Chamber and committees

That is a good question and is a focus of the Audit Scotland report. I will respond to Ms Harper and suspect that we will go into more detail in the forthcoming debate on the subject.

I regularly meet stakeholders, particularly those who have lived experience of long Covid. I also meet Long Covid Kids, which is an important organisation that represents young people who continue to be affected by the long-term impacts of Covid. It would be fair to say that those stakeholders feel that there is no consistency in approach, either from a geographical perspective or within different parts of the healthcare system. That is a key challenge that they have raised with me.

What are we doing to support them? The member will be aware that we try to provide as much of the best guidance that we can to our clinical colleagues in healthcare. Our primary care colleagues in particular will often be the front door for people who are suffering from long Covid. The notes in the Scottish Intercollegiate Guidance Network guidelines say that services for people with long Covid

“may be provided through integrated and coordinated primary care, community, rehabilitation and mental health services.”

and they note that

“areas have different service needs and resources”

so there is not one model that will fit all areas. Different approaches are taken in different parts of the country.

You will know that we announced a £10 million long Covid fund to be spent over the next three financial years. We will soon be able to give details about how some of that funding will be distributed.

One key thing that we have tried to do to deal with the question of consistency is to establish a national strategic network for long Covid. The network is managed by NHS National Services Scotland and brings together clinical experts, GPs, allied health professionals and specialists in secondary care. Most importantly, it brings together those with lived experience, who are informing us on how that funding should be spent and where the gaps in provision and services are. The network will continue to examine and act as a check on the work that we are doing on long Covid.

There is a lot more to do in that space. The last thing that I will say is that we are still learning about the long-term impacts and effects of Covid, so we have provided funding for research. That research will take time and it might not lead to immediate results or benefits, but it will be critical to our understanding of how we treat and manage long Covid in the future.

I think that there is a difference of view among clinicians. I of course respect your clinical judgment on that, but you would acknowledge that many clinicians have a different view and think that, actually, a one-stop clinic that GPs could refer to would end up taking away resources from other parts of the health service. They think that, actually, we could refer people into a respiratory pathway or another pathway, so there is no need for a one-stop clinic. At the same time, I accept that there is contrary view to that.

In my articulation to Ms Harper, I was trying to be fair and to say that, where there are good models—I purposefully referenced the Hertfordshire model—that we think can be replicated here in Scotland, I have no issue with health boards replicating, implementing and embedding those models in their areas. As I said, once the final decisions are made, which will be shortly, we will be able to give detail about funding in relation to the £10 million long Covid fund. The purpose of that fund is to plug the gaps in provision. The strategic network will help with looking at where the gaps in provision are and whether the funding can help to plug some of those.

If the health board believes that there should be a one-top clinic, that is fair enough. However, NHS Highland is a classic example of how challenging running a one-stop clinic might be. I take the point that virtual access can be a key part of that, but many people’s expectation of such a clinic would be to be able to see a clinician face to face and have a detailed conversation with them. We have to be up front and say that that model may work in some areas but may not be suitable for others.

We were always up front about the fact that the funding would be for the next three financial years, one of which we are now in. The reason why we took some time was—not to rehearse the point too often—that it was crucial that we understood where the gaps in provision were. That understanding was informed by clinicians, health boards and people with lived experience and we did detailed consideration of that, which then allowed health boards to bid for money to plug some of those gaps in provision. Therefore, it was very important that that work was done.

I am confident that the disbursement of the first tranche of that money will considerably improve the experiences of people who are suffering from the long-term effects of Covid. However, as I keep saying, it will be a work in progress because we are learning more about the condition and our approach should develop as a result of that.

That is a very good point. I am pleased that Mr Torrance has time to socialise. [Laughter.]

The committee could have a whole separate session on screening. I want to commend, on the record, our colleague Edward Mountain MSP, who I thought spoke very bravely and with great humour about his bowel cancer journey. I managed to speak to him privately to share my admiration for that. He reminded people about the importance of returning the screening kits, because early diagnosis can save lives. Of course, we wish him all the best with his recovery.

Our work on screening is hugely significant and our decision to pause screening for a few months, which we took early on in the pandemic, was one of the most difficult decisions that the Government had to make during the pandemic. The recovery of screening is an important part of our recovery plan. There are some elements of it that are not yet fully recovered. We are working on recovering self-referral for breast cancer for women who are 71-plus by September this year, but there is still work to do.

