Chamber and committees

That is another really good question. I commend the short-life working group’s published recommendations to you, if you have not already seen them. The key issue is data, and although our data collection is relatively good, when it comes to inequalities it could be far better.

Another key issue is the development of services through co-production with the people who are most affected by the changes. The work that we are doing with patient groups, particularly in areas of deprivation, where inequality is greater, demonstrates the need to develop services with those individuals.

We now have a development group, which will take forward a number of the working group’s recommendations. I have instructed that team to ensure that we co-produce work with people who experience inequalities at the sharp end.

That is not to place an additional burden on such individuals, who have enough to deal with in their daily lives, as we all do. However, qualitative data in that regard is important. We have robust quantitative data, but the qualitative piece can add significant value.

Those are both good questions. I defer to Dr Gulhane’s expertise in that regard. He speaks from professional experience, and he has articulated well some of the safety concerns, as he rightly put it, around the sharing of data.

We often talk about data as though there is not a person behind it, but there very much is, and there may be potential implications for that individual. Again, I commend to Dr Gulhane our work in the digital health and care strategy, which outlines clearly what our actions are and how we are undertaking them. They are being undertaken at pace, as the national digital platform work is very much under way. It is under new leadership within NHS National Education for Scotland, and we are investing in it.

It would be wrong for me to say that that will be done overnight or in a matter of weeks. Some complex digital IT solutions will have to be found as the work develops. Nonetheless, going back to the point that I made to Sue Webber, I note that that is why the Government investment in that team is so important.

On the second part of the question, Dr Gulhane makes an important point. We are all aware of the importance of ensuring that we safeguard that very sensitive health information, which can relate as much to people’s mental health as to their physical health. Our digital strategy states clearly that one of the key pillars is about ensuring that information governance is “at the heart of” that work. That includes the need to ensure that the right and appropriate assessments—I am talking about data protection impact assessments and equality impact assessments—are carried out.

The confidentiality of patient medical records is at the heart of the strategy, and the need to ensure that we live up to our responsibilities in sharing such data is at the core of everything that we do. As I said, it is a key component of the national digital health and care strategy.

That is a really good question. There are a few things that we can do, but I will try to keep my answer brief.

For a start, we are investing in telephony systems. In fact, we have provided health boards with around £2 million for that. We might cover this a bit more later on, but digital access to health services is also hugely important, which is why, as part of a digital healthcare strategy, we talk about the digital front door. In future, there could be less reliance on having to rush to phone at eight in the morning, for example, and having to hit the redial button 16 times to either get or not get an appointment. That is frustrating for everybody: it is frustrating for the receptionists, who I expect are feeling quite anxious at 7:59 am, and I suspect that it is pretty frustrating for the individuals at the other end. Digital will have a real role to play in that.

I agree with all those points, and that is why the discussions that are being had with the BMA and the Royal College of GPs are really collaborative. Given the independent contractor model that we have, it is important that we keep close to our GP colleagues in relation to the terms and conditions that Paul O’Kane has rightly referenced. I go back to my answer about the short-life working group, which is meeting again next month and is looking at the very issues that Paul O’Kane has highlighted around administration, development and training. Those are very key points.

The difficulty lies with standardising things across the country. That has its benefits, for sure, but it also has its disadvantages with regard to flexibility for more rural and remote areas. That said, I do not disagree with Paul O’Kane’s substantive points.

I refer to my earlier comments. First, we abhor any abuse of any staff. It is unacceptable. Also, we know that receptionists are a vital component of the GP and primary care team, so any abuse that they suffer is unacceptable. We have heard evidence of such abuse from a number of sources, which is why the big messaging campaign in primary care at the moment is focusing on the role of receptionists.

We launched our receptionist awareness-raising campaign across Scotland on 3 March. It is aimed at the general public and raises awareness of the important role that receptionists play. If anybody here has not seen the advert, I commend it to you. We are happy to send a link to the video in our letter to the convener. It is an excellent advert that shows the various pathways that are available, and shows that receptionists are trying their best to be helpful.

Receptionists are not trying to be blockers or gatekeepers, or to be difficult. They are caring for the person on the other end of the telephone line while they are under significant pressure themselves and saying, “Actually, we think that the best route for you is X, Y or Z.” Messaging is definitely part of it. My appeal to people is to understand that, although I know how difficult it can be—it is frustrating, too, I imagine—the demand on services means that patients cannot get consultations straight away, so it can feel as though they are being fobbed off, but that is not what GPs or receptionists are doing.

