Public Audit Committee
Meeting date: Thursday, December 2, 2021
Agenda: Decision on Taking Business in Private, Section 22 Report: “The 2020/21 audit of the Crofting Commission”, Section 22 Report: “The 2020/21 audit of NHS National Services Scotland”; and “Personal protective equipment”
- Decision on Taking Business in Private
- Section 22 Report: “The 2020/21 audit of the Crofting Commission”
- Section 22 Report: “The 2020/21 audit of NHS National Services Scotland”; and “Personal protective equipment”
Section 22 Report: “The 2020/21 audit of NHS National Services Scotland”; and “Personal protective equipment”
Agenda item 3 is an evidence-taking session on the Audit Scotland report on NHS National Services Scotland and, in particular, the “Personal protective equipment” report.
All our witnesses are joining us online this morning. I welcome from NHS National Services Scotland Mary Morgan, chief executive; Carolyn Low, director of finance; and Gordon Beattie, director of national procurement. I also welcome Caroline Lamb, chief executive, NHS Scotland, who is accompanied by Richard McCallum, director of health finance and governance, Scottish Government.
As you are all joining us virtually this morning, I suggest that, if you want to come in at any point, you put an R in the chat box. I also point out that you do not have to push your own mute and unmute button—broadcasting will do that for you.
Our time is necessarily limited, and I know that Mary Morgan and Caroline Lamb want to lead off with statements. If you want to bring in anyone to bolster, substantiate or develop any of your responses, please encourage them to do so straight after you finish.
Without further ado, I invite Mary Morgan to make a short opening statement.
Thank you, convener, and thank you, committee members, for welcoming me and my colleagues to the meeting. We are very pleased to have this opportunity to discuss the reports that have been mentioned. I thank Audit Scotland for those reports and its acknowledgement of the integral role played by our organisation in responding to the pandemic in Scotland.
Although the past two years have undoubtedly been the most challenging in NSS’s history, our teams continue to deliver solutions at an unprecedented rate to ensure the health, safety and wellbeing of the people of Scotland. During the pandemic, we have protected front-line workers by sourcing and supplying more than 1 billion items of personal protective equipment to health and social care, and we have established a virtual portal to help to process inquiries during periods of significant pressure. We have also established a domestic supply chain, with 88 per cent of supplies coming from Scottish companies. That not only provides Scotland with more resilience; it brings an added economic benefit.
We have played a vital role in Covid testing by establishing 94 testing centres across the country, along with three dedicated regional hub laboratories as part of the national health service in Scotland and the associated procurement, legal and digital services that have been required. We swiftly established the national contact centre to deliver the contact tracing programme, recruited and trained more than 1,200 contact tracers of our own, and supported an additional 2,000 across partner organisations.
Our digital and security team has delivered exceptionally, initially by rolling out Microsoft Teams across the NHS in Scotland. That revolutionised our work environment and ensured that thousands of NHS staff could continue to work safely from home. The team also provided security assurance and management expertise for the Protect Scotland app, and developed and rolled out the Check In Scotland app and the Covid vaccination appointment scheduling system.
NHS National Services Scotland has supported the build, stocking and decommissioning of the NHS Louisa Jordan field hospital. We have also provided legal guidance in numerous aspects of the pandemic response, and we continue to play a key role in the Covid vaccination programme.
Although our organisation has had exceptional achievements, we acknowledge the points in the reports about variations in standard processes and aspects of transparency with regard to procurement and the awarding of contracts during this time of extreme pressure, and we take on board the recommendations, particularly on consistency in recording and publishing documentation. I can tell the committee that, in order to address that issue, we have fully reinstated the standard processes for regulated procurement, contract approval and notice of publication.
Once again, I thank the committee for inviting us here today. We welcome any questions that members might have.
Thank you. I now invite Caroline Lamb to make a short opening statement.
Thank you very much, convener. I welcome Audit Scotland’s reports and the opportunity to give evidence to the committee.
