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Of course.

That is a fair question. As per my previous answer on that, we are looking to produce a revised financial memorandum that we will present to the Finance and Public Administration Committee as per its request. The amount that we will spend on the development of the national care service will be a fraction of the overall health and social care budget for the coming financial year. Richard McCallum will keep me right here, but, in the current financial memorandum, the figure is between £63 million and £95 million out of a budget of £1.2 billion for health and social care. We are talking about a not insignificant amount, but it is a small amount in comparison with the entire budget. We will make sure that we do not lose sight of improvements that need to be made right now to social care. We will not wait for the NCS.

The second thing that I would say is that one of the driving forces behind the national care service is precisely to improve pay, terms and conditions and to have sectoral bargaining and ethical commissioning, and to put all of that at the heart of the principles of the national care service. You can see that in the bill. That will make a big difference to the sustainability of social care in the future.

I do not think that we can afford not to. We just cannot. Given the scale of the pressure that we are under, we have to be focused on the preventative as well as dealing with the current demand. Dealing with the current demand, especially over the past few weeks, has been exceptionally exhausting for our healthcare workers, whether they are in community care, primary care or secondary care. They are utterly exhausted after almost three really difficult and relentless years of a pandemic.

I understand why David Torrance asks that question. Part of the solution has to be in the preventative work. We have to make sure that we do everything that we can, whether that be on smoking cessation, drugs and alcohol or obesity. I mentioned asthma, for example, and the need for clean air. A lot of focus is still on the mental health preventative space as well. You will see that in the 2023-24 budget. I can give you examples of where we are spending on preventative measures. I am keen that we do not lose sight of that, even with the pressure of the current demands on the service.

We will regularly do those analyses. I do not disagree with the fundamental premise of Paul O’Kane’s question, which is that, if you pay people better, you have a better chance of recruitment and retention. We believe in that. Notwithstanding the fact that he and I completely agree on the premise of his question, we cannot take money out of the NHS, because we still need to deal with the demand pressures that we have in it. We cannot just take £1 billion out and say, “Right, we’re going to put £1 billion in here because we think that money is better spent here”. We will do that to an extent—that is the entire point of budgeting—but, at the moment, I could not justify taking the cost of £15 an hour, or even £12 an hour, initially, away from the NHS and putting it into social care.

I am keen to work with local authorities and to do what we can to continue to increase pay where we can, but it is not just about pay. I accept that pay is fundamental, but there are also issues with the terms and conditions of the social care workforce and their career progression. If there is more that we can do in that space, I am absolutely up for that. That is always part of the calculations and analysis that we do. Perhaps I should not put words in Paul O’Kane’s mouth, but I do not think that he is suggesting that we take the cost of paying £12 an hour out of the NHS just now and put it in to social care. That would have a significantly detrimental impact on the NHS at this stage.

I do not have much to add. I have been in Government for more than 10 years and we have always been encouraged to work across portfolios. I can certainly say that, in this session, the Deputy First Minister has really made sure that any hint of silo working or compartmentalisation is quickly snuffed out. We are working exceptionally collaboratively.

There are lots of examples that we can give. Emma Harper has mentioned a couple, and the Glasgow pathfinder project that is set out in the tackling child poverty delivery plan is another. I agree with the premise of your comments.

I might bring Richard in shortly, given his experience in this regard. I do not argue with Audit Scotland’s premise or the point that, I think, the deputy convener is making: multiyear budgets clearly help with planning. That is not unique to the health service; it is the case right across portfolios. That is why the spending review was an attempt to give at least a high-level overview of what budgets might be for future years. Our difficulty is the unstable economic circumstances that we find ourselves in.

You talked about sitting here a year from now. If we were to go back a year, I do not think that any of us would have expected to see inflation at the level that we currently see it at, nor, indeed, would we have expected to see some of the geopolitical factors playing out and having an impact on the economy in the UK and in Scotland in the way that they have.

