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Do you mean in terms of trying to reverse depopulation in rural and remote areas?

You will be aware that we are taking forward a range of work to try to make our rural and island areas attractive locations, whether through addressing connectivity and economic activity issues to make rural and island areas viable places for communities to grow and thrive, or through measures that support people to live in those areas. For example, the islands growth deal and the Argyll and Bute growth deal are about helping to reverse depopulation by putting in infrastructure to make communities attractive and to encourage people to live in them.

When I was the minister who was responsible for taking forward growth deals, a key part of what we were trying to do, working in partnership with local government, was to put in place measures that we knew would help to support the people who were already there, but would also help to make those communities attractive for people to move to and live in.

One of the big issues that was often flagged up to me was digital connectivity. The digital superfast broadband programme was all about having the infrastructure in place to support rural and island communities in order to make them attractive locations, by giving people the ability to live, to work from home or to base a business there. Although they go well beyond my portfolio, those are the sorts of measures that the Government takes, on a broad economic basis, to make our rural and island communities attractive locations for people to stay and to go to live in.

Increasing training opportunities is one part of managing the challenges. Stephen, do you want to say more about the workforce and what we are doing to recruit people?

Our individual health boards have to meet a recurring 3 per cent saving target in order to try to free up resource to invest in other parts of the health service provision and to ensure that they are using their resources as efficiently as possible. I should add that they retain that money.

We could do many things with additional financial support. I recognise that I hold the biggest part of the public sector’s budget but, as we have already heard, some boards are facing extreme pressures across a range of services. Choosing to put extra funding into the provision of mental health workers in GP practices involves taking money away from somewhere else. There is not a spare pot of cash to draw on—money has to be taken away from another service. Very few people ever say to me that I should cut money from this service and put it into that one instead because it is more valuable—all services are valuable and important.

We have committed to increasing the health service budget by 20 per cent this parliamentary session. We will continue to try to make as much use as we can of the investment that is available to us in order to maximise the benefits. I hope that if inflation comes down—although it looks as if it will not come down as quickly as we would want it to—and energy costs come down, we will see some of the financial strain that we are facing ease over the next couple of years, which will allow us to consider how we can flex some of that resource into other areas and front-line services in a way that we are not able to do at present. I hope that we will be in a position to do so, but we are also going through a period of public sector austerity, which is having an impact on our budgets.

No, that is led by boards directly, as they are close to the issues. For example, with the institute of neurological sciences at the Queen Elizabeth hospital, which you mentioned, the health board would be responsible for putting together a business case for additional capital investment in that facility. The business case would come to our capital allocations team, which looks at such issues and all the demands that come in from different boards. Again, the lead on such matters is taken by the boards, which know what their estates need and what the challenges are, and any business cases then come to the national health infrastructure board for consideration. Therefore, there is a mechanism for boards to utilise, as and when required.

On your second point about the challenges at Edinburgh royal infirmary, they reflect the fact that the hospital is now more than 20 years old and that a significant demographic shift is taking place in the country, with the population shift that we are seeing from the west to the east putting additional pressures on public services in the east of the country. That has happened over the past 10 to 15 years, and it is putting pressure on hospitals such as Edinburgh royal infirmary at the front end. Again, the board has the opportunity to look at putting together a business case for investment to expand that facility, and it would be for the board to lead on that and to submit a proposal for consideration alongside all the other health capital expenditure proposals.

Okay. Let us try to deal with some of the facts around those issues. In terms of safe staffing limits, work is being taken forward just now through workforce planning, engaging our trade unions, stakeholders and health boards around planning for that. Right now, we are on track to take that forward and deliver it within the next year. It is a complex piece of work, but the working groups around some of that are already progressing.

I wholly and fully recognise the financial pressures and the stress and anxiety that staff are experiencing. A big part of that has been because we have come through a pandemic, which has placed huge pressure on our NHS in a way that it has never experienced in the 75 years of its existence. We all need to recognise and acknowledge that.

If your focus on my predecessor is your intention, and if you want to look for examples of taking very direct and clear action to help to support and reward staff, I cannot think of anything that does that more than the significant improvement that we made in their pay and conditions through the agenda for change. The 14.5 per cent that was provided to staff was the largest uplift for healthcare staff in the UK, and more than was provided by the Secretary of State for Health and Social Care in England. That demonstrates my predecessor’s determination to provide financial reward and support to NHS Scotland staff, recognising the enormous contribution that they made during the pandemic. That is a very practical example of his taking clear action and showing clear leadership in delivering such a significant improvement in pay and conditions.

It does not stop there, because the agenda for change is being reformed as a part of that. Again, that was a direct request from the trade union groups. The working groups that are responsible for taking that forward have already started. For example, the nursing and midwifery task force that I mentioned is already up and running. It is due to have its second meeting, which I will chair. The working groups to look at the reform of different parts of the agenda for change are also being taken forward.

You mentioned terms and conditions as an example of demonstrating our commitment to supporting staff. In what was agreed and provided through the agenda for change, my predecessor demonstrated that commitment in a way that was not done in other parts of the UK, where other health secretaries took a different route and provided less. In my view, that is a clear signal of where our priorities are and how we value staff.