The past 22 months have been exceptional in respect of the demands that have been placed on our health and care services. In turn, the response of NHS and social care staff has been nothing short of extraordinary. I place on record my thanks to NSS for, as the Auditor General put it, the “pivotal role” that it has played and which it continues to play in that extraordinary response.
As the reports have set out, we responded at pace to an immediate threat, which has evolved and continues to evolve over time. That has presented significant challenges and, in the responses to it, we have seen amazing innovation and progress. PPE supplies were not only sustained during a period of unprecedented global demand, but a resilient supply chain was established that included domestic PPE manufacturers.
We have seen the establishment and continued operation of our national test and protect programme; the opening in just 20 days of an entirely new hospital, which was then quickly repurposed to provide out-patient capacity and vaccinations; and, of course, the delivery of vaccinations to millions of people in a matter of months. Those achievements are remarkable but, as the audit report sets out, there are lessons to be learned to ensure that we are best placed to respond to the on-going and future challenges. I am committed to doing just that and to embedding the innovation that we have seen as we continue to remobilise our NHS and to respond to Covid and the emerging new variants.
I am happy to answer any questions from the committee.10:15
Thanks very much to both of you. I will start with a specific question on PPE supply chains. We have looked in awe at the growth in the domestic supply of PPE from zero to 88 per cent. That has been one of the more interesting consequences of the pandemic that we have been living through.
Can Mary Morgan tell us what the balance of trade is now? Are we still importing some PPE? If so, where from? The committee is also interested in whether, given the growth of the PPE supply chain in Scotland, we are in a position to supply international markets, including the lesser-developed parts of the world that perhaps need PPE at a time when we appear to have at least as much as we need or possibly even a surplus.
I will start and then hand over to Gordon Beattie, as he can give you some more detail on that.
The success around PPE has been largely down to two pieces of work: one is collaboration, particularly with Scottish Enterprise, in helping to secure Scottish markets; the other is the opening of a portal, which the report mentions. Many people stepped forward with information on their capabilities in relation to developing not only PPE but testing capacity. That portal was critical in helping the procurement teams to assess the potential across manufacturers in Scotland to develop PPE. Working together with Scottish Enterprise, we were able to harness the Scottish capability.
Gordon Beattie can give you a more detailed answer about the potential for the international market.
Through the supply chain development programme, we have been working closely with Scottish Government and Scottish Enterprise colleagues and our suppliers, who have stood up magnificently in response to the emergency.
We will continue to look at our forward forecasts and to seek best-value and high-quality products, and we really want to support our Scottish businesses in that endeavour. Scottish businesses are looking to use what has happened as a springboard for exports and, in some cases, they have already been successful in doing that. We have had some good news recently from one of the suppliers of specialist masks, which has developed a transparent mask. That mask is now being used within Scotland, and it is being deployed across our health boards. A final assessment is being done in NHS England. The supplier has also won export orders into Europe. That is a great example of the PPE development initiative being used as a springboard for exports. We do not have a direct role in that, but we are helping as best we can to enable the success of such suppliers.
Thanks, Mr Beattie—that is helpful.
My other question, which is again directed to NSS, is a bit more general. Paragraph 13 of the audit report draws the conclusion that
“NSS is now heavily reliant on non-recurring funding to deliver services”.
We are now a week out from the Scottish Government tabling its budget before Parliament. The Auditor General cautioned:
“Reliance on non-recurring funding limits the ability of NHS NSS to effectively plan and resource future developments.”
Is that funding uncertainty real? Are there areas of your work that you have been forced to deprioritise because of that? What risks are entailed in doing that if that is what you have been required to do?
Many of our services are non-recurrent in nature. It is not clear what the longevity of the pandemic response will be and what business as usual in that regard might look like. A lot of our funding and financing related to the Covid response is, by its nature, recurring. We are actively planning for what the future might be but, at this time, it is difficult to make assumptions about that.
