Chamber and committees

Deputy convener, you wanted to avoid a conceptual discussion and then went to Dr Allan, of all people—I say that tongue in cheek, of course. The question is a very pertinent one. I meet regularly with the chief executives, chairs and public health directors of health boards and of course that includes NHS Western Isles. We will show leadership, but the challenge is not just me communicating my expectations to the health board. There is a whole level of management below that that will be crucial. That gets to your point about the culture—with a small c—within health boards. I expect senior management to be very close to the people on the ground. That may be easier to do in slightly smaller health boards. I expect that it can be done in larger health boards too, but it can be more challenging. It will be challenging in rural health boards the scale and size of NHS Highland, for example.

We rely on every part of the management structure understanding what my direction is as health secretary in this regard. Being up front about it, I think that the challenge has been that the vast majority of the conversations that I have had with health boards have, as you can imagine, been about the immediate pressures of the pandemic and our recovery from that. I am very keen not to lose sight of that when we get into some more of the detail about recovery, which of course we are absolutely doing. Maybe it will be worth while considering how I bring Angus Robertson and some of my other cabinet secretary colleagues into those conversations with chief executives and chairs of health boards. Dr Allan raised an important point, and it is one that we can make further progress on.

First, as my colleague referred to, we are not starting from base zero. It would be wrong to suggest that there has not been progress since the Christie commission 11 years ago. If you wish, I can give you numerous examples of inroads that we have managed to make in relation to outcomes from preventative spend. [Interruption.] Sorry, I am getting a bit of interference from somewhere.

We can give you those examples—I am happy to provide the committee with examples either now or in writing.

Community link workers are a such an example. We have 200 community link workers in or aligned to a GP practice or a GP cluster, so we are not starting from base zero. We talk about the 1,000 additional mental health and wellbeing workers. Every GP practice will have access to one of those workers, who will build on the good work of the 200 that we already have in place.

Secondly, we have the NHS recovery plan, which covers the parliamentary session. I am saying now very clearly that we will embed social prescribing as part of that, and of course culture and the arts will feature.

Then we have national leadership, which relates to the question that Dr Allan asked me. If I and the Government provide that leadership collectively, making clear our expectations of health boards, integration authorities and local authorities in relation to the importance of this agenda to our health and wellbeing—particularly focusing on and providing the necessary funding for key areas such as mental health, including young people’s mental health—I think that we will continue to make transformative change.

You are right to ask about budgets. I know very well the saying, which we hear often, “Show me your budget and I will tell you your priorities.” A record £18 billion is going into health and social care in the next financial year, and I am very keen to use the weight and muscle of that budget to support the outcomes that we have discussed.

That is a really good question, and it is not too dissimilar to a question that I have just had at the Covid-19 Recovery Committee and which was based on evidence from GPs and the staff-side representative organisations that represent them. The very clear message was that we needed to improve our primary care data. There is no getting away from that; indeed, I have been saying it from day 1 in this job. We also have to bear in mind the independent contractor model that we have for primary care, which is different to our NHS acute services model, and we have to work with those information technology systems to extract data far better than we are doing at the moment.

There is a project under way that has received some funding assistance to help us extract far greater data than we currently have. One good thing is that close to 95 per cent of GP practices participated in the initial extraction of data; that data has come to me, and once we have had it quality assured and so on, we will publish it. It is absolutely right to highlight this as a key issue. If you were to try to extract data on, for example, social prescribing, you would find it patchy. It has to be improved.

Yes, I agree. You are right: I could give you tens of examples of where that is done well across the country, but the question is whether it is being done more systemically. This might sound like a perverse thing to say in the middle of a global pandemic, but there is an opportunity to fundamentally shift how we do that work.

Community link workers and the 1,000 mental health and wellbeing workers whom we have committed to providing by 2026, so that every GP practice has access to them, are key. They already play an excellent role. I have a really good relationship with the community link worker in my constituency. They are invaluable, given the connections that they provide to various community initiatives, cultural programmes, art programmes and art therapies. The trust that GPs have in that community link worker is heart warming and evident to see.

We have to do two things. First, we need to invest in community link workers and mental health and wellbeing workers. Secondly, we need to think about how we ensure that such work is a continual thread throughout our recovery process—Angus Robertson and I spoke about that at a recent engagement—and I am very open minded about how that could be done. The paradigm shift will come from the community link workers plus the additional mental health and wellbeing workers whom we have committed to providing.

Good morning, convener. I hope that you and committee members are keeping safe and well. I can be very brief.

I thank the committee for its invitation to appear alongside my colleague Angus Robertson. When considering our budgetary decisions, it is important that we set them in the context of the health and social care portfolio’s key priorities and key challenges. I have just come from another committee of the Parliament, where I reiterated that it would be fair to say, from my conversations with health boards up and down the country, that this week is the most challenging week of the pandemic—if not the most, then one of the most challenging weeks. The feedback that we are getting is that it is extremely challenging. Of course, that is in the context of the past couple of years of this pandemic.

