Chamber and committees

Again, I can be relatively brief. All the points that you have made are priorities for us. There is recognition that the sharing of information and data is crucial to ensure that people are not passed from pillar to post, which relates to Sue Webber’s earlier point.

I have just double-checked the details, and the digital health strategy is clear about how important cloud-based architecture could be. Again, I commend the strategy to anybody who has not seen it. Details of the national digital platform are on page 18.

We do not necessarily need a single product, which could take a lot of time and considerable investment. It is the integrated approach to cloud-based digital components and capabilities that will play an important and significant role in the data sharing that Stephanie Callaghan talked about.

Investment has been made, and it has to continue to be made, because the issue is not without financial implications. Some of the work is already under way, but it is incumbent on me, in my role, and the Government to accelerate that work, given the challenges that the pandemic has created and will, I am afraid, continue to create for our health service for many years to come.

Yes, I can, if that is not management information and it can be published. Even if it is management information, we will find a way of ensuring that it is quality assured and that we can publish it. I am happy to write to the convener, who will be able to pass on the information.

Paul O’Kane knows our commitment to increasing the head count. He is right to point out that difference. It is a significant target. I go back to the point that I made to Sue Webber and others: it is just one part of our strategy for ensuring that we have a sustainable GP service in primary care. Retention will be a key part of that.

Again, I am probably prejudging the findings of the review that will come through, but we tend to leave how local community link workers work and interact with the third sector and community groups to the link workers themselves and their expertise, as well as to the general practice that they work in and the other members of the multidisciplinary team whom they work with. There is not some kind of standardised, one-size-fits-all top-down approach where we say, “Here’s what we think you should do, and here’s how we think you should do it.” We have to have that local flexibility, because what works for the community link worker in my constituency in Pollok is not necessarily going to work for a community link worker in Peebles, Perthshire or somewhere else beginning with P that is not Pollok. Retaining that local flexibility is clearly important.

What we are hearing back—and I think that this is central to your question—is that people want to know how we are monitoring the impact of link workers. I would say that we probably have a bit of work to do at a national level on monitoring that impact in greater detail.

Yes. As I understand the situation, it is also the position in England that NHS trusts can bring forward recycling employers contributions schemes. You are right to point out that that option exists in England and Wales, which is why I am actively considering it.

However, I also have to think carefully about the financial impact on the Scottish Government of that support for a group of clinicians who work incredibly hard but are, we would all accept, at the higher end of the pay scale. What about the people who are at the lower end of the pay scale? We need to remove disincentives, but we should also put money and resources towards the people at the lower end of the pay scale, which is the progressive thing to do.

I am certainly not ruling out introducing a REC scheme. In fact, far from ruling it out, I am doing the opposite and am actively considering it. I expect to be able to say something more on that in the coming months; it should not take longer than that. We are in the middle of discussions on pay for agenda-for-change staff and we are waiting for recommendations from the review body on doctors’ and dentists’ remuneration. We are at a really important juncture when it comes to discussions around pay and terms and conditions, but the REC scheme is being actively considered and discussions on the scheme and its effects are on-going with the Welsh and UK Governments.

You make a good point about ALISS. I did not get to see the evidence sessions, but I read the evidence that you took, and what came across clearly is that although ALISS had the potential to be a really important tool, it was not being updated enough and its functionality could be better. That feedback from the committee’s evidence sessions has been really helpful to us in that respect.

ALISS is a great resource. It includes more than 5,500 services that are available from more than 800 organisations, so it has a significant amount of detail, and it was searched more than 26,000 times in the three months from October to December last year. However, we recognise that some work needs to be done on what is an important tool. Indeed, some of that work is being done at the moment. Work to enhance the performance and accessibility of ALISS is being undertaken by the alliance, and we hope that that will be finished this summer.

That is a good point, and I will say two things. Although there is a potential fixed penalty if someone does not comply, we hope that the introduction of the regulations, if they are passed, will enact behavioural change. I think that the vast majority of people will behave responsibly and make sure that they are outwith the perimeter if they want to smoke.

The second point is important—I agree with Paul O’Kane that we will keep the issue under review. In the local government settlement, there is baseline funding of £2.8 million for Scotland’s local authorities to support measures that relate to tobacco control. There is baseline money there, so we do not think that there is a need for additional funding—certainly that need has not been articulated to me by COSLA. However, I will commit to keeping that under review, as Paul O’Kane has requested.

Yes.

The short answer to that is yes. We already have the voluntary ban in place for NHS hospitals—I should point out that it is NHS hospitals that we are talking about here—and it is perhaps easier to turn that voluntary ban into something statutory.

