Chamber and committees

On your latter point, we recognise that the framework has to be updated, particularly in the light of Covid and some of the challenges that that has brought. We have not yet committed to a specific date by which it needs to be published, given that we are just coming out of the immediate pressures of a pandemic response because of the omicron and BA.2 wave. However, we recognise that the framework needs to be updated and published.

Remember that the medium-term framework does not set our budget; it gives us an envelope, and then it is for us to prioritise what the budget will look like. That is informed by our key policy priorities and, for example, how we align with the national performance framework.

On your question about confidence in the funding and the fiscal framework, I point to a recent joint study by the London School of Economics and The Lancet, which suggested that a 4 per cent real-terms growth in healthcare costs is to be expected if we are to improve the quality of care and the terms and conditions of the health and care workforce. That is in keeping with the assumptions that underpin the current medium-term financial framework.

That and other independent research will inform our review. We will update the medium-term financial framework and publish it after the resource spending review. I hope that that makes sense to members.

On your first comment, I will, of course, take any questions that the committee wishes to ask. If we can give you the detail today, we will do so. As always, I will provide further written detail if that is required.

As I said I my opening remarks, I thought that the Audit Scotland report on the NHS is a fair summary of the challenges and highlights the efforts that the Government has had to make during an extraordinary period. This period will be written about in our history books and learned about in our schools and modern studies classes until long after any of us are around. It has been extraordinary; I again commend all those who were involved for their extraordinary efforts.

You asked specifically about the care and wellbeing portfolio. It would be fair to say that work on that portfolio has been affected by the pandemic: there is no doubt about that. One of my key officials—in fact, a joint director of that portfolio—was working on the test and protect system for us. We had to move crucial resources away from various parts of Government in order to focus on the response to the pandemic.

The work is at the developmental stage. Officials are working to define the intended scope. There are a number of workstreams, which I will touch on. We are clear that the work of the care and wellbeing portfolio must be broader than just healthcare, and that how it interacts with other portfolios and other departments in Government will be crucial. The first meeting of the internal care and wellbeing portfolio board took place late last month.

Your question about sustainability is absolutely on the money. Prevention will be a key element of the care and wellbeing portfolio. The committee has often spoken about the importance of that agenda, which is a vital part of the recovery and renewal of the NHS and social care. The care and wellbeing portfolio will be critical to that and will help to make our services more sustainable. If we stop people going into our hospitals and acute sites, or if we can keep them there for as short a time as possible if they do have to go there, that will be to their benefit and will help to make our services more sustainable.

The portfolio’s approach is still being developed. It has three primary objectives: coherence, sustainability and improved outcomes. You asked about sustainability, which is one of the key objectives. As well as prevention, the care and wellbeing portfolio will also have a big focus on innovation and on developing infrastructure that can drive efficiency and productivity within our health and care systems.

That is an excellent question. I regularly speak about that issue with the chief executives and chairs of our health boards, who have real anxiety about it. For most of us, life feels as if it is back to normal. We can interact with our family, book a holiday or hold a 70th birthday party for our parents and have 100 people attend, if we want to do that. Life, for most of us, feels as if it is back to normal, but the health service is still under extraordinary pressure. I do not need to tell people in this room about that: you know it because you are close to it.

People whose lives have gone back to normal are asking why it does not feel as though their health service has got back to what it was like before the pandemic. There must be honesty. I am honest to the best of my ability; there must be honesty across the board that it will take not weeks or months, but years for our NHS to recover, because there have been two years of accumulating challenges.

I do not pretend that there were no challenges in the health service before—there were. However, issues have undoubtedly been unbelievably exacerbated by the pandemic, and not just in the health service, but in social care.

It is important for us to be up front and honest and to manage expectations, but also to be ambitious. We are ambitious, and our recovery plan is a demonstration of that ambition. From conversations that I have with my health board colleagues and integration authorities about social care, I know that they all want to be ambitious, but realistic, too.

There is a bit more work to be done—John Burns and I speak about this regularly—on cementing our delivery milestones on planned care in particular, because we know how long people have been waiting for some elective procedures. We will publish that work in due course. I hope that it will set a realistic but ambitious timescale for recovery. You are right that we must be up front and honest about the scale of the challenge and how people access their services.