We recognise that we need to transform. Covid has presented opportunities to do so with new ways of working, to optimise a digital-first approach where possible, and to realise the benefits of reducing travel. We have not had to pause, delay or stop any of our services because of funding difficulties or constraints. That has more been about the mobilisation required because of Covid and the prioritisation of that.
I ask Carolyn Low, who is our director of finance, to give you a bit more detail about what we are doing on that.
It is true that, if we go back to 2015-16, our baseline funding was £317 million. That represented 80 per cent of our total funds. In 2021, our baseline had increased to £337 million, but that was only 43 per cent of our overall funding. As an organisation, our gross expenditure is £1.3 billion. A significant amount of what we do passes through health boards and is paid-for services. We have a large reach, but a relatively small proportion of that is underpinned by baseline funding.
We need to transform as an organisation. We have a sustainability programme under way, and our services are all planning for the future to determine what we can do differently, how we can embrace hybrid working so that we can be financially and environmentally sustainable and—this is important—how we can deliver our services differently in a digital-first environment.
We are really confident that we can recover the underlying deficit of around £13 million that Audit Scotland identified in its report by doing things differently. However, we look forward to continuing the strong working relationship and partnership that we have with Scottish Government finance officials to explore the aspects of our services that have been funded non-recurrently for a long time and convert some of that to baseline funding. Those conversations continue.
Mary Morgan mentioned the extent to which we will have to maintain our Covid response and services over the long term. It is important for us to be able to confirm that position so that we can provide certainty of employment to the staff whom we have employed to deliver the excellent services that they deliver.
I reassure the convener that those discussions continue with the Government and that we are confident that we will get to an agreed position soon. We have funding confirmed to September next year. That gives us enough space to plan what the future will look like.
Thank you very much. If time permits, we will revisit some of those questions on the funding of NSS.
I want to drill down a little into the longer-term approach that is being taken to PPE supply and demand and perhaps capture how you are working with partners to develop capacity for on-going normal needs and for another pandemic, should that occur. This question might be for Mary Morgan. How has NHS NSS learned from the process that it has just been through? I am not necessarily asking about what you have learned. What processes have you gone through to capture learning and how are you ensuring that what you have learned is baked into future planning?
Our two additional new warehouses will allow us to increase our stock and supplies, and we are actively looking at what stock we retain on a business-as-usual basis. After all, we might not need to increase all our stock lines, depending on the turnover. There will be turnover at play, and inventory management and control data have been critical in supporting that work.
Gordon Beattie will be able to tell you about the detailed work of the team in gathering data and working together with Scottish Government colleagues on identifying the individual stock lines that might be needed.
We have done a lot of work on our forward planning arrangements. One of the lessons that we have learned from our experience is on the need to improve our understanding of what a future pandemic might look like and have good forward planning arrangements and demand profiles of the key products that we require. That work is under way, but we need the close relationship with the Scottish Government, Public Health Scotland and others involved in forward planning. We have good models that allow us to predict what we will need, and that is letting us get well ahead of the game as far as forward planning is concerned. Moreover, as Mary Morgan said, we have established two new large warehouses in Scotland, and we have very good stock of the key products that we think that we will need in future.
We are working across the public sector to understand what the needs will be on a wider footing. Furthermore, we are working with colleagues in the public sector and the Scottish Government on future pandemic readiness, which includes our role in providing—and providing access to—a national stockpile.
Finally, on the data issue that Mary Morgan mentioned, NHS Scotland has really good data. We have a great single finance system and a great single procurement system, but one area where we needed to improve was visibility of stocks at local hospital level. In the past year, we have purchased a new system that provides inventory management at individual hospital ward level. That system, which is being rolled out at the moment, will give a great deal of extra visibility and allow us to understand where we need to supply in order to ensure that everybody has the products that are essential to meet their needs.
Those are the elements of work that are on-going at the moment.
How do you balance the need for the stockpile with the costs? I assume that the products in question are perishable. Are you moving towards more of a just-in-time ordering system, or is having a stockpile important? I am bearing in mind the fact that the absence of such a stockpile was criticised at the beginning of the pandemic.
