Chamber and committees

I do not know what the exact costs associated with that are, but the UK Government has decided to fund the GMC to support the introduction of the regulation of PAs and AAs. Eventually, we will move to the normal self-funding model, which the majority of the regulators, if not all of them, operate.

How we use PAs and AAs in NHS Scotland will be determined by us. That will be the approach that we will take through the group that we have set up. As I mentioned, it will consider the role of PAs and AAs.

We have taken a very different approach from that of the UK Government, about whose approach to the matter the BMA has flagged up concerns. The use of PAs and AAs is a key part of the UK Government’s workforce plan, and a lot of concerns have been raised about the proposed fairly rapid expansion of their use. I understand that, which is why we have taken a different approach here in Scotland. I have outlined to the BMA that we will take much more of an incremental and evidence-based approach to how PAs and AAs will be used in NHS Scotland and how they will be deployed and utilised in the workforce. We have put in place a process to manage that.

We do not intend to replicate the rapid expansion of the use of PAs and AAs that the UK Government is planning in NHS England. We are taking a much more evidence-based approach to their use and how that will be defined, which will be much more limited.

I go back to my earlier answer. There was a debate around that, and it was part of the consultation in which we asked for feedback on which body would be the most appropriate to regulate PAs and AAs. The very clear majority—just under 60 per cent—said that the GMC should be responsible for that. The GMC has also been clear that it believes that it is capable of carrying out that regulatory function, and it has already begun putting arrangements in place to manage the process. It gave evidence to the committee, and we have met with it and discussed the matter.

I used to be regulated by the Health and Care Professions Council; it regulates a range of bodies and different professional groups, and I do not think that that causes confusion for the public. The idea of another regulator taking on an additional bit of regulatory work is not greatly difficult for the public to understand.

Two hundred and fifty-four properties were identified as priorities. I think that only one property had to be vacated—actually, it was in the process of being vacated anyway. The vast majority of the others require only additional monitoring. That information is all publicly available. Health facilities Scotland has that on the NSS website, and each individual health board has published information on that as well.

Once health facilities Scotland had completed that work—as I stated previously, it was completed on time before the end of last year; I think that it was completed before the end of November—some additional sites were identified that were not previously known about. Some of those are not facilities that are directly owned by the NHS; they might be GP surgeries and so on. A programme of survey work on 100 or so such buildings is being taken forward. That information is all publicly available.

The work that was carried out last year did not identify—

Our capital budget is dependent on the capital allocation that we get from the UK Government, which has cut our capital budget by 10 per cent. As a consequence, there is less capital funding available to invest in capital projects in Scotland. On top of that, we are experiencing significant challenges as a result of construction inflation. Indeed, some projects have almost doubled in cost as a result of the construction inflation that has been experienced over the past year to 18 months.

Not only are there increased costs for projects but, as a result of the UK Government’s decision to cut our capital budget, there is less money to invest in capital projects. That is a direct consequence of the decision by the UK Government to cut our capital budget.

—any remedial work that was required, other than the normal routine maintenance work that boards do. Instead of surveys being carried out every three years, they are being carried out every year, and there are details on the types of things that should be taken forward. However, no major costs were identified from the survey work that was carried out by health facilities Scotland.

There are a number of different ways in which we try to invest through preventative spend. It is normally around behavioural change programmes on things such as alcohol and drug use, eating habits and smoking. All of that work is about prevention and trying to reduce the health consequences that we experience as a result of those challenges. Much of that work is done through marketing campaigns and service delivery programmes, for which we fund the NHS boards. Many programmes will have targets. For example, smoking cessation programmes have a target for the number of people that they help to stop smoking. We are therefore able to monitor the progress that boards make against such targets.

We invest in a number of areas. For example, we are taking forward some innovations around type 2 diabetes remission, type 2 diabetes prevention programmes, the digital dermatology programme, vaccination programmes and artificial intelligence for lung cancer. We use all those programmes to help to do more in the preventative space through the use of innovation.

How have we identified some of the things that we have taken forward? We have a programme called the accelerated national innovation adoption pathway, which is run in partnership with the chief scientist office to identify areas for investment in preventative spend and things that we know will have a significant impact in improving outcomes. We use a once for Scotland approach to identify the most appropriate areas for investment in new technologies in NHS Scotland to support preventative spend.

We can evaluate those programmes as they are rolled out and as those investments are made. With the combination of programmes that we run and evaluate through health boards for preventative healthcare issues and the ANIA programme, we target innovations that we know can help to prevent ill health and improve outcomes for individuals, and we assess the most effective routes for making the investments and evaluating their impact.

The fact is that it is very often the NHS that has to deal with the consequences of lifestyles that result in ill health, but other services could do more to prevent such issues from arising. As the evidence shows, the investment that we are making in areas such as the early years is critical in helping to improve outcomes for children and young people. We have seen internationally that early years intervention is much more effective in helping to improve outcomes not just for children but later in life, too.

Our investment in approaches to tackling child poverty, such as the Scottish child payment, will help to reduce some of the risks that are associated with child poverty, which can have an impact on an individual’s health and their long-term wellbeing. There is also the best start programme. Those measures, some of which are health related and some of which sit in other portfolio areas, can have an impact in helping to improve health outcomes.

If we look at the disease tree of obesity and all the different branches that come off it, from cardiovascular and respiratory issues to diabetes and all its consequent issues, including neuropathy and so on, we can see that, if we tackle some of the root areas more effectively, we will head off some of the other health complications that are consequent to the condition. As I suspect you recognise, tackling obesity is critical to helping to reduce demand on cardiovascular, diabetes and some respiratory services and everything that goes with that, and doing so would have a preventative benefit in the future.

That said, the biggest risk that we have in tackling these challenges, particularly the health inequalities that we are experiencing, is that two key areas are moving in the wrong direction. Mortality rates are increasing and health inequalities are widening—as they have been for more than a decade now, largely as a result of austerity. All the evidence demonstrates that, as the social protection system is reduced, the impact that that has in increasing mortality rates and inequalities gets greater. We have been going through that in the past 10 years, which is why that data is going in the wrong direction.

There are certain things that we can do to try to mitigate some of that, but it is clear to me that the austerity that we have had for more than 10 years and the austerity that we are experiencing at an even greater level just now will result in people dying prematurely because of the impact that it has on the social protections that people depend on. It is probably one of the biggest public health challenges that we face going forward. If there is one thing that I would do to tackle health inequalities and their consequent problems, it is to tackle the economic policy around austerity. That would have the biggest impact in helping to reduce some of the very marked inequalities that have been expanding in recent years.

I am more than happy to ask the justice secretary to respond to the issues that you have raised, given that it is a justice-led area rather than a health-specific area.

We made a commitment to invest an extra £250 million in the twin areas of drug and alcohol services over the course of this parliamentary session and we are on track to achieve that. That is an increase in investment over the past couple of years and we want to ensure that we continue to make progress with that.

It is down to local partners to determine how they think that funding should best be delivered at a local level. Some of the services that might operate around alcohol and drugs issues are not funded directly by the health portfolio—they sit in other portfolio areas. I am more than happy to ask the justice secretary to respond to the concern that you have raised about the 218 service.