Chamber and committees

As I said in my opening statement, we have provided additional specialty training places, in recognition of the fact that it is a competitive landscape. I put on record that I think that it is right that it is competitive, as that serves to ensure that the best come through. People who receive their medical education and training in Scotland and the rest of the UK are held in very high esteem internationally. Therefore, we have incredibly high standards to ensure that the best come through into our system.

We review annually the number of specialty training places that are available. As I said in my opening remarks, we have allocated an additional £14 million to increase the number of specialty training places by 10 per cent. That matches proportionately what the UK Government is delivering. Obviously, we will keep under review the impact that the bill has on the delivery of the workforce supply that is required and whether we need to move that up or down in future years.

That will be part of the discussions about recruitment that we have on a four-nations basis. NHS Education for Scotland has representatives in those discussions, which help us to determine what our need will be as regards specialty training and how many people should be recruited to that. As I said, there is a fine judgment to be made to ensure not only that the process is competitive but that it delivers the number of specialty training places that will allow us to fill the gaps in our supply that we need to fill.

A number of factors determine the attractiveness of Scotland, or any other part of the UK, as a place for people to live and work. There are a number of reasons why people should want to choose to live in Scotland and to work in the NHS in Scotland, which I am more than happy to put on the record. Through NES, we look to set out a competitive and supportive education programme and specialty programme. I have certainly not had any feedback to the contrary in discussions with either the British Medical Association resident doctors committee or the medical students committee.

There is concern from the BMA, which is why it has set out its support for the bill, although in some places that is qualified support. The bill will make it easier for UK-domiciled medical graduates to access specialty places. Everybody is aware of the issues that exist between the BMA and the UK Government at the moment. The bill is an attempt to resolve some of those issues.

We are taking a number of measures to try to improve recruitment in rural and island areas. Emma Harper mentioned ScotGEM, which is an example of that. We have taken forward a number of programmes to provide rural and island communities with people to serve those services. The bill will not necessarily directly change the perspectives in that regard but, taken alongside some of those programmes, it has the potential to help us to meet the skills gaps in our rural and island communities.

I will bring in Ms Gibbons in a second on the dynamic that is at play and the impact that the bill will have on the ability to have a mixture of practice and to diversify. In rural communities such as the one that Ms Harper is from and the one that I am originally from, it is incredibly important to have medical professionals with diversity in their practice. We understand the need for rural practitioners, whether they be medical practitioners or part of the wider multidisciplinary team, to have diversity in their portfolios. They need to be able to deliver a wider variety of services. I have seen evidence of that in my visits to rural and island communities where, because of capacity and what needs to be responded to, people are stepping into areas of specialism that would be delivered by specialists in the central belt.

It is important for us to consider the crux of the point that you are making and I will bring in Ms Gibbons to talk about the dynamic in the context of the bill.

11:15

I will need to write to the committee to give numbers, but I understand Ms Mochan’s point about the wider impact that international medical graduates have across the whole system, which is why I talk about the importance that I place on us being a welcoming nation not just to international medical graduates but international workers in our health and social care system in general. Ms Mochan and I have corresponded on that on a number of occasions. I will write back to the committee with the numbers that Ms Mochan is asking for, because I do not have them to hand.

I very much share the concern that Ms Mochan puts on the record, which is why the Scottish Government is content with this approach as opposed to others that we discussed with the UK Government before this legislation was mooted. In my view, it achieves the inclusive and welcoming approach that we want to take and the legal and workable element that I mentioned in my opening remarks. From our perspective, the UK Government’s previous attempts to address the issue, which we heard about in our private discussions with it, did not pass that test. We are now in a much better place with the bill.

Such monitoring is carried out routinely through discussions among the four nations on the recruitment that is required. Given that I will be writing to the committee in response to Ms Mochan’s questions, I am happy to add a paragraph to provide the assurances that Ms Mackay is looking for.

No.

That relates partly to Dr Gulhane’s questioning. There will still be a need for international medical graduates for some specialties, where there is not the same popularity among UK-domiciled medical graduates. That will not change—I expect that we will still have that.

The dynamic that might change is that the more popular specialty places among UK-domiciled students might be harder for international medical graduates to come into. However, if those graduates continue to have a determination, as I hope that they will, to live and work in the UK—I want that to be in Scotland, but it could be other parts of the UK—they might have to choose other specialties to practise.