���˿���

That leads on quite well to my other question on the issue. I have heard, particularly from GPs in Glasgow, that people are so busy firefighting in their clinics day to day that their practices simply do not have enough time to consider innovations or improvements. That is a real frustration, because they know that digital solutions could help to alleviate some of the pressures that are facing primary care. The written submissions refer to digital care technologies such as NHS Near Me. Do any of you have views on how we can create a space not just to deploy technology, but to allow people to be trained and the technology to be embedded, particularly in primary care settings? I see that David Gibson has put up his hand.

You mentioned NHS Fife and the example in NHS Lanarkshire. When there are examples of good outputs being achieved and clear evidence that they reflect good performance, how does the system or the span of control at the Scottish level capture that and normalise it across the health board territories? There is quite a cluttered landscape—shall we say?—of management structures.

A number of the written submissions question how data from previous years has been used to evaluate the impact of winter planning and identify gaps and opportunities for improvement. It is clear that there are multiple concerns regarding last year’s plan alone.

One of the recommendations in the submission from Public Health Scotland and the Scottish directors of public health group is to

“Stop things that have not worked and not introduce anything that has not been evaluated in a robust way”.

Ahead of this year’s plan, has the Scottish Government undertaken any assessment of what has and has not worked well in previous winter plans? Can you highlight some examples?

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.