Chamber and committees

That is probably the most crucial question that we are dealing with at the moment. This Government has progressed the preventative spend agenda for a number of years. It was core to the Christie commission report, which is as relevant today as it was when it was published.

We can do everything that we want to do in health but, if we operate in a silo, we will not make the difference in people’s lives that we want to make. We have to make sure that we are working with our colleagues—which we are—across the education, social justice, justice, housing and economy portfolios.

The work that the Deputy First Minister does in bringing us together, at least weekly, with a laser focus on, for example, child poverty targets, helps us to work in a way that is even more collegiate than was previously the case. That will both help us as decision makers and have an important effect on outcomes for those who have, regrettably, fallen through the cracks between the various systems and been passed from pillar to post, which is not acceptable. Good joined-up working is taking place between various portfolios.

Good morning, convener, and good morning to all members who are present. I hope that you are all keeping safe and well. Although I am pleased, as always, to appear before the committee, it is a shame that the session has to be done virtually because of the constraints that are on us. I look forward to being with you face to face.

You asked a really good question, convener. The budget that we have put in place helps us to build on the manifesto commitments that we have already achieved this year. It is important to recognise that, in the first 100 days, we made an incredible amount of progress in meeting our manifesto commitments, including abolishing dental charges for people aged under 26.

We have gone beyond what we promised to do in the first 100 days—for example, we have introduced the paramedic bursary, which members across the committee were very supportive of, and we have put in place the first steps for the national care service. I will no doubt come back to that. We managed to bring forward many other commitments in the space of 100 days, including the pay rises for not just agenda for change staff but doctors and dentists.

There is a lot that we have done in this financial year that we hope to build on in the next financial year, and the budget goes into great detail on that. One of the key, significant reforms that we hope to progress will undoubtedly be the national care service. That will be the biggest public sector reform in the devolution era. We hope that that will be fully operational by the end of the parliamentary session, so we are putting in place the appropriate building blocks for it.

Crucially, we have funding in the budget to help us to progress with the national recovery plan, including the increase to health boards, which I can go into detail on if necessary. That will help to drive the recovery. We need to make sure that we recover as well as deal with the effects of the pandemic.

A lot of resource is going into capital. Members can see some important projects in the capital allocation, such as Parkhead health centre and the Baird and ANCHOR—Aberdeen and north centre for haematology, oncology and radiotherapy—project, and the money to progress the replacement for Monklands hospital, which is also much needed.

I am sure that we will get into the detail of this, but the big uncertainty continues to be the UK Government’s lack of transparency in relation to Covid funding. We desperately need certainty on that because, as we all know, we are not yet through the pandemic. This meeting being conducted virtually is testament to that.

I wish that I could, convener. That is exactly the point that you are making. I will not delve too much into what happened last week, but it was extremely poor that those kinds of silly political games were being played in the midst of a global pandemic or, certainly, at the foothills of another wave. When the First Minister got to her feet, there was a press release from the Treasury that claimed that there would be new money, but it was nothing of the sort. Indeed, there was a potential reduction in the consequentials that are coming our way. Those consequentials are vital, as you have rightly said, in dealing with the effects of the pandemic and for the crucial tools that we have in our armoury against the virus, such as vaccinations and test and protect.

On the UK Government spending review, the Covid consequentials were far less than we had expected, given how much has already been spent on fighting the virus and the fact that the virus has not yet gone away. We desperately need certainty from the Treasury about the amounts of money and how the money will be spent. As members can imagine, I push the Secretary of State for Health and Social Care on those issues in my regular four-nations calls, as do the Welsh and the Northern Irish. In fairness, he is always constructive in those conversations, but there has been no clarity forthcoming, which is deeply concerning.

I do not know whether Richard McCallum wishes to add to that. He is involved in discussions with finance colleagues at an official level.

I do not think that we are giving distinction awards. We took a decision not to do that. Richard McCallum might want to provide further clarity.

Paul O’Kane uses the 48p figure—I appreciate that if I were in his position, I might end up doing the same. However, if we look at what that pay increase means for an adult social care worker over the course of a year, it is not to be scoffed at. We are talking about just shy of an additional £1,000 a year. That is not the only pay increase that we have introduced as a Government or that I have introduced as health secretary. It comes on top of an additional pay uplift from £9.50 to £10.02, which of course was then increased to £10.50.

As we continue to be in the budget process, if Paul O’Kane believes that funding should increase social care workers’ pay to £12 or £15 an hour, for example—I am not sure what his current position is—we would have to find that within the allocated budget and such increases do not come cheap. I know that Paul has previously called for an increase to £12 per hour; that would cost £420 million per annum. If we took it to £15 per hour, it would cost £1.3 billion and, once improvements to terms and conditions were factored in, it could cost up to £1.6 billion. Those are not small numbers.

