Chamber and committees

Earlier, I mentioned that the burden of disease over the next 20 years is projected to increase by some 20-plus per cent. If we are to address that, we need a very clear focus on prevention, to try to reduce some of that burden of disease—in particular, as our population gets older and people live longer. The measures that we take on prevention—the public health measures, the immunisation programmes, the screening programmes—all play a critical role in that. That requires action at both primary and secondary care levels.

There is no doubt in my mind that we have to make sure that we do as much as we can around the prevention agenda if we are to manage what will be a very significant increase in the disease burden that we will experience over the next 20 years.

I do not know, but I am happy to check whether we have that data. I will come back to the committee on that.

On your wider point, I think that there is a lack of public understanding of the treatments that people can get from a community pharmacy. That is understandable. Let us say that someone has an eye infection and is thinking about making an appointment to see their GP. If they have a mild eye infection they could go and see their pharmacist, who will be able to prescribe a medication that can treat it appropriately. You mentioned inhalers for folk who have asthma or other airways diseases.

There is still a lack of understanding and recognition of what community pharmacies can provide, which is why there is a need for the on-going education of people around what is available through pharmacy services, which are a key part of our primary care services. We need people to use pharmacy services rather than just taking the traditional route of making a GP appointment. By using the community pharmacy, they could be seen more quickly and probably much closer to home.

You touched on the sort of thing that we can do to make those areas attractive. Obviously, NHS Scotland has an apprenticeship programme that recruits individuals into a range of non-regulated professions, including estates department staff. That is one thing that we can do.

The second thing that we can do is ensure that staff have good terms and conditions. Thirdly, we can provide alternative pathways into the regulated professions. That could be done through earn-as-you-learn programmes and by providing apprenticeships into programmes that are presently dependent on having a university degree. We could also allow folk the ability to flex into other professional groupings using the skill set that they have—for example, advanced nurse practitioners do some prescribing work.

All those measures play a part in helping to meet some of the challenges. Terms and conditions, training opportunities and routes into training for AHPs and others all play an important part.

Recently, I had a really good discussion with the Royal College of Podiatry, which talked about how important apprenticeship programmes could be for individuals who might already have a career but who want to move into podiatry. They could be allowed to flex into that career through earn-as-you-learn-style programmes. All of that could have a significant impact.

A pilot project that the Royal College of Podiatry is running with NHS Greater Glasgow and Clyde has been really successful in delivering that, so I agreed to take that information away and consider how we can do more of that kind of work. That is the sort of thing that we need to do much more of in an effort to move folk into the regulated and non-regulated professions.

I am not sure about a minimum standard, but I am happy to check that for you and come back to the committee on that.

On the staff wellbeing issue, the NHS is nothing without its staff; its staff are absolutely critical, so supporting their wellbeing is of high importance.

If there is one thing that frustrates me—it frustrated me when I was a health minister previously, and it has frustrated me since I have come back into the health portfolio—it is the inability to do things using the once for Scotland approach. If one health board is doing really well in an area, it can be a challenge to get other health boards to adopt that practice. We are doing work on the once for Scotland approach to ensure that, where we see good practice in supporting staff and wellbeing, we can utilise it in other health boards so that that experience and knowledge are shared. We are doing work to support that happening much more effectively.

It is important to learn from and share boards’ experiences. We also provide the national wellbeing hub, which gives staff 24/7 support through a range of different programmes. The key thing is that, where there are good initiatives, other boards should learn from them. Those experiences should be utilised much more effectively.

We have a number of programmes to support rural GP initiatives. Some of that is about financial support—making it an attractive setting for them to work in. Stephen Lea-Ross can say a wee bit more about that and about ScotGEM, which, as you mentioned, is a specific Scotland-based project to support recruitment.

