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I understand the concern. I will ask Nigel Robinson to say a wee bit more about the practical application of the process and how the GMC might address some of these issues.

We are looking for the national board to take forward that work. I will let Scott Wood say a bit more about that, but we need to ensure that there is a consistent approach.

By and large, we do not get a Barnett consequential for social care. There is no direct Barnett consequential for that in the way in which there is for health.

There are a couple of different routes through which money flows into social care. We provide funding to local authorities. Some health boards will invest in social care provision alongside some of the central funding that we provide for social care. That is largely for things such as pay uplifts. The scale of financial demand in health is markedly different from that of social care. Obviously, healthcare gets the lion’s share of the funding. We have made a deliberate decision to ensure that we increase investment in social care, particularly in staff, in order to increase or sustain the capacity of the service, because we know that it is under significant pressure.

One of the things that it will be absolutely essential to deliver as part of our reform programme is a national care service through which we can ensure that there is a greater consistency of approach to the provision of social care and that that aligns with the NHS much more effectively. We can see variation across the country, and that impacts on how social care services are received by individuals who require social care support and on the performance of the NHS.

Going forward, we will need to see even further investment in social care, and we will also need to see service reform. A national care service is going to be critical to ensuring a much more consistent approach to how social care is delivered and provided in the country, and one that aligns much more effectively with the NHS and helps to support it. Further investment and service reform are going to be critical.

That is a legitimate concern to raise. As I mentioned to Dr Gulhane, we are taking a measured and evidence-based approach to the use of PAs and AAs and where those will sit in NHS Scotland and our workforce development. Scott Wood can say a wee bit more about that, because it is important that we ensure that the important training environment for our junior doctors is not compromised. However, I believe that it can all be managed in a proper programmed way, with a clear sense of where we see the role of PAs and AAs sitting and where they can add value to our healthcare system. Scott, do you want to say a bit more about that?

I think that most boards would say that they would prefer not to have to do it, if they could, but it is important that we set that challenge for them in relation to driving efficiencies in the system. It is a bit like the four-hour wait target at A and E; taking that away would probably cause more problems, because it drives some of the systems. The 3 per cent is a way of driving boards to make sure that they are looking at their expenditure and where they can be more efficient.

Notwithstanding the challenges that go with achieving that, it is an important challenge that we put to them. We make sure that we hold them to account for that, given the huge amounts of taxpayers’ money that they are responsible for spending each year, and that they are doing that as efficiently and effectively as possible.

As I said, that will cover HR functions, including payroll, that can be managed jointly.

It is worth adding that the changes bring the GMC within the competence of the Scottish Parliament. Ultimately, therefore, the GMC will be accountable to the Parliament and to this committee if the committee believes that the GMC’s approach is not consistent with what it thinks is the right way to do things. The committee will be provided with a direct route into the GMC, which has not been available previously.

I will ask Nigel Robinson to talk about the history going back to 2003, and why there was a change in the name at that point.

Okay. We can look at that in a number of ways. Yes, increasing staff pay places a challenge on the budget, but I do not grudge them that at all, given their important role. That means that it will not be possible to make some of the investments that we might want to.

However, the impact of not increasing pay for staff and not settling such types of issues is also very costly in financial and service delivery terms. If we were not able to reach a settlement on some of the pay deals, we would inevitably face industrial action, which we know has significant financial cost to the NHS.

Let us take the industrial action by junior doctors in England as an example. I think that that has cost more than a billion pounds as a result of all the additional measures that must be put in place to try to cover absences during such action. In addition to that, around 1.2 million appointments have been cancelled, which has an impact on overall service delivery.

We have to recognise that, if we do not invest in our staff and do not try to resolve those types of issues in a co-operative fashion, that can be hugely disruptive and very costly for the way in which the NHS is able to deliver its services. The approach that we have taken is to try to help to resolve those matters in a fair and reasonable way with the employee side, but that, of course, has a financial impact on wider service delivery. You may not be able to expand services in the way in which you would wish to, given the financial environment in which we are operating. Notwithstanding that, the way to invest in services is by investing in staff. I view pay uplifts for staff as an investment in our NHS.