Chamber and committees

I just noticed that you seem to have a particular focus on him, but let me try to deal with some of the issues.

Obviously, investing in mental health is a priority for the Government, and there has been significant investment over the past decade or so. There is a financial aspect to the specific workers that you mentioned. The biggest challenge is in managing all the competing demands within the NHS budget. Financial constraint is limiting our ability to run forward with the programme as it stands. When financing becomes available to us, we will be able to do so. You will be aware that we provide other projects in support, such as link workers, who are very valuable in GP practices and help to signpost people, including those who have mental health conditions, to other services. The principal reason for our not being able to take forward that programme is a lack of available finance for us to extend it in the way that we would have wanted to.

Of course.

Yes, but we must also keep in mind the fact that capital investment is a very expensive exercise to undertake right now, because of the huge capital inflation that we face. Construction inflation is running way ahead of standard inflation—it is up in double digits—so that has had a significant impact.

Our capital budget has been cut by around 5 per cent by the UK Government, which has had a direct impact on us. The value of what we have is less and buys us less, because of construction inflation, so we must be very nimble on our feet and focused on how exactly we maximise the investment that we are able to make to deliver on the right capital investment projects. In my view, boards are not slow to flag up where they need capital investment and what that might look like. I would certainly never discourage a board from bringing forward a proposal but, equally, our boards understand the financial pressures that we are under, and things might not happen according to a timeline that they would ideally want.

I am absolutely confident that we will do everything that we can, but I will not sit here and say that all the financial challenges in NHS Scotland or the public sector will be magicked away—that will not happen. Across the UK, we are going through a period of austerity in the public finances, which is having an impact on our budget and means that we must try to manage the finances as efficiently and effectively as possible. You can be assured that we will do everything that we can to provide financial support where possible, but that will be within the limits of what is available to us to invest in the health service and other public services.

Obviously, inflation is having an impact on the NHS across a range of areas. From procurement of food through to drugs, equipment and maintenance costs, all areas of the NHS are, by and large, impacted by inflation costs, alongside energy costs. That is placing a very significant strain on NHS budgets.

I will get Richard McCallum to say a wee bit more about PFI and the inflationary impact. Inflation is having an impact across a range of areas within health and social care, outwith PFI.

There are a couple of points to make in that respect. First, NHS Scotland has, like the rest of the NHS across the United Kingdom, used agency staff at various points. If you look at the figures, you will see that over the past 12 months there has been a bit of a spike in the number of agency staff being used. Greater use of such staff largely reflects the significant recruitment challenges that the NHS faced over the course of the pandemic. In the past month, we have applied additional restrictions on boards in order to reduce our agency spend. To put that in context, though, I point out that our agency spend is a relatively small proportion of our overall budget: I think that it is less than 2 per cent.

If there is a need for flexibility in relation to staff, we would much prefer to work with NHS bank staff who are on NHS contracts and NHS terms and conditions. We have applied some restrictions on boards to make sure that they are focusing much more on using bank staff where necessary.

We must also make sure that the NHS is an attractive place for staff to work. That is why the agenda for change settlement was critical, through taking forward measures to address issues related to pay and conditions in order to ensure that NHS Scotland is seen as an attractive place to work and to take one’s career forward.

Work was also done through, for example, the nursing and midwifery task force to improve recruitment to and retention within NHS Scotland.

Those are all areas of work that are about retaining staff within the NHS and making it an attractive place to come and work. It is also about looking at new routes into the regulated professions.

Reform around workforce, training and planning, alongside work on pay and conditions and much greater focus on use of NHS bank, rather than agency, staff are all part of the combination or package of measures that we are taking forward to reduce our dependency on locum and agency work.

Health inequalities and the illnesses that are driven by those are the result of social inequality so, very often, our health service is dealing with the symptoms of social inequality that manifest themselves in health inequalities. It is important that we take forward programmes such as reducing child poverty—through, for example, the Scottish child payment. All those will have an immediate benefit for the individuals concerned, but they will have a long-term benefit in reducing child poverty, which can result in health inequalities.

In addition, through the work that we do on tackling tobacco use, there have been reductions, and we want to continue to build on that. On alcohol misuse, a report that was published today by Public Health Scotland shows that minimum unit pricing has helped to reduce alcohol-related deaths by more than 13 per cent. All those factors play an important role in supporting us to prevent ill health, alongside our social policy actions to tackle social inequality. All that will be critical to supporting us in the preventive agenda in health.

No single action alone would help to address issues around population shift and make our rural and island communities attractive for people to live and work; rather, a range of actions will have to be taken. You will be aware, for instance, of actions that have been taken in some rural areas on housing, as well of measures that we are planning to take to free up housing capacity in our rural and island areas. There is a combination of factors to consider, including transport infrastructure, housing, digital infrastructure, good-quality and sustainable health services, access to education and so on. They all play key roles in helping to make our rural and island communities attractive places for people to live and stay in. They cut across all Government portfolios, and some of the work that we are taking forward in Government is on trying to ensure that we take a consistent approach to delivering them and that we are prioritising them.

I am not sure; I would have to check for you. I will be happy to come back to you once we have checked whether we are doing any work on that.