A balance certainly has to be struck. At the beginning of all this, we found that the stockpile was designed with an eight-week period for replenishment. With the collapse of the international supply chains as mentioned in the report, trying to ensure that we had supplies coming in to replace stock in time became a real issue for us.
We have increased our stock levels, which are good at the moment, and we are well ahead of things. However, we have to ensure that we can turn over stocks that have a shelf life. We are having discussions about the role of a national stockpile across the public sector in Scotland. More areas will be able to access that and, therefore, there will be more stock turnover, which will allow us to maintain stock in shelf life. The pandemic is, we hope, a fairly rare occurrence and there will be times when we have stocks that we need to try and use before they run out of date. We are working with that and thinking it through as we look to the future.10:30
The Scottish Government has a key role in that as well. We have been working with NSS and other partners across the public sector to learn the lessons from the pandemic so far and take them into future PPE procurement. That includes the work that Gordon Beattie just described on understanding the data, being clear about what we need to stockpile and how we predict demand and supply. It also involves the further development of Scottish manufacturing capability, thinking about opportunities for further innovation, being clear about policy for PPE provision to primary and social care providers and focusing on the lessons learned. That is all wrapped up in the PPE futures programme with a view to developing a strategy that we hope will be produced by the end of the financial year.
We have spoken about the importance of data, and one of Mr Hoy’s questions was about how we learned the lessons. Some of that has been about using a dynamic process to apply the early learning from PPE provision across other areas. We have worked closely with Public Health Scotland and our digital services to produce more real-time dashboards and access to data at the point of need so that people can access their own data and have wider communication.
One thing that we learned early on was the importance of communication and shared intelligence of what is happening. With colleagues, the NHS national procurement PPE team developed a daily stock bulletin that went out across NHS Scotland and our partners. We learned from that experience and replicated it in, for example, the testing service and beyond. Latterly, with the vaccination programme, we are using Microsoft Teams channels to improve communications.
Many of the lessons that we have learned are about PPE provision and stockpiling. We need to consider those going forward because we remain in the pandemic response. However, many of the learnings have been dynamic, replicated, tested and innovative. Therefore, we need a bit of time for evaluation and to consider what the situation might look like post pandemic.
One of the phrases that has come up is “partnership working”. We have talked about the capacity building that has taken place in the domestic PPE industry. Is that sustainable? Does it pivot towards buying domestic product? Are health services internationally replicating that?
Partnership working is definitely sustainable and is enabled by our new ways of working. We have found that, using Teams and other mechanisms that we have put in place, it is easier to have wider communication with people and work together with them. I am not sure whether it is sustainable on an international basis.
There is work on procurement strategies. We have a procurement strategy. We need to consider the carbon footprint of our purchasing, and part of that strategy is about buying locally wherever possible. We will continue to work with our partners to ensure that we are sourcing locally to Scotland wherever we can. That is embedded in the published procurement strategies.
I will raise an issue that has been touched on already. Incredibly, no PPE was made in Scotland prior to the pandemic, but 88 per cent of all PPE, excluding gloves, is now manufactured here. What kind of support was given to Scottish companies? Was financial support given? Were there already specific skills in Scotland to develop that? I will pick somebody at random to answer: Mary Morgan.
I will again defer to Gordon Beattie, because he has all that detail to hand. We needed to undertake many assessments and we have data on the numbers of people and companies that came forward to offer their services. A considerable number of those went through an assessment process. We work jointly with Scottish Enterprise to carry out quality assurance processes. Clearly, finance and cost were part of the award of those contracts.
Gordon can provide you with more details about the process.
I lost reception a wee bit during your question, Mr Beattie, so I hope that I picked it up correctly.
In relation to our supply chain, we worked closely with our contracted suppliers and known suppliers to try to get access to available stock. Locating and buying that stock was the first phase. It became apparent that the stock was not available once the initial range of purchases had taken place, because everyone in the world was chasing the same stock.
