Chamber and committees

That is a core element of our NHS recovery plan. We have been up front and honest about the situation. We have increased the number of graduate places for medics year on year and we have increased training places for certain parts of the workforce. We are doing all that to increase recruitment as far as possible. However, that will not be enough. We have said in the plan that we will look to conduct ethical international recruitment—I emphasise the word “ethical”, because we cannot drain resources from parts of the world that need those resources.

For example, I have had a good conversation with the Academy of Medical Royal Colleges and Faculties in Scotland, which is helping us and will no doubt be a help in relation to ethical international recruitment. The plan also shows that retention is a hugely important part of what we are looking to do. In my conversations with the British Medical Association and the Royal College of General Practitioners, for example, they have stressed the point about retention.

Some of that is within our gift and we are, of course, working hard to see what we can do, but some of it is not within our gift. I have already had exchanges of letters and conversations with the Secretary of State for Health and Social Care, Sajid Javid, with whom I have a good relationship. As members would imagine, it is a frank relationship, but it is a good one. I have already mentioned the fact that pension changes that have been made by the UK Government are an adverse disincentive for those in the medical professions, particularly doctors and GPs. As I said, some of that is within my gift, and we will work hard on that, but some of it is not.

Recruitment and retention are important, and domestic recruitment and ethical international recruitment will be part of our plans.

Forgive me, I do not have a note of all those countries in front of me. However, it is not uncommon—a number of European countries have vaccination certification schemes. I will not stray into the politics too much, but they are often countries that have Governments that are centre-left or left-of-centre, or have liberal parties in power. As the convener rightly said, there has been some worry about the encroachment on people’s civil liberties, but a number of the countries that have brought in certification schemes have politics that I would say are more left or left of centre.

It is not an unusual step to take, and I also say to Emma Harper that, across the European continent and in other countries far beyond Europe, we have seen certification schemes incentivising vaccination. In France, as soon as the certification scheme was announced, there was a huge spike in the number of people looking to get vaccinated. Therefore, I am hoping that we will see something similar here.

I am more than happy to examine the issue. At my meeting with representatives of the BMA, they raised a number of issues on which they thought the Scottish Government could take action, one of which was the issue that Dr Gulhane mentioned. All of these things undoubtedly come with a cost. There are a number of issues that the BMA and the Royal College of General Practitioners have raised where they think that the Scottish Government could help with retention. We are working closely with the BMA, the RCGP, the Academy of Medical Royal Colleges and Faculties in Scotland and others. Where we can, we will do that. Where those powers exist elsewhere, we will of course work constructively with the UK Government.

I have mentioned that my relationship with the Secretary of State for Health and Social Care is a constructive one. He has promised to consider the issue and to come back to me on it. Where we can take action, we will look to do that. If that involves an additional financial ask, of course that is a decision that we must weigh up in among the other recruitment and retention issues.

This answer will be slightly unhelpful, but I hope to be able to give a little bit more detail on that next week. We were due to have our debate on the NHS and social care this week but, because of the need to have a parliamentary debate on the certification scheme, which was rightly brought forward, we will be having that debate on the NHS next week. I hope to say more next week about our strategy on long Covid and about what we are considering doing to bolster the local response to the long-term effects of Covid.

We are currently trying to ensure that the pathways that we have provide care as close to home as possible. That does not rule out the possibility of setting up long Covid clinics—health boards could do that tomorrow if they wanted—but the model of long Covid clinics does not necessarily work everywhere. In NHS Highland, for example, there may be challenges in having a long Covid clinic in one part of the Highlands given the travel and the distances that require to be covered, which could cause problems for people suffering the long-term effects of Covid in other parts of the Highlands. That one model does not always fit, although that does not mean that it does not have merit. I reiterate that, if a health board wanted to create a specialist clinic, it could do so.

The point is that there is a current referral pathway, and there is an implementation note with GPs on the long-term effects of Covid. Essentially, using existing services, we are trying to get people the best treatment that they can get in the long term, and as close to their home as possible. We are also trying to understand more about long Covid, which is why we are investing in research. Our understanding of long Covid and of the long-term effects of Covid is evolving day by day.

I am not surprised that Ms Mochan gets to the heart of the issue, given her experience before she became an MSP. It is clear from her raising those very issues in Parliament that she has an understanding of the area.

I am extremely focused on ensuring that we weed out some of the inequalities that have existed in the system. It might sound a challenging thing to say in the middle of a global pandemic but, because we have to remobilise and rebuild from the pandemic, it presents an opportunity to do that in a way that might not have been possible before.

We have the very ambitious target, which I think is achievable, of halving childhood obesity by 2030. We are going to do that through a range of actions. We have to make healthy food easier to access for people who live in the areas of highest deprivation. I clearly remember that, 10 years ago, when I was on the Public Audit Committee before I was a minister, we went into the heart of Drumchapel and had a session at the health centre there. One of the users of the centre said, “Don’t you politicians come and lecture me about healthy eating when I have two or three takeaways right beside me and they cost half what it would cost me to go to a supermarket to get a healthy meal”. She was right to put that challenge to us.

