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In short, yes. I expect there to have been significant improvement when we are sitting back around here in a year’s time, particularly and absolutely in those three boards—Ayrshire and Arran, Borders and Highlands—that have been escalated. I would expect there to be significant improvement.

We have already been in discussion with those boards around their escalation. As you can imagine, we have a process. As the member knows, escalation entails a higher level of monitoring, supervision and support. That is all on-going, but it is fair to say that I would be very disappointed if we were sitting here in a year and there had not been significant improvement, particularly in those three boards.

I hope that our 2023-24 budget restates our commitment to mental health support. If you compare this year’s budget to previous years, you will see that we are up 6 per cent on 2021-22 spend and up 139 per cent on 2020-21, so there has been a significant increase in mental health spend over that three-year period.

There is little that I can add to what I have already said. The focus must be on prevention, but each of us, as a member of the Scottish Parliament, knows that a significant challenge still exists around backlogs in access to child and adolescent mental health services in particular and to other mental health services. Our focus—the budget demonstrates this—continues to be on doing our best so that people, particularly our children, adolescents and young people, can be seen in a timeous fashion.

It depends on what you mean by looking at models of primary care. I am not looking at fundamental reform of the independent contractor model at the moment. We are where we are with the contract and this would not be the right time to upend the entire independent contractor model. That said, I am really up for a national conversation about our health services and their reform.

Over the years, we have seen a change in the model of general practice. Sandesh Gulhane mentioned multidisciplinary teams and allied health professionals in GP practices. They have been in place for a number of years, but there has certainly been a significant increase in the number of health practitioners in GP practices, from your physio to your advanced nurse practitioner, who all contribute to a general practice model.

This Government’s key innovations include the community link worker and the mental health wellbeing worker. I have a fantastic community link worker in my constituency. Anyone who has interacted with community link workers will know just how impactful they are as part of the general practice team. We will continue to invest in those additional members of staff in general practice. They are part of that more holistic approach to primary healthcare delivery.

It is still a very uncertain time. Although we are in a different phase of dealing with the pandemic and are much more into the endemic phase, it is still a very challenging time, as we all know, for NHS boards up and down the country. We are trying to revert to some of the pre-pandemic processes that we had in place. For example, in this financial year, we are urging boards to get into a position of balance. It is fair to say that we do not expect every single board to quite get there, but we are making it clear that if further brokerage is required, as per the pre-pandemic arrangements, they will have to look at the repayment of any additional brokerage. We are getting back to practices that we had pre-pandemic, which help the financial stewardship of NHS boards.

As you know, there are still a number of boards—three—that have been escalated in relation to their financial performance, and we continue to work exceptionally closely with them. Given the phase of the pandemic that we are in, we are taking an even closer look. We already had quite a close relationship with those three boards, but we are taking an even closer look at what can be done to get them to de-escalate in relation to their financial performance.

If I am being frank and honest, there is still a way to go in that regard given the experience of the past two and a half years—almost three years—of this pandemic, during which the financial landscape has been so uncertain and unstable. Given that we suddenly had to fund a whole new vaccination programme and so on, I am very keen, now that we are in this new phase, that the boards are getting back to really sound financial management; I certainly get that impression from the annual and mid-term reviews that I have with the boards.

I referenced the comments from the BMA about the EBR savings that we looked to make. Obviously, we have a significant budget for 2023-24, but I have no doubt that the reprofiling that we had to make in primary care had an impact. I will not argue about that with Dr Gulhane or the BMA, but it is why our strategy, over a number of years, has been to increase those multidisciplinary team members that you talked about. We have recruited more than 3,220 since making that announcement. On top of that, there have been increases in general practitioners. We still have a way to go in that regard, but I am pleased that we were able to ensure that, in the 2023-24 budget, primary care will be well funded. That puts it on a sustainable footing.

All that having been said—I do not need to tell Sandesh Gulhane, given that he is working in primary care—the workload pressure on our GPs is still exceptional, even with the multidisciplinary teams in place. That is why I am very keen to try to ensure that that workload is spread more evenly. For example, I have spoken about NHS 24 and what more can be done around that. You will see in the 2023-24 budget a significant investment in primary care that I am proud to stand by.