The problem is probably more acute in our hospital sites, given their size and scale. It is maybe less pronounced in a GP surgery, for example. I am not saying that it is impossible, but you are less likely to come across somebody smoking at the entrance of your GP surgery than at a hospital site.

I am definitely open minded about that suggestion, but I hope that members understand the logic behind progressing with this step first.

Thank you very much, convener, and thank you for letting me stay on to talk about these important regulations, at the heart of which lies the proposal to set up no-smoking perimeters around NHS hospital buildings.

As we will all agree, hospitals should be places of health promotion, where healthy ways of living are demonstrated, and environments in which people are protected from harm and are supported in making positive lifestyle choices. Unfortunately, though, it has become commonplace to see patients, visitors and, at times, staff standing and smoking close to hospital buildings and their entrances, despite an existing voluntary ban on smoking on hospital grounds. Those entering and leaving buildings, some of whom are vulnerable and very unwell, might have to walk through smoke, and there is no means of reproaching those who ignore the request not to smoke.

Our current tobacco action plan, “Raising Scotland’s Tobacco-free Generation”, confirmed our intention to progress the work that is needed to introduce a mandatory ban on smoking near hospital buildings. The regulations support the existing voluntary ban by introducing fixed penalties and fines for those who smoke near hospital buildings or who allow others to smoke there. By effectively extending the successful 2005 ban on smoking in enclosed public spaces to areas outside buildings, they reduce the risk of exposure to second-hand smoke near entrances and windows and prevent smoke from drifting into hospital buildings, ultimately protecting those, particularly the vulnerable, who use hospitals. Because smoke from a single cigarette can be detected from at least 9m away, and because weather conditions and wind speed can cause further drift, we propose a perimeter of 15m, focusing on the high-traffic areas where people leave and enter buildings.

Just like the indoor smoking ban, the regulations are primarily about behaviour change. They denormalise the act of smoking by making it socially unacceptable to smoke near hospital buildings, and they reinforce the NHS as an exemplar of health promotion. Smoking can be a hard habit to break, and people are advised to seek support in doing so. Anyone smoking within the perimeter could receive a fixed penalty of £50, and any individuals who are taken to court could be liable to a fine not exceeding £1,000. Those who manage and have control of the no-smoking area are responsible for ensuring compliance, and should they knowingly permit someone to smoke there, they could be fined up to £2,500.

We will ask health boards and those who manage and have control of the area to work with local authorities on enforcement initiatives and arrangements to ensure compliance. The Scottish Government will provide all signage for hospitals, prepare information and ensure that everyone is aware of the change before it is introduced.

Every year, tobacco use is associated with more than 100,000 smoking-attributable admissions and, unfortunately, 9,332 deaths—in other words, one fifth of all deaths. It contributes significantly to Scotland’s unfair and unjust health inequalities as both a cause and an effect.

Smoking rates have reduced from 31 per cent of the adult population in 1999 to 17 per cent in 2019, but we still have some way to go if we are to meet our ambition of 5 per cent or less by 2034. When asked, 66 per cent of smokers say that they want to quit, and I also note that a clear majority—over 70 per cent—of respondents to the 2019 consultation on the regulations support the proposals and see the benefits of removing tobacco smoke from NHS properties. It is now time to make that a reality.

I am happy to take the committee’s questions.

On the point about serious financial investment, our £360 million investment to deliver those multidisciplinary teams is a sign of the importance that we attach to this, so I hope that we would meet that ambition.

I also know—as do Carol Mochan and the rest of the committee members—that the past two years have been absolutely unbelievable in terms of the pressure that everybody across the national health service and social care has faced. If we did not have a pandemic, I do not doubt for a minute that we would be able to use more of our communications muscle and the weight of the Government to get some of those key messages out. All that being said, I take Carol Mochan’s point that, during a pandemic, it is perhaps even more important to be doing that.

On people feeling that they are being passed around, that is something that I hear too and, again, it is a fair comment. From our perspective, that is why we have worked and are continuing to work on the digital health and care strategy. The strategy is available online and I am certain that members will have seen it—if you have not seen it, I recommend that you look at it. It lays the foundation for that cloud-based architecture where information can be shared a lot better than it currently is. We know that that area still needs significant improvement.

I think, though, that with the embedding of community link workers, for example, the sharing of information about a patient is better, so that people are not passed around as much, whether that relates to third sector support, primary care, or secondary care.

It is extremely important that the interface between primary and secondary care is working. Every time that I meet the BMA and RCGP, they stress to me the importance of that interface working, so that people are not passed between primary and secondary care—which, in fairness, is a bit of an artificial boundary that we have created as opposed to a boundary that means anything to patients, who just need to receive treatment or diagnosis or care for the condition that they have.