Chamber and committees

You are right, of course, to couch that question in terms of those pressures. I hope that I am not speaking out of turn by saying that, in the conversations that my officials and I have had with health boards this week, many of them gave us the consistent message that they feel that this week is probably the toughest week that they have faced in the course of the pandemic.

We have not had today’s numbers of those in hospital with Covid—they have not been published yet—but yesterday’s number was just under 2,000, and we can add to that a high level of delayed discharge. Yesterday, I talked to the Glasgow health and social care partnership, which is unable to discharge people to care homes, given the scale of the outbreak. If we add to that staff absences and the accumulated pressure, it looks like this week is shaping up to be, if not the worst or most challenging week of the pandemic from a health service perspective, certainly one of the most challenging.

With regard to routine screening programmes, all adult screening programmes have resumed safely. However, although they have restarted, it is fair to say that they are playing catch-up in some respects. Breast cancer screening has restarted, and, of course, anybody with signs or symptoms of breast cancer should seek screening.

We have taken action to address our screening capacity challenges. On cervical screening, we are having to clinically prioritise higher-risk participants in non-routine pathways. Bowel cancer screening has resumed and new home testing kits have been sent out. That programme is generally operating in line with pre-Covid performance. The triple A—abdominal aortic aneurysm—screening has resumed, and men in the highest risk cohorts are being prioritised. Diabetic eye screening has resumed and is targeted towards those with the greatest risk of developing diabetic retinopathy. Therefore, screening has resumed, but there is clinical prioritisation, given the backlogs and capacity constraints.

I am shortly due to meet NHS Fife, local government and the local health and social care partnership. Nicky Connor and her team at NHS Fife do an excellent job. I had very helpful conversations with them about delayed discharges last autumn and winter. We were going in the wrong direction, but we managed to pull that back. However, I am afraid that, because of the most recent wave of the pandemic, we have begun to go in the wrong direction again. I will consider the specifics of the question and raise those issues directly with NHS Fife.

We know of the pattern that Alex Rowley has mentioned in relation to palliative care, and we know that more deaths have occurred at home throughout the pandemic; further investigation is needed on that.

We have committed to producing a palliative care and end-of-life care strategy to ensure that people and their loved ones get the care and support that is right for them when they need it most. To help inform the strategy—because I think that some of the data could be more robust—the Scottish Centre for Administrative Data Research is already undertaking research to investigate home deaths during the pandemic. That work will help us to understand what strategy we should develop, so that we can understand more clearly the causes of the shift in place of death during the pandemic and whether that will be a long-term trend. If so, we need to ensure that the appropriate structures and, where necessary, the appropriate funding, are in place. That answers the more general part of the question, but I will take up the specifics with the appropriate partners in Fife, whom I am due to meet relatively soon.

Patient confidentiality is clearly working very well, because I was not told that.

I was seeing Dr Shackles and some of the rest of the team at the Taymount surgery, and they have done exceptionally well. They are part of a group that also has a surgery in Scone, as Murdo Fraser will know. They told me that they have had challenges even though their surgery is a relatively large one. Other surgeries are much smaller, such as my medical practice, and their ability to see people face to face has been even more constrained. As we recover from the pandemic—we are recovering and will recover—we will need to look at a hybrid model, of which telephone consultations, video consultations and increasing face-to-face consultations must all be parts.

Dentistry has been hit really hard because of the nature of the aerosol-generating procedures that are undertaken and the infection prevention and control measures around that. Again, it is recovering, but that will take time, particularly as we continue to have the IPC measures in place.

Many of the patient pathways give me concern, but the one that gives me the most concern—I suspect that I am not alone in this among those who are round the table—is probably the cancer pathway. You heard, again, compelling evidence from a range of organisations that represent those with a variety of cancers. We have evidence that there are some 5,000 so-called missing cancer patients from 2020. During the first nine months of the pandemic, 2,681 patients were diagnosed with breast cancer, 1,958 patients were diagnosed with colorectal cancer and 3,287 patients were diagnosed with lung cancer. Those numbers are, respectively, 19 per cent, 25 per cent and 9 per cent lower than would have been expected in that period if Covid had not happened.

There are a range of pathways that I am concerned about, but cancer causes genuine concern, and that is why it is such a priority for the Government.

They would say the same, I think.

First of all, convener, I apologise for being slightly late. In view of the fact that I am slightly late, I am more than happy to pass back to you and go straight to questions and answers so that we have as much time as possible for that.

I will say a few things about that. First and foremost, I welcome the committee’s inquiry into the matter and its detailed analysis. I have had time to read over and, when I have been able, listen to the evidence that you have taken. It has been a reminder for every person around the table of how sobering the data is and how every person in Scotland has been touched in some way by tragedy involving Covid. That could be anything from an individual in a family who has suffered from long Covid right through to people who have been bereaved by Covid. People talk a lot about statistics and numbers in the committee, and with good cause, but I remind everyone that, behind each of those statistics, there is a human tragedy.