We then had to secure production. We secured some production overseas and it became apparent that we could secure some production in Scotland, so we went to suppliers that we knew. One supplier was an existing provider of masks to NHS Scotland, particularly the specialist FFP3 mask, which had already been fit tested for use by staff and was a preferred product. That gave us a point of reference and discussion with that supplier. It became apparent that the supplier could not access overseas supply chains but could try to onshore the capacity in Scotland. That was the initiating element of talking to the supplier and building capacity in Scotland.
There was a similar process in relation to a number of types of PPE, which led to a really good response from Scottish businesses and to the ability, as has been mentioned, to deliver 88 per cent of our PPE from Scottish sources, with the exception of gloves.
That was the process. We carry out full checks on suppliers’ factory standards and their ethical and fair wage standards. We worked closely with Scottish Enterprise colleagues to undertake those checks on the overseas companies that we initially used, so we had a good level of due diligence on the suppliers that we chose.
Are there any specialised areas of PPE that we cannot produce in Scotland? Is that why we are not at 100 per cent? I am being ambitious here.
The main one is gloves. Gloves are typically produced in the far east and there is very little capacity for that in Europe, never mind the UK. There are some green shoots of new production in the UK, and we are engaging with companies that are trying to set up businesses here. Options are emerging. At the moment, our PPE predominantly comes from Scottish sources.
We are still some way from being able to say that the pandemic is over. How resilient is the PPE supply chain? Is it reasonably secure as far as you can project?
Yes. We have established good relationships through one of our master vendor contract providers, which is able to pull together a supply chain that includes Scotland-based organisations. We continue to have a close relationship with that master vendor and its supply chain to ensure that capacity is in place.
We have secured good stocks of PPE, and as a result we have been able to make a long-term projection, certainly over the next year. However, we are keeping a close eye on what is emerging, working closely with our colleagues on future pandemic modelling and ensuring that future supply orders have been placed and production capacity secured. That work will include discussions with the master vendor as well as with producers in Scotland.
Given the changes in the virus that we are dealing with, are we confident about the type of PPE that we are producing or reasonably satisfied that we can secure the PPE that we might need in future? I know that the question is a bit hypothetical, but do we have flexibility to effect the changes in PPE that might be needed?
The answer is yes. We are having close discussions with our supply chain partners, and we know that we can ramp up capacity in, for example, Scotland. We are also having close discussions with our infection prevention and control colleagues so that we can react to any change in guidance that might occur. Our discussions with the supply chain are about maintaining flexibility and having the ability to ramp things up, if required.
In his opening questions, the convener talked about export markets. To what extent are such markets not necessarily important but significant in maintaining the viability of the local supply chain? In other words, is the production line geared to Scotland, with just a wee bit of export activity, or does its viability rely on a certain proportion of exports?
I am going to have to pick Gordon Beattie again to answer that.
That is fine.
The fact is that these items are used not only by the NHS or health services, and I guess that the companies in question will have to service a broader marketplace. Obviously, they know their business much better than I do, and we will continue to support them in developing products from which we hope they will get some advantage in exporting to worldwide markets. It is, of course, down to individual companies, supported by Scottish Enterprise and us, to find ways of accessing and being successful in those markets; I know that they are doing that and that they are trying to modernise, improve the efficiency of their equipment and so on in order to make a good-value proposition.
As a last angle on this question, I would say that one of the important by-products of all this, apart from the PPE itself, is the jobs that have been created in Scotland. Do we know what proportion of those jobs are permanent and whether that situation is likely to continue?
