Chamber and committees

I point Ms Baillie to the community link worker network, which seeks to move provision upstream, although I recognise the challenges that there are with that in some parts of the country.

I know that there is a petition from the deep-end practice network that calls for an expansion of the community link worker network. The CLW programme is under national review. Community link workers try to ensure that people, in a trusted place—the GP surgery—can be signposted to other services through which the root cause of the issue that they are presenting with can be addressed. Often, that support relates to housing, income maximisation, education and other elements of public service. It is also about the need to increase the opportunities that are available through social prescribing to address people’s mental health issues, which is in the population health framework.

The community link worker network is there to do that, and it is where we seek to move things upstream. The likes of the family nurse partnership is similarly about ensuring that we are supporting people much earlier in the journey than we are at the moment, where we treat the acute situation.

Agenda for change staff have protected time for developing skills and for training. We are asking our staff to go the extra mile in order to get through the Covid-related backlog. I am incredibly grateful to them for that, and recognise that we can see activity levels increasing and waiting times reducing. In July, we delivered the highest number of operations in the NHS in Scotland since February 2020.

Clearly, a shift in delivery has resulted from the investment that has been put in and the endeavours of staff, as well as the optimisation of capacity to ensure that we maximise the ability of the service to deliver. However, I recognise that, where we are asking staff to go further, that is putting stress and strain on them when they are already in a stressful situation, and is putting at risk their ability to undertake continuous training and upskilling. That is why the agenda for change contracts include protected learning time, which I expect boards to honour.

Following on from the discussion that Ms Baillie and I had previously about paediatric nurses and nurse vacancies, Ms Baillie will receive correspondence—she might already have received it—which will inform her that NHS Greater Glasgow and Clyde advertised for additional paediatric nurses this year, so there are jobs available.

I recognise the position in terms of resident doctors moving through specialty training, and, because we need the increased capacity, we are working with boards to ensure that they have the resource to be able to offer those places.

The short-term plans on priority areas and projects were set out and voted on by Parliament as part of the budget process. The long-term capital position is under review as part of the infrastructure investment plan, which we expect to bring forward as part of the budget and spending review process.

There is a substantial amount in Mr Golden’s question, which points to the future provision that we will need to get to in order to ensure that we maximise the clinical capacity for the health service, that only humans can deliver on. We have already spoken about the demands that are upon us in the health service, and we need to ensure that we free as much clinical time as possible to meet those demands.

I will point to a number of areas. First, we have a theatre optimisation tool, which is a digital-based product that has been rolled out across Scotland. I saw it in a demonstration in NHS Lothian, and it means that we are able to optimise—the clue is in the name—the level of productivity in our theatres. It ensures that the human estimations of how long an operation will take are being challenged through the application and that we have the maximum optimised level of bookings in the system.

Secondly, we will soon be setting out in detail the roll-out plan for the health and social care application—the app—in Scotland. It will start in Lanarkshire and be rolled out from there. That will initially be on a relatively minimal viable product basis, which will be about appointments, access to vaccinations and so on.

The question is how we scale that up. Part of the discussions that we are having with the BMA and the Royal College of General Practitioners—to address Mr Golden’s point—is about the data that we get from our general practitioners and how that can help to inform what can go through the app. The app can be integrated across health and social care, giving people much more power in their own hands and saving substantial amounts of resources in relation to appointments, bookings and other services that might be able to come through the app.

Lastly, Mr Golden referenced AI. There are good examples of where AI is being utilised, such as in NHS Grampian where it is being used in the lung screening process. Other services are coming through the system—good opportunities are coming through. When I was in Japan, I was able to see the phenomenal work that has been done by some of the companies that are based in Japan but work here in Scotland, which is looking at how AI can help to transform radiology. Alongside moving upstream into a more preventative health service, better utilising technology and having advancements come through the health service is also where we will meet the demands that are coming at us.

One such demand is the expectation of a 20 per cent increase in the burden of disease. How do we reverse that? How do we move forward? It is through the utilisation of innovation and new technology and moving further upstream into the preventative space. Mr Golden has struck an incredibly salient and pertinent point, which we are absolutely committed to moving forward with.

Forgive me, convener, but I did not address Mr Ewing’s direct question. The answer is contained in my response to Mr Golden, which is that the infrastructure investment plan and the spending review will set out our capital investment plans. We will get to that as part of the process for this year’s budget.

I recognise that we have cantered across quite a lot but might not have addressed all the issues that the petitioners have raised. I recognise that raising issues through a petition, which often involves talking about very personal healthcare issues that affect the petitioner or their family members, can be incredibly traumatic and difficult. If I have not fully responded to any points, for whatever reason, I am happy to address them in correspondence to you, convener, because it is very important that we continue to do so.

It goes back to the point that this is about specialisation rather than centralisation. On the point about patients having to travel, the national treatment centre initiative has demonstrated that it does not always have to be patients from rural areas travelling to the central belt. The national treatment centre Highland is a good example of patients travelling north from parts of the central belt. As someone who is originally from Orkney, it pleases me greatly that we have that level of co-ordination and that, rather than people having to travel towards the central belt, a level of service is being delivered in some of our more rural communities and is serving their interests, too.

A balance needs to be struck. Sometimes, we might need to take decisions nationally on diagnostic or treatment pathways; at other times, it is for local boards to determine how best to deliver and to serve patients in their areas, and they sometimes work in concert with other boards. Regardless of whether it is us, in Government, who help—whether through a cancer pathway or specialisation, or by ensuring that we provide neonatal services for the sickest babies—a condition must go through an assessment of need.

In response to your exact questions, convener, it is about ensuring that we provide a service that is specialised but that does not restrict people’s access to it. Careful consideration has to be given, and public consultation and clinical input must be involved, to ensure that we provide the best services for people.

Mr Ewing and I, along with GPs in his constituency and with Mr Mountain, have corresponded and met repeatedly on the issue, and I well recognise the concerns that have been raised. I recognise the case that he has raises, but he will forgive me, because I clearly cannot comment on it.

Access to the whooping cough vaccine is clearly very important. Given the geopolitical discourse that has taken place this week, I encourage any expectant mother to access a vaccine that they are eligible for. As we approach winter, we should also take the opportunity to remind colleagues that they should take up the vaccines that are available to them, because of the preventative benefits that they offer. Vaccines are among the best public health measures that are available to us.

Mr Ewing asked why the contract change happened in the first place. In the lead-up to 2018, a request came from the British Medical Association during the GP contract negotiations. There is flexibility in the contract for local boards to take alternative measures, which, as I have made clear in my work with NHS Highland, needs to happen. There has been an assessment of the situation in Highland, and there will be flexibility in offering vaccination clinics, which GPs will lead on.

I have corresponded with Mr Ewing on the issue, and we are currently in discussions with the British Medical Association about its future funding provision and the services that it provides as a result. If requests come from the BMA again, we will consider them.

Convener, I thank Edward Mountain for raising the issue, as he has done in correspondence with me, persistently ensuring that the needs of his constituents in the Highlands are across my desk on this issue and on others. As he will understand, I well know what that trip from Wick to Inverness looks like—I commute it regularly—so I well understand the challenge of accessing a service, even in Raigmore, for patients elsewhere in the Highlands.

A review of the national provision of vascular services is on-going. An interim position is in place at the moment to support the acute need for support for Highland vascular services. We are looking to move to a model that would ensure better vascular provision not just for the Highlands but across Scotland, to be delivered on population-based need while also understanding the clear points that Mr Mountain raised about travel within the Highlands and between the Highlands and other parts of the country. I will be happy to correspond with Mr Mountain on what that review is looking at.