I do not pretend that our NHS does not face significant challenges. We are still recovering from the pandemic and its legacy. We are going through a period of austerity in the whole of the UK, which is having a significant impact on public finances. We have been dealing with record levels of inflation. Households are having to manage a cost of living crisis, which impacts on the health and wellbeing of staff. We are dealing with significant increases in fuel costs, which have an impact on public finances. Construction costs and maintenance costs are all up significantly. All of those have an impact on our NHS.

You can be absolutely assured that I will continue with the approach that was taken by my predecessor in valuing and recognising the staff and the important role that they play in our NHS, and maximising the level of investment that we put into NHS Scotland—as demonstrated by the £730 million that we have put in this year and the further £200 million on top of that, as I mentioned earlier. We are ahead of trajectory on the 20 per cent increase during this parliamentary session. Again, that shows clear leadership in putting finance into the health service where we can.

All those factors will play their part but, equally, we do what we can to support our staff and to recognise the important value—the critical role—that they have within NHS Scotland.

Let us take an example. Are you talking about Fife?

We have provided NHS Ayrshire and Arran with tailored financial support because of the pressures that it is facing. If you asked whether issues arise because my predecessor did not make decisions about X, Y or Z, I would say that my predecessor gave a commitment to increase health spending in this parliamentary session by 20 per cent, and we are well ahead of the trajectory for where we should be on that.

The decisions that my predecessor made have increased the investment that is put into health services ahead of what was planned—we are ahead of where we should be. That demonstrates the determination to provide as much financial support as possible and the urgency with which action is being taken to provide additional finance to our boards. In this financial year, there is an additional £730 million and, alongside that, a further £200 million of support.

None of that demonstrates a lack of urgency, understanding or leadership on doing what we can. However, our health service is experiencing the same challenges as other parts of the public sector are because we are going through a period of austerity, which is having a direct impact on the Scottish Government’s budget, and because inflation means that we are experiencing a significant increase in the costs that are associated with running public services, which is having an impact on those services. All of that is having an impact on our budget.

Another point that is worth not losing sight of is that we are still dealing with the pandemic’s consequences. Costs are still associated with Covid-19, but Barnett consequentials for dealing with Covid-19 have stopped, so we now have to meet those costs from core budgets.

Extra money is being provided where it is available, and that is being done earlier and more quickly, which shows urgency. However, alongside that is the fact that we must deal with a range of additional cost pressures, which are having a significant impact not just on health services but across the public sector and in society as a whole—households are also experiencing that in their budgets.

Some of that is geographically specific to your part of the world. For example, one challenge that we have around social care in my area is staff from social care going into areas such as healthcare, because they are more highly paid.

Historically, our social care workforce has been less valued than our healthcare workforce, which is reflected in the rate of pay. That has been the case for some time, and we have to try and address that. We provided additional funding to local authorities to support increases in social care staff pay partly to try to stem the loss of staff from social care into healthcare and other areas of employment where they can get higher rates of pay. We have a commitment to aim for £12 an hour over a period of time, and we are doing some work around what that timeframe will look like.

The other part is that we need to provide good career pathways for those who work in the social care setting, and provide them with opportunities to progress their career and move into other parts of the care setting. For example, someone with considerable social care experience might be interested in doing nursing, but might not necessarily have the academic qualifications that get them into a university place to do a nursing degree.

We are looking at aspects such as the nursing apprenticeship, and we are taking forward that work through the nursing and midwifery task force to look at how we can create pathways into areas such as nursing for people from social care. We want them to see that there is a very clear pathway for them to follow, but we also want to make the social care setting appear as a much more attractive professional setting for staff.

My view is that pay is a big part of that, and we will do what we can to try to help to address the issue, because, historically, social care work has been paid less and had a lower relative value than healthcare work, which has resulted in challenges around the social care workforce.

You will be more aware than I am whether there are shortages of particular labelled medication or their alternatives. We try to encourage prescribing of alternative medications that might serve the same purpose but might not be the prescribed medication that the person had previously been on.

I do not know whether John Burns can say a bit more about other aspects of prescribing. We try to work very closely with the pharmaceutical industry to smooth out issues around procurement and the availability of medication. Sometimes the challenges that we face are, as you rightly say, not peculiar purely to Scotland or the UK. They can be as a result of a worldwide shortage or other challenges. Some of that will be because of stockpiling of medication.

I cannot remember the exact medications, as it was before I had responsibility for health, but I remember some occasions in recent times when there was concern about access to certain medications—in particular, certain forms of antibiotics. I remember being involved in that and hearing a discussion in which the chief pharmaceutical officer was talking about procuring some medications in advance so that we could hold some of them in reserve, if necessary.

It is a matter of planning around procurement of the medication. Where there are concerns around supply chain issues, it can be a matter of trying to stockpile some medications where that is possible. It is not always possible for all drugs, as some of them may have a short shelf life, but it is about trying to manage those things as best we can within the structures that we have, through procurement and with the help of clinical advisers on procurement and the stockpiling of medication. Those would seem to be most appropriate ways to address the situation.