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Sorry. Unfortunately, I do not have control of my mute button. Apologies for that.

I will move on to proposals for delivery of services. We know that there is a postcode lottery in access to social care services. How does the Scottish Government plan to improve access in the new structure of the national care service?

Could it be an option to have the initial codified version of the charter in the bill—even if it was added at stage 3—and then have provisions in the bill so that the charter could be amended in the future through delegated powers? That would at least make it a focus point in the bill. The NHS charter is very much the focus of the Patient Rights (Scotland) Act 2011, so it would be nice to have the charter feature as part of primary legislation for the national care service. Might the Government consider that?

That is very helpful.

I thank the witnesses for their contributions so far. I want to turn to health and social care outcomes. Many written submissions to the committee have noted that the short-term nature of national targets is impacting on clinical priorities for investment. Decisions are often made to satisfy expectations in the short term, as opposed to the long-term impact of patient investment being measured. What are the panel’s views on alternative measures for monitoring performance that would allow for longer-term planning and more rational decision making on investments?

Yes. Sorry about the delay; I was waiting for my microphone to be unmuted.

That point is fairly made. However, I recently met GPs in Glasgow who said that they are so focused on dealing with immediate clinical requirements, which are overwhelming, that it is just not feasible for them to have any head space or time to consider continuous or process improvement with their teams in practice. There is not the capacity or the space to undertake such activity.

That really goes to the core of the tension between short-term firefighting and longer-term continuous improvement. The biggest commodity in the NHS is, of course, time. How can we move the NHS, as what we might call a learning organisation, away from such firefighting and being in crisis mode into creating a space for continuous improvement and for workstreams that can help to drive activity? For example, is there an account management service, or do you bring in specialisms from other industries? For instance, many economists say that we should look to the aerospace industry for good examples on how to drive productivity.

The NHS is the single largest employer in Scotland so its approach will have an impact on our national performance. How can we move to getting the everyday economy in areas such as the NHS mobilised in the same way? How can we bring a culture of productivity improvement into the service? Have you ideas for how that could be achieved?

At what point does the charter become stabilised as a codified document? Is it the intention that it will be codified? You said that it is a fluid process, but clearly at some point it will have to be finalised, agreed and ratified by all the stakeholders. At what point do you envisage that that will happen?

That is reassuring. Thank you very much.

Thank you for that. Do you feel that lean improvement—continuous improvement—is very much driven from the ground up, and that it is often the innovators on the front line who have the best insights on what we need to do to improve productivity and efficiency?

With that in mind, do you feel that we could do more on continuing professional development, even looking across to different Scottish Government agencies, such as Scottish Enterprise and the Scottish manufacturing advisory service, to teach tools and techniques that could allow more practitioners in the national health service to identify opportunities where there is waste and where efficiencies could be achieved? In that way, we could start to develop those ideas organically and move them forward.

I think that it does, and it brings us neatly on to the point about the charter being critical; it will be the linchpin of how the service will operate. There was a bit of dispute about having the charter in the bill. Will that opportunity be taken now, given that a draft has been produced and has gone out to consultation as part of the co-design process? Will Parliament be able to have sight of that and to codify it? Is it the intention of the Government that the NCS charter and the workforce charter be in the bill?

Thanks to the panel and the minister for attending today. There has been confusion about what co-design means and how it differs from consultation, so could you clarify exactly how much influence the learnings from this summer’s forum events will have? Are they geared towards how the national care service will operate in relation to the processes and procedures or the design of individual services in specific areas or in the territorial boards?