Seòmar agus comataidhean

In the course of this session, I will try to be as helpful as possible. I hope that you will note that, in response to Ms Mackay’s questions, I tried to give as expansive an answer as I could. I cannot say anything beyond what I have already set out and what is already in the memorandum that I sent to the committee.

I cannot say much more than I have already said in my memorandum to the committee. However, to summarise the Government’s views, we believe that the bill in its current form is outside the legislative competence of the Scottish Parliament. In particular, we believe that section 15(8), which gives power to the Scottish ministers to specify in regulations a drug or other substance as an “approved substance” to be provided to terminally ill adults to end their own life, appears to relate to the reserved matter of medicines, medical supplies and poisons, as set out in section J4 of schedule 5 to the Scotland Act 1998.

Given that the bill represents a novel and fundamental shift in the role of medical practitioners and the regulatory framework in which they operate—a shift from protecting or enhancing patients’ lives to assisting in the termination of life—we also have concerns that some of the other provisions in the bill may relate to the reserved matter of the regulation of health professionals, as set out in section G2 of schedule 5 to the Scotland Act 1998. That is a confirmation of the position that I set out in the memorandum.

In the Government memorandum, I set out the elements around the potential costs. On the particular issue that Mr Torrance raises about training costs, if we were to assume that half of all doctors would undergo training, and that the training time would be around seven hours—as is suggested in Mr McArthur’s financial memorandum—there would be a total cost of just over £6 million for training time, which has not been factored in. Again, that is for the Parliament and the committee to consider. We have noted that as part of our memorandum to the committee for you to consider.

I recognise that some might have raised that as a concern, but I hope that I have set out the steps that we are taking to try to address its being a concern. I would highlight the draft strategy on palliative care that is being consulted on and which seeks to improve the position in that respect, and the steps that we are taking in the budget to fund our health boards and our hospices to maintain or expand provision.

It is important to stress, too, that there is a belief, wrongly held by some, that palliative care is only for those with a short time left to live. Such care can—and, in many cases, should—be offered from the time that a person is diagnosed with a serious or life-threatening condition, because it can help them to get the right support in place, manage their symptoms better and allow them to think through the best treatment options, taking into account what really matters to them. That is the person-led approach that we want to see, and it can be offered alongside other treatments that aim to prolong their life.

Such care has to be bespoke and person led to ensure that we are addressing the needs of people as they see them. It is not just for those at the end of life. I hope that that provides additional clarity for the committee in considering whether that should be a factor in decision making.

I heard the evidence that was given earlier and I note the debate that is being had and the points that have been put across. I hope that Mr Gulhane will accept that I cannot put forward a position on the matter; it is for the committee and the Parliament to determine. As the lead minister on a bill on which the Government has taken a neutral position, I cannot influence people’s consideration of the issue in any way.

I thank Mr Whittle for his question, and I understand where he is coming from. There is a balance to be struck around allocating fixed pots of money towards particular areas of investment. Mr Sweeney’s question was particularly directed towards mental health services, which I understand, but we must also ensure that our boards that deliver those services have the certainty of on-going, multiyear funding. That is where Alan Gray’s point around baselining is so important.

The situation is similar for drug and alcohol services, which we have given an additional £19 million of baseline funding to provide greater certainty to those who provide the services—through employment contracts for new staff, as opposed to providing short-term contracts. Those services provide certainty and additional baseline funding, and the providers know that that funding will be recurring, which will allow them to invest in more sustainable services.

I understand the premise of Mr Whittle’s question. I will follow up in writing to give clarity on where we envisage the funding going, which will be helpful to him because it will demonstrate that the funding is going to front-line services, delivering a more efficient and productive system and ensuring that those who deliver our front-line services have greater certainty on what they can invest in—this goes back to Mr Sweeney’s point about providing certainty through our budget—based not just on one year’s budget but on multi-annual funding. That will allow services to invest in clinics and projects over not just the short term but the longer term.

There is progress on both, and we are happy to set that out in a letter to the committee after this session.