I appreciate what Paul O’Kane is trying to do, but—

Yes—evaluation will be a critical part of any funding that we give. That goes for any portfolio, but I am particularly keen that evaluation should be embedded with any of the funding related to long Covid, because it is a condition that we are still learning about. I can absolutely commit to there being evaluation but, if you will forgive me, I will take the exact timescales of the evaluation off the table and furnish you with more detail.

Evaluation of the funding of any model is critical, because we are learning about long Covid day by day and week by week. The strategic network will also have a role to play in that evaluation. Everybody in the network is important, but I think that Dr Gulhane will agree that the most important people are those with lived experience. For me, the feedback loop that we have with them will be crucial in any evaluation.

Quite right, and it is nice to get back out socialising now that we can.

The member raises a serious point. A balance needs to be struck. I am conscious of that, because I have asked for a lot of data from our healthcare colleagues during the pandemic and during my year as health secretary. I have asked for a lot of data and the Government has asked for a lot of data. Undoubtedly, that has placed a level of strain on people. We try to get the balance right in terms of how often reporting takes place and what data is being reported on and so on.

When we get into the matter in more detail, the key issue that I hear from healthcare professionals is that barriers still exist to sharing data across the health and social care landscape. That continues to be a significant problem. Last year, we published our digital health and care strategy. That lays the foundations of easing some of that in the future and removing some of those barriers.

We are alive and alert to your point about the need for us to ensure that we have the data that we need while not burdening our health services at a time of extreme charge.

I go back to the guidance note, and the point that there is not one model that fits all. For example, if a health board wanted to set up a clinic based on the Hertfordshire model, it could do that. As I have said, I will not pre-empt any funding decisions that are still being considered. We will make those decisions fully public and transparent soon. It is up to individual health boards to understand the needs of those whom they serve and what is the best model that they can put in place.

I know that the approach works exceptionally well in some places. I spoke to a patient called Pamela in the NHS Greater Glasgow and Clyde area who has had exceptional treatment and care for the long-term effects of Covid. She could not speak highly enough of the physios who have helped her during her care and treatment. Equally, I have spoken to people who say that the support that they have received for the long-term effects of Covid has been inadequate. That is why the strategic network must ensure that there is consistency across the country, and my job is to ensure that it is resourced effectively.

The member has consistently raised the issue of health inequality when I have been in front of the committee and it is an important issue for us to focus on collectively.

I will make a couple of points. I go back to my substantial point to your previous question. The work that we are doing around data on health inequalities will not wait for the strategy to be published. We are getting on with that work now. I will give you a couple of examples. You will know that, during the vaccination programme, we ensured that we collected data on people’s ethnicity for example. That gives us much richer detail around some of the health inequalities. It is very clear that the uptake of vaccinations was lower among particular ethnic community groups, such as the Scottish African population and, I think, the Scottish Polish population.

Another example is the great work of the primary care health inequalities short-life working group, in which colleagues from the deep-end project have been involved. As you know, the deep-end project involves GP practices that are based in some of the most deprived parts of Scotland. I commend the group’s report to all members of the committee, if they have not seen it already.

The data strategy will set the direction for improving data collection and the recording of protected characteristics data, which will enable highly detailed research into health inequalities to be carried out. That will be an element of the data strategy, but I give Ms Mackay an absolute assurance that we are not waiting for that strategy to improve data collection on health inequalities—that work is taking place right now.

In responding to the pandemic, we have ensured that every health board has received the support that it has needed. When health boards have requested additional support, we have been up front in making it available.

However, there is no doubt that the challenges of the pandemic have not made it any easier for the boards that were escalated in relation to financial sustainability prior to the pandemic. Therefore, significant support has been provided to the boards. I am not going to give you an absolute assurance on how things will end up at the end of the financial year, but there will have to be continued work with those boards in the period ahead.

Our aim and ambition in providing that support is to de-escalate the situation. That is the entire purpose of providing the support. You will be aware that, when boards are escalated, we ask for a significant amount of reporting in addition to what we would ask for from any other health board. I am confident that the boards will de-escalate in good time, but I also make the point that the pandemic has made achieving financial sustainability more challenging.

Richard McCallum might want to add something.

