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I think that that demonstrates the Scottish Ambulance Service’s very innovative approach to providing services. The same applies not only to those services, but to the services that NHS 24 provides, with a significant amount of resource being made available to help support individuals who present with mental health issues. There has been a significant improvement in the service’s performance in that area. In fact, the chair of the board was highlighting to me yesterday how mental health supports are a key priority as it moves forward.

We are seeing the Ambulance Service, in particular, becoming almost more of an outreach service in some ways, although that is probably not the best way to explain it. A see-and-treat approach is being taken much more often, in which the service provides direct interventions to patients there and then, instead of its having to convey them to an accident and emergency department or a mental health unit. That is an area where we want to see innovation and development continue.

The committee will be aware of the additional finance that we provided to the Scottish Ambulance Service to increase its recruitment, and that is another expanding area. Some of the preventative work and support that the Ambulance Service can provide with regard to urgent unscheduled care are really important, and I think that that sort of approach will prove increasingly critical in helping to sustain and support our services. I absolutely want to continue to build on and progress that approach in both mental health and non-mental health settings.

It is clear from looking at some of the capital investment that we have made recently in national treatment centres, including in one in the Highlands and the Baird family hospital and ANCHOR centre in Aberdeen, as well as our investment in a new hospital in Orkney, that there is not a preconceived view that more things should be centralised. That is not the approach that we are taking. Where we can make the investment to deliver such services in rural settings and to provide the right infrastructure, we are doing so. I am simply acknowledging that there is a trend towards specialisation in the clinical setting—that is an international trend, not just a Scottish or UK trend.

That is why, as John Burns rightly said in response to an earlier question, our rural health boards are among our most innovative health boards because they have to think about how they can deliver services in different ways. We will continue to do what we can to support them to achieve that. I mentioned the Baird and ANCHOR and the new NTC in Highland, which are examples of our determination to deliver as much as we can in some of our more rural areas in Scotland.

However, we must also acknowledge the need to deliver services that are clinically safe. There might be occasions when it is not possible for us to deliver all the services that we would want to deliver in some of our rural areas, and people will require to travel to urban areas. That is not a new thing—it has always been the case that some people from rural areas have had to travel—but there is an increasing tendency towards that, given the specialisation that has taken place.

We want to see more people being treated at home. We are expanding the hospital at home programme so that more people get clinical care in their own bedroom and their own home, never mind in the local hospital. We have more than doubled the funding for that—we have increased the funding by £400 million to expand the programme further. That has a particular benefit for patients in rural areas.

We need to continue to recognise that it is a dynamic situation, to which we need to continue to adapt. Given the particular challenges that we face around our rural communities, we must be innovative. I will do everything that I can to support our rural health boards to deliver the best service that they can in their local areas.

I do not think that we have given money to health boards to build their own accommodation. I am sure that some partnership work has been done in the past with health boards and local housing providers around what can be done to support them in making affordable housing available to the boards but, again, that is outwith my portfolio. I would be more than happy to check with my housing colleagues what specific work they are doing with boards to address affordable housing issues. Of course, there was a time in the past when we had accommodation for staff in the NHS, but that obviously changed many years ago.

I will check with our housing colleagues around any specific projects or programmes that they have taken forward. I know that programmes have been developed in some rural settings that are about bringing together public sector investment, which is health, housing and wider community investment, and trying to utilise that money in a way that helps to deliver more infrastructure in an area. However, I am not sure whether there have been specific programmes to provide housing for staff who work in the NHS. I think that it will be a more general programme.

I just noticed that you seem to have a particular focus on him, but let me try to deal with some of the issues.

Obviously, investing in mental health is a priority for the Government, and there has been significant investment over the past decade or so. There is a financial aspect to the specific workers that you mentioned. The biggest challenge is in managing all the competing demands within the NHS budget. Financial constraint is limiting our ability to run forward with the programme as it stands. When financing becomes available to us, we will be able to do so. You will be aware that we provide other projects in support, such as link workers, who are very valuable in GP practices and help to signpost people, including those who have mental health conditions, to other services. The principal reason for our not being able to take forward that programme is a lack of available finance for us to extend it in the way that we would have wanted to.

Of course.

Yes, but we must also keep in mind the fact that capital investment is a very expensive exercise to undertake right now, because of the huge capital inflation that we face. Construction inflation is running way ahead of standard inflation—it is up in double digits—so that has had a significant impact.

Our capital budget has been cut by around 5 per cent by the UK Government, which has had a direct impact on us. The value of what we have is less and buys us less, because of construction inflation, so we must be very nimble on our feet and focused on how exactly we maximise the investment that we are able to make to deliver on the right capital investment projects. In my view, boards are not slow to flag up where they need capital investment and what that might look like. I would certainly never discourage a board from bringing forward a proposal but, equally, our boards understand the financial pressures that we are under, and things might not happen according to a timeline that they would ideally want.

There is quite a bit of work going on around that at the present time. John Burns could say a bit more about electronic prescribing. Some new information technology infrastructure is being rolled out for general practices, and about 30 or 40 practices have in place some of the new IT system, which will help to facilitate that. The system is due to be rolled out over the next couple of years, which will allow us to move towards electronic prescribing so as to reduce some of the burden. IT infrastructure is key to facilitating that, and the new GP IT system is designed with a view to providing much more around electronic prescribing.

The burden of disease will continue to increase during the next 20 years by something in the region of 21 per cent, largely because of the demographic shift that we are experiencing as the population gets older. We need to do a number of things to tackle that burden of disease, one of which is to make sure that we are implementing all the right preventative measures to reduce the impact that lifestyle options can have on health. All the public health measures that we take to improve people’s health will be important.

Secondly, we need do all that we can to tackle the social inequalities that drive health inequality, including by tackling poverty and reducing child poverty. Those are key factors in helping to ensure that we focus on preventing ill-health because of social inequality.

Thirdly, we need to continue to develop and adapt our services to meet the increasing demand from older people and people who have multiple conditions so that we can manage their long-term conditions effectively in a way that improves their health and allows the health services to be sustainable.

Prevention is critical, but we also need to adapt our services to meet the increasing demand that we will face as our population gets older. We will also need effective integration between our health and social care services, given that they are critical to one another, particularly in helping older people to manage at home by giving them the support and assistance that they require.

I will probably bring in John Burns to say a bit more about some of the work that we do. The particular challenges that the rural boards face are that they can experience difficulty in recruiting specialist staff because the number of patients that they deal with in some departments means that positions are not so attractive to the staff who need to be recruited to them.

There are a number of reasons for that. For some time now, clinical care has been undergoing ever-increasing specialisation and has moved away from being provided on a more general basis. The general physicians whom we had many more of in the past are becoming fewer and more specialised. That has driven behaviour that results in clinicians wanting to work in specialist centres where there is much more throughput so that they can see the range of patients that they are looking for and build up experience and so on. That is much more challenging in our rural boards, especially given that the population levels are much lower and the boards are not able to sustain the same services.

For a number of years now, we have been putting in place arrangements for managed clinical networks in which we can use clinicians in some of our bigger centres to provide clinical support to boards in our rural and remote areas. Sometimes that involves their going out and holding clinics in those areas, and sometimes it is about supporting clinicians in those areas in their decision making and reviewing of patients. That is one of the ways in which we support our rural and island boards so that they can sustain services. Of course, that sometimes means that patients have to come into the larger clinician centres for specialist care and interventions.

John Burns can maybe say a bit more about some of that work, which has been on-going for some time now.