Chamber and committees

Yes, although I have work to do relating to topical question time and the debate later today.

I am always of the opinion that we can never have too much engagement, and I think that engagement and visibility are positive. It can be tricky. For example, last week, I had to cancel a meeting with the fantastic women’s hub in north Highland, much to its annoyance—understandably so—because of certain pressures in the parliamentary schedule. There will always be times when engagement can end up being disrupted for understandable reasons.

However, what frustrates me slightly—I will not mention any health board, as all health boards need to be cognisant of this issue—is that it can often feel as though there is a disconnect between the health board management, and health services and provision locally on the ground. My instruction to all the health board chairs, chief executives and senior management is that they should be visible and that they should ensure that engagement happens regularly. There should be not just engagement. What can be done to make people feel that they are being heard, and what proactive action can be taken to demonstrate that we are listening? Although we will not be able to do everything that everybody wants—that is simply the nature of what we deal with—I would say that the engagement has gone well, but there is certainly more to do.

I also encourage boards to make the best use of technology. I know that it is not always possible to travel around the vast expanse of the NHS Highland area, for example, and that it is not always possible to get everywhere all the time in Orkney, Shetland and other islands, so one of my instructions is to make the best use of technology.

That is an excellent question. I often go to remote and rural health boards. Let us take the example of NHS Highland, which probably covers the largest geographical area and which—as you know, convener—covers Argyll and Bute as well as the north Highland area. People in Argyll and Bute might say that although there are similarities there with what other parts of NHS Highland are facing, there are also unique challenges, given the area’s geography, particularly on the islands. Therefore, yes—a conversation is absolutely needed about further devolving decision making.

That is why, when I visited the Caithness Health Action Team, for example, which is the campaign group on Caithness hospitals, it came across very strongly that the group feels that there is a disconnect between the community in Caithness and what it says comes from the health board at management level. That is what it communicated to me, so I took that back to the board. I am pleased to say that there are now regular scheduled meetings between CHAT and the health board.

There absolutely should be devolution, as far as that is possible for a health board. Even if there is no direct decision making, it is certainly important to have engagement at local level. That is important for urban areas, but I would say that it is even more important for remote, rural and islands health boards.

I might draw a line under that at this point, because we are not looking at a wholesale structural review of health boards. Given all the other pressures that we are facing, we are also not talking about breaking up health boards into smaller health boards—certainly not at this stage. We have a structure in place, and disrupting that in its entirety now would take a lot of focus away from the significant challenges that we face.

Having said all that, I note that the National Care Service (Scotland) Bill is going through Parliament, and I know that every member around this committee table knows that healthcare and social care are integrated, so there is therefore certainly a conversation to be had about the interaction between healthcare and social care—under the current system, but certainly with a view to a national care service coming into play.

Thank you for the question. There is no doubt that NHS 24 is an absolutely vital service. It is critical to us. It has been an extremely successful service since its inception. NHS 24 has exceptional levels of data, as you can imagine, including call data, call-waiting data, data on how many people are triaged and data on how many people are recommended for transfer to A and E. It is very clear from the data that the overwhelming majority do not need onward transfer to A and E. I therefore see NHS 24 as being critical in trying to reduce that demand to the front door. The thinking is that the more that we can bolster staffing levels with call handlers and clinical staff, the better, and we have increased the number of clinical staff quite significantly. If I look at figures from September 2021 to September 2022, I can see that the real increase in clinical nursing staff has helped with that.

The reason why you will see funding as it is for NHS 24 is that there is definitely more that we can do on the digital offer. NHS 24 has launched an app, which you can download whether you are on Google or Apple. It has self-help guides and provides a great service whereby you can view the pharmacy, general practitioner services and other primary care services that are local to you and what their opening times are. It is a minimum viable product at the moment, as it has just launched, but it will grow arms and legs as time goes on, and some of the funding in the budget will help us to do that. In short, a lot of the focus will be on staffing and the digital offer.

That is a good question and one that we anticipated coming up, because members of Parliament are right to ask for that clarity on the national care service. If you look at our current financial memorandum for the NCS, you will see that we talk about the figure for the coming financial year being around the £63 million to £95 million mark. You will also probably be aware that the Finance and Public Administration Committee has come back to the Government to say that it wants a revised financial memorandum. There has been a fair degree of scrutiny. Richard will correct me if I am wrong, but I think that we said that, once we have the draft of the revised financial memorandum, on which we are working, we propose to come back next month to the committee with it. It will lay out in detail how much we will be spending specifically on the national care service. It is therefore work that is under way, given that we have been asked to provide a revised financial memorandum.

