Health and Sport Committee

Meeting date: Tuesday, February 9, 2021

Official Report 573KB pdf

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Budget Scrutiny 2021-22

Agenda item 9 is consideration of the Scottish Government’s budget for 2021-22. I welcome Jeane Freeman, the Cabinet Secretary for Health and Sport, and Richard McCallum, who is interim director of health finance and governance at the Scottish Government. Thank you for joining us.

On 10 November, the committee published its pre-budget report, “More than 50% of the Scottish Budget—What are the expected outcomes from the Health and Social Care 2021/22 Budget?”. The purpose of the timing of the report was to provide the Government with time to consider the implementation of our recommendations in its forthcoming budget.

The Scottish Government response to our report was received just yesterday, which has limited the opportunity for members to consider it ahead of the meeting. Nonetheless, I am sure that the cabinet secretary will reflect on the response in her opening statement, after which we will move to questions.

I am grateful for the opportunity to give evidence on the budget proposals for our health and care services.

As Kate Forbes said in Parliament, the 2021-22 budget is delivered in “exceptional circumstances” that require and have required an “exceptional response”. The budget provides funding to support our urgent work to control the virus and to protect our health and care services and the people of Scotland while the vaccine is delivered as quickly and safely as possible. It provides funding to remobilise and reform health and care services, and to reduce health inequalities, which have been exacerbated by the pandemic.

To deliver that, spending on health and care services will exceed £16 billion for the first time, with a further £869 million allocated to support the on-going response to the pandemic. The funding settlement sees every penny of additional health resource consequentials passed on in full.

We will ensure that our front-line services have the funding that they need to respond to the unprecedented challenges that the virus continues to present, to remobilise and to recover, and to redesign services. Funding for front-line NHS boards will increase by £316 million, which is a 2.8 per cent increase. That builds on our record level of front-line health spending in Scotland, which is currently £112 per person and 4.8 per cent higher than the spend per person in England.

We have ensured that all NHS boards are within 0.8 per cent of their target funding share, which is the closest that boards have been to parity since the formula was established.

Our budget will deliver investment of £180 million to tackle waiting times, enabling boards to start to address the pandemic-induced backlog when it is safe to do so, and to improve access to hospital-based services.

The Scottish Government will increase its package of investment in social care and integration by a further £72.6 million, thereby underlining the commitment to support older people and people with long-term conditions, and recognising the vital role that unpaid carers play. That takes the total package of investment in health and social care integration to £883 million and supports our on-going commitment to move the balance of front-line spending to community health services.

Primary care is, of course, central to our health and care service, and plays a critical role in promoting self-care and supporting management of long-term conditions. In 2021-22, we will invest more than £1.9 billion in primary care. We will further increase our primary care fund from £195 million to £250 million, which includes support for delivery of the new general practitioner contract and for wider primary care reform to improve access and outcomes.

We will increase direct investment in mental health services to £139 million, taking overall spending on mental health to more than £1.1 billion. That funding will underpin our continued approach to improving mental health services and support for children, young people and adults and will support the delivery of the mental health transition and recovery plan, providing continued support for mental health assessment services and building on innovations and new service designs that have emerged in response to the pandemic. That includes the “Clear your head” campaign and continued expansion of digital services.

We will continue to invest in digital health and care to improve digital capabilities and digital access to care, to drive collaboration and innovation and to support self-care and digital inclusion. That will include continued expansion of the Near Me video consulting service, which is now being offered to all public service organisations in Scotland.

The budget further supports our work to tackle health inequalities and protect those who are most at risk. One of the greatest health inequalities that Scotland faces is the disproportionate harm that is caused by drugs and alcohol in some communities. The budget provides funding of £145.3 million for alcohol and drug services, including £50 million that is targeted towards reducing drug deaths. The funding will be directed through a wide range of partners in order to focus on reducing harms, promoting recovery and supporting our national mission to reduce drug deaths.

In 2021-22, the budget will continue to provide support to improve opportunities to participate, progress and achieve in sport and physical activity in order to improve physical and mental health, wellbeing and resilience. We will work with sportscotland to protect sports investment and we will continue to underwrite potential shortfalls in lottery funding, in line with previous years.

Capital investment in 2021-22 will increase by more than £100 million to £529 million. That investment in our infrastructure will support the delivery of the Baird family hospital and Aberdeen and north centre for haematology, oncology and radiotherapy—ANCHOR—as well as increasing elective capacity across Scotland to further support a reduction in waiting times. We will also provide additional resource funding to continue implementation of the Scottish trauma network.

