Chamber and committees

No, that is led by boards directly, as they are close to the issues. For example, with the institute of neurological sciences at the Queen Elizabeth hospital, which you mentioned, the health board would be responsible for putting together a business case for additional capital investment in that facility. The business case would come to our capital allocations team, which looks at such issues and all the demands that come in from different boards. Again, the lead on such matters is taken by the boards, which know what their estates need and what the challenges are, and any business cases then come to the national health infrastructure board for consideration. Therefore, there is a mechanism for boards to utilise, as and when required.

On your second point about the challenges at Edinburgh royal infirmary, they reflect the fact that the hospital is now more than 20 years old and that a significant demographic shift is taking place in the country, with the population shift that we are seeing from the west to the east putting additional pressures on public services in the east of the country. That has happened over the past 10 to 15 years, and it is putting pressure on hospitals such as Edinburgh royal infirmary at the front end. Again, the board has the opportunity to look at putting together a business case for investment to expand that facility, and it would be for the board to lead on that and to submit a proposal for consideration alongside all the other health capital expenditure proposals.

Okay. Let us try to deal with some of the facts around those issues. In terms of safe staffing limits, work is being taken forward just now through workforce planning, engaging our trade unions, stakeholders and health boards around planning for that. Right now, we are on track to take that forward and deliver it within the next year. It is a complex piece of work, but the working groups around some of that are already progressing.

I wholly and fully recognise the financial pressures and the stress and anxiety that staff are experiencing. A big part of that has been because we have come through a pandemic, which has placed huge pressure on our NHS in a way that it has never experienced in the 75 years of its existence. We all need to recognise and acknowledge that.

If your focus on my predecessor is your intention, and if you want to look for examples of taking very direct and clear action to help to support and reward staff, I cannot think of anything that does that more than the significant improvement that we made in their pay and conditions through the agenda for change. The 14.5 per cent that was provided to staff was the largest uplift for healthcare staff in the UK, and more than was provided by the Secretary of State for Health and Social Care in England. That demonstrates my predecessor’s determination to provide financial reward and support to NHS Scotland staff, recognising the enormous contribution that they made during the pandemic. That is a very practical example of his taking clear action and showing clear leadership in delivering such a significant improvement in pay and conditions.

It does not stop there, because the agenda for change is being reformed as a part of that. Again, that was a direct request from the trade union groups. The working groups that are responsible for taking that forward have already started. For example, the nursing and midwifery task force that I mentioned is already up and running. It is due to have its second meeting, which I will chair. The working groups to look at the reform of different parts of the agenda for change are also being taken forward.

You mentioned terms and conditions as an example of demonstrating our commitment to supporting staff. In what was agreed and provided through the agenda for change, my predecessor demonstrated that commitment in a way that was not done in other parts of the UK, where other health secretaries took a different route and provided less. In my view, that is a clear signal of where our priorities are and how we value staff.

I do not pretend that our NHS does not face significant challenges. We are still recovering from the pandemic and its legacy. We are going through a period of austerity in the whole of the UK, which is having a significant impact on public finances. We have been dealing with record levels of inflation. Households are having to manage a cost of living crisis, which impacts on the health and wellbeing of staff. We are dealing with significant increases in fuel costs, which have an impact on public finances. Construction costs and maintenance costs are all up significantly. All of those have an impact on our NHS.

You can be absolutely assured that I will continue with the approach that was taken by my predecessor in valuing and recognising the staff and the important role that they play in our NHS, and maximising the level of investment that we put into NHS Scotland—as demonstrated by the £730 million that we have put in this year and the further £200 million on top of that, as I mentioned earlier. We are ahead of trajectory on the 20 per cent increase during this parliamentary session. Again, that shows clear leadership in putting finance into the health service where we can.

All those factors will play their part but, equally, we do what we can to support our staff and to recognise the important value—the critical role—that they have within NHS Scotland.

Ideally, we would be in the position of trying to address as much of the backlog as possible to reduce the risk of its becoming a safety issue for patients or staff in a building, but the challenge that we face is that capital budgets neither provide for that nor allow us to achieve it. Boards work in a dynamic environment in which they address maintenance backlogs on the basis of priority, and some of that will relate to clinical safety purposes. They will continue to work on that basis.

Alongside the need to provide new facilities and deal with the maintenance aspect, there is huge pressure on our capital budgets. I expect boards to work dynamically to identify the critical elements that have to be taken forward and ensure that matters are being addressed efficiently and effectively so that they do not interrupt clinical services or cause safety issues. We continue to try to invest in our estate as we go forward, both in maintenance and in new facilities where necessary.

Good morning, convener, and thank you for inviting me to meet the committee this morning. This is my first appearance at the committee since I was appointed as Cabinet Secretary for NHS Recovery, Health and Social Care. I welcome the opportunity to engage with the committee, and I look forward to discussing a range of vital issues in the weeks and months ahead, as recovery and renewal of the NHS and social care services continue.

I also thank the NHS boards for continuing to provide information to the committee, which has been taking evidence about their performance in recent weeks.

Ministers and Scottish Government officials regularly meet representatives of all health boards to discuss matters of importance to local people. It is my strong belief that the Scottish Government should not only fund, but should empower and enable boards to make the decisions that they feel are most appropriate to their localities and areas.