In the past 10 years, we have managed to make some progress and we have seen some of the effects of that. We have also commissioned research in order to understand in a lot more detail how health systems can support pregnant women. After all, we want to do this as early as possible pre-birth and to focus on children in the early years to see whether, for example, we can put more interventions in place to ensure that they eat well. We have made £650,000 available to NHS boards and community projects to work with families in order to prevent childhood obesity, and in the current financial year we will invest £3 million in improving young people’s weight management services.

Moreover, as I said, we will work constructively with the UK Government, where we can. As you know, it has responsibility for television advertising. I welcome its commitment to banning junk food advertisements before the 9 pm watershed, but I want it to go even further and look at how online advertising of less healthy food and drink can be restricted, too. In fairness to the UK Government, it is keen to work with the devolved Administrations on such shared issues and agendas.

That is a long-standing issue that was raised by a number of people in the previous parliamentary session, too. That is why we set up an independent group to consider in detail the issue of rejected referrals. An audit was done of rejected referrals and a number of recommendations were made in 2018. We accepted all the recommendations of that group. We have implemented the service specifications for CAMHS, which set out the standards of service that children, young people and their families should expect, and we have funded boards to implement that specification. Within that specification, a clear expectation is set out in black and white that services should be appropriately re-engaged, where necessary.

As I said, we have provided about £15 million of additional funding to local authorities to deliver locally based mental health interventions and wellbeing support for five to 24-year-olds. Those services are linked closely to CAMHS, so signposting can be ensured. That means that, if a referral is rejected by CAMHS, the individual is not just left to their own devices but is signposted to one of those local interventions.

Ultimately, decisions about whether referrals are accepted are not for ministers to make; those are important clinical decisions. However, I hope that no young person would be left without any support whatsoever, given the mental health challenges that they might be facing.

I apologise for not answering that part of Mr O’Kane’s question; I was not trying in any way to be evasive.

I have seen the report on non-communicable diseases that was published yesterday. It will take time to look at the recommendations, but I will give considerable weight to anything that comes from the British Heart Foundation and the many other charities that were involved in the report. I will give the report my attention.

Emma Harper has a track record of speaking about issues relating to diabetes and her own personal journey in that regard. There is probably little for me to say other than that I agree with her.

On social prescribing more broadly, there was a committee report on the matter in the previous session of Parliament. In the 2020 programme for government, we included a commitment

“to establish a short life working group to examine social prescribing of physical activity”

and sport. The group’s remit will be to

“identify and communicate examples of best practice, and co-produce resources for practitioners”.

The establishment of the group has been delayed by the pandemic—which, I hope members agree, is understandable. However, my officials are currently considering how we will take forward the short-life working group, which will look at the predecessor committee’s report and its recommendations on social prescribing.

Ultimately, that is the position that we want to reach. Of course, we have to remind ourselves that we are in the midst of a global pandemic and that there are important infection prevention measures still in place. GPs are seeing patients face to face, and we want them to increase the number of those consultations, with focus being on the people who are in most need. However, ultimately, the short answer to the question is yes—we want to get to that position.

I should point out that in surveys that we have conducted we have found that more than 80 per cent of people prefer digital or telephone appointments with their GPs. There might be lots of reasons for that—perhaps such appointments interfere less with people’s days, for example. However, for those who prefer face-to-face consultations, we want to get to a position at which they have that opportunity. I will say, however, that we have to be mindful that we are still in the midst of a global pandemic and are still contending with a highly transmissible virus.

That is all in our NHS recovery plan. We will meet that 10 per cent increase for out-patient activity by the end of the parliamentary session. By the end of the session, in-patient and day-case activity should increase by closer to 20 per cent. You will find that on page 5 of the recovery plan, where we go into detail about how we will increase in-patient activity, out-patient activity and diagnostic activity year on year.

I am still waiting for the detail, but I note that the UK Government is due to make an announcement on its plans today and, from what I have heard communicated in the media, my understanding is that it will also try to increase capacity by 10 per cent. I am pleased that the UK Government has seen that ambition in our recovery plan and will try to match it.

I will repeat what I said to Mr O’Kane earlier: we will of course be ambitious, but we will also be realistic about the timescales that it will take to clear those backlogs and get our NHS back to complete normality.

That depends on what system we are talking about, although we obviously have to comply with all the regulations in statute and, ultimately, we are accountable to the Information Commissioner’s Office with regard to how we use that data. That is exceptionally important. Who the data controller is will depend on the system in question, but if it gives Dr Gulhane comfort, I can tell him that we already engage regularly with the ICO on development and introduction of new systems. Moreover, our cybersecurity centre of excellence is working hand in glove with practitioners on the ground not only on our current systems but on the development of new systems.

Of course, I do not need to tell Dr Gulhane any of this—he will be well aware from his other role in primary care that our practitioners on the ground are usually well aware of their responsibilities in handling data. However, I am more than happy to hear suggestions if we need to do more, particularly with regard to the development of new systems.