I can certainly write to you. Forgive me; I am just checking, but I do not think that I have quite that level of detail. It was not just NHS 24, of course; there was redeployment to NHS boards, territorial as well as non-territorial. Forgive me; I do not have that detail to hand, but I am more than happy to write to the convener, who can share it with the rest of the committee.

There is no doubt that there are impacts on budgets and therefore on the ability to be innovative, whether with the estate or otherwise, in trying to mitigate those impacts. You will know from the 2023-24 budget that we have increased funding to boards by just under 6 per cent, which is a significant increase. I should have said from the offset that the health and social care portfolio is getting an additional £1 billion. I hope that that is a demonstration of how much the Government values our national health service, and it is more than the consequentials that we received. However, all that being said, inflationary costs are putting real pressure on us.

We are investing in a number of capital projects. It is important to say that there are also significant refurbishments—and not just normal maintenance refurbishment, although that is very important, of course, as a number of health boards are also looking at how they can make their buildings more carbon efficient in line with our net zero targets and our net zero health plan. That work does not come without an up-front capital cost, and we are very mindful of that. The net zero agenda has always been incredibly important. It has even greater importance, given the eventual savings that could be seen in energy costs in the future, although it involves up-front costs.

I refer Gillian Mackay to our net zero strategy, which I know she has seen because she and I have had conversations about it. The strategy goes into great detail in a few areas. We have rightly talked about capital infrastructure. We have to look at the existing estate as well as new estate—the national treatment centres, the replacement for Monklands and so on. We have to look at how we make sure that those projects meet our net zero ambitions. That will probably involve additional cost, particularly for new build. We have to be up front about that.

The second area that our strategy looks at in a lot of detail is treatments. There is already really good innovation and really good practice in that space, around treatments that release less carbon into the environment. One of the areas of focus that I am keen on is the use of asthma inhalers and switching to more carbon-friendly treatments for asthma. Obviously, our first focus is on prevention, and there is a lot that we can do in the preventative space around asthma. However, we are also trying to get those who have inhalers on to more carbon-efficient and carbon-friendly ones. I have seen that up close. I met a couple of patients in a Dundee GP practice who talked me through the difference that the switch made to them. They felt a lot better for it, and, of course, it helps the environment too.

There is a group of GPs—I am trying to remember whether it is Tayside specific or wider than that; I will take a look at that and come back to you—who have got together to look at how to make primary care treatments more carbon neutral where they can. From the secondary care perspective, as I say, we have outlined in our net zero strategy what we think we can do around treatments in the NHS to improve our carbon footprint.

Emma Harper is right. There was a unilateral decision by the UK Government to withdraw funding for Covid. In some respects, we were always going to get to that position. My argument with the UK Government was always that withdrawal should be phased. We have gone from spending billions of pounds on Covid and getting additional funding for that to the tap being turned off. I think that withdrawal should have been phased over a period, but we have had that argument and it is not one that we won, so we are where we are.

To answer Emma Harper’s question, we have funding of circa £250 million for 2023-24, which includes funding for vaccinations and test and protect. The remaining costs for Covid will have to be managed within the baseline budgets as we move to a position where Covid will be part of our everyday lives—and, undoubtedly, we will live with Covid for a number of years to come.

We are also waiting to see what further Joint Committee on Vaccination and Immunisation advice there will be in relation to future vaccination programmes. Clearly, that is where the big cost comes from when it comes to Covid.

To answer Emma Harper’s direct question, £250 million is provided in 2023-24, which includes funding for vaccinations and test and protect. The remaining costs are baselined into budgets.

One of the reasons why that programme exists is so that we do not lose focus on the preventative spend. It is not just about the health and social care portfolio, although that is really important. We take a preventative look through our entire budget from oral health right the way through to some of the areas that I mentioned, such as smoking cessation, obesity and so on. The Deputy First Minister also brings the cabinet secretaries around the table together regularly to talk cross-portfolio about what can we do around the preventative space. We all know about the socioeconomic determinants that can lead to poorer outcomes for health, and we have to focus on those as well. The whole family wellbeing fund or other funds that are focused on reducing poverty will also be crucial. The health and social care portfolio will certainly play a part in that.