The Scottish budget for 2021-22 takes investment in health and care services to more than £16 billion for the first time, in recognition of the immediate and long-term effects of Covid on physical and mental wellbeing and on health inequalities. We will protect front-line services, continue to shift the balance of care towards community health services and continue to provide investment for direct interventions to address health inequalities. I commend the budget to the committee.

Thank you, cabinet secretary. As you said, in the coming financial year, there is significant additional funding that relates to Covid-19, as we would expect. However, if we set that aside, we see that the increase in the health resource budget is broadly in line with that in the wider Scottish budget, whereas in recent years it was slightly ahead. Does that reflect a shift in priorities on the part of the Scottish Government or just a balancing effect, given the additional Covid funding for the health budget?

11:45  

Excluding Covid-19, the increase to the overall Scottish Government block grant settlement is 2.9 per cent in cash terms. We are not shifting our priorities. Health resource consequentials have been passed on in full, and there is more, with additional funding for drugs—the £30 million—which takes the total increase to £730 million.

In addition, as you have rightly recognised, there are significant Covid consequentials amounting to £869 million. The Government’s overall priority, in addition to those in other portfolios, remains that of providing significant investment in health, not only to respond to the demands of the current pandemic but, as I have tried to say and as I might have the opportunity to cover in response to the rest of the committee’s questioning, to recognise that a number of areas of continuing investment have been initiated because of Covid and will need to continue. Testing and vaccination are two of those areas. We also need to invest in remobilisation and recovery of our health service as we, I hope, move out of the pandemic in the months ahead.

The first part of the funding for Covid that has been provided in the current financial year was set out in some detail in the summer budget revision. However, there is still some detail to come, I think. There is not much detail in relation to the plans for the £869 million in Covid-related funding for the next financial year. Can you indicate what the priorities are for those allocations?

I can. As I said, the costs of testing and test and protect, as we refer to it overall, will continue significantly throughout the coming financial year. On vaccination costs, generally speaking, we all agree that, although we do not yet know about the efficacy of the current vaccines in preventing transmission, the general expectation, which is sensible, is that our annual vaccination programme will be significantly greater in the coming year, and potentially the years thereafter, than the flu vaccination programme. We do not and cannot yet know the scale or size of it, but we need to retain the capacity to invest in the infrastructure.

NHS boards need to scale up or return to more normal working as we move out of the current situation. That requires boards to remobilise and to consider how they will catch up with the non-Covid health harms that are inevitably occurring.

Social care support is another key element of the priorities for the use of the consequential funding. As you know, we have already allocated funding in that area in the current financial year. We anticipate that we will continue to need to provide that support, and that includes support for additional personal protective equipment. As you know, we support social care with PPE and we will continue to do so. The overall cost of that might change, depending on infection prevention and control guidance, but those areas of expenditure are there. Given the many pressures on boards, we anticipate an underachievement of board savings.

All that will be informed by the third iteration of board remobilisation plans, which I expect to receive by the end of this month. We have specifically set out to consider the remobilisation of health and social care as one system, if you like, and the board plans will come to us by the end of February.

Cabinet secretary, will you explain and describe how Covid-related funding allocations are made for individual boards?

I can do that briefly. Richard McCallum might want to add some details, since he undertakes and oversees that important work to ensure that we do it well. As I said, we are waiting to receive the third board remobilisation plans. The initial ones were produced in April and supported the immediate response; the second ones were produced at the end of July and mapped out a forecast for the rest of the year; the third remobilisation plans, which are due at the end of this month, will recognise anticipated costs for 2021-22.

The plans are subject to constant review and challenge. We then consider actual additional costs and allocate the funds on that basis. Richard will be able to give you a bit more detail about how that process works.

I have two points to add to what the cabinet secretary has said. In allocating that funding, we have taken a hybrid approach that involves a mix between formula allocation and direct targeted funding. Where all boards have incurred similar levels of costs, we have allocated on a formula basis. However, we know that there have been particular pressures or costs in individual systems in some instances, and we have allocated accordingly where that has been the case.

We have worked closely with directors of finance throughout the pandemic. In the initial wave, we got weekly updates to understand the full cost implications that they were incurring so that we could undertake appropriate due diligence and governance at pace. We then moved those regular meetings to monthly ones. As the cabinet secretary has laid out, the detailed review with each board, through which we can assess, challenge and scrutinise costs, has allowed us to allocate the funding.