There is quite a bit of work going on around that at the present time. John Burns could say a bit more about electronic prescribing. Some new information technology infrastructure is being rolled out for general practices, and about 30 or 40 practices have in place some of the new IT system, which will help to facilitate that. The system is due to be rolled out over the next couple of years, which will allow us to move towards electronic prescribing so as to reduce some of the burden. IT infrastructure is key to facilitating that, and the new GP IT system is designed with a view to providing much more around electronic prescribing.

I do not know why that is the case, and I am more than happy to have a look at the matter and respond to you directly on it. It seems a reasonable issue to raise and to be addressed, but I know neither the background to it nor the reason for it. I am more than happy to take a look at it and come back to you.

I think that that demonstrates the Scottish Ambulance Service’s very innovative approach to providing services. The same applies not only to those services, but to the services that NHS 24 provides, with a significant amount of resource being made available to help support individuals who present with mental health issues. There has been a significant improvement in the service’s performance in that area. In fact, the chair of the board was highlighting to me yesterday how mental health supports are a key priority as it moves forward.

We are seeing the Ambulance Service, in particular, becoming almost more of an outreach service in some ways, although that is probably not the best way to explain it. A see-and-treat approach is being taken much more often, in which the service provides direct interventions to patients there and then, instead of its having to convey them to an accident and emergency department or a mental health unit. That is an area where we want to see innovation and development continue.

The committee will be aware of the additional finance that we provided to the Scottish Ambulance Service to increase its recruitment, and that is another expanding area. Some of the preventative work and support that the Ambulance Service can provide with regard to urgent unscheduled care are really important, and I think that that sort of approach will prove increasingly critical in helping to sustain and support our services. I absolutely want to continue to build on and progress that approach in both mental health and non-mental health settings.

It is clear from looking at some of the capital investment that we have made recently in national treatment centres, including in one in the Highlands and the Baird family hospital and ANCHOR centre in Aberdeen, as well as our investment in a new hospital in Orkney, that there is not a preconceived view that more things should be centralised. That is not the approach that we are taking. Where we can make the investment to deliver such services in rural settings and to provide the right infrastructure, we are doing so. I am simply acknowledging that there is a trend towards specialisation in the clinical setting—that is an international trend, not just a Scottish or UK trend.

That is why, as John Burns rightly said in response to an earlier question, our rural health boards are among our most innovative health boards because they have to think about how they can deliver services in different ways. We will continue to do what we can to support them to achieve that. I mentioned the Baird and ANCHOR and the new NTC in Highland, which are examples of our determination to deliver as much as we can in some of our more rural areas in Scotland.

However, we must also acknowledge the need to deliver services that are clinically safe. There might be occasions when it is not possible for us to deliver all the services that we would want to deliver in some of our rural areas, and people will require to travel to urban areas. That is not a new thing—it has always been the case that some people from rural areas have had to travel—but there is an increasing tendency towards that, given the specialisation that has taken place.

We want to see more people being treated at home. We are expanding the hospital at home programme so that more people get clinical care in their own bedroom and their own home, never mind in the local hospital. We have more than doubled the funding for that—we have increased the funding by £400 million to expand the programme further. That has a particular benefit for patients in rural areas.

We need to continue to recognise that it is a dynamic situation, to which we need to continue to adapt. Given the particular challenges that we face around our rural communities, we must be innovative. I will do everything that I can to support our rural health boards to deliver the best service that they can in their local areas.

I do not think that we have given money to health boards to build their own accommodation. I am sure that some partnership work has been done in the past with health boards and local housing providers around what can be done to support them in making affordable housing available to the boards but, again, that is outwith my portfolio. I would be more than happy to check with my housing colleagues what specific work they are doing with boards to address affordable housing issues. Of course, there was a time in the past when we had accommodation for staff in the NHS, but that obviously changed many years ago.

I will check with our housing colleagues around any specific projects or programmes that they have taken forward. I know that programmes have been developed in some rural settings that are about bringing together public sector investment, which is health, housing and wider community investment, and trying to utilise that money in a way that helps to deliver more infrastructure in an area. However, I am not sure whether there have been specific programmes to provide housing for staff who work in the NHS. I think that it will be a more general programme.