���˿���

I thank Mr O’Kane for the question, and I thank you, convener, for the invitation to address the committee today. I am genuinely sorry that I cannot join you in person—I hope that the committee understands. As many of you will know, after a gentle game of badminton, I seem to have ruptured my Achilles tendon, so—as Dr Sandesh Gulhane, Emma Harper and other members with clinical experience will tell you—I have to keep my leg elevated for as long as possible.

Before I answer Mr O’Kane’s question in some detail, I want to say how genuinely pleased I am to be in front of the committee. From me, as the Cabinet Secretary for Health and Social Care, and from my team, you will get responsiveness, openness and transparency. We will not attempt to stifle debate or be in any way defensive with regard to the work that we are doing, nor will we try to be anything other than constructive in respect of the committee’s work.

Having been a minister for the best part of nine years, I have always thought that committees and Government can work best when we focus on moving in the same direction together. I am really looking forward to working with the committee, and I am sure that we will generate more light than heat.

To go back to Mr O’Kane’s question, capacity is absolutely imperative. As the committee would imagine, my immediate focus, from the minute that I was appointed as Cabinet Secretary for Health and Social Care, has been the pandemic and the current crisis that we face.

We are still in the midst of the pandemic and—as Mr O’Kane rightly says—we face some real and significant challenges. Our job is, therefore, to work with every single health board up and down the country to maximise capacity and flex in the system. We have additional capacity—we based our modelling for capacity on best-case, medium-case and worst-case scenarios, and we have ensured that there is as much flex as possible in the system.

I will be frank, however—I intend to be frank with the committee, not just at this session but in any appearance that I make—that that involves making difficult decisions. We are seeing those decisions being made up and down the country; Mr O’Kane referred to some of them. There are usually tough decisions to be taken on non-urgent, elective surgery. A number of health boards have now decided to pause such surgery, because doing that is one of the pressure valves that we have. We cannot stop people having heart attacks or strokes, so we have to—and we will—attend to that sort of urgent care. With non-urgent care, we are able to release the valve where necessary to increase the capacity in our national health service.

Of course, that does not come without consequences. I have no doubt that we will talk about backlogs and the fact that every paused surgery has an impact on the individual who is waiting for their elective procedure. There are huge challenges, which is why controlling transmission of Covid is our top priority—we do not want to overwhelm an NHS that is already under extremely significant pressure.

There are a couple of issues that we did not touch on, which the committee may follow up with other ministerial colleagues. For example, the national mission on tackling drug deaths is also a clear priority for me. My ministerial colleague Angela Constance is taking forward that work, but I want to give you an assurance on that issue, because I know how important it is to every member of the committee. Ms Constance and I are working extremely closely on that. If you want me to come back to the committee, I will do so, or if you want Ms Constance to attend, I am sure that she will come to the committee to talk about that.

I just want to assure you, convener, that, as cabinet secretary, I am working hard on that. I am more than happy to come back to the committee if you want me to do so, even at particularly short notice, especially given the nature of the pandemic that we are dealing with, in which things can move extremely quickly. I will make myself available to the committee whenever it is a suitable time for you.

I thank Mr O’Kane again for an important question that gets to the nub of the issue.

First, I point out that NHS staffing is at record levels—over the past year, we have increased the number of staff by 5,000 whole-time equivalents. That is not to say that there are not significant challenges. In some areas of our NHS workforce the vacancy rate is too high, so we will work to try to reduce that.

Mr O’Kane used the phrase “a perfect storm”. I agree whole-heartedly with that description. The summer has seen a perfect storm, with higher rates of transmission—we have eased restrictions, so we would expect that to happen—and in the past month, schools have returned as well. Understandably, NHS staff are taking some of their annual leave because they are—again, to be frank—knackered as a result of the past 18 months. Community transmission is high, which has an impact in terms of those in the NHS having to self-isolate if they test positive or become a household contact.

That is a perfect storm, as our NHS recovers. It is not like it was at the beginning of the pandemic, when we stripped the NHS right back to urgent care, cancer treatment and so on. Now, we are recovering the NHS, so the headroom is much smaller. I could say a lot more, and the “NHS Recovery Plan 2021-2026” goes into a great deal of detail about how we will achieve those ambitious targets, including that of increasing capacity by 10 per cent over the course of the plan, which will involve the additional recruitment of staff. As Mr O’Kane alludes to, it will also require the retention of staff, and we have a good record on that. Our pay increase for NHS staff ensures that they continue to be the best paid in the United Kingdom, and it is the biggest single-year pay increase for the NHS, which I am really proud of. However, there is more that we can and will do.

