Chamber and committees

I looked closely at Derek Feeley’s evidence. He undertook a tremendous piece of work that, in many regards, still holds true, which found that we need care to become far more person centred and that any reform or structural change must be about enabling the workforce and people to have a connected journey. It is not all about the medical world and the national health service; it is also about the many different people who require and expect an investment in their services, because it is an investment in them.

Sometimes, our narrative and the debates around social care become very focused on delayed discharge. I am very exercised about delayed discharge because, first and foremost, it is really bad for patients. However, the social care issue is wider than the delayed discharge issue. I agree entirely with your point about culture, which is why we are proceeding with that reform journey, whether on NHS simplification or on social care. Although I am always impatient—I am a woman in a hurry, believe you me—we need to take time and care to ensure that we always have the right folk in the room and the right spread of people, because that change in culture, values and ethos is as important as change in any of the structures that are in place.

I recognise that issue. It is not a new concern, which makes it all the more frustrating. There are different experiences of that time of transition from children’s services to adult services, depending on whether we are talking about social care or a clinical service, and that will vary by specialty. A bit of grip is required in that area, and the once-for-Scotland approach is important. I sometimes wonder whether we are reinventing the wheel multiple times in different services and locations. Addressing that area should be knitted into plans. As someone goes through their life, transitions are periods when care is at risk of disruption. For some areas, there will be clear requirements about planning ahead.

I ask my officials whether they have anything to add on transitions.

The national “Health and Care Improving Flow Plan 2026-2031” was published just a few months ago—an announcement was made at the time. The plan has a renewed focus on the movement of patients throughout our system.

It is important to focus on delayed discharge, but I think that you were intimating that issues in and around social care go beyond that. Within the hospital flow plan, there is a renewed focus on things such as rolling out frailty units and delivering an improvement in ambulatory care.

It is also imperative to focus on interventions such as discharge without delay, and we have a renewed focus on that. I have seen and heard that, in particular areas of the country, there have been improvements in relation to the discharge of patients due to an approach that involves planning for someone’s discharge as soon as they are admitted to hospital. The plans might change, depending on somebody’s clinical presentation, but that planning starts at the point of admission. Where that approach has been adopted, the length of stay in hospital has reduced.

My challenge is, if we have interventions that are evidenced and that work, why are we not implementing them across the country? I am determined to do everything that I can to ensure that such interventions are more broadly adopted. That is part of the purpose of the hospital flow plan.

On the broader issue of social care, I am clear that social care, by necessity, needs to be reformed. That is a significant undertaking. I respectfully remind the member that the Government is not a social care employer. However, we provide substantial funding for the sector. Some £2.3 billion of the health and social care budget goes into social care, and the funding routes for that involve health boards and integration joint boards.

Your point about coterminous boundaries is interesting. Coterminous boundaries tend to support a simplification of approach. That is a point that is worth bearing in mind, particularly as we proceed with public sector reform more widely. I am sure that we will come to NHS reform, but I would say that there is a huge interdependency between NHS reform, social care reform and local government reform. Of course, in terms of social care, we are in a period of intensive discussions with our partners, and it is important that we have timely, intensive discussions in good faith.

09:45

No decisions have been made about the future of IJBs. However, the frustration that I hear from members representing their communities—and, indeed, from those who are working hard in our services—is about the fragmentation of care. I hope that addressing that will be a significant objective of reform. Irrespective of the structures that will be negotiated and agreed for the future, we should have a single, co-ordinated care journey across the health and social care system.

We have—I will be brief, convener—always set a budget that has recognised the priority that not only parliamentarians but the people of Scotland place on health and social care. The annual budget uplift for the health and care portfolio has been between £0.7 billion and £0.9 billion, and £10 billion of additional funding has been provided at the top level of the health and care budget over the past decade or so. Some of that is due to our investment in improving social care terms and conditions and in funding the real living wage.

