Chamber and committees

I think that I have made it clear that we wanted to proceed with the national treatment centres programme as was laid out. We believed that that was going to be the best way to reduce waiting times. However, the capital position has been such, with regard to both construction inflation—we are all aware of the corrosive impacts of inflation over recent years—and the real-terms reduction in our conventional capital budget that has come from UK Government decisions, that we have been faced with very difficult choices to make.

We have had to pause the majority of the capital programme in health. We are restarting it now in priority areas such as Monklands, the Belford, the joint campus in Barra and the Princess Alexandra eye pavilion in Edinburgh. We are also looking at what we can do around a revenue finance model for primary care facilities so that, in spite of the capital settlement that we have received, we are still able to make progress on building infrastructure that meets the needs of a modern health and social care service.

I have been very clear with my board chairs and chief executives on the importance of partnership working with the community and voluntary sector. We have to recognise—as I absolutely do; I think that I set this out in a previous evidence session in response to questions from Gillian Mackay—that our community and voluntary organisations can often reach people better than our statutory services can, simply because they provide specialist services and are, by their nature, embedded in communities.

I have been clear with chairs and chief executives on the need to ensure that there is continued collaboration with services such as the one in Dundee that Mr FitzPatrick mentioned, which can, on a preventative basis and from the perspective of managing long-term conditions, provide significant benefits not only to individuals but to our public services.

I think that Ms Robison is giving evidence in committee next door and is probably touching on those very areas. As an example, I will set out the investment that we are making in general practice, which I see as one of the headline areas for the preventative spend that we are seeking to make. As a result in particular of the work around enhanced services, such as cardiovascular disease testing, that we put in place last year, we are able to spot things much earlier, which is resulting in better disease management in general practice. However, we can do that to a greater extent only if we increase capacity, so that was the philosophy behind my approach in seeking to increase capacity in general practice.

It was very much about working in a preventative space, moving much further upstream in our intervention rather than, as in the mental health space—which is another case in point—allowing something to escalate until it becomes an acute problem. We all know that it is much more costly—although it seems callous to put it in pounds and pence—to intervene at a later stage, through the acute system, than it is to intervene earlier in the community and primary care space. That was the philosophy behind our approach to expanding provision and capacity within general practice.

There are other areas in which interventions such as the hospital at home programme are very effective in preventing further escalation and the hospitalisation of individuals. Some areas, such as rural and island communities, are using the hospital at home service to meet the capacity requirements for incredibly complex social care that otherwise may not have been met. We recognise that meeting the demand for access to social care, given the complexity of individuals’ needs and in some cases their infirmity, sometimes presents a challenge when it is addressed purely on a social care basis. Hospital at home allows us to do more of that and give people the opportunity to receive a fantastic service in the comfort of their own home.

Mr Whittle is absolutely right, and that issue came through in my discussions with the SFA last week. There is no point in our having one-off events that bring loads of people in but do not sustain participation—that is not a legacy. We are looking to build a legacy, and that is what the governing bodies are also looking for as they develop their programmes. Having spoken to the SFA about the programmes that it is looking to build, I can say that, from its perspective, it starts with community clubs. I declare an interest in that I coach at one of those, so I know that ensuring broad appeal, accessibility and support is incredibly important to the community club network. I expect that to be replicated in the plans that the other sports governing bodies bring forward. It was certainly part of the pre-budget discussions that we had about what they would be able to do to broaden participation and accessibility for families on lower incomes. That is a key consideration for the programmes that the governing bodies are seeking to offer; they will seek to ensure that the athletics clubs network and other sports networks at a community level are where we will make the difference by making the offer more accessible.

The intervention that we are making in this budget was in response to governing bodies setting out concerns such as that. I can see some of those concerns, because my children participate in athletics, swimming, football and a range of sports. I can see the strength that there is in the club network, in the community network and in the volunteers that allow these clubs to be sustained.

Another element is how we can continue to support volunteering in sport across Scotland, because that is the life-blood. That is what empowers and allows clubs to put on sessions and take on additional teams, to get more children and young people involved.

