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We are on a path to understanding long Covid much more effectively. You might be aware that quite a bit of global research is taking place to understand the impact of long Covid and the most appropriate treatments for it.

My understanding is that, as it stands, no single treatment type is appropriate for long Covid patients. We often have to try to provide a holistic form of treatment. For example, the service that is being offered in Glasgow—the long Covid pathway—has a range of different clinical inputs, from physiotherapy, through occupational therapy to psychological services. All of those are about trying to address some of the issues that can present with patients who experience long Covid.

It is fair to say that we are in a learning environment on how we treat long Covid. From some of the patients with long Covid whom I have met, I know that its presentation is variable and they often have different needs. That is why some of our NHS boards look to provide services much more holistically with a range of different supports that can be provided to patients and to tailor those to best reflect patients’ circumstances.

We are all learning more about long Covid. That will continue to influence how we intend to deliver services for patients with long Covid in the future.

I am not familiar with the amendments that you are referring to, but I am more than happy to have a look at them and to consider how they will work in relation to safe staffing levels.

Do you want to say something about that, Ms Minto?

Going back to my earlier point, I make it clear that the clinical advice not just at a Scottish and UK levels but at the global level is that Covid-19 should now be managed as a seasonal infection and in the way that we manage other seasonal infections such as flu, because the level of vaccinations that have now been provided to the population gives us much greater protection. Our intention is to continue to manage Covid-19 on that basis.

If the clinical advice changes at some point and we have to take further action, we will respond to that. However, the present advice is that we should continue to manage things as we are managing them and in the way that we manage other seasonal infections.

The majority of health boards have those pathways in place now. Those that do not are carrying out the work at the moment and I would expect those pathways to be in place this year. The funding has been made available for them this year as part of the £10 million programme so there is no reason for the boards not to achieve that. We will continue to monitor their progress.

First, I will just correct you. We are not struggling to find 800 GPs—we are ahead of the trajectory to recruit that number. Also, in relation to recruiting to GP specialty training, this year, we not only reached 100 per cent but even more applied for the training than the spaces that were available.

We are in a strong position to deliver on our commitment to recruit 800 GPs during this parliamentary session and to increase the number of GPs in training. I note that, this year, all specialty options were taken.

In addition, we have been expanding medical training places. We have made a commitment to increase the number of medical students in Scottish medical schools by 500. This year, we have increased that by 300 places and we are on target to increase places by another 200. Believe it or not, the BMA has asked us to slow down a bit, to make sure that there is capacity in the system to train those medical students.

We face challenges in relation to our medical workforce—I would not want to give people the impression that we do not—but it would be wrong to give the impression that we are struggling, because we have been able to recruit to the places that have been made available for general practice and for the training programmes.

However, we must continue to do more, because general practice is under huge pressure. A big part of that is not just the GP workforce but the multidisciplinary team that we have in primary care. A key part of what we must do in primary care is to ensure that we have a broad range of healthcare professionals that can meet patients’ needs and can meet the increasing demands that primary care will face. Having that combination will be key to ensuring that we meet those demands as best we can.

I will deal with those issues in turn. There are challenges in rural general practice—there have been for many years, particularly in single-handed practices. When GPs in such practices choose to leave or to retire, it can be difficult to recruit replacements. That can be for a variety of different reasons, but I agree and accept that there is a challenge in some parts of rural Scotland.

On what we are doing to address some of those issues, first, we have the Scottish graduate entry medicine—ScotGEM—programme, which is about recruiting and encouraging doctors to work in our rural environments. We also have the bursary programme—I wrongly called it the “golden hello”, but that is not what it is—which is, again, about supporting individuals, who may be GPs, to work in rural areas by giving them financial support, or a financial incentive, as part of the programme. The third thing that we are doing is—as the committee will be aware—setting up the centre for remote and rural healthcare, which is a programme designed to consider specifically how we can create and deliver greater resilience, in particular in primary care, to deal with the systemic challenges that we have in recruiting people into our rural areas. That combination of programmes to retain and support people in rural settings, and the creation of those financial incentives, is all aimed at supporting getting people into general practice in our remote and rural areas.

