I will make three points.
The first is about the NRAC formula. We touched on that last week and discussed whether there is a case for reviewing the formula. I made it clear that I think that there is a case for doing so. That will be a lengthy exercise and will be one for the next Government.
In the meantime, as Richard McCallum made clear and as I have also said, we recognise that events such as the pandemic can lead to specific additional costs. When such events happen, there is a need for greater flexibility in our approach to the allocation of funding. In this instance, we have adopted what I would describe as a hybrid model. We will consider how that sort of flexibility might be applied to future allocations of health board finance as we move out of the pandemic.
The second point is that it is critical that we shift the balance of spending. Covid hubs have been mentioned. The hubs were introduced as a direct response to the pandemic. They provided a community-based route to healthcare and support and allowed us to keep our primary care general practices free of Covid, as best we could.
To an extent, the flexible approach to considering what primary care needs and how it works is replicated in the redesign of urgent care, which is under way but in its very early stages. That approach can also be seen in the flow centres, which use a triage model to ensure that people get the right care in the right place using more of our primary care resource, including community pharmacy—the role that it plays has increased significantly, and there is still more for it to do—optometry and dentistry. The shift in the balance of care applies to resourcing, of course, but also to a wider recognition that community-based and primary care exist in addition to general practices.
The third point is the importance of considering health and social care funding in the round, so that we recognise that the resource that goes into social care can have an impact on the demand in healthcare and, equally, that the flow through healthcare has an impact on the demand in social care.
That will all feed into a future Government’s response to, for example, the Feeley report. It is also a feature of our regular consideration of the pandemic and the public health measures that are necessary to restrict the transmission and spread of the virus.
We talk about non-Covid health harms, which are serious and significant. The mobilisation plans that boards are currently working their way through and finalising, before sending them to us, look specifically at what needs to be done to reduce the scale of non-Covid health harms that have, inevitably and unavoidably, been created by the response to the pandemic. That links directly to social care. For example, if someone’s hip operation has been delayed, their dependence on social care support will have increased, because they will have been less mobile for a longer time than if we had been able to deliver the planned procedure as we would have done before the pandemic.