We know that, since the start of the pandemic, there have been 12,140 excess deaths from all causes. That figure is 11 per cent higher than the five-year average, which demonstrates Covid-19’s impact. Over the same period, there were 13,429 deaths involving Covid, and Covid was the underlying cause of 11,443 of them—85 per cent of all the deaths involving Covid. Therefore, the excess death measure during the pandemic clearly demonstrates Covid’s impact.

On how the pattern changed in the latter half of 2021, I strongly associate myself with remarks that you heard in previous evidence sessions such as those by Dr Lynda Fenton, who is a public health medicine consultant at Public Health Scotland. She recognised that, in view of the breadth of the situation, it is likely that there will have been health service factors—I am certain that we will get into that in the committee discussion—as well as factors that are related to the determinants of health. Peter Hastie from Macmillan Cancer Support—I have a lot of time for him as an individual and for Macmillan Cancer Support—made the undebatable point that people with cancer are being diagnosed later than they were before the pandemic. That is also a factor in the figures.

In the latter half of 2021, the vaccination programme was well into its stride, and there is no doubt that vaccines have played an important role against the severest impacts of Covid and, of course, Covid mortality. That might be demonstrated in the figures, too.

Professor Leitch might want to add something to that, given his clinical expertise in the area.

You will remember that one of the things that the First Minister made clear in her announcement is that testing for health and social care staff will remain, including the testing of asymptomatic individuals; that will not change.

As we move from the transition phase to the steady state, might that have an impact on staff absences? Potentially, but the biggest impact will be if we can control transmission. The more that we can control community transmission, the more impact that will have on staff absences.

The general number of staff absences sometimes masks the detail. If we look at staff absences that are not just related to Covid but related to those who are testing positive themselves, we find that we have unfortunately seen rises in the past few weeks—that is the case in the community, too—which have exacerbated the pressure that we were already feeling.

I can give you a very brief reassurance that the cabinet secretary and I discussed the national care service and that very issue. I return to my point that such matters should not be seen as a bolt-on. We are much better to include consideration of the arts and culture and the health and wellbeing benefits that people get from them at the inception stage rather than towards the end.

On social care, Angus Robertson was absolutely right to reference the point about local authorities. Right across the country, our integration authorities are already doing this work, and many of them are doing it very well. The challenge for us is that sometimes there is inconsistency across the country, and the national care service might be able to help with that. However, it goes to the very core of the original question about the preventative space. By way of reassurance, I can say that that is absolutely being considered as part of the national care service.

I thank Jenni Minto for a very important question. I think that there is a lot in this space. Our approach thus far to using culture and the arts as a very important social prescribing tool has been largely through grant funding local initiatives, and it is working very well. Part of the learning—and it is part of the challenge that the deputy convener put to me—is how we do it in a more systemic way. That is where the conversations between Angus Robertson and me are very important.

Where the public can get significant benefit is in the mental health space, particularly but not exclusively among young people. We know the challenges that we are facing with child and adolescent mental health services and the backlog. I would be the first to say that there were issues pre-pandemic that have been exacerbated by the pandemic.

Going back again to the points about Christie that you and the deputy convener have raised, we want to look at the preventative; we want to look at how we can stop people getting to the crisis point. When they get to the crisis point, of course CAMHS will be there to assist, and we have to clear that backlog, but—this goes back to Angus Robertson’s point—where we can scale up good initiatives, such as some of the work that we have funded, we should do that.

Again, I hold my hands up and say that the Government can sometimes suffer from pilotitis. We need to be able to scale up some of those good initiatives and do that in good time. If the pandemic has taught me anything—it has taught me a number of things, frankly—it is that, if there is a will to move quickly, we can move quickly. That might mean that we do not quite get it 100 per cent perfect first time, but in the benefit risk analysis, going quickly and scaling up quickly can have real benefits. I definitely think that there is a lot in the mental health space. I could talk to many other areas, but I am conscious of time. I think a particular focus for us in this space will absolutely be mental health and, in particular, young people’s mental health.

I am keen to look at that evidence, and I will give serious consideration to it and all the committee’s evidence.

It is right that we take a cross-Government approach to the work. Since I have been health secretary, for the past 10 months, I have made it clear to my officials and to colleagues across Government that we are not fortress health—we will not put our arms around what will now be an £18 billion budget and try to protect it just for ourselves. We absolutely understand the need to work across Government. Such work has undoubtedly been done previously, but we want to expand on it.

In his role in Government, the Deputy First Minister brings Cabinet colleagues together regularly—trust me, if he has a sniff of siloed working, he is quick to ensure that that is dealt with—and we are working more collaboratively, with more cross-Government and cross-portfolio working, than at any time before now. That is a positive.

We might be able to go into this more throughout the meeting, but I could give numerous examples of really good projects that are being funded by the health service—a lot of the funding comes from our mental health budget—in relation to arts therapies and community initiatives that help people, particularly young people, to deal with mental health issues.

When budgets require to be shared—that is a strange way of looking at it, because we are one Scottish Government—we will absolutely use the might and the muscle of the health budget to help. Yesterday, I think, the national partnership for culture published a really good report that includes a number of recommendations about funding and funding streams. I give a commitment to look at those recommendations with an open mind.