I will say a bit on that, and our national clinical director, Jason Leitch, might want to add to or correct what I say. There are two primary purposes to what we are doing. First and foremost, I want to say that we have been very public about the fact that we are not taking that step lightly at all, and the Deputy First Minister and the First Minister have spoken about it in a similar way. It is being done because of the challenging circumstances that we face because of the case numbers. Everybody knows that the case numbers yesterday were around 7,000, so we are in a challenging position. I would not have considered such a scheme had case numbers been far lower, as they were at the beginning of the summer. However, we are now in these different circumstances, and therefore our thinking must evolve.

There are two things to say about the clinical rationale. First, yes, we hope that vaccine certificates will help us to control transmission in particularly high-risk settings. We should remember that the certification scheme is limited to high-risk settings, such as nightclubs. Again, we can go into the reasons why we think that nightclubs are high-risk settings, but they involve a largely, although not exclusively, younger age cohort, and we know that there is lower uptake of the vaccine in that age group. We know that some of the behaviours exhibited in nightclubs, such as close-contact behaviours, are riskier with regard to transmission of the virus. Therefore, in that setting and the other settings that we propose to include in any certification scheme, we hope to be able to control transmission. From the point of view of public perception, if I were to attend the football at Parkhead, I would feel much safer knowing that everybody around me was double vaccinated too. That does not mean that these become no-risk settings—nobody is suggesting that. It just means that we can mitigate some of the risk.

The second point, which is important, is that we hope that vaccine certificates will incentivise people to get vaccinated, particularly in the cohort in which uptake is low. It is far too early to comment definitively on causation, but the figures for first dose vaccinations administered over the weekend just gone were 50 per cent higher on the Saturday and 70 per cent higher on the Sunday than on the previous Saturday and Sunday. Again, it is too early to comment definitively on causation, but, if we continue to see that trend, any rise in vaccination will help us as a society as a whole.

I hope that that answers the question, but it might be appropriate to bring in the national clinical director, if he wishes to add something.

In short, yes. Forgive me—I will need to double check when we are hoping to publish the refreshed framework for effective cancer management, but I hope it will be in a matter of weeks, and that will go into the detail of exactly what Ms Harper mentioned: making sure that we have the right treatment at the right time and in the right place for people.

We recognise that there are challenges in rural areas with cancer referral and pathways. Let us be honest: even pre-pandemic, there were challenges. The refreshed framework—the effective cancer management framework—will help to address some of those issues.

That is a very good question. I perhaps touched on the issue in my answer to Ms Mackay. I will not pretend to you; it would be insulting to your and the public’s intelligence for me to suggest that we are able to meet those ambitious recruitment targets simply by domestic recruitment. We will do that, but we will also try to recruit from other parts of the common travel area. It is clear that ethical international recruitment will be part of what we do.

In relation to training, do we get the absolute most out of the current staffing cohort or can we train them to an even higher level? Can we incentivise them to stay for longer? A number of the stakeholder member organisations that I suspect Dr Gulhane and committee members have met tell me that retention is a key issue, and we are working hard on how we can retain people. Where those powers are within our gift, of course we have to use them, and where they are in the gift of other Governments, we will work constructively with them, because these are common challenges. The challenges that GPs and consultants in Scotland face are probably very similar to those faced in other parts of the UK.

Yes, we should invest in the pipeline and make sure that there is an increase in training places and graduate places; increased domestic recruitment and retention and ethical international recruitment are also part of the mix.

Again, my connection timed out briefly. I think that I got the gist of Mr O’Kane’s question, but if I do not answer any part of it, I am happy to come back to him.

Mr O’Kane is absolutely right. Nobody waits for a workforce plan to come at the end of the year before taking immediate action. That is why our staffing levels are the highest that they have ever been. A record number of whole-time equivalents are working in our NHS. An additional 5,000 WTE staff are working in our NHS this year compared with last year. We are investing in staffing right here and now. It is important to make that point.

We have had ambitious plans right across the NHS. As you know, we have targets to increase the number of GPs, paramedics, mental health workers, community link workers and paramedics in the Scottish Ambulance Service, and that investment is happening here and now.

This is where I briefly lost my connection, but I think that part of the question was about social care. We are also working really hard with the sector to see what we can do to retain current staff, but also to do a bit of marketing and communication to incentivise people into social care and to ensure that those who study social care go on to work in the area rather than going off to another profession. We are working with them while they are still doing their courses at university or college in order to try to attract them to stay in social care.