As we look forward, we need to reform the NHS and social care. How we do that and how we recover is clearly set out in the NHS recovery plan. NHS boards are facing a population with the cumulative effects of the last two years and all the health implications that come with that. That population is, thankfully, living longer, but that means that they have more complex needs. Maintaining current services while clearing the pandemic backlog and dealing with levels of staff absence are accumulative challenges.

We also need to develop the national care service, which will require significant investment. I do not say that because I do not acknowledge that the health and social care portfolio has the largest budget in Government, but because we have to think about that recovery in a way that is bold, radical and transformative.

I believe that culture and the arts can play a role in that. Just as we know that physical activity can increase our mood, help with sleep, and reduce stress and anxiety, undertaking cultural and arts activities can undoubtedly have a range of benefits. Bringing people closer together helps to reduce isolation. There is a clear potential for grass-roots community intervention such as the craft cafe in my own constituency in Govan.

I am keen to explore the benefits of broader health and wellbeing activities, including the role that culture can play, as part of our work on social prescribing. I am sure that we will get into the detail of that. Our 2021-22 programme for government made a commitment that, by 2026, every general practitioner practice will have access to a mental health and wellbeing service, which will help to grow community mental health resilience and direct social prescribing at a grass-roots level. The committee will be aware that, in October, we launched the communities mental health and wellbeing fund for adults, which has now been increased to £21 million. Although local third sector interface partners are still processing awards, we certainly expect that grass-roots cultural activities that contribute to community wellbeing will benefit from that fund. There is a range of examples. Again, I will not go into the details here about how that is already happening.

I will conclude. While my overarching focus must be on revitalising our NHS and social care as we recover from the pandemic, I see the benefits that cultural activities can bring to people’s physical and mental health not as a bolt-on but as an important and integral part of the recovery and transformation. We will certainly work together closely and have already had constructive meetings to see what more we can do to promote culture and the arts in our recovery and the renewal of the NHS and social care.

Having had a conversation yesterday with the screening team, I know that the position in Scotland is different from the position in, for example, England and Wales. Therefore, we are looking to see how we can quickly resume the self-referral process. I hope to do that and to be able to say something more on that in the coming weeks. We must bear in mind that allowing self-referral for those aged 71 and over could cause slippage between screening cycles for those in the 50 to 70 category, but we might judge that the benefit of allowing that self-referral outweighs that risk. That is the conversation that we are having and which I had yesterday with the breast cancer screening team.

I agree with that. I acknowledge that Brian Whittle has a long-standing interest in that area and has advocated for a preventative model of healthcare. A preventative approach is incredibly important. Many years after the Christie commission, we invest heavily in that space, but we could definitely do more.

Education can play a role in prevention, as can social prescribing, which we are looking to expand. I mentioned the community link workers that we have in place. We have also committed to providing 1,000 additional mental health support workers, whom every GP practice in Scotland can access for assistance with social prescribing. The ability to do that is incredibly important.

Sport plays a huge role in that respect. I recently had a really good meeting with the Scottish Football Association on how we can use Scotland’s most-loved sport, and the grass-roots network of football clubs across the country, more strategically to address some of our health aims as we move forward. We are doing a lot in that space, but there is plenty more that we could do.

Brian Whittle is correct to say that there is an opportunity, although it comes from tragic circumstances, to improve our public health outcomes.

I did not know that.

I would like to see an increase in face-to-face consultations, but as part of a hybrid model. That is where I agree with Dr Buist, Dr Shackles and many others who represent GPs and GP services. I do not think that anybody, including anybody round the table, would suggest that GPs have not been working hard throughout the pandemic. They have.

We need to make improvements on data. I know that committee members asked questions about that during the inquiry. We are working on a project to get better data extraction from primary care. I have seen the first cut of that data extract, but it needs to be quality assured and so forth. I promise the committee that it will be published as soon as it has gone through that appropriate process. However, the first cut of the data is unsurprising in that it shows that GPs are working incredibly hard, but as part of a hybrid model.

I think that that hybrid model should remain. I contacted my GP a number of months ago, and it was much more convenient for me to be able to telephone, have a video consultation and pick up my eczema cream at the pharmacist. That saved me a journey to the GP’s clinic and the time that would have been involved in that. We want to see an increase in face-to-face appointments, but as part of a hybrid model.

What Murdo Fraser hears anecdotally from his constituents and what I hear anecdotally from mine is also something that I hear from nurses in admission wards in acute hospitals, for example. There is more to do to increase the number of face-to-face appointments, but we have to recognise that GP practices are still operating under really difficult infection prevention and control conditions.

I am happy to do that. Again, though, I would highlight page 18 of the strategy, which refers to a national digital platform. As you have rightly pointed out, we are not talking about a single product but about a collaborative and integrated approach to delivering cloud-based digital components that will allow us to share data in a way that we might not have been able to thus far. I am certainly more than happy to have that discussion offline, Mr Whittle, if you wish.