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The procurement side of the issue is of particular interest, given the recent failure to achieve success in the latest phase of the procedure. It seems that breaking it down into phases is an inefficient method of delivering the programme, and I wonder whether a continuous mobilisation for road construction approach is necessary. If it is about improving the route by dualling rather than constructing a new road, that would comply with our goals around climate change and so on.

It is about road safety on an existing route, but how the Government delivers the programme is critical. There are other examples around the world. I had the opportunity to visit India recently, and I was on the world’s highest metalled road, in the Himalayas. It was delivered by a state corporation called the Border Roads Organisation, which mobilises a national mission to deliver strategic road networks in India. That is just an example of how the Indian Government is delivering that mission as a continuous programme. It does not stop to procure each phase, which introduces huge stop-start inefficiencies. It knows what its national road network will look like and builds it over a continuous period.

I wonder whether we need to look at the fundamental sanity of the current approach. Railways have achieved significant efficiencies by having continuous rolling electrification. The teams do not stop between phases; they just run across the network, putting up the pylons and running the cables. A similar approach for the strategic road network and the trunk road network could be an interesting proposition.

I agree with the proposed actions, and I have some familiarity with the petitioner’s case from press coverage—I think that it has had quite a high profile in recent months.

I will make one additional point. The university in question—the University of Glasgow—is not affiliated to NUS Scotland, so it would be appropriate to also ask that university’s student representative council to make a submission, simply because the institution is not under the ambit of the NUS.

I want to pick up on some of the maintenance backlog issues that we heard about from the chief executives. For example, NHS Greater Glasgow and Clyde cited backlogs at the Inverclyde royal and Royal Alexandra hospitals of £100 million and £80 million respectively. I understand that most boards will allocate their resource based on which outstanding issues for repair pose the highest risk to patient safety. However, is it sustainable for boards to take that more reactive approach to addressing such matters by doing so only once they become a serious patient safety issue instead of their having a much more robust, preventative maintenance programme? What does best practice look like, and how can we help health boards move to a more preventative approach instead of their simply reacting to issues that could cause deaths?

Cabinet secretary, you mentioned that prevention is critical to controlling overall cost pressures on the NHS, yet the NHS in Scotland has the lowest share of preventative spend of any Organisation for Economic Co-operation and Development healthcare system. One way to address that is through the mental health challenge that this country faces.

In the 2021-22 programme for government, the Government committed to a mental health and wellbeing service for every GP practice and 1,000 new roles to support community mental health resilience. Despite health and social care partnerships planning for the roll-out of those services and the vital role that such community-based support provides in preventing mental health crises from reaching an acute situation, implementation has not yet started. Will you explain why that has not happened and why it has not been a bigger priority, given that it was in the programme for government?

The NHS Greater Glasgow and Clyde chief executive cited the particularly shocking example of the institute of neurological sciences in Glasgow, where the maintenance backlog has come at a human cost, with 17 incidents of patient death or harm in the past five years. The board has also spent £3 million on private surgery for patients, so it is clear that there is a business case for accelerating or expediting investment in that particular infrastructure, given the cost already associated with the backlog in terms of patient deaths and the cost of private provision to make up the difference.

There are also structural issues to address. NHS Lothian has stated that the Royal infirmary of Edinburgh’s

“accident and emergency department was designed for a population of about 85,000”—[Official Report, Health, Social Care and Sport Committee, 6 June 2023; c 6.]

but it is actually seeing around “120,000 to 130,000” people coming through it, so the physical infrastructure is struggling to cope. Do you have a national risk register that you personally oversee to demonstrate where we need to prioritise capital investment, based on those metrics around patient safety and clear structural challenges? Is that something that is reported to you and on which you can take personal action?

I recognise your point that finance is tight, although you have a relatively privileged position, in that your area has the biggest expenditure by the Scottish Government, with a 6 per cent cash and 3 per cent real-terms increase in the projected budget for the next financial year.

We know that when we do not aggressively pursue opportunities for savings and prevention, we end up incurring costs somewhere else in the system. One area that we have identified in our discussions with chief executives is NHS 24, which has seen a 580 per cent increase in calls based on an annual rate of calls that are associated with mental health problems, and where dental health calls have also significantly increased, with 67,000 calls made in 2022-23 in comparison to just under 30,000 in 2019-20.

The pressures are visited elsewhere in the system, which seems unsustainable in view of those figures, which certainly shocked us when we heard them. Do you recognise that we need more investigation of where we can aggressively pursue opportunities for savings and push that prevention spend because costs will otherwise be incurred elsewhere?

[Inaudible.]—your 20 per cent increase. One of the other commitments is for the mental health share of health spend, which is currently around 8.8 per cent, to rise to 10 per cent. We are kind of stuck on 8.8 per cent at present because, effectively, we have just had a restoration of the cut due to the emergency budget review. What is the push ahead to that 10 per cent target? Will we get there? What is your view on how achievable that target is?

Are the boards moving quickly enough on those proposals to achieve cost avoidance? If you are going to expend on those capital programmes, will you avoid revenue expenditure? Are you pressing boards on the need to bring proposals forward more quickly?

I thank Mr Miller for coming today. Information that was obtained by a freedom of information request shows that, in recent years, there has been an extreme increase in the number of dental calls to NHS 24. In 2018-19, there were 25,509 calls but, in 2022-23, there were 67,189 calls. Your submission explains that a new urgent care model that seeks to minimise onward referral is in place

“for all but dental and some pharmacy calls”.

How has NHS 24 adapted to manage that increase in demand with regard to calls about dental complaints?

Data has shown that the number of mental health related calls to NHS 24 increased from 20,434 in 2019 to 139,008 in 2022, which by my calculation is a 580 per cent increase, which is an extraordinary number. Has that overwhelmed you? It seems an incredible figure that is not necessarily proportionate to the extra resources that you have been able to put into the service. How have you been able to adapt to that significant increase in demand?