Chamber and committees

I slightly disagree with the characterisation of the question, because I have made it abundantly clear that we do not intend to wait for the national care service to make improvement. In the time that I have been health secretary, we have announced three pay increases: £10.02, £10.50 and, for 2023-24, £10.90. We are not waiting for the national care service to come into place to continue to uplift wages where we can. That absolutely has to be a part of it.

I have nothing to add that you and I have not already rehearsed, but, if people are going to call for a wage uplift, which they are perfectly entitled to do and have good reason to do, they have to do that within the context of a fixed budget. Every penny of the £19 billion in my budget has been allocated. If you think that there should be an uplift in 2023-24 to £12 an hour, you have to spell out where those hundreds of millions would come from within that fixed allocated budget, bearing in mind that we have also made really difficult tax decisions, which I stand by full square because I think that those who earn more should pay more to strengthen our public services.

I will say a couple of things. You fleetingly mentioned a 48p pay rise, and it is worth my coming back on that slightly. The pay rises over the past two years, since 2021-22, mean that adult social care workers to whom we have given an increase have had an increase of £2,380. I accept that high inflation costs and so on have meant that the cost of living crisis bites, but £2,380 is not an insignificant uplift. It is 12.7 per cent, and it is important to put it in that context.

On your substantive question, I have said publicly that I am up for a discussion about the reprofiling and rephasing of the national care service. I do not think that that is the impact of the National Care Service (Scotland) Bill. It is a framework bill—an enabling bill. It is there to create the foundations of the national care service. On current plans, the care service will not be fully operational until the end of the parliamentary session and for good reason.

However, my door and my inbox are open, if Paul O’Kane, the Labour Party or any political party around the table wants a discussion on the reprofiling and rephasing of the national care service. I met trade unions before the festive period, and they indicated to me that they wanted to discuss that. I said that I would consider it, and I will do that. They have given me some of their concerns about the national care service, but I am generally up for a discussion. Anybody who proposes any reprofiling of the national care service has to make it clear what purpose and benefit that will have, as opposed to simply being seen to kick it into the long grass. I am trying to be constructive and helpful, and I am up for a discussion in that respect.

On the latter point, we made a number of commitments—you can call them targets—in our manifesto. We committed to increasing our social care spending by 25 per cent over the course of the parliamentary session. We are well ahead of the trajectory to do that. I am confident that we will meet that target. Social care spending will increase by more than £800 million in 2023-24.

We have also promised to increase mental health spending by 25 per cent, to increase primary care funding, and that half of all front-line health spending will go into community health services—again, talking about that preventative agenda. We have looked at half of all front-line spending going to community health services. In 2020-21, the last year for which data is available, 49.6 per cent—effectively, 50 per cent—of spend was in the community, compared with 50.4 per cent that was not. We are almost there. I am confident about the increase to mental health spending as well.

I am confident that we will meet many targets that we committed to in our manifesto and programme for government. There will always be targets that we keep under review, depending on how pressured the health service is at any given time. I would be giving a false impression if I did not mention at this stage the pressures that we have faced over the past few weeks. For example, health boards have had to take really difficult decisions on reducing some elements of elective care. Clearly, that will have an impact on planned care targets, if they are unable to make up for that in future weeks and months.

There will always be targets that we keep under close review. Obviously, if there were ever any change to targets, this committee would be the first to know.

Convener, I should have prefaced my remarks by wishing a happy new year to you and the rest of the committee. I hope that everybody got a bit of downtime and a break. I suspect that, as we get into this session, that may feel like a distant memory.

In response to your question, it is important for me to say, first and foremost, that the £400 million of savings around the EBR were—you are absolutely right—partly to do with the significant record pay offer that we have given to NHS workers. They were also—to a quite significant extent—to do with the impact of inflation and, in particular, of the UK Government’s mini-budget and the inflationary pressure that that brought to bear on our budget. With regard to the health and social care portfolio, Richard McCallum will correct me if I am wrong, but the impact of inflation alone means that our budget is worth £650 million less than when it was set in December of the previous year.

We are trying to find money to give a record pay offer to avert, as best we can, industrial action—as you know, that threat has not been completely negated—and to deal with the impact of inflation. Obviously, I will give details of where that £400 million is coming from. Some of it comes from Covid savings and some of it comes from social care, primary care, mental health and so on. It would be completely false to tell you that that has not had some impact on service delivery. You cannot take £400 million from a budget and not expect there to be some impact on delivery. Many stakeholders, such as the British Medical Association, have been very vocal about the impact of those savings on primary care, and the Stroke Association has been vocal about the impact on, for example, thrombectomy services. Stakeholders have spoken about the challenges for delivery.

In answer to the last part of your question, I cannot speak for the Welsh or the UK Government. Northern Ireland, too, is in a slightly different situation. Essentially, this is about making difficult choices—that is how we have been able to afford the pay offer that we have put on the table. It means that, thus far, Scotland is the only country where nurses and ambulance drivers have not walked out on strike in the midst of an exceptionally difficult winter, not just here but across the UK. As I said, the threat of strike action has not been completely negated. Three trade unions—the Royal College of Nursing, the Royal College of Midwives and the GMB—are still in dispute over the pay offer, and we will continue to have meaningful dialogue with them.

The EBR was an exceptionally difficult process to go through, but one that I thought necessary in order to avert strike action and get a fair pay deal for NHS workers, who absolutely deserve it.