I cannot tell you what proportion of them are permanent, but I know that about 470 jobs have been created, with a major chunk of them in Dumfries and Galloway. That particular company is investing heavily in production and the workforce and, in doing so, is looking towards future business, exports and so on. It is a great example of the springboard into exports that we have been able to create from the NHS business and, indeed, purchasing from other parts of the United Kingdom.10:45
I have a final question that you might or might not be able to answer. The companies producing PPE have geared up their production lines in order to produce the required quantity and types of PPE. That will probably not continue at the same pace forever—at least, we hope not—and, at some point, it will settle back to what might be called a normal level. I suppose that this is a question about resilience. At the end of all this, will the companies be able to repurpose their production lines so that they can move into other areas, or will it be a case of their having to lay off all the surplus people and reduce production?
I hope that they will be able to repurpose things. As I said, some of the products are used not just in health but in, say, the chemical industry, laboratories and so on.
A good example that I mentioned earlier is that of transparent masks, the production of which is already a repurposing of one of the mechanisms in the business in Dumfries and Galloway. In that case, equipment was repurposed to make a specialist mask that allows the user’s mouth to be seen for those who require to see a person speaking.
I call Sharon Dowey, after which we will move to Willie Coffey.
I want to ask about the environmental impact of PPE. The Auditor General’s briefing paper recommends that, when developing a future approach to PPE supply and demand, the Scottish Government and NSS should consider how to support suppliers in developing more environmentally sustainable PPE. We have all seen masks lying in the streets, in bushes and in fields. What is the current environmental impact of PPE? What work is the Scottish Government, NSS and partners doing to develop more environmentally sustainable PPE, and what are the challenges associated with that?
I do not know who wants to answer that one. Is Gordon there?
I see Gordon Beattie volunteering again.
I will try to answer that question in two parts.
First, with regard to the sustainable future issue, we have through colleagues in NHS Tayside initiated an innovation competition in which we are inviting companies to propose innovative ideas and solutions for sustainable and reusable PPE. That competition will carry on over the next few months, and we expect to see the results of it in our innovation approach in early spring. We have already introduced some items such as launderable gowns, which were brought in quite early on in the pandemic and which take a bit of pressure off having to use the full non-sterile gowns that have to be worn with aerosol-generating procedures. The gowns can be used up to 50 times and can be laundered through our NHS laundries.
As for the environmental impact, there has been, as you will imagine, an increase in the tonnage of clinical waste. In a hospital, tonnage has typically gone up by about 20 per cent, while the percentage for community services, which did not use PPE to a great extent previously, is much higher.
It is not only the tonnage but the volume that is going up; these things might be quite light, but they still add quite a lot to the bulk. In some respects, though, that helps with waste processing. All of our clinical waste goes through our clinical waste processes, and these things reduce the density of waste and make it easier to go through machines such as shredders and through treatment processes. However, the volume has increased. The big 700-litre wheelie bins that we use in hospitals should take about 75kg, but now they are probably taking about 45kg, which in turn increases the amount of movement needed to deal with the waste.
Those things are having a direct impact, and we are working closely with others to understand how we can reduce waste and improve the situation.
Thank you. We will see the results in the spring.
As nobody else wants to come in on the environmental impact of the types of PPE that have been manufactured and used, we will move to questions from Willie Coffey.
Good morning to everyone on the panel. Given where we are, it is probably too early to gaze ahead beyond the pandemic, but I invite Mary Morgan and Caroline Lamb to say a few words about the remobilisation plan that they have been asked to work on.
Mary, in your opening remarks, you gave us some great examples of the achievements that we have seen, and you particularly mentioned the digital aspect, such as the use of Teams. As part of the remobilisation plan and getting back to business as usual, will we retain some of those good elements of practice which, although they were forced on us, have turned out to be very advantageous for the way in which we and your staff work? Could you give us a flavour of how you see that going ahead? Will we retain the best of what came out as a result of Covid?
Yes, absolutely. We have undertaken a programme called future ready, which has had tremendous engagement among our staff internally. For example, yesterday, more than 900 of our staff participated in a future ready question-and-answer session, and staff engagement on working virtually and digitally has been very positive. Around 90 per cent of our staff have told us that they would prefer to continue to work from home into the future. Some of them do not want to work wholly from home but want to work in a hybrid scenario, and we are working towards making that happen for them. We have all the processes in place and we rolled out all the equipment that they need for that. We need to iron some things out, and that dynamic process of risk assessment and learning is on-going, but we see ourselves embracing that.