On the point around the number of practices that are now in the NHS, that has happened historically. Over the years, some people give up their contract, which is taken over by the NHS. That happens in urban as well as in rural areas.

Yesterday I had a meeting with the health and social care partnership in Grampian and the chairs of the integration joint boards, so I know that they are taking forward a programme of work to look at creating a much more sustainable approach to the delivery of primary care within the NHS Grampian area, and that they have a plan to deal with some of the very specific issues that they are experiencing within the NHS Grampian area. They expect to have that programme of work completed by the end of this year. I have explained to them that I want them to look at how they can work in an innovative way using the existing system to deal with some of the particular challenges that they have in their area.

No—it will not be sufficient. It is one aspect. Part of the challenge around social care comes from the fact that we, as a society, have not valued it as much as we value other professional groups, particularly when comparing social care with health. That is a wider societal issue, which we have to be honest and open about, but the consequences of not valuing social care are now clear, given the challenge that it now faces.

Pay is one part of the matter. The other important aspect is to see social care as a career of choice, with a career pathway and progression and opportunities stemming from that. We are exploring whether we could do more to create career pathways in social care, to encourage people to go into it and build up experience within it, and to pursue opportunities to go into other professional groupings.

One area of work that we are considering is the potential creation of pathways into regulated professions, perhaps through approaches such as the nursing apprenticeship model, so that someone’s extensive experience in social care will allow them to progress into some of the regulated professions through a different route from those that are available at present. Creating career pathways is critical to encouraging people to go into social care.

As I say, pay is one part of it, but social care has to be a credible career option for people, and we need to do a lot more around that. Some of the work that we are doing is aimed at encouraging people who are going into social care by providing them with specific routes into other professional groupings if that is what they choose at some point in the future.

Increasing training opportunities is one part of managing the challenges. Stephen, do you want to say more about the workforce and what we are doing to recruit people?

Our individual health boards have to meet a recurring 3 per cent saving target in order to try to free up resource to invest in other parts of the health service provision and to ensure that they are using their resources as efficiently as possible. I should add that they retain that money.

We could do many things with additional financial support. I recognise that I hold the biggest part of the public sector’s budget but, as we have already heard, some boards are facing extreme pressures across a range of services. Choosing to put extra funding into the provision of mental health workers in GP practices involves taking money away from somewhere else. There is not a spare pot of cash to draw on—money has to be taken away from another service. Very few people ever say to me that I should cut money from this service and put it into that one instead because it is more valuable—all services are valuable and important.

We have committed to increasing the health service budget by 20 per cent this parliamentary session. We will continue to try to make as much use as we can of the investment that is available to us in order to maximise the benefits. I hope that if inflation comes down—although it looks as if it will not come down as quickly as we would want it to—and energy costs come down, we will see some of the financial strain that we are facing ease over the next couple of years, which will allow us to consider how we can flex some of that resource into other areas and front-line services in a way that we are not able to do at present. I hope that we will be in a position to do so, but we are also going through a period of public sector austerity, which is having an impact on our budgets.

No, that is led by boards directly, as they are close to the issues. For example, with the institute of neurological sciences at the Queen Elizabeth hospital, which you mentioned, the health board would be responsible for putting together a business case for additional capital investment in that facility. The business case would come to our capital allocations team, which looks at such issues and all the demands that come in from different boards. Again, the lead on such matters is taken by the boards, which know what their estates need and what the challenges are, and any business cases then come to the national health infrastructure board for consideration. Therefore, there is a mechanism for boards to utilise, as and when required.

On your second point about the challenges at Edinburgh royal infirmary, they reflect the fact that the hospital is now more than 20 years old and that a significant demographic shift is taking place in the country, with the population shift that we are seeing from the west to the east putting additional pressures on public services in the east of the country. That has happened over the past 10 to 15 years, and it is putting pressure on hospitals such as Edinburgh royal infirmary at the front end. Again, the board has the opportunity to look at putting together a business case for investment to expand that facility, and it would be for the board to lead on that and to submit a proposal for consideration alongside all the other health capital expenditure proposals.