What financial lessons have been learned through the course of the pandemic? Have you found a need for more central planning, which Governments are always alleged to want, or has more devolution of decision making to boards been required? Alternatively, has it been a mixture of both?

Again, Richard might want to say a bit more about that. We have conducted almost continuous reviews of lessons learned across all the areas of the health portfolio, with boards, integration authorities and other key stakeholders, including our partners in local government. We are applying some of those lessons as we go.

It is a mixture of both approaches. When delivering a national response to a pandemic, it is important to be really clear about what we expect boards to do nationally and how they should operate. The clinical prioritisation framework, with which I know Mr Stewart is familiar, is clear that, in responding to more Covid cases with a finite resource of beds, staffing and so on in our health service, decisions need to be made about which services to slow down or perhaps pause completely. I know that members understand that.

We have been clear that urgent trauma and cancer care need to remain a priority throughout the pandemic. However, the framework allows boards to make their own decisions and gives them flexibility to respond to the varying levels of Covid demands that they face, while ensuring equity of approach across the country. Boards work within the clinical prioritisation framework to prioritise planned procedures in a particular way, while knowing that what is classified as a P4 procedure in one part of the country has exactly the same classification in another. We attempt to give flexibility so that boards can make quick decisions in response to the pandemic and to provide equity for patients across the country.

Richard might want to touch on other lessons with regard to overall financial planning and so on.

I will add three things. First, we have found real benefit in the whole-system approach, where local systems have not just viewed additional funds from an acute or health board perspective but looked at social care pressures and community care opportunities in the round. That whole-system approach is what integration is all about, but it has been strengthened through the pandemic. Where that approach has been taken, it has been key in terms of funding.

Secondly, to go back to Mr Stewart’s previous question, although allocations can be done on a formula basis up to a point, during the pandemic, we have seen cases where the NRAC—NHS Scotland resource allocation committee—formula is not the most appropriate approach, so it might be worth reviewing NRAC to see whether there are other options for how we allocate.

Thirdly—I guess that I would say this as a director of finance—there is the on-going importance of governance. Although we have had to make quick decisions and be agile, nonetheless, we have had to bear in mind the value-for-money implications. The ability to balance the need to make quick decisions while testing value for money has come through in the pandemic.

I have a final question. What efficiencies have been identified as a result of the new way of working? Has that led to savings or has—[Inaudible.]—funding areas such as social care?

Again, Richard McCallum might want to add to what I have to say. A number of efficiencies and improvements have been achieved. Examples of that would include staff working remotely, and increased use of telephone and video appointments for patients, when that is the right approach for clinicians to take.

It is interesting to touch briefly on the fact that, pre-pandemic, we had the Near Me video consulting facility, which was primarily used in NHS Highland and had very little uptake elsewhere. It is now used across the health system in many instances in primary care and is growing into other areas. A number of specialist consultant colleagues are also looking to use it for some of their out-patient facilities, and there has been really good feedback from clinicians and patients. Of course, it has to be a clinical decision about whether face-to-face consultation is needed, because digital does not replace face to face.

It is a bit early to quantify the position on savings. In our 2021-22 planning process, we will review those areas across the sector. I hope that we will see boards wanting to embed new ways of working because of their clinical impact and patient-centred approach, and also because they might produce efficiencies. Again, Richard McCallum might want to add to that.

Before I call Richard McCallum, as part of that territory, does the Scottish Government plan continue to use community hubs?

Thank you; that is an interesting question. As an innovation, community hubs were very quickly and rightly set up in response to the pandemic, and our thanks are due to all those, including primary care colleagues, who worked so quickly to set them up within three weeks. However, they and we can see a continued use for that type of approach in a non-pandemic health system. At the moment, we are thinking about how the community hub approach, the increase in out-of-hours coverage, minor injury units and the redesign of urgent care—which is under way—can work together to bring the right care as close as possible to the patient.

I will not add much to what the cabinet secretary said. In some ways, it is quite early to know the full extent of the benefits that we might have seen through the use of digital and measures such as the redesign of urgent care. One of the key things that we will pick up with health boards through the remobilisation plans that the cabinet secretary talked about, which are due at the end of February, is to understand in more detail what opportunities the boards see in that space, and we will have those meetings with boards in March.

12:00  

I will ask a couple of questions on medium-term financial planning and commitments. What impact has the pandemic had on the forecasts and assumptions that are set out in the medium-term health and social care financial framework?

