Chamber and committees

I actually do agree with that, because there is a direct relationship between A and E congestion, delayed discharge and social care in the community. Those three areas are directly linked. What Mr Rowley fairly asks me is whether they are sufficiently well connected in local planning. Ultimately, they involve people. In those three categories—A and E, delayed discharge and social care—we are dealing with people, and we must ensure that services revolve around people. Services must be built around people as opposed to being delivered in little compartments where—I do not intend any criticism of anybody with the language that I am about to use—A and E deals with A and E. I suspect that there are many A and E staff who would love there to be more activity in social care, because it might allow them to get around the A and E department slightly more easily than they are able to just now, and because they might not be quite so up against it in their working day as they are every single day at the moment.

The A and E folk will be focused on the A and E problem in front of them, but they need the rest of the system to deal with the social care issues so that the A and E problem becomes less significant. Therefore, there must be cohesion among those services, and the players in that are the local authorities, the health boards, the integration joint boards and the care providers. Those are the people who have the key to all that. There are arrangements in place to ensure that planning is undertaken to deliver the services in a cohesive way. The challenge that we face is that the work that is being done is not delivering the outcomes that we need it to, because A and E is too congested, delayed discharges are too high and social care provision is not as extensive as it needs to be.

What is driving that? Amongst all that, unemployment is at 3 per cent. Therefore, from that, I deduce—Mr Rowley inadvertently mentioned it earlier—that we come back, I am afraid, to Brexit. I cannot speak for Fife, as I do not represent the kingdom of Fife, but I represent the county of Perthshire. If I were to have gone into a care home in my constituency prior to Brexit, I would have encountered many people working there who had come from eastern European countries—lovely people who were faithfully looking after our loved ones in our communities and delivering care packages. As I sit here, I can think of folk—folk whom I know well—who have now gone back home because they did not feel welcome after Brexit.

As Mr Rowley knows—he does not need me to tell him—our working-age population has been declining for 20 years, and we have now reached a critical point. We got temporary respite from the situation after the expansion of the European Union in 2004. We had all those years when folk came here, made it their home, contributed, looked after our loved ones and played their part in our communities.

Then, in 2016, we took part in the folly of Brexit. We had it inflicted upon us and, as a consequence, we have lost those people from our population. I think that that is a big factor. I do not think that money is the problem; the availability of people is the biggest problem that we face just now.

Mr Rowley said that there might not be all the cohesion that we need; I accept that and assure the committee that I will take it away and consider it. I discuss that issue with the Cabinet Secretary for Health and Social Care all the time, and he understands the relationship between A and E, delayed discharge and social care just as much as I do. I totally accept Mr Rowley’s analysis of the problem, but we do not have all the people we need to ensure that we can deliver a fully connected approach. If we can make it more connected, I will endeavour to do so, but I do not have a magic solution to the people question, because we have committed folly in our decision making.

We undertake an annual risk assessment, and I am deadly serious when I say that, in every year in which I have been a minister, a global pandemic has been in the top category. I remember conversations that we have had around different resilience tables in which the Government has said, “We must be due a pandemic some time soon.” That was always there. When the pandemic came, it came with absolute ferocity, as any pandemic will.

To go back to the point that Mr Mason put to me earlier, we have to be ready. A global pandemic is in the top risks that the Government assesses that the country is exposed to, and cybersecurity risks are increasingly up there. Then there are the natural issues that we face due to Scotland’s climate, such as winter weather and flooding, and the enhanced level of threat because of climate change.

Those are all the factors that we consider, and we need to have a level of preparedness for all of them. We have flood resistance plans and flood alert systems that give us advance warnings of circumstances that might come towards us, and we judge them to be appropriate. We cannot build flood defence systems in every community to protect against every eventuality, but we can make a risk-based assessment about where they are required.

The other week, I was down in Hawick, which is in Mr Whittle’s region. Huge construction works are going on there as part of schemes to protect the town from the River Teviot, because there has been flood damage there in the past. We are responding to risk there.

With a pandemic, there are a lot of things that the state can do. There are the steps that Professor Morris will have gone through with the committee earlier this morning, the expenditure that we undertake, the surveillance measures that we have in place and so on. Those things are all part of equipping ourselves to deal with those kinds of situations.

However, there are also individual preparations. There is one big lesson that we have learned from the pandemic: the healthier you are, the more you will have the capacity to resist it. On a personal level, that makes me ask myself, “How many times have you been out running this week, John Swinney?” Well, it is now Thursday, and Ah’ve no been oot yet.

Obviously, we are engaging with Professor Morris and we have had a number of discussions; I do not want to characterise it as us simply waiting for the end of a process. That is an on-going dialogue to understand the questions that the committee is looking at and the likely direction of travel that will come out of that. We will take steps to ensure that we are responding appropriately, rather than waiting till the end of the process to make a formal response.

