Seòmar agus comataidhean

Good morning, convener, and thank you for inviting me to meet the committee this morning. This is my first appearance at the committee since I was appointed as Cabinet Secretary for NHS Recovery, Health and Social Care. I welcome the opportunity to engage with the committee, and I look forward to discussing a range of vital issues in the weeks and months ahead, as recovery and renewal of the NHS and social care services continue.

I also thank the NHS boards for continuing to provide information to the committee, which has been taking evidence about their performance in recent weeks.

Ministers and Scottish Government officials regularly meet representatives of all health boards to discuss matters of importance to local people. It is my strong belief that the Scottish Government should not only fund, but should empower and enable boards to make the decisions that they feel are most appropriate to their localities and areas.

We acknowledge the pressures that are felt by boards across the country as we all continue to deal with the aftermath of the biggest shock that the NHS system has felt since its establishment some 75 years ago. We continue to prioritise investment in front-line services. We have provided an increase of some £730 million for NHS boards through the 2023-24 budget and an additional £200 million in-year support above initial plans to support the financial sustainability of NHS boards. That means that no board is more than 0.6 per cent from NHS Scotland resource allocation committee parity.

In addition, we continue to provide constant support and guidance to NHS boards to ensure that they are doing everything that they can do to provide the best possible care for people in their localities. Our new prospectus for the year ahead demonstrates our collaboration, with a key part of our plan to deliver year-on-year reductions in waiting lists being to deliver additional capacity through our national treatment centres in NHS Highland, NHS Fife, NHS Forth Valley and NHS Golden Jubilee National Hospital.

Another good example is the work that is being done to increase the workforce through hiring an additional 800 staff from overseas. That was helped by £8 million of funding in October last year. We set an ambitious target of recruiting some 750 additional nurses, midwives and allied health professionals from overseas; I am pleased that, due to the hard work of health boards, we have exceeded that target. That is the kind of joint working between central Government and local boards that I will hope will go from strength to strength, as we go forward.

I am happy to respond to questions.

Do you mean in terms of trying to reverse depopulation in rural and remote areas?

You will be aware that we are taking forward a range of work to try to make our rural and island areas attractive locations, whether through addressing connectivity and economic activity issues to make rural and island areas viable places for communities to grow and thrive, or through measures that support people to live in those areas. For example, the islands growth deal and the Argyll and Bute growth deal are about helping to reverse depopulation by putting in infrastructure to make communities attractive and to encourage people to live in them.

When I was the minister who was responsible for taking forward growth deals, a key part of what we were trying to do, working in partnership with local government, was to put in place measures that we knew would help to support the people who were already there, but would also help to make those communities attractive for people to move to and live in.

One of the big issues that was often flagged up to me was digital connectivity. The digital superfast broadband programme was all about having the infrastructure in place to support rural and island communities in order to make them attractive locations, by giving people the ability to live, to work from home or to base a business there. Although they go well beyond my portfolio, those are the sorts of measures that the Government takes, on a broad economic basis, to make our rural and island communities attractive locations for people to stay and to go to live in.

As you will be aware through the inquiry, funding is allocated to health boards through the NHS Scotland resource allocation committee formula, and is distributed on the basis of population share, geography, deprivation factors and so on. That approach has been taken for some time now and continues to be taken. As has been the case historically, we also provide tailored support to individual health boards if they face financial issues in-year and require financial support as a result. In the short term, therefore, if NHS Grampian requires additional financial support, we will try to provide it, if the funding is available.

Equally, we will continue to make progress with our use of the NRAC formula. I know that NHS Grampian has raised the issue of parity. As I have mentioned, we have already provided another £200 million in this financial year to try to close that gap further, and we will continue to try to do that in the medium term, too. We will, through the combination of short-term tailored support and the move towards NRAC parity, try to manage the issues for boards including NHS Grampian.

I am surprised by that, because I do not get such feedback when I talk to boards about the financial challenges. They readily acknowledge that we are aware of the significant pressures that they are under, so I am surprised if some have given you the impression that you described.

I think that I understand what you mean. Are you talking about providing more money?

You raise a really important point. A big part of some of the challenges that services have experienced in recent times has involved managing public expectation of services that are available and awareness of the most appropriate route to access them, whether that is at primary care level or at secondary care level.

