delivery plan from the board for how that review and its recommendations can return to implementation. The review was implemented for a period, but there were issues with sustainability, for the pertinent reasons that we have heard around attracting and retaining staff in rural and island communities. I am keen to ensure that Highland can deliver on that.

That is a microcosm of what we need to see to a much greater extent across the country. We are working with our rural boards in the areas that I have set out, which include supporting our workforce and supporting the work that NHS Education for Scotland is doing to provide education and training so that urgent care services in remote and rural areas can continue to be sustainable.

I would be happy to follow up on that in writing, and Paula Speirs wishes to come in on that.

Integration has happened at a different pace in different parts of the country. There are some good examples of integration working well, as I was able to see, for instance, in Shetland, where there has been very strong integration in health and social care across all levels of public sector delivery, which allows decision making to be informed on the basis of service delivery. I point Ms Maguire and the committee to that very good example. There are other areas where levels of integration could definitely be better, however, and that is part of the reason why I believe that the national care service is the right thing for bringing things forward from a service delivery perspective.

I am conscious that Ms Maguire is looking at the wider issue of service delivery around social infrastructure, housing and childcare, for instance. I believe that that comes from the discussions that are taking place on an integration basis. Where we can improve on that, obviously we will.

First, I am pleased to hear that the committee was in Skye last week. Initially, there was a suggestion that I might have joined you there for that evidence session, but I am very pleased to be here this morning and grateful for the opportunity to discuss what is a very important issue for me, having been born and brought up in Orkney.

Like other colleagues around the table, I understand well the importance of delivering health and social care services in rural and island communities, and I also recognise the challenges therein. I am very much looking forward to seeing more of the work that comes through from the committee, and I am very grateful for the work that you are doing.

I will bring in colleagues on the progress that has been made off the back of the centre’s establishment, which has had financial support from the Scottish Government.

The centre has also led to the development of a rural and island workforce recruitment strategy by the end of this year, because the Government recognises that, for all elements of the health and social care service, but particularly in rural and island communities, the workforce is critical to ensuring that we can deliver services. Having that strategy is critical, and I believe that the task and finish group is meeting right now to discuss continuing that work. I do not know whether colleagues wish to add to that.