We acknowledge the pressures that are felt by boards across the country as we all continue to deal with the aftermath of the biggest shock that the NHS system has felt since its establishment some 75 years ago. We continue to prioritise investment in front-line services. We have provided an increase of some £730 million for NHS boards through the 2023-24 budget and an additional £200 million in-year support above initial plans to support the financial sustainability of NHS boards. That means that no board is more than 0.6 per cent from NHS Scotland resource allocation committee parity.

In addition, we continue to provide constant support and guidance to NHS boards to ensure that they are doing everything that they can do to provide the best possible care for people in their localities. Our new prospectus for the year ahead demonstrates our collaboration, with a key part of our plan to deliver year-on-year reductions in waiting lists being to deliver additional capacity through our national treatment centres in NHS Highland, NHS Fife, NHS Forth Valley and NHS Golden Jubilee National Hospital.

Another good example is the work that is being done to increase the workforce through hiring an additional 800 staff from overseas. That was helped by £8 million of funding in October last year. We set an ambitious target of recruiting some 750 additional nurses, midwives and allied health professionals from overseas; I am pleased that, due to the hard work of health boards, we have exceeded that target. That is the kind of joint working between central Government and local boards that I will hope will go from strength to strength, as we go forward.

I am happy to respond to questions.

Do you mean in terms of trying to reverse depopulation in rural and remote areas?

You will be aware that we are taking forward a range of work to try to make our rural and island areas attractive locations, whether through addressing connectivity and economic activity issues to make rural and island areas viable places for communities to grow and thrive, or through measures that support people to live in those areas. For example, the islands growth deal and the Argyll and Bute growth deal are about helping to reverse depopulation by putting in infrastructure to make communities attractive and to encourage people to live in them.

When I was the minister who was responsible for taking forward growth deals, a key part of what we were trying to do, working in partnership with local government, was to put in place measures that we knew would help to support the people who were already there, but would also help to make those communities attractive for people to move to and live in.

One of the big issues that was often flagged up to me was digital connectivity. The digital superfast broadband programme was all about having the infrastructure in place to support rural and island communities in order to make them attractive locations, by giving people the ability to live, to work from home or to base a business there. Although they go well beyond my portfolio, those are the sorts of measures that the Government takes, on a broad economic basis, to make our rural and island communities attractive locations for people to stay and to go to live in.

As you will be aware through the inquiry, funding is allocated to health boards through the NHS Scotland resource allocation committee formula, and is distributed on the basis of population share, geography, deprivation factors and so on. That approach has been taken for some time now and continues to be taken. As has been the case historically, we also provide tailored support to individual health boards if they face financial issues in-year and require financial support as a result. In the short term, therefore, if NHS Grampian requires additional financial support, we will try to provide it, if the funding is available.

Equally, we will continue to make progress with our use of the NRAC formula. I know that NHS Grampian has raised the issue of parity. As I have mentioned, we have already provided another £200 million in this financial year to try to close that gap further, and we will continue to try to do that in the medium term, too. We will, through the combination of short-term tailored support and the move towards NRAC parity, try to manage the issues for boards including NHS Grampian.

I am surprised by that, because I do not get such feedback when I talk to boards about the financial challenges. They readily acknowledge that we are aware of the significant pressures that they are under, so I am surprised if some have given you the impression that you described.

I think that I understand what you mean. Are you talking about providing more money?

You raise a really important point. A big part of some of the challenges that services have experienced in recent times has involved managing public expectation of services that are available and awareness of the most appropriate route to access them, whether that is at primary care level or at secondary care level.

We have set out a commitment to taking forward a national conversation, part of which involves the design and provision of healthcare services into the future. That includes how people access healthcare services: when it is appropriate to make a GP appointment and when it might be more appropriate to see a community pharmacist, a musculoskeletal physiotherapist or an advanced nurse practitioner, rather than a GP. It might sometimes be right to attend a minor injuries clinic. Thinking of my experience with constituents, I note that people will consider when they should go to minor injuries and when they should go to accident and emergency, so there is a question around how people understand the best route for them and when they should access emergency departments. There is a need for us to provide on-going dialogue, explanations and information about the best route to accessing the type of support and assistance that people may require at a particular time.

Turning to one of the things that we have introduced more in recent times, we have used NHS 24 to try and manage some of the challenge that we are experiencing in emergency departments in particular. The ability to contact NHS 24 allows people to speak to a clinician or advanced nurse practitioner, who is able to prescribe medication and have a discussion. They can then facilitate the person’s prescription, reducing the need to go and see a GP or attend the emergency department. We want people to understand and be aware that those initiatives are available to them, and they might be the best route for them to use.

It is not about doing one thing or the other. There is a need for us to continue a discussion and explore with people the options that are available to them and what might be the best option for them should they require to access healthcare services, whether digital, primary or secondary care.

I do not think that we will ever reach a point at which everyone will know the route that they should take. We will always have to provide an explanation to support people to make the right choices. I do not think that we have cracked it as well as we could. We could probably do more to help people to understand how they access their services.

Part of the future redesign of services is about engaging the public in the process of deciding what health services will look like and how they might want to access them. For example, I expect to be able to do much more digitally in the future, but I know that, for some people, particularly older people, that might not be the right route or tool for them. There will always be a natural transition as some people make more use of digital while others do not, and we need to make sure that we give people the options that best meet their needs as and when necessary.