I am very cognisant of the 2025 Audit Scotland report that spoke about the importance of data. Data is important for transparency, for scrutiny and for holding people to account. If it is used in the right way, it can invigorate and motivate change. The report also spoke about the need to continuously focus on the resilience of the workforce, and I acknowledge that the workforce is key.

The short answer to the second part of that question is yes, absolutely. That is why we have the ANIA project and are interested in the work of the centre for sustainable development. Again, the development and implementation of technology is a key feature in our public sector reform plans more broadly. Also, at a practical level, I do not want people who work with more than one health board having to have two laptops and operate two systems and so on, and I want there to be shared digital records.

We are continuing to roll out the MyCare.scot app, and, after next spring, there will be a phased introduction of the capacity to use it for secondary care appointments.

I have answered lots of parliamentary questions on GP practices transferring to the Vision system and have met Public Services Delivery Scotland to discuss some of those concerns. In the vast majority of cases, the transition is working well. I can see from the parliamentary questions that there are some hotspots in parts of the country where things are not working well, and I know that additional attention and support are being given to GP practices as a consequence. There is a bit of a complex history to the situation, and I would be happy to write to Mr Harley and the committee on that.

I recognise the importance of facilities and resources for sport. A facilities review was undertaken by a range of sport governance bodies, and we will continue to work with them on that.

I point to the fact that, in this budget, we have provided record funding for local authorities. Of course, the provision of sports facilities is much more in the local government domain than in mine specifically. I am not demurring from the pressures that are faced across public services, including those faced by our partners in local government, but local authorities have additional means of borrowing, for example, and different ways to resource facilities.

The point is well made. Of course, it is Scottish women and girls in sport week this week, and we need to address the gender gap in participation.

Responsibility for the forthcoming football tournament sits with Mr Flynn. The issue is interesting, in that responsibility for international sporting events seems to vary. Sometimes, it has sat in external affairs and culture, sometimes in the economy portfolio and sometimes in health.

I am aware that there has been some overtures from that organisation regarding free tickets. Why would we not want sport to be as inclusive as possible?

Yes, the accelerated national innovation and adoption pathway, which, again, involves a once for Scotland approach and is extremely connected to the research community.

The issue of public sector reform has already been flagged, and one of the many reasons why I want to see a simplification in our structures is due to the engagement that I have had with the research community and the frustration that it has expressed about having to deal with 14 different health boards—I can think of a particular example around the work on brain cancer research at the BioQuarter in Edinburgh. Rightly, there is an ethical process for onboarding patients into clinical trials, but those researchers have to do that 14 different ways. To be able to motor on with clinical trials, researchers and clinicians need a particular volume of patients, and there might not always be the right number of people in the one health board. There is also an issue of equity arising from the fact that they have to embark on 14 cumbersome processes. Essentially, there are opportunities in that regard in the reform agenda.

It is quite a specialist area, so my officials might want to add something at this point.

There absolutely should be. We like social prescribing, as it is the way to make best use of resources at a community level. That is about recognising that not all treatment, recovery or interventions need to be medical in nature, and it speaks to the sense of engagement and connection with the local community, which is good for people’s health, reducing isolation and helping people to get exercise.

I flag that the annual reviews of NHS Grampian and NHS Highland take place next Friday and this Friday respectively, and that I will chair both those reviews. As the member has said, it is no secret that NHS Grampian has been escalated for financial reasons. There is considerable oversight of the matter, which involves senior officials—indeed, Christine McLaughlin had a big part in that process in her previous role.

The board moved to stage 4 escalation, which is very high, to ensure that it has the support not only to mitigate the financial and associated operational pressures but to stabilise the system. In addition, an assurance board will strengthen the measures that are already in place. You will be conscious that several changes have taken place, including some new leadership in NHS Grampian.

This budget received nearly £1.5 billion in baseline funding, so scrutiny and oversight by the Scottish Government is crucial, because we want to be assured that that substantial slug of public money is used effectively to serve the good people of the north-east. Do you want to add anything about the assurance process, Christine?