That is another fair question. We expect to see some immediate improvement from the action that we are taking. Your question was on whether we would see significant improvement. There is not a magic bullet or a panacea—Dr Gulhane knows that, given his clinical experience—but I think that it will see an improvement.

As well as the shorter-term measures that I will announce in the statement today, it is really important that we as a Government do not lose focus on the medium to longer-term issues, particularly in and around social care. The national care service is a part of that, but let us all accept that we have to make improvements now rather than wait for a national care service to become operational before doing so. As well as the shorter-term impact, the immediate improvement that I expect to see as a result of the action that we are taking will be on the eight-hour and 12-hour waits. Interestingly, given the flow through the hospital, we will probably see improvement in the eight-hour and 12-hour waits before we see it in the four-hour waiting time target. We will not lose focus of the longer-term changes and reforms that we have to make to social care, which will help to make a long-standing, more sustainable impact in the longer term.

Although we are focusing a lot on the back-door delayed discharge—understandably so, because it is the issue that clinicians and healthcare leaders predominantly raise—we will not lose focus on the front door. I will talk in the statement later about how, through the preventative agenda, we continue to drive down demand at the front door.

I am not sure of the nature of Tess White’s disappointment, so she can, if she so wishes, come back to me on that. The budget for NHS 24 for 2023-24 is outlined in the budget document. On any additional information on that, as I said, it is right and appropriate that we have agreed to update the entire Parliament in the chamber, so we will do that.

For the period from October to December, again, if Tess White does not mind, I will come back to her with the exact figures. There has been additional recruitment, because I have seen a note from NHS 24 on that since October. I will come back to Tess White with the exact figures so that I do not inadvertently give her incorrect ones.

First, although I know that that figure for the maintenance backlog was released publicly, we went back to the query that was made in order to correct the figure. The figure was incorrect: it is closer to £1 billion. That is still a significant maintenance backlog, but I think that it was inflated by around £500 million.

Nonetheless, Tess White’s point stands: there is a significant maintenance backlog. Over the capital spending review period, we have committed to invest more than £1 billion in enhancing or refurbishing existing healthcare facilities, and updating and modernising essential medical equipment. We will do that, but it will take time, which is why it will happen over the capital spending review period. However, it was a fair question.

Tess White’s second question was also very fair: why has the backlog not been mentioned? It is not because that commitment does not stand: the commitment to £10 billion over the decade stands. We always thought, and it has always been the assumption, that that would have to be back-ended towards the later years, given the financial circumstances that we find ourselves in, which have been exacerbated by various factors, as I have said. We are still committed to that £10 billion investment over the decade, but it will undoubtedly be back-ended towards the later years.

As I said, the argument at the time, from not just the Scottish Government but the Welsh and Northern Irish Governments, was to phase that in over a period. However, we rehearsed that argument and we lost it. The UK Government has decided not to continue funding Covid costs.

I am not often sympathetic to the UK Government, but meeting those costs was a huge undertaking. Our difficulty is that we have a new infectious virus in our health system that requires periodic vaccination, surveillance—to an extent—through test and protect, and some level of testing. We now have to baseline into our budgets the costs associated with that, and that is very difficult to do.

We will see how 2023-24 progresses. Our big worry, as Emma Harper referenced, is about what will happen if there is a new variant—and we are keeping an eye on XBB.1.5—that has immune escape and causes more severe illness. If that happens, we will need to go back to the UK Government with this discussion, given the implications of that.

Yes. As the member knows, sectoral bargaining is part of the national care service proposals that we have put forward. It is very difficult to do in the current structure. We are always looking to see what we might be able to do. Given that we have a very fragmented landscape across the country, with independent providers, third sector providers and local authority providers, sectoral bargaining has been virtually impossible or very difficult, thus far, but it is certainly part of the national care service proposals, if we can do it outwith the national care service. We are looking at that in the context of our fair work agenda for social care. We will certainly do that, because there is strength in sectoral bargaining.