However, I will be very frank and honest with you: that side of things—recruitment into social care—is probably one of the elements that gives me the most significant concern, because we do not have the same leaders in social care that we have in the NHS.

I agree whole-heartedly with Gillian Mackay. I will make a point that the entire committee knows about. The NHS and social care are interlinked and integrated so, when there is pressure on one part of the system, there is pressure on social care. Those are important points to stress.

On social care, I give as much assurance as I can to Ms Mackay that we are not just waiting for a national care service to be fully operational. It will take until the end of the parliamentary session to get it up and operational. We are taking action now. An example of that is the more than £60 million of funding that we provided to ensure that our social care workers get at least the real living wage. We want to see how we can go even further than that, of course, and that will no doubt be an important topic of conversation in relation to future budgets. We are not waiting around for the national care service.

We are working hard with the social care sector on underoccupancy levels. Ms Mackay will know about the scheme that is in place for payments around underoccupancy, which has existed throughout the pandemic. We are supporting the social care sector where we can. The national care service is hugely important to that. Whereas full terms and conditions can be set consistently across the national health service, that cannot be done across the care sector. With a national care service, which would, of course, be accountable to ministers, we would be able to have a consistency of approach right across the country. Depending on what the final shape of the national care service is, it could involve a full range of care services—not just adult social care but many other care services, such as child services.

We are certainly not waiting around for the national care service. We are working with national care providers to do what we can to help to alleviate the pressure.

We will always do everything that we can from a communications perspective to help to alleviate those pressures. Let us be absolutely clear: GP practices are open, and people can get face-to-face appointments. Some people prefer to have a Near Me video consultation or, indeed, a telephone consultation. I phoned my doctor a couple of weeks ago because I had a bit of an eczema flare-up. That was very easy; I did it in between meetings. I got the ointment that I needed, and that did not take away from my work day. Many people might, like me, prefer doing that, but a number of people would prefer a face-to-face meeting.

GPs are working extraordinarily hard, as everybody in the NHS is, and we owe our GPs at the primary care level all the thanks in the world for the incredible work that they have done. Any suggestion that they are not seeing people face to face because they do not want to is false, and I absolutely reject it. However, a number of members of the public, particularly in our elderly population, want to see a GP face to face. Some of the guidance published today will make that easier.

Thank you for that excellent question, which raises an issue that is at the heart of what we are planning for and doing at the moment.

The decisions that must be taken are difficult, but they are not unique to Scotland. That is no consolation for your constituents or mine who are waiting for a procedure or are waiting a long time in the A and E department in the Queen Elizabeth university hospital, but it is fair to say that these challenges are being faced across the United Kingdom. Although you are right to note that Scotland’s A and E service has had challenges in terms of its performance, it still remains the best performing A and E service across the UK. Again, of course, I accept that that is no consolation to our constituents.

You ask what is being done. The immediate priority is to get through this crisis. We need to reduce community transmission as best we can because, if we do that, we alleviate the pressure that is put on the NHS by Covid. At the moment, we have more than 700 Covid patients in our hospitals. That might seem like a low number but, if you add that to all the other services that the NHS provides, it all begins to add up.

Today, Public Health Scotland should publish some guidance that is focused on primary care and general practitioners in particular. I hope that that guidance will enable more face-to-face consultations to take place at GP surgeries. I know that GPs are already seeing people face to face, but I suspect that, like me, you have been contacted by many constituents who are saying that they are finding it difficult to get face-to-face appointments. That guidance, along with the further investment in primary care that we will make, will help the situation at that end.

I do not need to tell anyone in the committee just how challenging the situation is with ambulances, given the demand on the Scottish Ambulance Service. We have just increased our investment in the service and are already seeing that pay off. I think that more than 60 people were recruited to the service in the north and north-east of Scotland last week.

We are doing what we can on the acute side, including increasing bed capacity and putting in place the NHS recovery plan. No doubt we will come on to this, but the back end is also important, because there are increased levels of delayed discharge. We are working to put in place rapid units that can make the assessments that are necessary in order to get people back into their communities. That includes considering whether it is possible to have a bridging care plan in place that meets those people’s needs for a period of time and allows us to work closely with the local authority, the health and social care partnership or the integration joint board to ensure that we can make a full care plan available for that individual.

In short, the point that I am making is that the NHS recovery plan, backed by a £1 billion investment, takes a whole-system approach. There is no point in trying to tackle the situation in A and E on its own; we will have to tackle the entire system if our efforts are to have any effect.