Chamber and committees

Last week, we had a chamber debate about out-of-hours GP services and I quoted some percentages in relation to out-of-hours care reducing the number of hospital admissions, so that approach has been quite successful. I know that there are challenges around staffing out-of-hours services in some places in Scotland, but those have been a good way of reducing hospital admissions. Is that correct?

Since we got our papers last week, I have been doing a bit of reading about the NHS estate and sustainability, and how the NHS can achieve net zero by 2040.

I am interested in what the panel thinks about 20 million miles per annum being saved during the pandemic through the implementation of NHS Near Me. That shows that mileage reduction can be achieved—it is a hefty figure. When calculated as CO₂ emissions saved, it is in the billions of milligrams.

Another issue relates to remote virtual clinics and using telemedicine so that, for example, blood pressure readings can be obtained remotely and then analysed by a GP, who can see the results without seeing the patient.

How do we marry up the technologies? How do we get the biggest bang for our buck in saving emissions in our NHS estate? I will go to Professor Bell first, as he is in front of me.

Yes. Thank you, convener. I am sorry to keep coming in.

Leigh Johnston mentioned that data or other information was missing from general practices. Why is that? Is there a plan to get that data? Is that in process, as Audit Scotland has highlighted that that data is missing?

Journeys will still need to be made in relation to NHS travel. The Scottish Government has a switched-on fleets fund of £20 million. NHS Lothian is using it and Aberdeenshire Council has added 20 new zero-emission vehicles using that funding. We can measure those journeys and we know the mileage for NHS employees’ travel.

However, I am thinking also about dialysis patients. They have very predictable journeys if they use taxis, which many of them do. We know the start point of the journey and the end point. We know that those journeys happen on Monday, Wednesday and Friday or Tuesday, Thursday and Saturday. The same patients have the same appointments every week. If Audit Scotland is looking for data to measure emissions reduction by replacing diesel-driven vehicles with electric vehicles, those journeys would be very measurable.

Should we consider doing that? Would we be able to get a big win if we rapidly adopt electric vehicles for patient journeys that we can measure and for which we can demonstrate emissions reduction?

Okay—thank you.

We have talked about preventative spend, better outcomes and better health overall.

An example that comes to mind is how we keep people out of hospital in relation to asthma attacks or chronic obstructive pulmonary disease exacerbation. An overnight stay in hospital costs a minimum of £1,100. However, renewing a person’s annual asthma plan and ensuring that people use their inhalers appropriately—whether they have COPD or asthma—can help to keep people out of hospital. Such support from a practice nurse or specialist in airway management and respiratory issues has to happen in primary care. Does that mean that we must take money away from secondary care and give it to primary care? Do we get an extra pot of money from somewhere?

Do we have a wee borrowing pot? Oh no, we do not, because we cannae borrow in Scotland. What is the best way to divvy up a pot of money?

On the back of Tess White’s question for Professor Bell—I will be quick—I have a question about recruitment and retention, and the plans for clinical training and career pathways for health and social care workers. The Scottish Government has introduced bursaries for training of nurses, midwives and paramedics, and there is free university tuition in Scotland. I think that that will help recruitment, as well. Should anything else be done or introduced, in addition to the bursaries that have been introduced already, to support further recruitment and retention, and to encourage some of the people who have left the healthcare environment to return?

I picked up from Dr Bell’s submission that a review is being undertaken of the NHS Scotland resource allocation committee—NRAC—formula and that certain recommendations have been asked for in relation to the way in which funding is allocated. I am thinking about remote and rural areas, whether those are in the Highlands and Islands or in the south of Scotland. What, if anything, needs to be changed in the NRAC formula?

Okay. Thanks for that. I will halt there.

Thank you.