The short answer is no. Obviously, we keep a close eye any time there is a discussion about “new money”. As you may know, yesterday there was an announcement by the UK Government about what it plans to do about delayed discharge. There was a lot of focus on additional bed capacity, much as it will be in Wales, Scotland and Northern Ireland. That was touted as new money, but we asked HM Treasury and were told that it is being found from within the department there, so there are no consequentials to it.

Every time there is an announcement, we keep a close eye on whether there will be any further consequentials, but I have to say that I am not holding out any hope that there will be additional money coming in this financial year. However, I am also mindful of the fact that some level of discussion is taking place at UK level between trade unions and the UK Government. If any funding comes in-year, we have a commitment to pass on health and social care consequentials to the health and social care portfolio.

The question is a fair one. The level of delayed discharge is far too high. It should be said that the First Minister was talking about real-time data. The data that you are referring to is monthly data; obviously, that has a time lag to it, but you are right about the levels of delayed discharge. I am certainly not going to argue with the idea that they are far higher than we would like them to be in Scotland and across the United Kingdom. I will give further detail of that in the statement—I am conscious of the need not to pre-empt too much of what I will say in the statement. The focus will be on interim beds. I will give the detail on the number of beds that we are potentially looking at with the funding, and the detail of that funding, in the statement later today.

Those interim beds can be used in a number of ways. They can be used for people who are waiting for a care home placement—we will be able to put them in an interim placement. Frankly, we should also be looking to use those interim beds for people who have not yet had their assessment, whom we will be able to assess when they are in an interim bed space. Whatever clinician I talk to—doctor, nurse or whoever—on any busy acute site, they continue to tell me that the exit block is the number 1 issue, and I am certain that the whole committee knows that. It is not the only issue, but it is the number 1 issue, so creating that capacity will be important.

You also asked about the timescale. Again, I will give some detail, but I do not think that I will be sharing too much detail from the statement if I say that that work has already started. You will know that I set up a ministerial advisory group that brings together the Convention of Scottish Local Authorities, Scottish Care, chief officers, the Society of Local Authority Chief Executives and Senior Managers and so on. This is one of the key issues that it has been looking at.

I do not want to pre-empt the statement, but we have about 600 interim beds that we already use, and the clear message that is coming through from Scottish Care is that it feels that the current national care home contract rate that is paid does not take account of the effect of the inflationary pressures and the high energy costs that have been experienced since the contract was first set. Again, without pre-empting the detail of the statement, we think that we have found a way around that, at least in the short-term interim.

That comes with challenges for sure, but that is the right thing to do.

Emma Harper and I are in agreement that the value of the third sector is enormous. We saw that pre-Covid and we certainly saw it during Covid. I will give you a couple of examples.

We fund a really good partnership project on oral health called eat well for oral health, which receives a relatively modest amount of funding. Two third sector organisations—Edinburgh Community Food and LINKnet Mentoring—work with the NHS to deliver the programme. I think that those organisations are known to many folk around the table. They have an oral health improvement model that uses food and nutritional skills as a medium by which to remove barriers and promote cultural understanding and dental services among families who are affected by, in particular, socioeconomic and racialised health inequalities. It is a good project that has a real-life impact on the ground. We are able to monitor the impact of that project.

Another example—we have not touched on this issue in committee, but it might well come up—is our investment in the communities mental health and wellbeing fund for adults. Over the past two financial years, £36 million has been provided, resulting in thousands of awards to community projects. Those focus very much on prevention and early intervention. There can be challenges in monitoring that, but we must have faith, as I do, in our third sector partners, and we must ensure that there is appropriate monitoring and governance of any distribution of those funds.

In short, yes. I expect there to have been significant improvement when we are sitting back around here in a year’s time, particularly and absolutely in those three boards—Ayrshire and Arran, Borders and Highlands—that have been escalated. I would expect there to be significant improvement.

We have already been in discussion with those boards around their escalation. As you can imagine, we have a process. As the member knows, escalation entails a higher level of monitoring, supervision and support. That is all on-going, but it is fair to say that I would be very disappointed if we were sitting here in a year and there had not been significant improvement, particularly in those three boards.

I hope that our 2023-24 budget restates our commitment to mental health support. If you compare this year’s budget to previous years, you will see that we are up 6 per cent on 2021-22 spend and up 139 per cent on 2020-21, so there has been a significant increase in mental health spend over that three-year period.

There is little that I can add to what I have already said. The focus must be on prevention, but each of us, as a member of the Scottish Parliament, knows that a significant challenge still exists around backlogs in access to child and adolescent mental health services in particular and to other mental health services. Our focus—the budget demonstrates this—continues to be on doing our best so that people, particularly our children, adolescents and young people, can be seen in a timeous fashion.

It depends on what you mean by looking at models of primary care. I am not looking at fundamental reform of the independent contractor model at the moment. We are where we are with the contract and this would not be the right time to upend the entire independent contractor model. That said, I am really up for a national conversation about our health services and their reform.

Over the years, we have seen a change in the model of general practice. Sandesh Gulhane mentioned multidisciplinary teams and allied health professionals in GP practices. They have been in place for a number of years, but there has certainly been a significant increase in the number of health practitioners in GP practices, from your physio to your advanced nurse practitioner, who all contribute to a general practice model.

This Government’s key innovations include the community link worker and the mental health wellbeing worker. I have a fantastic community link worker in my constituency. Anyone who has interacted with community link workers will know just how impactful they are as part of the general practice team. We will continue to invest in those additional members of staff in general practice. They are part of that more holistic approach to primary healthcare delivery.