I acknowledge the Audit Scotland report, and we will work constructively with the Auditor General on the findings that are contained in it.

In June, I made a statement to the Parliament, setting out what my vision for health and social care services looks like and what reform and improvement need to deliver. I think that all of us around this table, across the Parliament and across health and social care services recognise that there is a need to shift the balance of care from our acute hospital settings into primary and community care services. This budget continues that process. It provides increased spending for general practice, a substantial increase in funding to primary care services in general, including ophthalmology, and more capacity for dental services and pharmacy. It also seeks to ensure that we utilise the capital and resource funding that is available to us to make use of innovation that is coming on stream.

As part of the national conversation, last week, I met the Health and Social Care Alliance Scotland-led stakeholder advisory group that is helping us to capture patient voice. I have regularly met our royal colleges and trade union representatives, including the British Medical Association, on recognising clinical voice. We will continue to meet academics and others so that the national conversation is on-going.

We all understand what needs to happen. There needs to be a shift in the balance of care: we need to ensure that we treat people earlier, prevent ill health, stop people’s ill health progressing into the hospital setting and keep them at home for as long as possible. There is much in the budget that helps to achieve that, including the expansion of hospital at home and support to free up our hospital services through investment in social care to prevent delayed discharge.

As I set out in June—in direct response, I think, to a question from Sandesh Gulhane—the challenge was around how we do this; how we shift the resource that is needed into primary and community settings without detriment to our secondary care services. We are all engaged in trying to deliver that. This budget starts the process, and I am very pleased that we are able to start making progress, because we need to ensure that we deliver a sustainable, productive and efficient health service that meets the needs of the people of Scotland.

Emma Harper is absolutely right. Looking at the health budget in isolation misses the cross-Government impact on, and contribution to, our health and wellbeing. She pointed to the example of a choir, and various organisations do incredible work for people that would not ordinarily be seen as a health intervention but which clearly is. I am thinking of Scottish Ballet’s work, which I was able to see when I was culture minister, as well as that of a number of cultural organisations that help with our physical health and wellbeing.

Community and voluntary organisations do incredible work in our communities. I am thinking of the national mission to reduce drugs deaths. In particular, there are phenomenal organisations that support individuals who have a drug dependency and their families. Those organisations are able to reach parts of our community that statutory services are unable to reach. There is a range of other interventions across various specialties, including cancer charities that do incredible work to support individuals. Those organisations provide a level of service that goes above and beyond what is provided from a statutory perspective.

I am clear about my appreciation and understanding of the central importance of our community and voluntary organisations; they supplement and add value to statutory interventions, and they can deliver services in an incredibly efficient way. I am very appreciative and cognisant of their impact. Since I have been health secretary, I have always encouraged our boards to continue to support community and voluntary organisations so that they can support the work that, as Emma Harper pointed out, makes a difference in individuals’ lives.

Mr Torrance is absolutely right to raise the issue. Multiyear settlements for Government would be incredibly helpful, and I hope that the spending review will deliver greater certainty for us. However, as I said to Mr Whittle and Mr Sweeney, I recognise that that is also incredibly important for our boards and for our community and voluntary sector partners, who help to deliver services. We want to do more in that area. In the proposed budget, we have baselined more of our budget and have provided greater certainty for mental health services, as I have referenced, and for alcohol and drug partnerships.

That is exactly what Mr Torrance is asking for and suggesting would be right for our public sector. I hope that I gave a pretty detailed answer to Mr Whittle on why that is important. However, certainty on the majority of our funding, which is the block grant, is the greatest barrier to that. The more certainty that we have on that front, the better. In that regard, I pray in aid the capital position. We have had increased capital investment from the UK Government for this year, but our longer-term trajectory makes it difficult for us to have certainty on the multiyear position. When you are building a hospital, in particular, or with other capital infrastructure projects, you need multiyear certainty, because capital investment is required on a multiyear basis.

I hope that that gives Mr Torrance clarity on why providing as much certainty as possible beyond a one-year budget settlement is so important.