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In the past two years, Covid-19 has dominated every part of our lives, particularly our actions on health inequalities. I am keen to get a sense of the witnesses’ views on the Covid-19 recovery plan. What should be prioritised in the plan to tackle health inequalities? I appreciate that that is a big question.

I am keen to understand more about the policy interventions that we can make in a devolved context. The committee has heard quite a lot of evidence and had quite a lot of discussion about what happens at the reserved and devolved levels, but I am keen to get a sense of what policy makers can do in the devolved context to make a difference. I ask Ed Pybus to start, because I know that his organisation, CPAG, has been close to the work around the Scottish child payment. Ed, I am keen to get your sense of how we can go further.

Of course.

Good morning. We cannot escape Covid, because we have lived through two years of the pandemic. A lot of the submissions in response to our call for evidence reflected the Covid experience. In our informal evidence sessions over the past few days, a lot of the conversation has been dominated by the impact of Covid and the barriers that it has created to people improving their health.

What has been the biggest impact? We have obviously seen an impact on people’s physical health, such as their ability to get out and about and access healthcare and exercise. However, in addition, a number of policy initiatives that were designed to tackle health inequalities have been paused or deprioritised. Is it too early to say what the impact of those things have been? What has been the most serious impact?

Those were helpful points on the broader context. An important part of any Covid inquiry should be to look with laser focus at a lot of those issues and try to understand their impact.

Claire Stevens alluded to this already, but some unintended positives came out of the pandemic. That was probably about communities coming together in a way that they had not done before, and voluntary health organisations in particular stepping up. How do we measure that and protect it in the future? I think that we would want to see investment in the sorts of softer services that have made the difference for people.

Audit Scotland is particularly concerned about, or interested in, the learning that can be taken from previous public sector reform. Its analysis highlights that the expected benefits are often not clearly defined and that, even where they are defined, they are not always delivered, particularly in the short term. Are you confident that the benefits have been defined and can be delivered?

I certainly will—scrutiny is the job of all of us so that we get this right.

I wonder if I can just scrutinise the benefits and the understanding of them among the respondents to the consultation. We have heard that the Government’s analysis acknowledges that a large number of criticisms were made in the consultation process, in all formats of submission. Two of the principal reasons that were given were the complexity of the issues and the lack of detail in the proposals. Does the minister accept that people are struggling to engage and to understand the benefits that we have just talked about? I know that the minister has committed to further engagement work, but it is clear that people want to see that detail and to continue that conversation.

Good morning, minister. In evidence to the Public Audit Committee, the Auditor General said:

“We know that the social care workforce has been under immense pressure during the pandemic”.

You spoke about that in your opening statement. The Auditor General went on to say:

“indeed, that was the case even before the pandemic ... The Scottish Government now needs to take action to improve working conditions for this vitally important workforce, otherwise it will not be able to deliver its ambitions”

in the longer term

“for social care.”—[Official Report, Public Audit Committee, 3 March 2022; c 3.]

The Audit Scotland briefing outlines what those pressures and challenges are, and it is clear that there is an immediate need to resolve some of them.

I am also interested in the exacerbation of those issues by the cost of living crisis. It is very clear that many of these workers—who are very often women and lower-paid workers—are struggling to make ends meet and to be able to do their job because of the rising costs of getting to work between their shifts on public transport or in their car. What is your assessment of what needs to be done immediately to deal with some of that?

I do not think that anyone would deny that the pandemic has exacerbated the pressures. I was just pointing to the fact that the Audit Scotland report says that there was no financial sustainability prior to it. The committee will be keen to hear an update on the progress of the boards to which I referred when we get to the financial year end.

I will ask more broadly about the increase in funding. The Scottish Government committed to a £2.5 billion increase in funding for health and social care over the parliamentary session. However, the medium-term framework for health and social care has not yet been updated. In the absence of any medium-term financial framework, how can the cabinet secretary be confident that the additional funds that were committed will be allocated and used effectively? When will the updated medium-term financial framework be published?

I will continue in that vein. We have seen evidence in the Audit Scotland report that data and planning have not been adequate. That answer suggests that we have to do a lot more to understand and profile where we are.

I return to the cabinet secretary with a question about nursing places and vacancies. There are 6,674.4 whole-time equivalent nursing and midwifery vacancies in the NHS, and we have heard some of the cabinet secretary’s reasons for the challenges in that. Will he also accept that the reduction in the number of nursing training places—a decision that was taken by his predecessor—has exacerbated those challenges?