Until the end of 2019-20, the financial performance was broadly in line with the trajectories that we set out in the financial framework. It is still a bit too early to fully assess the impact of Covid-19 because, of course, we are still experiencing it, but we expect to see a greater shift in services for the community, and the performance and financial assumptions that underpin the financial framework will need to be revisited in due course. We have that work in our sights.

I am sorry about the video; the connection is not great here. Maybe it is good that you cannot see me, I do not know. I understand that reply and I thank the cabinet secretary for the paper that she sent to us last night, which included some answers to my questions, which I will reply to. My second question carries on from that; when does the Scottish Government plan to publish its update on the medium-term health and social care financial framework?

Mr McCallum might want to say a bit more, because he will undertake that significant piece of work. Our current position is that we will review that as we move out of the current pandemic; it is very difficult at this point to confirm timings, and I will make sure that the committee is aware of that. As I have said, the financial performance assumptions that underpin the framework will need to be revisited. There will be a further iteration, but I cannot be certain when that might be because it will be determined in part by how swiftly we move out of the current pandemic state.

We made a number of assumptions in the financial framework, which the committee will be familiar with, about the levels of savings that we expected to make and the shift to community spending of more than 50 per cent during the current parliamentary session. All those things need to be reviewed and revisited in view of what has happened in the past year, because it has, in some instances, accelerated some of that shift and, as the cabinet secretary said, it will take time for that to be bedded down in the next year or so as we continue to work through the pandemic. From my perspective, we are committed to updating the financial framework and will keep the committee updated on that work.

The cabinet secretary talked about some of the highlights in the capital investment strategy. Will a strategic document be published to set those out in more detail and are there plans to use revenue financing to fund future capital investment in health facilities?

I will answer the question about the capital investment strategy first. Last week, the Cabinet Secretary for Finance published an update of the infrastructure investment plan, which informs capital funding for all portfolios over the next few years. That will inform the capital investment plans for the health and sport portfolio, and we will be using it as the basis for our strategy and plans.

On the question about revenue financing models, there are no plans to use revenue finance in any of the schemes or capital programmes that we have under way that the cabinet secretary mentioned at the start, such as the Baird and ANCHOR in Aberdeen and the elective centres. The Government is considering whether the mutual investment model, which is a revenue financing scheme, could be used in the future. As I say, however, there are no plans for any current capital spend in health to use that model.

My questions are about national health service board budgets. NHS territorial boards appear to be receiving a much smaller cash increase than in recent years—1.8 per cent compared to 6.3 per cent last year. Can the cabinet secretary explain why there is a lower increase this year?

It is important to say a number of things. First, when we take into account the additional funding for primary care, mental health, trauma networks and drug policy, the uplift is actually 2.8 per cent. Health boards have significant responsibility for all those. We cannot think about health boards exclusively in terms of acute and hospital-based care. There is also the additional Covid funding.

The uplift does not take account of the agenda for change pay negotiations that require to be undertaken as we move into the 2021-22 financial year. As Mr Cameron will know, we are in year 3 of a three-year agenda for change pay deal that affects a significant number of staff. We have very consciously said that, in addition to the current board allocations, the Scottish Government will fund in full whatever is the outcome of those negotiations. We need to acknowledge that that is additional funding that will go to the boards.

The other point that I would make is that last year, about 3 per cent of the uplift to boards was in recognition of an increase in pension costs. That was a new spending demand on boards, but it is now part of the recurrent funding and that additional 3 per cent is now in the baseline.

If we take all that together, we are looking at an uplift of 2.8 per cent against, broadly speaking, 3.3 per cent last year. However, this year we have still to add in the funding requirement, whatever it is, for the negotiated agenda for change pay deal.

Will the three health boards that are receiving on-going financial support be required to repay that funding? What is the general prospect for those boards? For example, do you expect them to break even within the next three years?

Again, Mr McCallum might want to add to what I am about to say. Boards will not be required to repay any funding received in 2021.

It is still too early to say whether boards will continue to require in-year financial support and whether they are likely to break even within three years, although things are not where we want them to be. We need to revisit that through the remobilisation plans and the additional financial scrutiny that we will be doing. We will be clearer on that as we move out of the pandemic and see what the boards are planning and as a result of how we scrutinise, challenge and approve those plans. We will then understand more clearly the financial position of all the boards and, on that basis, what we think is a fair position to take with them and a fair expectation to have of them.

In 2020-21, there will be no repayment of the funding that has been provided in this financial year, in recognition of the fact that all boards have required significant additional funding for understandable reasons related to Covid. As the cabinet secretary said, working with those three boards, we are keen to understand the full impact of what has happened in the past year and what that means for their trajectories. Undoubtedly, it will have had an impact—it will probably have an impact on the financial plans of all boards, and that will be picked up with the boards. Given the nature of the non-recurring funding for Covid, it might take a year to understand that fully, but we will work closely with the boards on it in the next few months.

