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I accept that that will continue to be challenging, but it is important that we continue to push for maximum efficiency and productivity in our health service. We need to make sure that every penny and pound that are invested go as far as possible. That is why we have the national conversation, through which we are working with our clinicians—to ensure that reform and improvement are clinically led and managerially enabled—and which is about reducing the areas of low clinical benefit.

It is about making sure that we successfully deploy polypharmacy reviews. We know that the cost to the health service of people who are on multiple prescriptions—10-plus prescriptions—is about £350 million a year. A lot of work is going on to reduce the potential harm that can come from that. Polypharmacy reviews are important in reducing prescribing rates and making sure that we continue to practise realistic medicine in delivering better outcomes for patients. Those are some of the areas that boards can look to and that are in the 15-box grid that we provide to them.

It is also about more positive innovations, rather than feeling that service detriment can come from such decisions. It is about embracing innovation—a point that I know Mr Whittle is particularly interested in—and making sure that we free up greater clinical capacity to deliver the parts of care that can be delivered only by humans and the care, compassion and loving approach that our clinicians deliver. There is a range of areas that our boards can look to.

I recognise that delivering recurring savings will continue to be challenging, because we have asked boards to do that in recent years, too. However, as Mr Whittle said, it is vitally important for the public to be able see the £21 billion budget being delivered as efficiently and effectively as possible and delivering the greatest bang for its buck.

In the 35 seconds that I have available, I will agree that we need to shift to a more preventative model. We have provided a real-terms increase to local government, with more than £1 billion extra in the budget.

I recognise that, as is the case with the health budget increase, there will still be pressures across local government—of course there will be. We have had a decade and a half of austerity that has eroded the potential for investment in our public services. However, the 2025-26 budget directs funding to public service investment for exactly the reasons that Mr Whittle has set out. I very much recognise the extent to which health is affected by many other portfolio spending areas. Mr Whittle gave the example of the role that local government plays in providing leisure facilities and sporting facilities. I hope that the budget will help to support those facilities and that the impacts that he has suggested will occur are not an inevitability, because of the investment that we are making.

Measuring prevention is, by its nature, difficult, because it is difficult to know what you have stopped happening.

However, I recognise Mr Whittle’s point. We can look to a number of areas. For example, we are working with the British Medical Association on how we can get more data through from general practice. Primary care is where the bulk of the preventative activity in health spending occurs. Because the provision of primary care is contracted, it is difficult to have a clear picture of where improvements are happening. That said, according to the most recent figures that are available, the number of GP appointments has gone up substantially. In October, there were 8.3 million interactions across the entire multidisciplinary team in general practice, which represents an increase of almost 900,000 on the previous month. The number of such interactions has gone up by a substantial amount year on year.

We know that the level of engagement has increased and that we need to increase capacity. We need to work with the BMA on how we can record what those interactions are doing so that we can have a greater understanding of what they are preventing. That is what Mr Whittle is asking for, and I know that the BMA is up for that and that it wants to continue to provide the answer to those questions.

A huge amount of work is being done by the chief medical officer, along with clinicians, on cardiovascular disease prevention. That is an area that we are seeking to prioritise this year, for all the reasons that Mr Whittle has set out.

A number of conversations are on-going with local government and health boards around social care provision and national care service reform. We have obviously paused stage 2 of the National Care Service (Scotland) Bill to allow for consideration among political parties, as well as discussion with local government. We are looking at what is possible in the budget, with the £100 million that is there, to improve the picture in delayed discharge. I expect a substantial amount of that funding to go into social care provision and to arrive at IJBs in one way or another, whether that is through health boards directly or through local government.

We recognise that we need reform and that we need to improve financial transparency and accountability, and to take account of the service user and carer voices in the process. All those matters are part of our discussions and considerations with local government and other political parties about the next stage of the National Care Service (Scotland) Bill and how we will deploy the £100 million that is there to improve the delayed discharge picture.

With regard to social care, we have set out in this budget the very clear transfer that is taking place between my portfolio and that of local government to increase the baseline level for social care provision. That is a pretty good story to tell. We have increased social care spending by 25 per cent, as was committed to two years ago. In fact, we have gone beyond that. We are spending an additional £350 million beyond the 25 per cent increase, which takes the health and social care budget commitment on social care to £2.2 billion. That is important, given the impact that delayed discharge has on the whole system and the need for us to have a whole-system approach to ensure that we have a smooth process for patients who seek to navigate it, which we will probably come on to talk about.

Again, if more detail is required by the committee on such known transfers, either in the budget or the budget documents, I am more than happy to provide that in writing, so that you get clarity.

