Chamber and committees

I have nothing further to add than what was discussed in the debate.

I move,

That the Health, Social Care and Sport Committee recommends that the National Health Service (Scotland) Act 1978 (Independent Health Care) Modification Order 2024 be approved.

That the Health, Social Care and Sport Committee recommends that the Healthcare Improvement Scotland (Inspections) Amendment Regulations 2024 [draft] be approved.

No—I have not said that. I was talking about the issues that we face regarding the workforce challenge. It would be remiss of anybody not to acknowledge the impact of making migration to the UK harder and the impact that Brexit has had. Indeed, I think that Mr Macaskill, who represents social care providers, would make those very points, too. Of course we have a responsibility to continue to deliver for social care, and we will continue to do all that we can, which is why we are looking to implement the national care service so that standards can be raised and can become more consistent—both for those working in the service and for those we are providing it for.

When decisions are made for us that are not in our interests and that are detrimental, of course I have to point those out, and Mr Gulhane will understand why I would need to do so. There was a 10 per cent drop in our workforce off the back of Brexit, and the new migration rules will make it much harder for social care providers to employ social care staff. It is understandable that I would wish to make such a comment.

We are working with the specialist advisory group at the moment on the stage 2 amendments, and we will be providing them to the committee as soon as we can.

I have already given the example of ScotGEM, where we have people coming through a training system that is dedicated to serving remote general practice. We are improving the situation with regard to GP numbers, which I think are up by 256, or 257, in recent years, and we have a record number of GPs—1,200—in training. I recognise that we need to go faster in order to meet the target. That is why, over recent years, we have added new GP training places to the system. I hope that, through the record level of GPs in training and the work that we are doing with ScotGEM—as Stephen Lea-Ross and Paula Speirs outlined, and as I highlighted—a large number of those new GP entrants will go into the rural communities that we wish to see continue to be sustainable.

No. We consulted the British Medical Association and others directly on the implementation of the 2018 contract. It is obviously very difficult to bring forward something that takes a one-size-fits-all approach, while understanding that there will potentially be an impact of that.

That is partly why we are working to ensure that we have multidisciplinary teams coming through; looking at the primary care improvement plan; and providing investments so that we continue to see further investment in primary care in rural communities. It is also why we are continuing to support initiatives such as ScotGEM, which is about encouraging people who are going through medical training to specialise in rural general practice. We recognise the need to ensure that we continue to support rural general practice.

As I said, I was born and brought up in Orkney, and I recognise the role that general practitioners play in rural communities. Those general practices are anchor institutions, and they are a critical element of the sustainability of those communities. I am passionate, therefore, about ensuring that we continue to support rural general practice so that it is sustainable, and so that we continue to have a primary care service in rural and island communities to prevent further ill health among people who might otherwise end up in secondary or acute care.

That is part of the reform and improvement discussions that I hope to bring forward later this month. I will be looking to work with all parties, and others who are represented around the table, to ensure that we take forward the best ideas for how we can put the NHS on a sustainable, improved and recovering footing as we move forward.

It is about making sure that we continue to see a sustainable workforce for our rural and island communities. It is in development; we have already set out the fact that some of the work is very much live. The focus is on ensuring that we continue to see a supportive and encouraging workforce strategy that ensures that we have a strong recruitment and retention policy for rural and island communities.

I believe that it is for the social care side as well.

I can speak to a more local example that I am aware of. I declare an interest in that I am recused from Government decision making on the new Monklands hospital. However, from a constituency perspective, I am very aware of the close involvement of clinicians in that hospital’s design.

If that has not happened to the same degree in Broadford on Skye, I would be keen to know about that to ensure that NHS Highland and others can learn from that experience, so that we have projects that are informed by clinical experience to ensure that we get them right.

Again, that goes back to the discussion around the nursing and midwifery task force and looking at how we make sure that we are set up to take advantage of the existing opportunities that are available in higher education institutions. The training places that we have available are not fully subscribed, so for those considering a potential career or a career change, look at the opportunities in your local university. There is also the nursing bursary to help to support a transition to or an entry into nursing.

Stephen Lea-Ross referenced the helpful example of the Open University work. I am very keen to look at what more can be done—the discussion is happening at the task force—around the earn-as-you-learn pathway and whether there are more opportunities for that, so that people can either shift within the health service or come into the service.

To get directly to Ms Maguire’s point about training being delivered as locally as possible, we will continue to work with higher education institutes to see what more is possible, particularly for remote and rural areas. I was at Robert Gordon University last week and saw some of the fantastic work that is being done there around nursing and paramedic training. There is real enthusiasm among nursing students for what they are embarking on and where they are looking to serve their time.

I hope that we can continue to provide that opportunity to others, particularly, for the benefit of this discussion, in remote and rural areas, so that we continue to have people to serve in the areas where we need service provision.

Ms Mackay strikes right at the heart of the clear challenge that we are facing in the health service and in how we move forward with reform. If resource was aplenty, of course I would be looking to invest far more in primary care services to help with the prevention work and in community and voluntary sector organisations that are doing incredible work across all disciplines.

As part of mental health awareness week last week, I saw some of that work from a mental health perspective in Aberdeen Football Club Community Trust’s work on the changing room extra time initiative. That is incredible work to prevent more acute presentation. If resource was aplenty, we would go there.

Ms Mackay is right that we have to continue to sustain services, but we also need to drive change. That is where I hope that we will all be able to come together to discuss how we move human and financial resource to ensure that we are improving people’s health in the first place.

That will be most acutely felt in rural and island communities. Paula Speirs talked about the fragility of some services, because sometimes they are provided on a small team basis and, if one person moves on or retires, the service is compromised. We need to continue with the workforce planning perspective, but we also need to look at prevention. Supporting people through hospital at home in rural areas, for instance, is an important innovation. The community care model that treats people as close to home as possible has better outcomes, but it also prevents further deterioration in their health that requires greater intervention in the acute settings, which is what we want to avoid.