My final question about the long-term issue of the NRAC funding formula was touched on in answers to a question from David Stewart. Do you consider that NRAC remains the best way to allocate resources, given that a number of funding streams are not allocated using NRAC?

That is an important question. I am on record in the committee as saying that all formulas have their advantages and disadvantages and that it is pretty difficult, if not impossible, to devise an entirely fair formula that produces no disadvantages. That said, Mr Cameron makes an important point. The NRAC formula should be reviewed, partly in light of the pandemic but perhaps also in view of the review of adult social care led by Derek Feeley, the report of which was published last week, as members will be aware.

As Mr McCallum said, the process of looking at the system in the round—how it has worked during the pandemic and how we are planning as we move into the next financial year—must be underpinned by reconsideration of the basis on which funds are allocated and the need for that to be a whole-system approach. The NRAC formula needs to be reviewed in light of all that, and a different formula or approach might need to be adopted as a consequence of the review. At this point, the safest or the fairest thing to say is that, yes, it should be reviewed.

The boards that have received brokerage will be pleased by what they have heard today. Mr McCallum said that there is an understanding of the pressures on all boards, and that, therefore, there will be no pressure for repayment and the process of achieving a break-even position will take time. Looking at it from the point of view of other boards, the question might be: what incentive is there to achieve a balanced budget, given that you could be described as taking a forgiving approach to those boards that have not achieved a balanced budget?

Convener, I am very rarely described as taking a forgiving approach, so I hope that somebody has put that on the record. All boards understand that they will face difficult situations at different times and that the approach should be fair to the system overall. That is the approach that we are taking.

12:15  

We recognise that, not just for the boards that you mentioned but for all boards, achieving savings in the current financial year has been an exceptionally difficult ask, not least because all boards’ resources and energy have gone into responding to the pandemic. That is about not just the number of cases and people in intensive care units but, for example, the need to set up community hubs, contribute to the testing and vaccination programmes and do all the other vital things that had to be done. As we come to the end of this financial year and have discussions about the mobilisation plans for the next year, into that mix will go consideration of what is a reasonable expectation of overall board performance, including the performance of the boards to which you referred, and what timeframe we should be looking at. We will ensure that the future cabinet secretary and health and sport committee are fully apprised of whatever conclusions we come to. At this point, however, it is not possible to give a more definitive answer—I do not know whether Mr McCallum wants to add anything.

I will add two things. First, on the point about 2020-21, we have recognised that this has been an exceptional year, given the additional funding pressures—as well as many other pressures—on boards. We had to take that into account in our expectations on savings and the delivery of financial plans, and I think that it was right that we did that.

Secondly, there remains a statutory obligation on boards to break even. Our having had to recognise the challenges of this year—and potentially 2021-22 and beyond—does not mean that boards do not still have a responsibility to deliver financial plans that are achievable and can get them to the financial targets that they have set. We have to hold these things in balance, recognising the pressures that boards have faced while, as we move on from the pandemic over the next few years, recognising that there will need to be a focus on financial management and control as well as on service and quality. It is important that we do not lose sight of that.

Cabinet secretary, there is always a challenge to do with how set-aside budgets operate when it comes to integration authorities. What steps are being taken to address the continuing concerns about that? Can lessons be learned from IAs that are doing well when it comes to the effective operation of set-aside budgets?

Before the pandemic, quite a lot of work was under way to look at set-aside budgets and their operation with individual partnerships where that was a particular issue, such as the Fife partnership. All that work had to be slowed down—and, arguably, halted—for a number of months while people, including the partnerships, responded to the pandemic.

There are two factors that need to be considered as we move into the next financial year. The first is—Mr McCallum made this point and I completely agree with him—that the experience of the pandemic has seen significantly greater integrated working in practice on the ground, with proper joint decision making and an understanding of the contributions that different parts of the health and social care system make and the value of those contributions. There has been significantly greater learning in the past year than we had managed to achieve before that. It is unfortunate that it takes a pandemic to do it, but it takes everyone having to point in the one direction and work together to resolve matters and make decisions about the appropriate use of funds and so on.