The use of digital is, of course, important, but we also need to make sure that screening is accessible as close to people’s homes as possible. That is really important in our remote rural and island communities. In relation to cervical cancer screening, it will be really important to have mobile screening units of the kind that are used for breast cancer screening around the country. That will enable us to ensure that such screening is as accessible as possible as close to home as possible, which will be key to helping us with our recovery.

A lot of our funding streams are focused on preventative spend. I commend the third sector for the role that it plays. We often talk about the important role of our public bodies, which of course play an exceptionally important role in all this, but the third sector also has a vital and critical role to play in the prevention and preventative agenda. Our funding will often be targeted in the preventative space and—as I mentioned in a previous answer—will always be evaluated in relation to outcomes and what it is achieving.

We also have an important role in relation to policy making and what can help in the preventative space. For example, I am thinking about some of the action that we have taken on smoking cessation, obesity and alcohol consumption. Our policy also has to be focused in the preventative space.

That is also why I am very keen that, when we talk about health and social care, we do not lose focus on the social care aspect. The more we can resource our social care and care in the community, the more we will prevent people from coming in the front door of our hospitals—and, even if they do have to come in the front door of our hospitals, the more we can hope that they are there for a relatively short period of time. Certainly, we would not want to see the level of delayed discharge that we are seeing at the moment, which I fully accept is far too high.

There is therefore an important role for funding and for the third sector and public bodies. However, Government leads on this agenda, and I hope that our own policies give some reassurance that it is a top priority for us.

I recognise from the outset that Ms Mochan has had a consistent interest in the issue of health inequalities. I share that interest, and it goes to the heart of what we are doing right across Government. If she has not seen it, I commend to her the health inequalities and primary care report that I referenced to Ms Mackay. I appreciate how much paperwork members will see on a daily basis, but we would be keen to share that report with the committee. If members have not seen it, we will pass on the link.

It is really important that the Government considers the report and its recommendations, which provide a strong basis for dealing with health inequalities at a primary care level. As we know, primary care is often the first port of call. We have invested in community link workers and have promised to provide further investment in mental health and wellbeing workers in every general practice.

I will not give a long list of what we have done with the powers that we have—I will perhaps just give a short list. We have worked across portfolios. In education, we have provided free school meals. In early years, we have increased the number of hours of free childcare, with a particular focus on at-risk and vulnerable young people. We have invested in affordable housing. In healthcare, we have delivered a number of preventative programmes and policies in the public health space, as I mentioned. There is also concessionary travel, free personal care and so on.

You are right: we are taking a cross-Government approach to tackling inequalities. However, I have to be up front and frank. As I hope Ms Mochan will accept, there is only so much that we can do when we have a UK Government that is not adequately addressing the cost of living crisis, fuel poverty and the energy crisis. The passive nature of how the UK Government is tackling the cost of living crisis comes on the back of 10 years of really difficult austerity.

Some of the powers are, absolutely, in my hands, and Ms Mochan is right to challenge me to go further and use them more. We have often done that. However, to be frank, there is only so much that I can do to mitigate the impacts and effects of decisions that are made elsewhere.

A number of bottlenecks are the result of the pressures of the pandemic. Some people will say to me that they find accessing primary care a challenge, and we know that there can be challenges in that respect. I believe that you used the example of a patient waiting for an X-ray, but access to diagnostic testing, waits for elective procedures and screening that we have previously talked about have all been impacted by the pandemic.

There is no doubt that there were challenges with waiting lists before the pandemic. I am not suggesting that you are saying so, but any suggestion that the pandemic has not significantly exacerbated those problems would be inaccurate. Unfortunately, because of the pandemic, there are bottlenecks across the system.

We intend to publish that data in late summer, but we will have to add to it. We will continue to have to ensure that it is live, which will be an iterative process, and where we can add to it and develop it even further, we will do that. We expect the first cut of the data on clinical prioritisation to be published in late summer.

Yes, we must embed that technology in our system. We built on some of that technology out of necessity. Near Me existed before the pandemic, but it was used significantly more during the pandemic than it had been previously.

The issue that you raise comes back to the convener’s question about being up front and honest with people about how access to services is provided. We will work with GPs to try to increase the number of face-to-face appointments, but the hybrid model—which includes telephone and video consultation—will be part of access to general practice.

As Ms Harper will be aware, we published the digital health and care strategy in October last year; I am sure that committee members will have seen it. That goes to the heart of what our digital ambitions are in relation to health and social care. The Public Audit Committee highlighted the fact—I am paraphrasing slightly, of course—that it would be a wasted opportunity if we did not embed some of those technological advances in our response to and recovery from the pandemic.