Chamber and committees

We will always do everything that we can from a communications perspective to help to alleviate those pressures. Let us be absolutely clear: GP practices are open, and people can get face-to-face appointments. Some people prefer to have a Near Me video consultation or, indeed, a telephone consultation. I phoned my doctor a couple of weeks ago because I had a bit of an eczema flare-up. That was very easy; I did it in between meetings. I got the ointment that I needed, and that did not take away from my work day. Many people might, like me, prefer doing that, but a number of people would prefer a face-to-face meeting.

GPs are working extraordinarily hard, as everybody in the NHS is, and we owe our GPs at the primary care level all the thanks in the world for the incredible work that they have done. Any suggestion that they are not seeing people face to face because they do not want to is false, and I absolutely reject it. However, a number of members of the public, particularly in our elderly population, want to see a GP face to face. Some of the guidance published today will make that easier.

Thank you for that excellent question, which raises an issue that is at the heart of what we are planning for and doing at the moment.

The decisions that must be taken are difficult, but they are not unique to Scotland. That is no consolation for your constituents or mine who are waiting for a procedure or are waiting a long time in the A and E department in the Queen Elizabeth university hospital, but it is fair to say that these challenges are being faced across the United Kingdom. Although you are right to note that Scotland’s A and E service has had challenges in terms of its performance, it still remains the best performing A and E service across the UK. Again, of course, I accept that that is no consolation to our constituents.

You ask what is being done. The immediate priority is to get through this crisis. We need to reduce community transmission as best we can because, if we do that, we alleviate the pressure that is put on the NHS by Covid. At the moment, we have more than 700 Covid patients in our hospitals. That might seem like a low number but, if you add that to all the other services that the NHS provides, it all begins to add up.

Today, Public Health Scotland should publish some guidance that is focused on primary care and general practitioners in particular. I hope that that guidance will enable more face-to-face consultations to take place at GP surgeries. I know that GPs are already seeing people face to face, but I suspect that, like me, you have been contacted by many constituents who are saying that they are finding it difficult to get face-to-face appointments. That guidance, along with the further investment in primary care that we will make, will help the situation at that end.

I do not need to tell anyone in the committee just how challenging the situation is with ambulances, given the demand on the Scottish Ambulance Service. We have just increased our investment in the service and are already seeing that pay off. I think that more than 60 people were recruited to the service in the north and north-east of Scotland last week.

We are doing what we can on the acute side, including increasing bed capacity and putting in place the NHS recovery plan. No doubt we will come on to this, but the back end is also important, because there are increased levels of delayed discharge. We are working to put in place rapid units that can make the assessments that are necessary in order to get people back into their communities. That includes considering whether it is possible to have a bridging care plan in place that meets those people’s needs for a period of time and allows us to work closely with the local authority, the health and social care partnership or the integration joint board to ensure that we can make a full care plan available for that individual.

In short, the point that I am making is that the NHS recovery plan, backed by a £1 billion investment, takes a whole-system approach. There is no point in trying to tackle the situation in A and E on its own; we will have to tackle the entire system if our efforts are to have any effect.

I thank Evelyn Tweed for that important question. I suspect that she is not alone among MSPs and that every one of us receives difficult cases in our inboxes and at our advice surgeries from desperate family members on the criticality of their children’s mental health.

I have a number of things to say on this, but I will try to be brief. I can go into more detail if Evelyn Tweed or other members want me to. First, I note that we are investing in services that I would say are pre-CAMHS, in that they are designed to be accessed at a much earlier stage, before people get to the point at which CAMHS crisis intervention is needed. That programme of local interventions is, again, designed to be suitable for whatever the local need is. For example, it might be different in Stirling compared with Selkirk or other parts of the country. That investment is important.

Some of our approach in the area will include ensuring that we have the appropriate services in place in schools. I am happy to expand on what we have done to ensure that we are getting more and more resource into schools.

As Evelyn Tweed will know, we set up a CAMHS task force that gave us an evaluation of the service and made recommendations, and we are investing quite significantly in CAMHS—some details of that are included in the NHS recovery plan. Some of that investment will address staff recruitment. We intend to provide funding to increase recruitment to CAMHS by 320 additional mental health workers. That increase in the staff cohort will undoubtedly work.