Yes—we all do. All those who are at leadership and decision-making levels have responsibility and accountability for delivering health and social care services. Sandesh Gulhane is right that, ultimately, I am the health and social care secretary and the buck stops with me. That is why I am determined to show the leadership that I can to deliver against the priority areas with the budget—reducing waiting times, increasing access to primary care services and reducing delayed discharge. If we achieve against all those areas, we will improve the system for our patients and create a more sustainable service, which is what we all want.

I will make several points to Ms Mochan. First, reducing alcohol-related harm, as well as drug-related harm, is a clear priority for the Government, and it is one that we continue to invest in.

Secondly, on the resource that is going in, there is a cash increase to our alcohol and drug partnerships. I have already pointed to the additional £19 million of baseline funding, which is to give greater certainty to our alcohol and drug partnerships and will enable them to employ people in the projects that they are delivering for a longer period, rather than on a short-term basis. As a result, they will be able to deliver more sustainable services.

Thirdly, I point to our work on wider interventions. We have already increased the minimum alcohol unit price, which has had a demonstrable impact on reducing alcohol harm through fewer hospitalisations and deaths. We are also working with Public Health Scotland on alcohol advertising and on whether greater impact could be made, using an evidence-based approach, by using further restrictions. I expect Public Health Scotland to report back on that in the coming months. If further intervention is required from the Government, we will take those opportunities. There are a number of areas that we are investing in.

Lastly, the investment that we are making in our alcohol and drug partnerships includes £60 million a year for the drugs mission and reducing drug-related deaths, which takes us to £250 million across the lifetime of this Parliament. That supports the capacity for our alcohol and drug partnerships to ensure that they can meet the demands from people with alcohol dependency and from those with both an alcohol dependency and a drug dependency. I believe that that is making a demonstrable difference, and that we will continue to make progress. That is, in part, thanks to the investment that has been made; it is also due to the incredible work that has been delivered by the staff in the partnerships and those in the community and voluntary sector who are supplementing that.

We can certainly look at that. I do not know whether Alan Gray has more information on it than I do.

Like Mr FitzPatrick, I am particularly pleased with where the IJBs in Tayside are on that. That has come about after a number of years of work in which the whole system has been geared towards responding to need. The whole system has bought into the way that the service is run and into ensuring that there is a good flow.

Mr FitzPatrick is right that there is not the same consistency in other parts of the country. I do not know whether I have done this in the committee, but I have certainly pointed out in the chamber the service difference in NHS Ayrshire and Arran, for instance. There is significant variation between the best performing IJB in Ayrshire and Arran and those that are struggling a bit more. My officials continue to work with the areas in which we need to see improvement.

This is not all about social care or local government; it is also about recognising that, from a healthcare perspective, we must get clinical pathways working well and efficiently. We should have in place discharge-without-delay processes so that we understand predicted dates of discharge and have discharges before noon and weekend discharges. All those things should be happening in the health service.

Where the best services are being delivered, there are clear and strong relationships between acute services and the community. I point to the phenomenal work that has been done in NHS Ayrshire and Arran on the frailty assessment units in the acute sites at Crosshouse hospital and University hospital Ayr. That has made a demonstrable difference for people with frailty who arrive in accident and emergency departments. There are better lines of communication between our unscheduled care services and those in the community, so there are better connections and people are able to be discharged before being admitted into the wider hospital. The best way of reducing delayed discharge is by avoiding admissions in the first place. The work that we are doing through the investments in this financial year is about ensuring that we have those strong and sustainable frailty assessment units across Scotland.

The clear lesson from NHS Tayside is that good, strong integration between health and social care services and community services is paramount. My team and the Convention of Scottish Local Authorities are working very closely to achieve just that.

I do not think that it is an either/or. We have to address hospital capacity. Hospital occupancy rates across Scotland are far too high and there are people in hospital who have been there for too long. The lengths of stays in hospital are too long, and one of the drivers of that is delayed discharge. There are people who stay in hospital for far too long, and we need to get them out into the community.

Artificial intelligence is an option if the technology is available for us in that regard. However, as I said to Mr FitzPatrick, proper collaboration between our acute sites, the community and our health and social care partnerships is critical in ensuring that we recognise and address the needs of individual patients. I saw evidence of some of that work in East Lothian when I sat in on a morning huddle in which we looked at what work was being done to get each patient in an acute setting back into the community.

As I said, some of the pressure in our hospitals, with the performance of our accident and emergency departments sitting at too low a level, is driven by hospital occupancy rates being too high, the lengths of people’s stays in hospital being too long and, as Mr Whittle set out, people not moving back into the community—into their own homes or other facilities—quickly enough. The £100 million that we have set out is about addressing those issues and allowing primary care to hold more patients in the community for longer.

We need to invest in all those areas, because we need to take a whole-system approach in order for things to work. We need to look at all possible avenues and opportunities, including the use of technology and direct resources.