Chamber and committees

Thanks for the question, and thanks to the individual who asked the question. First, the reduction in the working week is one of the issues that trade unions have brought forward. That fundamental issue was raised by those who represent the workforce at the regular meaningful engagement that we have with trade unions as part of the pay negotiations. It was not something that was necessarily brought forward proactively by the Government or, indeed, by employers. We thought that it was important to listen to the trade unions and that is why we have made a commitment to the reduction of the working week.

Clearly, the reason why we have not said that we will do that by tomorrow, next month or within a short or narrow timescale is for precisely the reasons that the individual who has contacted you highlighted: we would have to look at the implications for staffing.

We are committed to continuing to invest in our workforce. Inevitably, that will mean growing it. If we are going to reduce the working week, there is no doubt we will have to look at filling some of the significant numbers of vacancies. I would be the first to admit that there is a significant number of vacancies in nursing and midwifery.

I hope that the individual who asked that question will be reassured that we will work through the detail before we implement a shorter working week. We must understand what the demand pressure on the workforce and the impact on services would be, and then ensure that we have adequate staff to respond to that.

Yes—and incur the wrath of the Presiding Officer. There are two areas of focus. The first is freeing up more capacity for interim beds. We have used interim beds already, but they will be a slightly different feature in what I announce in a few hours’ time in the chamber, given the pressures that social care is facing.

The second area of focus will be to bolster the NHS 24 workforce in particular, who have been exceptionally effective in keeping people away from busy acute sites. The vast majority of those who call NHS 24 and get through to a call handler get the appropriate triage without having onward transfer. However, I will lay out the funding—the pounds and pennies involved—in this afternoon’s statement, as appropriate.

Obviously, I did not know that you would ask about that specifically. It is probably best for me to lay that out to the chamber in the statement later today. There will be two essential areas of focus. The First Minister outlined those in very broad terms so that I could give the detail to Parliament, as we said throughout yesterday.

No, I do not think that anybody asking for higher pay in health or social care is being unreasonable. I hope that, for all the differences that we might have on the issue, Carol Mochan and others will recognise that the Government’s approach to discussions and negotiations with trade unions has been constructive and meaningful and is a stark difference to the approach of a number of other Governments across the UK. That is why I continue to reiterate that, so far, Scotland is the only part of the UK that has not seen nurses and ambulance workers go on strike. I am not taking that for granted, because we know that the RCN, the RCM and GMB continue to be in disputes, so we will continue to engage with them.

On social care, in the 2023-24 budget there is about £100 million as part of the uplift of adult social care pay to the real living wage rate of £10.90. Richard McCallum will correct me if I am wrong on this, but I understand that that is the same as the increase by the Welsh Government, which has also increased the real living wage. That £10.90 figure is higher than the UK Government’s uplift, which is, I think, 48p lower than the £10.90 rate.

I do not disagree with the premise of Carol Mochan’s question and Colin Poolman’s comments: we have to continue to see what more we can do to improve pay, terms and conditions for social care workers. That obviously comes at a cost. Previously, Carol Mochan and the Scottish Labour Party called for an increase to £15 an hour, for example: I would love to give £15 an hour to adult social care workers—yesterday—but that would come at a significant additional cost of well over £1 billion, which would be very difficult or, frankly, near impossible to fund, given the financial pressures that we are under. We have to keep working at that. I certainly do not see the uplift to the real living wage as being the final uplift. We will continue to progress that.

That is another fair question. We expect to see some immediate improvement from the action that we are taking. Your question was on whether we would see significant improvement. There is not a magic bullet or a panacea—Dr Gulhane knows that, given his clinical experience—but I think that it will see an improvement.

As well as the shorter-term measures that I will announce in the statement today, it is really important that we as a Government do not lose focus on the medium to longer-term issues, particularly in and around social care. The national care service is a part of that, but let us all accept that we have to make improvements now rather than wait for a national care service to become operational before doing so. As well as the shorter-term impact, the immediate improvement that I expect to see as a result of the action that we are taking will be on the eight-hour and 12-hour waits. Interestingly, given the flow through the hospital, we will probably see improvement in the eight-hour and 12-hour waits before we see it in the four-hour waiting time target. We will not lose focus of the longer-term changes and reforms that we have to make to social care, which will help to make a long-standing, more sustainable impact in the longer term.

Although we are focusing a lot on the back-door delayed discharge—understandably so, because it is the issue that clinicians and healthcare leaders predominantly raise—we will not lose focus on the front door. I will talk in the statement later about how, through the preventative agenda, we continue to drive down demand at the front door.

I am not sure of the nature of Tess White’s disappointment, so she can, if she so wishes, come back to me on that. The budget for NHS 24 for 2023-24 is outlined in the budget document. On any additional information on that, as I said, it is right and appropriate that we have agreed to update the entire Parliament in the chamber, so we will do that.

For the period from October to December, again, if Tess White does not mind, I will come back to her with the exact figures. There has been additional recruitment, because I have seen a note from NHS 24 on that since October. I will come back to Tess White with the exact figures so that I do not inadvertently give her incorrect ones.

First, although I know that that figure for the maintenance backlog was released publicly, we went back to the query that was made in order to correct the figure. The figure was incorrect: it is closer to £1 billion. That is still a significant maintenance backlog, but I think that it was inflated by around £500 million.

Nonetheless, Tess White’s point stands: there is a significant maintenance backlog. Over the capital spending review period, we have committed to invest more than £1 billion in enhancing or refurbishing existing healthcare facilities, and updating and modernising essential medical equipment. We will do that, but it will take time, which is why it will happen over the capital spending review period. However, it was a fair question.

Tess White’s second question was also very fair: why has the backlog not been mentioned? It is not because that commitment does not stand: the commitment to £10 billion over the decade stands. We always thought, and it has always been the assumption, that that would have to be back-ended towards the later years, given the financial circumstances that we find ourselves in, which have been exacerbated by various factors, as I have said. We are still committed to that £10 billion investment over the decade, but it will undoubtedly be back-ended towards the later years.

As I said, the argument at the time, from not just the Scottish Government but the Welsh and Northern Irish Governments, was to phase that in over a period. However, we rehearsed that argument and we lost it. The UK Government has decided not to continue funding Covid costs.

I am not often sympathetic to the UK Government, but meeting those costs was a huge undertaking. Our difficulty is that we have a new infectious virus in our health system that requires periodic vaccination, surveillance—to an extent—through test and protect, and some level of testing. We now have to baseline into our budgets the costs associated with that, and that is very difficult to do.

We will see how 2023-24 progresses. Our big worry, as Emma Harper referenced, is about what will happen if there is a new variant—and we are keeping an eye on XBB.1.5—that has immune escape and causes more severe illness. If that happens, we will need to go back to the UK Government with this discussion, given the implications of that.

Yes. As the member knows, sectoral bargaining is part of the national care service proposals that we have put forward. It is very difficult to do in the current structure. We are always looking to see what we might be able to do. Given that we have a very fragmented landscape across the country, with independent providers, third sector providers and local authority providers, sectoral bargaining has been virtually impossible or very difficult, thus far, but it is certainly part of the national care service proposals, if we can do it outwith the national care service. We are looking at that in the context of our fair work agenda for social care. We will certainly do that, because there is strength in sectoral bargaining.

Of course.