Chamber and committees

Yes. I understand that, and that is the constant dilemma between local and national decision making. Where we rightly expect there to be local decision making and priority set at a local level, the compromise is a level of variance.

To answer the first part of your question, although our territorial health boards are independent legal entities that are responsible for the delivery of services in their jurisdiction, yes, I bring them together at a national level and ensure that there is shared understanding of best practice, resolving challenges and ensuring that there are treatment pathways available and that we blur the boundaries between health boards.

I will give you an example. We recently changed the way that we deliver planned care services, so that we have national treatment centres that people are referred to from territorial boards and regional treatment hubs, because we recognise that ensuring that treatment is delivered in the fastest way possible sometimes means delivering at a national rather than a regional or local level. That is where our regular interactions with board chairs and chief executives ensure that there is greater co-ordination. I expect that in planned care, in particular, but also in some acute services. The service renewal framework will allow us to have better co-ordination of services between board boundaries than we have right now.

Davy Russell has alighted on an incredibly salient point, on which we have been working with boards over the past six to 12 months to optimise the capacity that is available within the system. In some cases, that will involve asking people to travel—from Lanarkshire to Fife, from Grampian to the Golden Jubilee hospital, or to NTC Highland, with which Mr Mountain and Mr Ewing will be very familiar—in order to ensure that, where capacity is available, it is utilised according to demand. It might well be that NHS Lanarkshire needs help to get through its waiting times for cataracts, for instance. Exactly that process is under way, to optimise the planned care capacity.

I appreciate Mr Mountain’s point, although I do not agree with the first point that he made. I do not think that it is an inevitability that services will always be lost from the Highlands, not least because, in relation to all the points that I have already raised, there must be a balance between population-based planning and safety, travel and access to services for people who live in the Highlands. Given the travel that is already involved for people to get from Wick or Dingwall—or, indeed, from Skye, where I was in the summer—to Raigmore, and the onward travel to wherever that service might be, what Mr Mountain set out is not how we are approaching how services should be configured.

I have already given a good example of people in the central belt travelling to services that are provided in the Highlands, which is in good evidence through NTC Highland. I have no interest in seeing the situation that Mr Mountain has set out continue.

That is done in concert with the UK National Screening Committee. Like all Governments across the UK, we take our lead from the experts in that committee. Based on their recommendations, we seek either to implement a population-based screening programme or to target screening, if that is more appropriate.

I am very appreciative of that, and I am happy to have a discussion with her after the meeting, if that would be helpful.

I am grasping that particular jaggedy thistle and we are pursuing the process of reform. I pray in aid the merger of NSS and NHS Education for Scotland, which is happening in order to provide a new service for NHS delivery. We are blurring the boundaries between territorial boards to ensure that services are being delivered on the basis of it being a national health service, as Ms Baillie referred to earlier. As Mr Ewing is aware from his time in Government, structural reform is incredibly challenging and time consuming, and it can be very costly and distract from what we need to happen at the moment, which is an improvement in service delivery. I am focused on ensuring that we improve and reduce waiting times and improve people’s access to services. We are starting to see the fruits of that particular labour of our incredible NHS staff. That is not to say that structural reform is not required and that it could not be taken forward. However, right now, I am focused on getting the same outcomes that the type of reform that Mr Ewing speaks of could achieve but without having to go through the pain and cost of a top-down reform process.

Healthcare Improvement Scotland is leading on that, and I agree that we need to make progress. It is also working on the regulation of cosmetic implants and surgeries, which is another area where there is a pressing need for reform. It is my understanding that this will go to a public consultation—next year, I expect—and I expect progress to be made in that regard.

I absolutely agree with Mr Russell that that is part of the cancer treatment; it is the conclusion of the cancer treatment and it needs to be considered as such. In my role as health secretary, I have met women who are in those circumstances, and I understand their pain and anguish and the mental health impact of having to wait for surgery. The challenge is the demand on cancer treatment services, because the theatres that are used for what is sometimes very complex breast reconstruction surgery are the same theatres that are used for the initial treatment.