I will be honest here: the wait for CAMHS treatment is unacceptable. We are not meeting the 90 per cent standard at the moment and I am afraid that we were not meeting it before the pandemic, either. We have therefore invested additional funding of £29.2 million to NHS boards specifically to target CAMHS, with £4.25 million of that being focused directly on those who are currently on the CAMHS waiting list.

There is a lot more that I could say but, for the sake of brevity, I will hand back to Evelyn Tweed, who I am sure has follow-up questions.

If it gives any comfort to Ms Callaghan, I point out that we have extremely regular contact with people on the ground. We can set all the national policy in the world, but we know that local delivery partners are key to what we are trying to do. That is why our investment is hugely focused on local delivery partners at NHS board level, IJBs, health and social care partnerships, and community-based and third sector organisations. They were doing good work pre-pandemic—let alone the good work that they have done during the pandemic. If it is any comfort to Ms Callaghan, I give her an absolute assurance that every single cabinet secretary and minister works closely with our local delivery partners. The Deputy First Minister co-ordinates a lot of that work.

In relation to out-patient activity, you are right, it will take us the parliamentary term to reach that 10 per cent. In relation to additional in-patient and day-case activity, we hope to get there by 2022-23, so I hope that we will get to that 10 per cent a bit earlier. The significant increases in diagnostics are important.

I missed part of your question, but was it on particular pathways or referral pathways? Forgive me, my connection seems to be timing out.

In relation to our cancer pathways, we are already trying our best to get early diagnostics, which is a key part of trying to alleviate the pressures on the system. We know that if we get people that care earlier, particularly in relation to cancer treatment, they have a better chance of recovery, which means that they will be less likely to end up in our hospitals for longer. Our early cancer diagnostic centres are clearly a part of that. The earlier that we can get people referred into the system, such as early cancer diagnostic centres, the better chance we have of alleviating that pressure and seeing more people through the system. Obviously, we already have some of those early cancer diagnostic centres up and running.

We know how important that is for patients, customers and everyone in society. Whether we are talking about an app that gets Uber Eats to deliver food to a person’s house or an app that is linked to a public service such as health, ethical and secure storage of the data that the app gathers is hugely important.

One of the first meetings that I had as health secretary was with our cybersecurity team, who had brought in an external consultant who was helping us to work through the security in our NHS systems. They are doing a good amount of detailed work.

We are going to publish a refreshed digital health and care strategy that will commit to the development of our first ever dedicated data strategy for health and social care, and will include detailed consideration of how to increase our citizens’ trust in data sharing, and of how to ensure that there is transparency in the system. We need to unlock the value of health and care data in a way that ensures that the data can be safeguarded and that there is full transparency over how it is used.

The security of the data is important; cybersecurity testing has already been carried out for all the other major systems, including Near Me. With regard to our Covid certification—which is a very topical issue—we will ensure that we have up-to-date security provision in place, particularly when the app is ready to go live at the end of this month.

Those are really important questions. We are looking proactively at how we can further incentivise out-of-hours working, because we know how challenging that is and how important it is to the recovery. As Ms Mackay will appreciate, we have to work with the trade unions and staff-side representatives on that to ensure that they are comfortable with what is being proposed. We are looking to finalise a lot of the detail on that.

An important issue that Ms Mackay touches on, which I am happy to say more about if we get into this in more detail, is wellbeing. Wellbeing is important not just for out-of-hours staff but for everybody. My first visit as health secretary was in Lanarkshire, and I was blown away by the testimony that I heard from healthcare workers and NHS staff more generally. As members can imagine, I spoke to porters, cleaning staff, doctors, nurses and everybody in between, and they all told me the same thing. It did not matter what their job was, they were knackered. They were really tired because of the past 18 months. That is why we are investing £8 million in their wellbeing. For brevity, I will not go into detail right now, but a whole range of services is available, some of which are very specialist. If we are going to ask NHS staff to help us with the recovery, which is vital, we are going to have to make sure that their wellbeing is paramount.

It goes even further than that. In effect, it will give relatives of care home residents rights that are akin to those of care home staff. Of course, the final shape of Anne’s law will be up to the consideration of the committee and the Parliament as a whole, but those rights will be embedded in statute.

I seem to have lost my connection. I heard you say that you had spoken to the BMA.