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We will explore that. Every report by the Auditor General on the NHS deserves such consideration. I am keen that we get the balance right. There is reform that is exceptionally important for delivery of service, but reform of governance and accountability is also really important. However, we must not end up so involved in reform that we get distracted from the immediate pressures of getting through the backlog, given the length of time that people have had to wait for various elective procedures.

Accountability is important. Although I cannot make a commitment on what more we might do in relation to the Auditor General’s recommendation, I acknowledge that it is worthy of further consideration.

On your latter point, we recognise that the framework has to be updated, particularly in the light of Covid and some of the challenges that that has brought. We have not yet committed to a specific date by which it needs to be published, given that we are just coming out of the immediate pressures of a pandemic response because of the omicron and BA.2 wave. However, we recognise that the framework needs to be updated and published.

Remember that the medium-term framework does not set our budget; it gives us an envelope, and then it is for us to prioritise what the budget will look like. That is informed by our key policy priorities and, for example, how we align with the national performance framework.

On your question about confidence in the funding and the fiscal framework, I point to a recent joint study by the London School of Economics and The Lancet, which suggested that a 4 per cent real-terms growth in healthcare costs is to be expected if we are to improve the quality of care and the terms and conditions of the health and care workforce. That is in keeping with the assumptions that underpin the current medium-term financial framework.

That and other independent research will inform our review. We will update the medium-term financial framework and publish it after the resource spending review. I hope that that makes sense to members.

I have tried not to stray into politics too much. Brexit has undoubtedly had an impact, which has been recognised by anyone who is involved in social care, in particular. Any MSP who has visited care homes in their constituency over the past year will have seen the differences in workforce demographics.

Any social care provider that we speak to—whether it be a small independent, a third sector organisation or local authorities that have in-house provision—has clearly said that Brexit has had an impact.

On the flip side of that, I was pleased that, after considerable pressure from the Scottish and Welsh Governments, and, I suspect, from providers in England, the UK Government made changes to its shortage occupation lists in relation to social care, but that does not go far enough.

Social care is a real concern of mine. I have talked about the workforce, and of course we have ambitious plans around the national care service. No doubt we will, in future meetings, get into the detail of that. We cannot wait until the national care service becomes fully operational at the end of the current parliamentary term; we have to take action now. There is no getting away from the challenges caused by decisions that have been made elsewhere that are having an impact here in Scotland.

Data is a really important part of the detail. I will come back to the question about more detail in a second; data is crucial to that. That comes across from the Auditor General in the report, which says that there must be more transparency in respect of data. That will help us in terms of the detail that we will bring forward.

We will provide even more detail than we already have, including on the workforce. We are waiting for workforce plans from health boards and we plan to provide more detail on the three-year projections this summer. We will also provide more detail in the form of the update on the recovery plan that we have promised to provide this summer. As I said, data is absolutely crucial to that.

The ambitions of the recovery plan were well recognised in the Audit Scotland report.

I go back to the guidance note, and the point that there is not one model that fits all. For example, if a health board wanted to set up a clinic based on the Hertfordshire model, it could do that. As I have said, I will not pre-empt any funding decisions that are still being considered. We will make those decisions fully public and transparent soon. It is up to individual health boards to understand the needs of those whom they serve and what is the best model that they can put in place.

I know that the approach works exceptionally well in some places. I spoke to a patient called Pamela in the NHS Greater Glasgow and Clyde area who has had exceptional treatment and care for the long-term effects of Covid. She could not speak highly enough of the physios who have helped her during her care and treatment. Equally, I have spoken to people who say that the support that they have received for the long-term effects of Covid has been inadequate. That is why the strategic network must ensure that there is consistency across the country, and my job is to ensure that it is resourced effectively.

The member has consistently raised the issue of health inequality when I have been in front of the committee and it is an important issue for us to focus on collectively.