We need to get the balance right with regard to ensuring that we are concluding a woman’s cancer treatment through reconstruction surgery. However, I think that Mr Russell understands, as I do, the need to ensure that the initial treatment is prioritised. We are working with the relevant boards to ensure that there can be the necessary recruitment of specialist surgeons, so that we have the ability to get through the waiting lists. I absolutely agree that the length of wait that some people are experiencing is not acceptable.

I very much appreciate the petitioner’s advocacy for the issue in an incredibly challenging situation—it is more than challenging; it is a tragic situation, for which I offer my deepest sympathies and condolences. A lot has changed since the petitioner lodged the petition and since the tragic situation that she set out happened. We have surpassed the commitment that we made to expand the number of mental health practitioners in accident and emergency units, general practice surgeries and other locations. We have surpassed the 800 that we anticipated. I recognise that, in many cases, that is still not enough—I have my own constituency cases where that has been the case—and we need to do better to support people in a crisis situation.

I am also keen—this is where the Government’s real priority is—to move further upstream and prevent people from moving into crisis in the first place. That is about looking at whole-family support opportunities and enabling the drivers of poor mental health—in relation to poverty and other environmental and social factors that colleagues will be aware of—to be addressed much earlier, so that the acute level of mental health demand is lessened. Clearly, that is where we all wish to be, rather than having to treat the symptoms at an acute stage when people are in crisis.

On the first point, I have been clear with our health board chief executives and chairs on my expectation about working with industry and academia on the utilisation of new health technology and medical products. We have set out a national programme for the adoption of health innovation called accelerated national innovation adoption. That is led by the chief scientific officer in Scotland, Dame Anna Dominiczak, who is well respected across the health service in Scotland and, indeed, in industry. That programme is helping to pull together the triple helix that I referred to earlier—the health service, industry and academia—to ensure that we are co-ordinated.

I will give the member an example, as I recognise his concern about start-up companies, which are often spin-outs from universities and which have, in the past, struggled to get access to the health service. That situation is changing. The linkage between the Techscaler network and the NHS test beds means that the risk to those who are innovating is reduced, because they have access to health service clinicians who are telling them, “Yes, this is the type of thing that we need,” or, “No, this won’t work in an NHS setting.” That gives them the opportunity to develop products and services that will be applicable to the health service. My challenge is to ensure that, rather than our having to go to 14 boards, the technology is proven and adopted nationally as quickly as possible.

The second point that the member raised is around how quickly we can adopt technology to ensure that it is not immediately outdated. That is built into the digital front door programme, as it is described, and the app is being developed to ensure that technology will be serviceable, can be used as it is rolled out and is still relevant to what people need and expect.

For clarity, I have already set out that there is clear demand for capital investment in the health estate. I recognise that and want to make progress. I recognise that our health service is still impacted by the effects of Covid—particularly on waiting lists—as we continue to work through the cancellations that occurred during the pandemic and work through the current backlogs. Additionally, individuals are now presenting at general practices and consultant clinics with more complex comorbidities than they did pre-Covid.

Part of that is, understandably, because we asked people to pause some elements of their care, and we are catching up with some of that now. During Covid, as we were literally confined to our own homes, we started to discover more about ourselves. As a result of greater awareness being raised, we are now, rightly, presenting to services and asking more questions about our care.

Regarding our response to Covid and the way that the health service has changed, it needs to deal with the backlogs, recognise people’s greater awareness of their own health and keep up with the changing ways that people who have more complex issues present to services.

The three documents that we published earlier this year are all about those things. The operational improvement plan is about the immediate operational demands that we need to address. The population health framework is about how, on a population basis, we need to be better at planning for our wellbeing and need to move upstream to a more preventative model. I recognise that it is not only a health service issue that needs to be answered. We must recognise the Organisation for Economic Co-operation and Development’s point that 80 per cent of the drivers of ill health—environmental factors, social factors and the drivers that come from poverty—are outside the health service’s responsibilities, and that is exactly where the Government’s prioritisation is going. We also need to address how, where and when we deliver our services. That comes through in the third document—the service renewal framework—which is more about the structural reform that we spoke about earlier.

Covid has had a profound impact on our health and social care services, which is why we need to make concerted, targeted and determined efforts to work through such challenges.