We have set out a commitment to taking forward a national conversation, part of which involves the design and provision of healthcare services into the future. That includes how people access healthcare services: when it is appropriate to make a GP appointment and when it might be more appropriate to see a community pharmacist, a musculoskeletal physiotherapist or an advanced nurse practitioner, rather than a GP. It might sometimes be right to attend a minor injuries clinic. Thinking of my experience with constituents, I note that people will consider when they should go to minor injuries and when they should go to accident and emergency, so there is a question around how people understand the best route for them and when they should access emergency departments. There is a need for us to provide on-going dialogue, explanations and information about the best route to accessing the type of support and assistance that people may require at a particular time.

Turning to one of the things that we have introduced more in recent times, we have used NHS 24 to try and manage some of the challenge that we are experiencing in emergency departments in particular. The ability to contact NHS 24 allows people to speak to a clinician or advanced nurse practitioner, who is able to prescribe medication and have a discussion. They can then facilitate the person’s prescription, reducing the need to go and see a GP or attend the emergency department. We want people to understand and be aware that those initiatives are available to them, and they might be the best route for them to use.

It is not about doing one thing or the other. There is a need for us to continue a discussion and explore with people the options that are available to them and what might be the best option for them should they require to access healthcare services, whether digital, primary or secondary care.

I do not think that we will ever reach a point at which everyone will know the route that they should take. We will always have to provide an explanation to support people to make the right choices. I do not think that we have cracked it as well as we could. We could probably do more to help people to understand how they access their services.

Part of the future redesign of services is about engaging the public in the process of deciding what health services will look like and how they might want to access them. For example, I expect to be able to do much more digitally in the future, but I know that, for some people, particularly older people, that might not be the right route or tool for them. There will always be a natural transition as some people make more use of digital while others do not, and we need to make sure that we give people the options that best meet their needs as and when necessary.

Earlier, I mentioned that the burden of disease over the next 20 years is projected to increase by some 20-plus per cent. If we are to address that, we need a very clear focus on prevention, to try to reduce some of that burden of disease—in particular, as our population gets older and people live longer. The measures that we take on prevention—the public health measures, the immunisation programmes, the screening programmes—all play a critical role in that. That requires action at both primary and secondary care levels.

There is no doubt in my mind that we have to make sure that we do as much as we can around the prevention agenda if we are to manage what will be a very significant increase in the disease burden that we will experience over the next 20 years.

I do not know, but I am happy to check whether we have that data. I will come back to the committee on that.

On your wider point, I think that there is a lack of public understanding of the treatments that people can get from a community pharmacy. That is understandable. Let us say that someone has an eye infection and is thinking about making an appointment to see their GP. If they have a mild eye infection they could go and see their pharmacist, who will be able to prescribe a medication that can treat it appropriately. You mentioned inhalers for folk who have asthma or other airways diseases.

There is still a lack of understanding and recognition of what community pharmacies can provide, which is why there is a need for the on-going education of people around what is available through pharmacy services, which are a key part of our primary care services. We need people to use pharmacy services rather than just taking the traditional route of making a GP appointment. By using the community pharmacy, they could be seen more quickly and probably much closer to home.

You touched on the sort of thing that we can do to make those areas attractive. Obviously, NHS Scotland has an apprenticeship programme that recruits individuals into a range of non-regulated professions, including estates department staff. That is one thing that we can do.

The second thing that we can do is ensure that staff have good terms and conditions. Thirdly, we can provide alternative pathways into the regulated professions. That could be done through earn-as-you-learn programmes and by providing apprenticeships into programmes that are presently dependent on having a university degree. We could also allow folk the ability to flex into other professional groupings using the skill set that they have—for example, advanced nurse practitioners do some prescribing work.

All those measures play a part in helping to meet some of the challenges. Terms and conditions, training opportunities and routes into training for AHPs and others all play an important part.

Recently, I had a really good discussion with the Royal College of Podiatry, which talked about how important apprenticeship programmes could be for individuals who might already have a career but who want to move into podiatry. They could be allowed to flex into that career through earn-as-you-learn-style programmes. All of that could have a significant impact.

A pilot project that the Royal College of Podiatry is running with NHS Greater Glasgow and Clyde has been really successful in delivering that, so I agreed to take that information away and consider how we can do more of that kind of work. That is the sort of thing that we need to do much more of in an effort to move folk into the regulated and non-regulated professions.