It is a fascinating approach from Mr Fraser to say that he does not expect me to come up with a number but then to ask me to come up with a number.

I do not expect there to be a distinct budget line for local government on Covid, for example, because I am trying generally to move away from overprescribing the local government budget. I would be surprised if local authorities said anything to the Government other than that they would like to have as much flexibility over the budget as they can in order to address the outcomes that they and the Scottish Government are interested in achieving. That is reflected in our joint work on the Covid recovery strategy. For completeness, I should say that the board that supervises delivery of that strategy is jointly chaired by the Government with COSLA. I chair it alongside the president of COSLA, so it is a really valuable joint endeavour.

The best way to address the point that Mr Fraser raised is to acknowledge that, today, the health service and local government are under enormous financial pressure. Mr Fraser and the other members of the committee will be familiar with the statements that I have made to Parliament since it returned from summer recess. In exercising my temporary responsibilities for financial management within the Government, it is clear to me that we face enormous financial strain in this financial year as a consequence of inflation and public sector pay costs, which will affect every budget across the public sector. I expect to be dealing with intense pressure within the public finances and I also fear that I will be dealing with some reduction in public expenditure. From what the Chief Secretary to the Treasury is saying, it seems likely that there will need to be reductions in public expenditure in order to create the route to financial stability. I very much regret that, because it will add to the significant pressure with which we are already wrestling.

I wish that we could claw back Brexit, Mr Rowley.

I can confirm that the Government is engaged in dialogue of that type with integration joint boards. Mr Rowley will be familiar with the statement that I made to Parliament earlier in September. We have to ensure that whatever resources are available to us are utilised to meet the enormous in-year financial pressures that we face during this financial year. Those discussions are under way.

I ascribe that to the burdens of office.

The question is: how do we all keep ourselves as healthy as possible? That is material to dealing with some of the issues relating to congestion in our public services that Mr Rowley has raised with me. The best thing that I can do for A and E is to keep myself healthy and stay away from it. There are things at both the societal and individual levels that we have to take forward.

If the Government directed local authorities to bring all of that work in-house, I think that a number of members—from different traditions—would say that the Government was centralising things once again. I am not looking at anyone in particular.

We have to acknowledge that a degree of local decision making is required, but, ultimately, health boards and local authorities, working together through IJBs, have a duty to ensure that the needs of individuals are met, and they have to ensure that they have a sustainable service in place.

The points that Mr Rowley put to me are all entirely legitimate, but enabling some of those issues to be better addressed might encourage local decisions to bring more of the work in-house. In some cases, services might have to be brought in-house because there will not be private providers to deliver the alternative services.

I come back to what I said in my earlier answer: that is all joined up in the sense that it must all, ultimately, be paid for. We must ensure that the resource is available to us at a time of intense financial pressure. Mr Rowley just ran through a series of real, tangible pressures that our public services are under. I do not dispute any of those. However, that is a measure of the scale of the financial challenge that we face.

This morning, I attended the meeting of the Social Justice and Social Security Committee, and I told the committee that, after having served for nine years as finance minister through the financial crisis and through the period of austerity of the Conservative and Liberal Democrat coalition, I thought that I had seen challenges in public spending. They were as nothing compared with what I am now wrestling with in my temporary period as finance secretary. The situation is much graver, and I am very pessimistic about the outlook for public expenditure, given what I heard overnight from the UK Treasury about revisions to public spending.

The Chief Secretary to the Treasury told me on Friday that he hoped to stick with the comprehensive spending review allocations for future years. I am now seeing that departments are being asked to make savings immediately. That makes me very fearful for what lies ahead, because if that changes at an English public expenditure level, that will have a negative effect on us.

Any reading of the Covid recovery strategy will show that the big lesson that the Government takes from Covid is the necessity—the imperative—of tackling inequality, and that is reflected in the contents of the programme for government that the First Minister set out earlier this month.

These issues matter in two principal respects, the first of which is the point that Mr Whittle has just concentrated on of changing provision to make a difference to the experience of individuals in order to generate better outcomes. However, there is also a direct relationship to the issues that Mr Rowley has raised with me, which leads me to my second observation. The fact is that all of this work is critical to reducing demand on the health service. If people are presenting inappropriately at A and E, because they are not generally healthy, looking after themselves and so on, that is an interaction with A and E that is unnecessary—if I can use that word. If those people were better supported in their community and their own home, they might be able to avoid that journey to A and E. After all, if they do not make that journey, we have one fewer person adding to the pressure that is already on our hospitals, so it is critical to the efficient operation of our public services.