I will make a couple of points. I go back to my substantial point to your previous question. The work that we are doing around data on health inequalities will not wait for the strategy to be published. We are getting on with that work now. I will give you a couple of examples. You will know that, during the vaccination programme, we ensured that we collected data on people’s ethnicity for example. That gives us much richer detail around some of the health inequalities. It is very clear that the uptake of vaccinations was lower among particular ethnic community groups, such as the Scottish African population and, I think, the Scottish Polish population.

Another example is the great work of the primary care health inequalities short-life working group, in which colleagues from the deep-end project have been involved. As you know, the deep-end project involves GP practices that are based in some of the most deprived parts of Scotland. I commend the group’s report to all members of the committee, if they have not seen it already.

The data strategy will set the direction for improving data collection and the recording of protected characteristics data, which will enable highly detailed research into health inequalities to be carried out. That will be an element of the data strategy, but I give Ms Mackay an absolute assurance that we are not waiting for that strategy to improve data collection on health inequalities—that work is taking place right now.

In responding to the pandemic, we have ensured that every health board has received the support that it has needed. When health boards have requested additional support, we have been up front in making it available.

However, there is no doubt that the challenges of the pandemic have not made it any easier for the boards that were escalated in relation to financial sustainability prior to the pandemic. Therefore, significant support has been provided to the boards. I am not going to give you an absolute assurance on how things will end up at the end of the financial year, but there will have to be continued work with those boards in the period ahead.

Our aim and ambition in providing that support is to de-escalate the situation. That is the entire purpose of providing the support. You will be aware that, when boards are escalated, we ask for a significant amount of reporting in addition to what we would ask for from any other health board. I am confident that the boards will de-escalate in good time, but I also make the point that the pandemic has made achieving financial sustainability more challenging.

Richard McCallum might want to add something.

Good morning. I hope that all committee members are safe and well. All of us are present in person. It is good to be around the table and really good to see everybody.

I am grateful to the committee for its time this morning, and I will make a relatively brief opening statement. I suspect that we will give most of the issues a thorough exploration.

First and foremost, I thank Audit Scotland for its report on the national health service, which was informative, insightful and fair in its recognition of the efforts that the Government has made and on where Audit Scotland thinks the Government and partners must go further in their response to the pandemic in particular.

The report correctly identifies that health and social care in Scotland is at a critical juncture. We are navigating our way out of the pandemic while dealing with case numbers that place continuing pressure on the NHS. It is not just current case numbers that are doing that; the cumulative impact of the pandemic over the past two years continues to put pressure on our health services. In addition, we have seen the emergence of new challenges such as long Covid, which is having complex detrimental effects on people’s lives. We will be able to say more about that in this meeting and in the forthcoming parliamentary debate later this month.

There are also challenges caused by the knock-on impacts of the pandemic. We know that we must address the backlog in treatment and care, support our health and social care workforce, and ensure that everybody can access primary care in a way that supports them and addresses their clinical needs. Addressing those challenges will require a significant changes in how we deliver health and social care while access to those vital services is maintained.

As the Audit Scotland report notes, our workforce has kept going in incredibly difficult circumstances. I—and, I am sure, everybody else around the table—thank our health and social care workers throughout Scotland for the invaluable work that they have done, and for their tireless efforts throughout the pandemic. I recognise the monumental challenges that they have faced. Every single health and social care worker whom I have spoken to has told me that the past couple of years have been the most difficult in their professional careers. That is why we have made £12 million available to support workforce wellbeing, and have put in place a national wellbeing helpline to support staff 24/7.

We are making significant progress on recruitment of staff. Members of the committee will be aware of our recent announcement that we have recruited almost 200 nurses internationally; many others are in the pipeline. They are in addition to the 1,000 additional support staff to work across the NHS and social care. However, more progress is needed. That is why we are taking the necessary steps to recruit more staff and, crucially, why we are not working only on recruitment but on what we can do to retain staff across the NHS and social care.

