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I thank the witnesses for coming today. Submissions in response to our call for input to our inquiry cited a disproportionate focus on secondary care in the most recent winter plan and claimed that it undermined the Government’s intention to support a whole-system approach. Indeed, health expenditure across the UK is similar to that of other Organisation for Economic Co-operation and Development countries in total, but differs in that most of the spend is allocated to hospital care as opposed to preventative care or community-based settings. It could be argued that the disproportionate expenditure on secondary care is a year-round structural imbalance that exacerbates vulnerabilities, particularly in the acute hospitals.

Do the witnesses agree with the views expressed in written evidence that primary care was not prioritised in the winter plan in the way that it should have been? Perhaps you could pick up on the point that John-Paul Loughrey made about GPs in deep-end practices?

I presume that that monitoring feeds back into the design of the services. However, trying to direct the immediate firefighting activity that goes on in an accident and emergency department towards building up that capacity might be a challenge. Dr Loughrey, do you have a view on the practical ways in which resource might be pulled out of areas in which there are people in crisis because they have not been dealt with earlier in their care journey?

The written evidence suggests that the rate and frequency of the reporting of performance data has been a challenge and that the process for feeding data back is labour intensive. Has any consideration been given to how that process could be streamlined so that pressure on staff can be reduced?

Is there a particular instance that springs to mind that might illustrate that point for us?

Yes.

It is clear from the submissions and the oral evidence that we have heard this morning that demand is at an unsustainable level and that simply inflating capacity, particularly in acute hospitals, is not an optimal solution. Relative to healthcare systems in other OECD countries, our expenditure share is much higher on acute hospitals and much lower in the primary care landscape.

How do we pivot to the fundamental restructure? How are you implementing a mechanism to monitor presentations in acute hospitals that could have been avoided had an intervention taken place in the community earlier? That could be as simple as providing heating for someone’s house, some pastoral support or whatever. How is that analysis being undertaken and how is that informing service design? How are you then responding to pull the system into the place that it needs to be in? Demand management is the key challenge.

I agree with colleagues’ recommendations so far. I add that, in practice, the feasibility of the roll-out would depend largely on local authorities leading the logistics. It might be useful to get an understanding from COSLA about how ready the school estate is to adapt to such a change, should it be introduced, what sort of capital changes might be required and what existing contracts might need to be changed. It would also be useful to get an understanding of the opportunity for things such as developing community food networks, using the school as the anchor for a community food network and building resilience around the good food nation concept, which was recently passed into statute by this Parliament.

Rather than simply seeing the issue as a potential liability, I think that it presents us with huge opportunities. Trying to socialise those ideas with COSLA and local authorities would be helpful at this stage, if the committee thinks that there is potential in them.

There are some major structural issues here. Most notably, in Glasgow, there is no common housing register across all the registered social landlords in the city, so having visibility of adapted housing is challenging and often involves making numerous duplicate applications to various housing associations. That has been a massive public policy failing since the stock transfer in Glasgow, and it has never been addressed in 20-odd years. That is one aggravating factor.

I would also highlight recent engagement that I have had with hospices in Scotland. There was a pretty harrowing exhibition at the University of Glasgow recently, which was called “Dying at the Margins” and which I think is due to come to the Parliament later this year. It presented case studies of people who could have lived out their final days at home but who, because of accessibility issues and lack of willingness of housing associations, councils and housing providers to make adaptations to housing, ended up in hospitals or hospices—often inappropriate settings where they did not want to spend their final days. That was pretty shocking. Often a pretty mercenary calculation was made that, if someone was going to be alive for only another few months, there was no point in paying the money to make adaptations.

There is an aspect of how palliative care is managed in the home, and the hospital at home concept, that merits consideration. The issue causes huge costs to the NHS as a result of delayed discharge. People who are terminally ill are in acute hospital wards, which are a highly medicalised environment and probably not appropriate for them. There are all sorts of aspects that introduce great costs that are not being dealt with. There is a bit of system failure in relation to ensuring that adaptations are efficiently and cheerfully carried out where needed.

A number of hospices were involved in the production of that exhibition. It might be useful to solicit their views on what policy changes need to happen. That might open up a pathway to other stakeholders that are engaged in the policy area. Marie Curie would be an obvious first stop for those discussions, because it was certainly an anchor organisation in the production of that exhibition and it has highlighted to me this critical issue in the community.

Yes. It was at the University of Glasgow, and I believe that it is due to be displayed at the Parliament.