There is so much that we can do around multiyear spending reviews, as we have done. They are not budgets—I accept that point—and do not go into the detail that a budget necessarily would, but they are an attempt, at a high level, to give some idea of what the financial envelope will be for future years. I entirely accept the point that that is different from a budget and that multiyear budgets could be more helpful. I think that the barriers you asked about are the instability and the economic circumstances domestically and globally.

Richard, is there anything to add from your experience?

I will take the second part of the question first. There is a genuine discussion to be had about alcohol and drug services being part of the national care service and the pros and cons of that. I can see the argument from those who oppose and have some concerns about that. We are taking time—we are doing research, working with general stakeholders and so forth—before we make any decisions about a number of services that might fall under the national care service.

As I said, the current plan is for the national care service not to be fully operational until the end of the parliamentary term. I have already given public commitments about entering into discussions with and hearing from political parties and, indeed, external stakeholders on whether they feel that that timetable is right.

Notwithstanding all that, and without putting words into my colleague Angela Constance’s mouth, whom I speak to on that issue very regularly, we have excellent ADPs across the country that do some phenomenally good work. Angela’s role is vital, because it gives us a national oversight of what is working on the ground and what is not. Of course, the lack of consistency was one of the reasons why the medication-assisted treatment standards were brought in.

You can bet your bottom dollar—this be of no surprise to the convener at all—that Angela is all over that with every single ADP and all the partners involved up and down the country. We have in place red, amber and green status, and we know who is doing well on what MAT standard and how far they are from whatever standard. Therefore, we—Angela will certainly do this—will keep a close eye on the governance and monitoring of that.

On the 2023-24 budget, part of the increase is an additional £12 million to deliver the cross-Government plan that will be published early in the new year. That speaks to the point that Emma Harper was making on that cross-Government, cross-portfolio working.

Obviously, I did not know that you would ask about that specifically. It is probably best for me to lay that out to the chamber in the statement later today. There will be two essential areas of focus. The First Minister outlined those in very broad terms so that I could give the detail to Parliament, as we said throughout yesterday.

No, I do not think that anybody asking for higher pay in health or social care is being unreasonable. I hope that, for all the differences that we might have on the issue, Carol Mochan and others will recognise that the Government’s approach to discussions and negotiations with trade unions has been constructive and meaningful and is a stark difference to the approach of a number of other Governments across the UK. That is why I continue to reiterate that, so far, Scotland is the only part of the UK that has not seen nurses and ambulance workers go on strike. I am not taking that for granted, because we know that the RCN, the RCM and GMB continue to be in disputes, so we will continue to engage with them.

On social care, in the 2023-24 budget there is about £100 million as part of the uplift of adult social care pay to the real living wage rate of £10.90. Richard McCallum will correct me if I am wrong on this, but I understand that that is the same as the increase by the Welsh Government, which has also increased the real living wage. That £10.90 figure is higher than the UK Government’s uplift, which is, I think, 48p lower than the £10.90 rate.

I do not disagree with the premise of Carol Mochan’s question and Colin Poolman’s comments: we have to continue to see what more we can do to improve pay, terms and conditions for social care workers. That obviously comes at a cost. Previously, Carol Mochan and the Scottish Labour Party called for an increase to £15 an hour, for example: I would love to give £15 an hour to adult social care workers—yesterday—but that would come at a significant additional cost of well over £1 billion, which would be very difficult or, frankly, near impossible to fund, given the financial pressures that we are under. We have to keep working at that. I certainly do not see the uplift to the real living wage as being the final uplift. We will continue to progress that.

Yes—and incur the wrath of the Presiding Officer. There are two areas of focus. The first is freeing up more capacity for interim beds. We have used interim beds already, but they will be a slightly different feature in what I announce in a few hours’ time in the chamber, given the pressures that social care is facing.

The second area of focus will be to bolster the NHS 24 workforce in particular, who have been exceptionally effective in keeping people away from busy acute sites. The vast majority of those who call NHS 24 and get through to a call handler get the appropriate triage without having onward transfer. However, I will lay out the funding—the pounds and pennies involved—in this afternoon’s statement, as appropriate.