Audit Scotland made it clear that healthcare and social care should be as inclusive and accessible as possible. Last year, we ran the general practice access campaign, which was shared across social media sites and radio for five weeks, to reassure the public that general practices were open. That campaign emphasised the variety of ways that treatment can be sought, including face-to-face, video and telephone consultations.

Outside general practice, we continue to develop a range of primary care services including, for example, NHS pharmacy first Scotland and NHS 24, which I am delighted to say recently celebrated its 20th birthday. We are also developing more online resources through the NHS Inform website and other channels.

The way in which we access services is changing, and will change, as our digital behaviours change and in accordance with clinical needs. By prioritising clinical resources, we are managing demand and, we hope, supporting people more effectively.

In its report, Audit Scotland rightly identified the importance of gathering and sharing health data to help to ensure transparency and the provision of effective joined-up care across the health and social care landscape. We have also committed to publishing a dedicated data strategy for health and social care. That will be a first for Scotland and we hope to publish it by autumn this year. It is backed by the Scottish Government investing £112.9 million in digital health and care over 2022-23 to help to make the best use of digital technologies in design and delivery of our services.

The NHS recovery plan, backed by more than £1 billion of investment, set out our plans for health and social care over this session of Parliament. That includes providing more than £400 million to create a network of national treatment centres across Scotland, increasing capacity for planned elective procedures and diagnostic care. We are increasing NHS capacity by at least 10 per cent as quickly as possible to address the backlog of care and meet continuing healthcare needs across the country.

We are still dealing with the pandemic. It is not over yet. It continues to have profound effects on the health of our nation and health services up and down the country. Our focus must be on ensuring that we transition out of the pandemic safely, and on tackling the backlogs in immediate and essential care that have resulted.

However, we must also provide access to care in a way that best suits people’s needs. We need a strong workforce where wellbeing is protected and recruitment and retention are at extremely high levels. We need to adapt to ensure that new technologies and models of working can help to support more of our citizens with their care as close to home as possible. That is my aim, as Cabinet Secretary for Health and Social Care.

I look forward to delving into the issues in more detail. I am, of course, happy to take your questions.

That is a good question. I can give you confidence that prevention is not viewed in isolation in health and social care, although it is, of course, vital to those of us in health and social care. The Deputy First Minister convenes—with a great degree of regularity—a group of cabinet secretaries and ministers that is focused almost entirely on prevention. Our recent announcements on the child poverty action plan are an excellent example of our coming together across a number of portfolios to work hard to deal with the issue of child poverty as it exists, but also to prevent more young people, children and families from getting into poverty, and setting out how we plan to do that. Such cross-Government, cross-portfolio working is vital.

Improving physical and mental health before crisis point is an important focus for us. There is a lot of focus on child and adolescent mental health services. That is understandable, because there are challenges around CAMHS referrals. I accept that, which is why we will put in significant investment. However, we are also putting significant investment into prevention, before people get to crisis point. For example, we are looking at what we can do in our schools as regards education in and around mental health.

On physical health, too, a lot of preventative work is being done. We are thinking about how we can make physical health opportunities, such as those that are offered by sport, more accessible. I am not talking only about sporting opportunities at the elite level, important though those are. Last week, we celebrated 10 years of the daily mile. My colleague Maree Todd deserves a shout-out for her vociferous championing of that project. We are trying to make opportunities to improve physical health as accessible as possible.

I can give you an absolute assurance that we have—and have had for many years—a laser-like focus on the preventative agenda, but I go back to Ms Mackay’s point about our data on the areas of highest deprivation, where, unfortunately, the health inequalities are still too wide. Those areas will be areas of particular focus for us in the coming period.

That is vital. There is not much for me to say except to agree ferociously with Ms Mochan on that point. We know how important those allied health professionals are, particularly when we think of the work that they do with GPs and multidisciplinary teams, which is just one example of how important they are. They are clearly part of our plan for the recovery of the NHS and social care.