Chamber and committees

I do not think that you would ever get a cabinet secretary for health to say that they would not want more resource to invest in the health and social care system. In the light of our very challenging budget settlement, we have achieved the best possible outcome that we can for the health and social care budget.

Notwithstanding that, efficiencies and savings will have to be made for us to live within the budget settlement that we have and the growing demand that we face. I think that this is the best outcome that we can achieve in challenging financial circumstances; however, there will be continued challenges for the health and social care system even with this budget.

One is continued investment in our NHS recovery, including in prevention, with a particular focus on primary care. Another is continued investment in mental health services, to ensure that they meet the needs of citizens across the country. Another is continued investment in social care, to ensure that we are doing everything that we can to give it greater resilience, particularly by way of recruitment into the workforce, which is critical to supporting our NHS.

I am sorry—I missed the first part of your question.

Before I bring in Ms Minto, I should say that a range of work is being taken forward by boards through the long Covid treatment pathways, which are being delivered as part of the £10 million that we have made available for long Covid services. I think that nine of our health boards have their long Covid treatment pathways in place, and around five are still developing them.

For example, NHS Greater Glasgow and Clyde’s long Covid service allows general practitioners to make direct referrals of patients for assessment and for appropriate treatment options to be made available. We have also allowed boards to design services that best reflect their local circumstances and what they believe to be most appropriate for patients in their areas.

A range of services is available, but one of the challenges has been to ensure that clinicians know that such services are available to refer patients to. Some of our boards have therefore been undertaking work with colleagues across general practice to ensure that they are aware of how patients can be referred directly to these services. Some will also accept self-referrals from patients for assessment and for an appropriate treatment programme to be put in place that reflects their individual circumstances.

I do not know whether Ms Minto, who leads on some of this area of work, has anything more to say.

It will take a holistic approach to consideration of some of the challenges with the delivery of healthcare in rural and remote areas to inform the approach that we should take to address them, and that will include areas such as midwifery as part of its programme. Your constituency is an area in which the centre will particularly be able to work with the local board and the different clinical groupings to try to address some of the challenges that it faces.

Yes. One of the potential benefits of a national care service is that it will allow us to create more consistent pathways for training and career options for individuals in the social care setting, with opportunities for people to move around the system in a way that they might not be able to do at present.

Part of the challenge is that it social care is a fragmented sector. We have public sector provision, voluntary sector provision and independent sector provision and, despite the fact that there are national standards for care delivery, how they operate often varies. One of the benefits of a national care service would be that we could take a more consistent approach across those three areas, which could help staff with training and potential career routes.

Addressing the fractured nature of the way in which the social care system operates at present is one of the core purposes behind the national care service. It could deliver much greater consistency across the country.

Yes. I am particularly pleased to see that fund reopening because I set it up when I was Minister for Public Health. When the fund was being closed at the UK level, I chose to establish an ILF here in Scotland. Our reopening it—with an initial budget provision of £9 million in the next financial year—will enable us to open it up to around 1,000 additional disabled people who often have much more complex needs.

One of the real strengths of the independent living fund is that it gives individuals, particularly those who have complex care needs, much more control over how their care arrangements are delivered and by whom. I am therefore particularly pleased that we are able to reopen it for new people to apply to it. We are now taking forward the necessary work to put in place arrangements for opening up the independent living fund for individuals in the next financial year.

We have previously discussed the services that have been provided for long Covid, including some of the pilots that have been taking place in England and how some of that could inform our learning here in Scotland. I know that some health boards have looked at that and learned from it. For example, NHS Greater Glasgow and Clyde has been using some of the long Covid funding to bring in paediatric occupational therapists to work specifically with children who are experiencing long Covid, and also, where necessary, using paediatric physiotherapists to support those children.

Health boards are trying to adapt their services to make sure that young people who are experiencing long Covid have access to clinical teams that can provide them with the support that they require, and they are using some of their core funding to design such adaptations. NHS Greater Glasgow and Clyde, for example, now has some paediatric services to address the needs of young people with long Covid.

