Chamber and committees

Okay. We can look at that in a number of ways. Yes, increasing staff pay places a challenge on the budget, but I do not grudge them that at all, given their important role. That means that it will not be possible to make some of the investments that we might want to.

However, the impact of not increasing pay for staff and not settling such types of issues is also very costly in financial and service delivery terms. If we were not able to reach a settlement on some of the pay deals, we would inevitably face industrial action, which we know has significant financial cost to the NHS.

Let us take the industrial action by junior doctors in England as an example. I think that that has cost more than a billion pounds as a result of all the additional measures that must be put in place to try to cover absences during such action. In addition to that, around 1.2 million appointments have been cancelled, which has an impact on overall service delivery.

We have to recognise that, if we do not invest in our staff and do not try to resolve those types of issues in a co-operative fashion, that can be hugely disruptive and very costly for the way in which the NHS is able to deliver its services. The approach that we have taken is to try to help to resolve those matters in a fair and reasonable way with the employee side, but that, of course, has a financial impact on wider service delivery. You may not be able to expand services in the way in which you would wish to, given the financial environment in which we are operating. Notwithstanding that, the way to invest in services is by investing in staff. I view pay uplifts for staff as an investment in our NHS.

I have listened very closely to the issues that have been raised by members of the committee on this matter. Ultimately, we should keep in mind that this is about helping to promote patient safety. For example, as things stand, PAs—even PAs who set themselves up in private practice—are unregulated. My view is that they should be regulated, and that we need to be clear about the terms of that regulation.

It is also worth keeping it in mind that most health regulators do not operate by setting out a scope of practice. They supervise or deal with issues on the basis of whether someone is within the scope of their competence in their role. People progress through their careers and gain greater experience and understanding and, as a result, they should be operating within the scope of their competence at that particular point. That regulatory process operates across healthcare professions.

Additionally, aspects such as supervision are dependent on experience and skills. A person who moves into a new area where they have less experience and knowledge might be put under increased supervision in order to achieve that experience and knowledge. Therefore, the issue of scope of practice is one that the regulators already deal with. They deal with it in terms of whether a person goes outwith the scope of their competence and their practice ability. Supervision is very dynamic—it is very dependent on the environment and on the person’s skills and their needs at that particular point.

When I first qualified, my level of supervision was greater than it became as I moved through my career, which reflected the experience and knowledge that I had built up. My regulatory body would expect that to happen on the basis of my competence.

PAs who are used in general practice are, right now, outwith the scope of the direction that we have set as the Scottish Government, because they can be directly employed by a general practice to be deployed in a way that the practice sees as being most appropriate for its needs. We are not able to give direction on that, as we can within the NHS. Again, that is why PAs should be regulated.

The key thing is that the GMC is undertaking a process to ensure that PAs and AAs are appropriately regulated. I do not think that it is in the interests of patient safety that those professional groups—which are already operating in our healthcare system—remain unregulated. In my view, the order will enhance patient safety and enhance accountability, so it is critical that it is passed today by the committee.

Are you not aware of the work that Health Facilities Scotland has been taking forward? I think that 254 properties were initially identified in the desktop exercise. They all had an initial risk assessment, and work—including intrusive survey work—was carried out before the end of the year. An update on each of those projects was published online.

There is no additional capital budget. Our capital budget has been cut by the UK Government by 10 per cent, and the construction costs for projects that are already in delivery have increased. We are trying to use the capital budget as fairly and reasonably as we can, but no additional money is available because of the cut that we have experienced alongside the construction inflation that projects face.

It is a reflection of the difficult public financial environment in which we are operating. Although we are not able to make all the increases that we would like, we have made a significant increase in the past couple of years. Sustaining that in the present financial environment is really challenging. We have sought to protect mental health funding as best we can and to sustain the significant increase in investment that we have made in the past couple of years, but whether we will be able to increase that further will depend on budgets in future years. If the present approach to public finances continues, it will be really challenging to do that, given the pressures on public sector budgets right across government.

About £15 million is for the national care service.

Do you mean multi-year budgets?

I think that the 218 service came through the justice funding that went into IJBs; it was not from health funding. I am not entirely sighted on exactly what has happened with the justice funding. I think that it would probably go back to the old justice boards and the funding that was transferred across to IJBs, rather than coming directly from the health portfolio. I would imagine that it is a matter that the justice secretary would be able to respond on, because it is not something that sits directly in my portfolio.

We do not micromanage services on the ground within individual health boards, but, clearly, there is a requirement for boards to ensure that there are safe staffing levels. Where there are concerns, there is a mechanism for staff to raise them and escalate them within the board.

There is a lot of work going on around the safe staffing legislation that we introduced. If concerns have been raised with you directly by staff, they should escalate them through the local mechanism to ensure that they are addressed. My expectation is that boards would address such concerns and do so quickly.

I have heard some of the commentary on that, and I do not subscribe to it. We have a range of health regulators that regulate a range of professional groups. In my view, the GMC taking on the regulation of AAs and PAs will not cause any confusion, so long as there is a clear regulatory body that is responsible for dealing with any issues relating to AAs and PAs. I have heard some of the commentary, but I am not persuaded by it, given the fact that we have a range of other regulators that cover a variety of professional groups. I do not see why that would create any confusion for the GMC, given that it does not do so for other health regulators.