Clearly, a number of NSS services are inseparable from the people who deliver them. For example, our warehousing and logistics staff need to be in the warehouse in order to make the distribution happen.
A substantial number of front-line Scottish National Blood Transfusion Service staff have had to change their ways of working. We are seeking to harness the best of their learnings, to make sure that their work environment has improved. For example, out of necessity, the blood transfusion service has brought in an appointments system, and that has had some real benefits, not only for donors, who know when they will go through the process of blood donation, but because we can match appointments for people with specific blood groups to the demand for blood groups across the sector. Therefore, we are keen to embrace the changes that we have experienced and to continue to work in that way, because it has been so positive.
We have also needed to learn how to lead in different ways. Many multinational companies will already have had leadership from a distance, but it is new to us in the NHS and our working environment, and I am amazed and in awe of how staff felt empowered and were able to step forward with their new ideas.
I was speaking to a member of staff the other day, and we will hear more about her story. When she joined us about a year ago, she identified the need for managers to be able to get together and have a community of practice, so she developed a Teams channel, called the management hub, which offers opportunity for training and shared experiences. We also have a water cooler place that opens up in the morning, which people can drop into and have those informal conversations that we might have been missing. Therefore, we are testing and trying out new ways of working that support our staff to deliver our services in different ways.
One of the things that I want to labour is that those ways of working mean that we have been able to be much more accessible to our staff. There is no way that we would have been able to have 900 people in one room for an hour-long question-and-answer session. It has been phenomenal to begin to see staff having that dialogue and answering their own questions as a community.
That is pretty amazing, actually. The technology worked with 900 people online at the same time, did it?
You make a great point that we had to develop new skills and expertise pretty rapidly as a consequence of the situation we found ourselves in. Do you feel that, rather than it being a one-off followed by a return to normal, you will be retaining, enhancing and embracing all those skills and that expertise as best you can? I imagine that it will inevitably lead to changes in how you and your staff want to work and that you will be embedding those practices, skills and experience?
I completely agree, and that is what future ready is all about: taking a digital-first approach to how we deliver our services and empowering staff to make their decisions. Work is not always about where or when you do it; it is about what you do and what you produce. We are well rehearsed on that and we have teams who are willing to take that forward. It is not just something that we would like to do; it is something that we need to do. Carolyn Low referred to the fact that we need to transform and change because there are financial benefits to this way of working. We no longer have people travelling up the M8 corridor between Glasgow and Edinburgh to attend meetings, so we are more productive with our time and we still have all the benefits of delivering services in a new way. It has also allowed us to collaborate much more freely. The fact that we can all jump on and off Teams meetings and still get work done is really positive. It is not just a wish and it is not just coming from the point of view of our experience; it is something that we need to do for our financial sustainability and indeed for climate sustainability.
I recognise that point about travel—I am one of those people who no longer need to run up the M77 and the M8 every day to come to Parliament, which is a huge advantage for me.
I will expand a little bit on what Mary Morgan said and apply it to the context of the broader NHS and social care system.
Some of the key things that we have learned and benefited from during the pandemic are around the use of digital technologies and having timely access to data. Having that daily access to data on what is happening with the pandemic has been critical to informing our decision making and the public messaging.
Members will be aware of the significant pressures that the NHS and our social care systems are experiencing. We announced a £300 million package of investment in October and key to understanding the impact of that investment is having daily data in relation to managing the system. It is about getting information on where we are in relation to which bits of the system—and it is a complete system. We focus on accident and emergency waiting times and they are important, but they are also a barometer of how the rest of the system is working.
Increasingly, we are becoming heavily dependent on data and on using data in a way that helps us to understand what we need to do to make improvements to the system. In the short term, that is working; in the longer term—I am thinking about our NHS recovery plan, which was launched in August—we are looking at some of the digital innovations.