We had, some years ago, a short-life working group that focused on the role of receptionists, which we will restart; it will meet in April for the first time since the pandemic. The group is chaired by Fiona Duff, who is senior adviser to the primary care directorate, and it will focus on development and the future needs of GP practice managers and admin staff. We can pick up the matter in that working group and look at the future role of receptionists.

I will try not to repeat what I have already said in too much detail. We have done the marketing and communications around social prescribing, but we might want to up the ante on that, particularly given the effects that the pandemic has had on people’s mental health. Social prescribing can play a real role in helping people overcome some of those mental health challenges, so we need to re-energise some of the national communication on it.

I hope that, as the expansion of the MDTs eases the workload pressures on GPs, they will have the time to explain to individuals that social prescribing is not about being fobbed off or passed on but that there is real value in what a community links worker can do. It is really valuable to have them embedded as part of the team. We have work to do on that, but it is the right way to go. Indeed, that is why we have committed to having 1,000 mental health workers in GP practices in the future. There is real value in those individuals connecting with services in the community.

There is more to do on that, and perhaps we need to think a little bit more about the national messaging with regard to the value of social prescribing.

I can absolutely see the argument that is being made; Sandesh Gulhane articulates it well. The difficulty here is not the mechanism because, ultimately, it is possible to do that if there is a desire to do it.

However, when we talk about the 1,000 additional mental health workers, they could include various different workers. A GP practice might not need an additional community link worker; they might prefer to have somebody who has specific mental health expertise. We must be cognisant of the fact that there are workers with different specialities in different practices.

The second thing is that, if we impose a national structure, will that remove the flexibility that is required in various localities, including in our island and rural communities? Is that a trade-off worth making? The answer to that might well be yes, and we are exploring that in committing to an additional 1,000 mental health workers. We just have to be careful that we do not remove local flexibility entirely. However, I take Dr Gulhane’s point and I assure him that it is all part of the thinking and development of the additional 1,000 mental health workers that we are committed to.

I do not think that there is any magic wand or magic bullet, but communication is certainly part of the approach. The more we can give people access to social prescribing, the more they will see its value as individuals, and they will then—I hope—let other people know about the benefits by word of mouth. Clearly, we will do what we can. In a previous answer, I said that there might be a role for more national messaging, and we could perhaps link with the third sector on some of that. However, when people hear stories about those who have experienced these benefits, such as the one that Emma Harper articulately put across, that sort of thing speaks volumes compared with what a Government marketing campaign can do, although maybe there is something that can be done on case examples. Those stories and personal experiences are hugely important.

I have mentioned our expansion of mental health workers, which absolutely could include community link workers, but could go even broader than that. As more and more of those individuals get embedded in GP practices, more and more people will have access to them, will—I hope—benefit from them and will speak to others about the positive impact on their lives.

The point is well made. If the regulations are passed by the committee and Parliament, we will ensure that there is good education and public knowledge about them before they come into force in September. There would be time for us to ramp up the communications around them, which it is really important for us to do.

I take Sandesh Gulhane’s point that people might not be paying attention to the voluntary ban that is in place. If someone is smoking, even if there are pictures of sick children on signs that say not to smoke, because the smoke potentially drifts up to their room, that is where the enforcement element could be quite crucial. If you end up paying that fixed penalty of £50, it is a really expensive fag to smoke. When the regulations first come into force, some health boards, in conjunction with local authorities, might choose to ensure that they are clamping down on those who are ignoring them.

I would expect there to be a sensible approach to enforcement, as there has been throughout the pandemic. Enforcement of the ban would not be heavy-handed to begin with but, if people ignore it and continue to ignore it, that option of a fixed penalty exists. Across the country, we may well see some people being hit in their pockets and realising that this is something that has to be done—it is not voluntary. I hope that the vast majority of individuals who smoke will understand the change in the regulations through our communications and will comply.

I have no remarks to make.

Motion moved,

That the Health, Social Care and Sport Committee recommends that the Prohibition of Smoking Outside Hospital Buildings (Scotland) Regulations 2022 be approved.—[Humza Yousaf]

Motion agreed to.