Hold that thought for one moment, then recognise that we also have the independent review of adult social care, which sets out a number of recommendations and challenges. As we move into the next financial year, we are likely to see a different set of funding arrangements for that integrated service than those we have been used to. That may well, in and of itself, resolve some of the issues around set-aside budgets and the difficulties that were experienced in some IJBs and partnerships but not, as Mr Adams rightly said, in others. Pre-pandemic, we were using the lessons of those other IJBs to help us with those that were experiencing more difficulty, much of which was around understanding different parts of the system. The system as a whole has moved on considerably in the course of the past year.

It is interesting that you mention the independent review of adult care in Scotland. It recommended that the budgets of integration authorities should be determined centrally. What do you think about that?

As Derek Feeley himself said, the review looked at what it thought needed to happen to get the practice of integration aligned with world-class legislation on integration and at what, if any, change had to be made to the architecture around that. His conclusion is that there should be a national care service that should be directly accountable to ministers, who should be directly accountable for it. The route of delivery that he identifies is through integration joint boards. That significantly alters their role and therefore the resourcing goes direct to them. I completely understand the logic of his thinking.

I have already said in response to the review that we welcome it and that the current Government is content with all the recommendations. As, I suspect, Mr Adam knows, a week today we will have a Government debate in the Parliament on the independent review. Of course, given the timing—next week is the middle of February and the Parliament will stop towards the end of March for a Scottish Parliament election—a great deal of pick-up on the review will be for a future Government. Nonetheless, we can take some steps in advance of all that to lay the foundations for the national care service and the particular person-centred approach that Derek Feeley advocates.

That was my final question, convener.

Does Richard McCallum have anything to add to the cabinet secretary’s points on integration authorities?

I will add one point in relation to set-aside budgets. A number of case studies in the response that came back to the committee show areas of good practice. Updates from Lothian, Grampian and Lanarkshire, as well as from Dumfries and Galloway, set out some of the improvements and changes that there have been in relation to set-aside work over the past year.

Brian Whittle has a supplementary question on the topic.

I was listening very carefully to your answers to George Adam about the IJBs’ response to the pandemic. Based on what my constituents are reporting to me, I suggest that the pandemic has raised significant issues around two different systems working without proper communication with each other.

Does the cabinet secretary agree that the incredible pressures that have been put on the IJB system have highlighted, and given you the opportunity to understand, where the real pressure points are and where the problems lie? Will the Government take cognisance of that, and what will it do to close the gaps in the system? We all agree that those who are working in the system have done an incredible job under incredible pressures, but the integration of the two systems has not worked as well as we had hoped that it would. What lessons can be learned?

Some, if not all, of Mr Whittle’s constituents are also mine. If I am completely frank, I am struggling a bit to answer his question, because I am not getting any specifics. In general, yes, all systems should be reviewed, lessons should be learned and, if there are gaps, they should be filled. However, until he tells me what they are, I do not know what specific concerns Mr Whittle is referencing.

Cabinet secretary, you do. You have been through sessions such as this one several times. The fact is that the NHS system that looks after those who are transitioning from home care to hospital care and back again has been extremely problematic. Those systems have to be reviewed, because they are not working as well as you seem to be intimating. That is not a criticism of those who are working in the system—the system itself is not working as well as it should be, considering the amount of time that we have been working with IJBs. I am asking whether the Government will take cognisance of the issues and look to close the gaps?

That is helpful. I disagree that it is the system that is not working, although all systems should always be improved and open to improvement.

In many of our IJBs and partnerships, support is provided to people who are living independently in their own homes or are in residential care, and that support is realigned to suit what they need, with them as the central part of the conversation, when they move into hospital or are discharged. Such support exists in some IJBs and partnerships and works well in parts of the country. The Feeley report recognises that, and uses some of those good examples, some of which are in my constituency. However, that is not consistently the case across the country, and Mr Whittle is absolutely correct about that.

Work on the matter has been going on for some time, and continues to focus on those partnerships and IJBs that are doing less well than we would expect, because, when someone is admitted to hospital for hospital care, we are not seeing an approach that involves forward planning to the person’s discharge date and focusing on them as a person and the help that they need to continue to live as independently as they wish. That work is under way, and it will continue throughout the rest of this parliamentary term, and undoubtedly inform part of the future Government’s response to the Feeley report.

Thank you, cabinet secretary. We may resume this evidence session on a future occasion. We have been able to ask, and get answers to, many important questions, but there are other areas that members wish to explore in some detail. If you are content for me to do so, I will conclude the session for now, but invite you to return to resume questions at a future date.

Of course.

Thank you. In that case, the meeting will move into private session.

12:29 Meeting continued in private until 12:34.