Near Me, the video consultancy system, was available and had been tried and tested pre-pandemic, but it was not really being used. Now, it has been rolled out and it has been enormously successful in enabling people to engage with their GPs and to see their consultants. It has also been used to enable people in care homes to get medical consultations at a point when it was difficult for people to move around and to keep engaged with their families.
In relation to digital technology and innovation, there are lots of things that we can start to deploy to support recovery. Telecare is probably one of the most common care supports across Scotland. As that gets transitioned to digital technology, it provides us with an opportunity to be much more proactive in predicting when people might have issues such as falls, and to therefore be able to take preventative measures that stop people from having to engage with acute services in the first place. It enables them to be supported to stay in their own homes, which is important.11:00
We have learned a lot about what we have been able to roll out quickly in the face of a threat, and we have learned a lot about how quickly we can pull together existing data sources and join them up. There are also opportunities from the testing network that we have developed. Unfortunately, that is still very much live and in use, combating old and new variants of Covid. We are also, in the background, planning for how we can use that network of infrastructure to support the health of the population. There are some exciting opportunities there.
Thank you for those responses and thank you to the staff who have done such a magnificent job for us.
And so say all of us. We have a limited amount of time, but I have a couple of short final questions. Mary Morgan and Caroline Lamb, if there are points that you feel as though you have not had an opportunity to make or that on reflection you wanted to make, please do not hesitate to put something in writing to us to capture anything that you think would be useful for our deliberations.
Mary, in your opening statement, you mentioned procurement arrangements and the legal framework and all that. You said that that was all back to normal. As the Public Audit Committee, we are always concerned to make sure that contract notices are uploaded within the legal framework and that they are published within legal timeframes. Could you confirm—with a yes-or-no answer—whether that is now the case?
Yes, that is the case. Some of our notices were delayed, which was purely down to the volume of work, the pressures that were placed on teams and the rapidity with which we were doing things, but we are all completely back to normal ways of working.
One of the other things that you mentioned in your opening statement was the Louisa Jordan hospital—a 300-bed facility with the option of expanding to 1,000 beds—which was set up in a rapid timeframe. One of the things that occur to me as we approach the pressures of winter is to ask what has happened to that equipment. Where have those beds and the rest of the supporting equipment gone? Can Mary or Caroline answer that question?
We maintain an active inventory of all the equipment and all the parts. Some of those pieces have been distributed to hospitals and some of the items are stored in our additional two warehouses. Does Caroline Lamb want to make any further comment on that? If you want further details, Gordon Beattie can let you know exactly what has gone where.
A tremendous job was done in establishing the Louisa Jordan so quickly. I am hugely grateful that we did not have to use it for Covid patients, but it was great to have the facility and we made enormous use of it for out-patients, diagnostics and the vaccination programme. Mary Morgan has answered the question about what has happened to a lot of the equipment. Convener, you would expect me to remind the committee that it is not just about equipment; we also need to have the staffing to support those beds and that equipment.
The context is that we are running a health service that is trying to cope with a lot of backlog and unprecedented demand at our front door while also running the biggest ever vaccination programme in Scotland with the additional acceleration that has just been announced. We need to focus on staffing rather than equipment, although it is great to have that spare equipment.
On that note, I will not bring in Gordon Beattie, and we will finish there. Caroline Lamb’s point is absolutely correct, and workforce planning is one of the things that the committee concerns itself with on a regular basis. If there are staff shortages or other staff issues, we are keen to learn about those and encourage organisations to address them and keep them as a priority. As Willie Coffey said, staff’s efforts have been monumental and they will continue to need to be as we look to the future.
I thank everybody who joined us to give evidence—Mary Morgan, Carolyn Low and Gordon Beattie from NSS and Caroline Lamb and Richard McCallum from the NHS and the Government directorate.
I now close the public part of the meeting.11:05 Meeting continued in private until 11:35.