Good morning. I hope that all committee members are safe and well. All of us are present in person. It is good to be around the table and really good to see everybody.

I am grateful to the committee for its time this morning, and I will make a relatively brief opening statement. I suspect that we will give most of the issues a thorough exploration.

First and foremost, I thank Audit Scotland for its report on the national health service, which was informative, insightful and fair in its recognition of the efforts that the Government has made and on where Audit Scotland thinks the Government and partners must go further in their response to the pandemic in particular.

The report correctly identifies that health and social care in Scotland is at a critical juncture. We are navigating our way out of the pandemic while dealing with case numbers that place continuing pressure on the NHS. It is not just current case numbers that are doing that; the cumulative impact of the pandemic over the past two years continues to put pressure on our health services. In addition, we have seen the emergence of new challenges such as long Covid, which is having complex detrimental effects on people’s lives. We will be able to say more about that in this meeting and in the forthcoming parliamentary debate later this month.

There are also challenges caused by the knock-on impacts of the pandemic. We know that we must address the backlog in treatment and care, support our health and social care workforce, and ensure that everybody can access primary care in a way that supports them and addresses their clinical needs. Addressing those challenges will require a significant changes in how we deliver health and social care while access to those vital services is maintained.

As the Audit Scotland report notes, our workforce has kept going in incredibly difficult circumstances. I—and, I am sure, everybody else around the table—thank our health and social care workers throughout Scotland for the invaluable work that they have done, and for their tireless efforts throughout the pandemic. I recognise the monumental challenges that they have faced. Every single health and social care worker whom I have spoken to has told me that the past couple of years have been the most difficult in their professional careers. That is why we have made £12 million available to support workforce wellbeing, and have put in place a national wellbeing helpline to support staff 24/7.

We are making significant progress on recruitment of staff. Members of the committee will be aware of our recent announcement that we have recruited almost 200 nurses internationally; many others are in the pipeline. They are in addition to the 1,000 additional support staff to work across the NHS and social care. However, more progress is needed. That is why we are taking the necessary steps to recruit more staff and, crucially, why we are not working only on recruitment but on what we can do to retain staff across the NHS and social care.

Audit Scotland made it clear that healthcare and social care should be as inclusive and accessible as possible. Last year, we ran the general practice access campaign, which was shared across social media sites and radio for five weeks, to reassure the public that general practices were open. That campaign emphasised the variety of ways that treatment can be sought, including face-to-face, video and telephone consultations.

Outside general practice, we continue to develop a range of primary care services including, for example, NHS pharmacy first Scotland and NHS 24, which I am delighted to say recently celebrated its 20th birthday. We are also developing more online resources through the NHS Inform website and other channels.

The way in which we access services is changing, and will change, as our digital behaviours change and in accordance with clinical needs. By prioritising clinical resources, we are managing demand and, we hope, supporting people more effectively.

In its report, Audit Scotland rightly identified the importance of gathering and sharing health data to help to ensure transparency and the provision of effective joined-up care across the health and social care landscape. We have also committed to publishing a dedicated data strategy for health and social care. That will be a first for Scotland and we hope to publish it by autumn this year. It is backed by the Scottish Government investing £112.9 million in digital health and care over 2022-23 to help to make the best use of digital technologies in design and delivery of our services.

The NHS recovery plan, backed by more than £1 billion of investment, set out our plans for health and social care over this session of Parliament. That includes providing more than £400 million to create a network of national treatment centres across Scotland, increasing capacity for planned elective procedures and diagnostic care. We are increasing NHS capacity by at least 10 per cent as quickly as possible to address the backlog of care and meet continuing healthcare needs across the country.

We are still dealing with the pandemic. It is not over yet. It continues to have profound effects on the health of our nation and health services up and down the country. Our focus must be on ensuring that we transition out of the pandemic safely, and on tackling the backlogs in immediate and essential care that have resulted.

However, we must also provide access to care in a way that best suits people’s needs. We need a strong workforce where wellbeing is protected and recruitment and retention are at extremely high levels. We need to adapt to ensure that new technologies and models of working can help to support more of our citizens with their care as close to home as possible. That is my aim, as Cabinet Secretary for Health and Social Care.

I look forward to delving into the issues in more detail. I am, of course, happy to take your questions.