I absolutely take the point that our social care colleagues—those in adult social care in particular—need to be recognised and valued and that is why we have ensured that they get a pay increase and a pay uplift. When it comes to any addition to that, let us have that discussion but let us be up front about where that money would come from.

In all honesty, I think that those two aspects are linked. We can help people through Covid with the various spends that we have already put in the budget. Vaccination is an example. We know from the data that vaccine uptake can be at its lowest among those in the most deprived areas. When we deal with preventative spend by focusing on child poverty and early intervention, that can help our vaccination efforts not just in the current pandemic, but in ensuring that we are prepared for whatever the next pandemic might be. It is important that we do not see those two aspects as distinct and separate; I know that you do not.

With regard to protecting spend, it would be fair to say, looking at our budget in detail, that it delivers on the commitment to direct 50 per cent of front-line spend towards community health services and progresses our commitment to increase primary care funding by 25 per cent. We have a good basis on which to build. I agree that, with regard to current pressures versus what are seen as preventative measures, it is difficult to get the balance right, but I try not to view those two aspects as distinct and separate. Our investment in preventative measures will also help us to deal with the pandemic.

That is a fair question, convener. As we have recognised already, the health and social care medium-term financial framework will have to be updated in the light of Covid and other significant changes, such as our work towards a national care service. The framework considers available resource and demands but, obviously, it does not set our budget. Our budget is informed by key policy priorities and the national performance framework, to ensure that commitments and linked budgets ultimately contribute to the delivery of desired outcomes.

A recent study by the London School of Economics and The Lancet suggests that 4 per cent real-terms growth in healthcare costs is to be expected, to ensure improving quality of care and terms and conditions for the health and care workforce. That is very much in keeping with the assumptions that underpin the current medium-term financial framework. I have no doubt that that, as well as other independent research, will inform our view. However, there is no doubt that, given the pressures and challenges of Covid, we will have to look at that medium-term framework once again.

As I am sure Sandesh Gulhane knows, NHS Ayrshire and Arran remains at level 3 on the escalation framework, which is a serious position for it to be in. That is specifically in relation to financial management. As you would imagine, we continue to act in line with level 3 escalation, and we are undertaking scrutiny and the provision of support in line with that framework. Of course, financial recovery remains a priority for those boards, and the focus has been on the response to the pandemic, which has undoubtedly impacted on their financial recovery plans.

We maintain a regular dialogue with NHS Ayrshire and Arran. As you can see from the budget for 2022-23, it is in receipt of additional funding, but we have put in place additional monitoring for that board and the other escalated boards to ensure that appropriate steps are taken in terms of cost improvement and efficiency in advance of 2022-23.

I remain concerned about NHS Ayrshire and Arran and also about NHS Borders and NHS Highland. NHS Highland was recently, of course, subject to a section 22 report in relation to finance.

There are a number of other ways that we can look to recruit and retain. Under this Government, there has been an incredible increase in the number of medical consultants since 2006, which we are pleased about. However, I take the point about retention.

We are looking at a number of avenues—one is to make sure that people are well remunerated, and another is to look at pensions. Some of that is within our gift, but a lot of it is within the UK Government’s gift, and I have been having discussions with it about potential pension changes. I think that Dr Gulhane is a member of the British Medical Association, so he will probably know that it has written to me about whether the Scottish Government can do more in relation to pension changes that would help with retention.

There are a number of other avenues that we can look at instead of distinction awards, which we have not provided for a number of years. I will work closely with the BMA and others to ensure that Scotland is a competitive place when it comes to not just recruiting but retaining more consultants, which is key to your question, Dr Gulhane.

Every health board is receiving an uplift, which is important. I completely accept that you will go out and bat for NHS Lothian, given your role. Why would you not do that? However, every single health board faces significant challenges. When I look at the figures, of course I see that the A and E department at the Royal infirmary of Edinburgh faces a challenge. However, if I look along the M8 to the Queen Elizabeth university hospital, to Forth Valley royal hospital or to Aberdeen royal infirmary in NHS Grampian, I see that A and E departments across the country are under significant pressure and are significantly suffering. Our NRAC formula, including the funding that we use to ensure that boards are within 0.8 per cent of NRAC parity, assists health boards across the country.

The funding to the non-territorial boards is vital. You mentioned the funding for Public Health Scotland. When we think about how crucial that board has been to our fight against the virus over the past 20 months, I do not think that anyone would argue—and you are certainly not arguing—that we should take money away from it to spend elsewhere.

All boards, territorial and non-territorial, are important. We have record investment of £18 billion in the health service. This is the first time that we have been able to finance health and social care to such a level. There is significant funding.

I give you an absolute promise that I meet NHS Lothian very regularly and I have a great amount of faith in the ability of the management team, the chair and the board to put the money to good use to improve what is a very difficult situation right across Lothian.