If the member has an individual case that he wants me to look into, and he wants to share the details with me after this meeting, I am more than happy to do that. Long Covid does not just affect adults; it also affects children, and services are being designed that will make sure that we also meet the needs of those young people.

A big part of that is because we have to deal with the backlog that built up during the pandemic. During the pandemic, a lot of our elective and diagnostic procedures had to be stopped and that resulted in a significant backlog that we are having to manage within existing capacity. New people are being added to the lists, but we are still dealing with the people who were already on the lists. That accumulation has made the situation extremely challenging and it will take some time for us to recover to the pre-pandemic levels.

Also, in some areas, the level of referrals has increased quite markedly. For example, we have seen a significant increase—of almost 45 per cent in some areas—in the number of referrals to our cancer pathways, which is way above what it was before the pandemic. We are having to deal not only with the backlog but, in some areas, with a significant increase in the number of referrals into those diagnostic pathways, which has an impact on waiting times overall. You will be aware that boards are making steady progress, particularly around long waits—we have seen a steady decline in outpatient and in-patient long waits—and we are continuing to work with boards around that, but it will take some time for us to be able to get back to pre-pandemic levels.

We are also working through the Centre for Sustainable Delivery on a programme of work to ensure that we are maximising capacity in our services. The centre is carrying out work with a new digital tool to consider how we can maximise the use of theatre times, which could potentially give us an additional 30 per cent capacity. Through the Centre for Sustainable Delivery, we are trying to get consistency across boards around how they maximise capacity and the use of resources in their existing services, because some of them are not operating at their pre-pandemic capacity and we need to ensure that we get greater efficiency there.

The issue involves that combination—the history, the increased referral rates and our trying to ensure that we maximise the capacity that we have in the existing system in order to use it to its full potential.

As I said earlier, we are taking forward a programme of work to tackle the backlog and waiting lists, but we can see that significant progress has been made across a range of specialities, and we are working with boards to support and sustain that.

Our healthcare system is experiencing challenges with the recruitment of staff in the same way that the health system across the UK is experiencing real difficulties. Some specialities are not just causing difficulties for the UK; there are global challenges because of the lack of specialists in those areas. However, we are taking things forward. For example, the fill rate in our speciality recruitment programme is at 93 per cent, which is a higher fill rate at this point of the cycle than we have ever been at previously. We have another fill rate to go, and it will be finalised in November, so we are making very good progress towards being an attractive location for clinicians to come for training and support.

Our NHS, however, will experience very significant challenges this winter. What are we doing to address that? We are expanding things such as the hospital at home service and see-and-treat programmes with the Scottish Ambulance Service. We are working closely with our health boards on the preparations that they are putting in place for their A and E departments, which often feel the brunt of these challenges.

We started our winter planning programme earlier than ever before. One of the first pieces of work I commissioned when I took over the portfolio was our winter programme, given the very challenging winter that we went through last year. We have taken forward that planning jointly with the Convention of Scottish Local Authorities and, just a few weeks ago, we had a winter summit that brought together all the key stakeholders in health and social care from across the country with the decision makers to look at planning and managing some of the challenges that we will face in the course of the winter.

It will be a challenging time. I am not going to shy away from that fact and I am not going to kid on that it will not be difficult and that things will be perfect. However, we have brought forward the planning and done it in a joint way that we have never done before to try to mitigate some of the challenges that we face.

You will be aware that we were starting our Covid vaccination and flu vaccination programmes earlier, so some of that was already at an earlier stage than in other parts of the UK. As a result of the new Covid variant, we brought forward the Covid vaccination programme for those who are more vulnerable, but we were always one of the first parts of the UK to move forward with the winter vaccination programme; I got my flu vaccine just yesterday. Anyone here who intends to get the flu vaccine or the Covid vaccine, please take up the offer that is being made.

We are doing what we can to plan for the winter and the challenges that inevitably will lie ahead. We are also trying to put in place programmes of work to deal with the large number of people who continue to wait extended periods for treatment, while we also deal at the same time with the recruitment challenges that are being experienced not just in Scotland but across the whole of the UK, particularly in certain specialities. So far we have made good progress, but we still have to do a lot more.