We also need to look at how we ensure that we are providing accessible services for adults who may well be watching the football world cup and the Commonwealth games and looking to get back into a sport that they have previously participated in, or looking to pursue a more active lifestyle by getting involved in something like walking football or the jogscotland network.

We are making a broad investment to provide an opportunity for increased participation across demographics and age groups. I would be more than happy to meet Mr Whittle, or for Ms Todd to do so, to discuss that in more detail with him.

I thank Ms Harper for providing the distinction. Since I took up office, I have been keen to introduce the interventions that we have been able to make through negotiation with the BMA, which will allow us to broaden and provide greater capacity in core general practice. We have reached a landmark agreement with the BMA, which is potentially generational in its impact, and will allocate £530 million over three years. This budget provides the first year of that funding—a £98 million increase that is front-loaded towards employing additional GPs.

More broadly, across its course, the deal is about improving GP surgeries’ digital offering and other elements of expansion and innovation within general practice. It is also about improving data reporting to the Government so that we can see the incredible efforts that our GP surgeries go to in providing a broad front door to the health service. The announcement was well received by the BMA, and my appearance at the local medical committee conference in Aberdeen just before Christmas was positive. I believe that there is much positivity in the GP community on what the future can hold.

That is absolutely right. There are huge opportunities for us as we attempt to shift the balance of care and move some of the clinic-based services out of hospital and into high street and community-based services. Providing the additional funding for community audiology is about attempting to move in that direction. There are already well-established pathways in that regard because of free eye tests in the optometry space. Pharmacy first has also undergone a significant expansion, while the prescriber status in pharmacy services has allowed us to move significantly forward. It is about trying to match that progress in an area in which we recognise that there are challenges with waiting times in different parts of the country. I am pleased that we have been able to commit additional resource to community audiology services.

The budget honours all the pay deals that have been secured. The deal that we arrived at with the BMA resident doctors committee was achieved through consensus and significant compromise by both parties. I am pleased that we were able to do that deal. As you say, there would have been significant disruption had the strike gone ahead; we reckon that more than 20,000 procedures, operations and appointments would have been cancelled in the strike period, which would have put at significant risk the incredible progress that has been made by our staff in reducing waiting times and improving access to our health service, particularly in the past six months but also over the past year or so.

I am pleased that we were able to avert industrial action. We have arrived at a deal that the resident doctor committee will recommend to its members, and we expect the ballot to proceed in short order. I hope that resident doctor members of the BMA will accept the deal.

That is one of the questions that I sought assurance on when I visited the Wester Hailes healthy living centre during the budget week a couple of weeks ago. The health board has already had significant offers of interest from GPs and wider practice staff in staffing a walk-in GP clinic. There is a record number of GPs who are currently in training, and we know that there are GPs who have recently qualified in different parts of the country who are looking for employment.

Alongside the record investment that we are making over three years in core GP services, which is about having more GPs employed in core general practice, the walk-in clinics will be another opportunity for those who are coming through the system to not just train and qualify in Scotland but live and work here. There will be opportunities across the country for GPs to have a fulfilling career, giving service to the people of Scotland.

09:30

No. The idea is not to displace people or replace core GP services. It is about providing additional flexibility for patients to access GP services. The times that the walk-in clinics are available at are designed to ensure that core GP practices continue to predominate. The clinics will be available from 12 until 8 pm, so they are crossing over into the out-of-hours space. We are trying to prevent people from self-presenting at accident and emergency when they do not need to be there and could be captured and treated in primary care or urgent care services. The aim is also to allow more flexibility in accessing GP services for those who work, because accessing core services is sometimes more challenging for them.

That is the design. As I said, it is a pilot. It is about testing and learning whether we have the right model. We are taking learning from how the approach has worked—or not—in other parts of the United Kingdom and are seeking to build on that to have a pilot that provides a broader front door to our health service. We believe that it will be very popular with the public, as people will be able to present without the need for an appointment and be seen by GP services.