Chamber and committees

Good morning, everyone. We have heard continually about regional variability in the implementation of SDS, and the care experience survey that was published on 28 May reveals significant variability in the satisfaction and experiences of people who receive care.

What specific measures are you all taking to address regional disparities in social care? What best practices can be shared in an efficient manner by IJBs and HSCPs that are doing better than others?

How, functionally, has the evaluation and monitoring that you do changed with the change in approach? Are the evaluation and monitoring now much more conversational in relation to some of the softer objectives, rather than getting information on the number of care sessions that have been delivered and so on? Does that help to drive and inform other pieces of innovation and tweaks to the system in East Dunbartonshire?

What is the staff feedback on that change in how you do evaluation and monitoring? Is there good, back or indifferent feedback from the staff who undertake the evaluation and assessment?

Do any of the witnesses who are joining us online want to come in?

The point about how the guidance is used and how it can be embedded is important. National consistency always comes up in relation to self-directed support. Which of the activities in the improvement plan will or will not help to address national consistency, and should or could any aspects of SDS be standardised nationally?

Good morning, panel. Audit Scotland has highlighted that waiting time standards

“do not provide a comprehensive picture of postpandemic service performance or recovery.”

What additional measures or indicators could offer a more comprehensive assessment of healthcare performance and recovery post pandemic?

I want to build on the questions that the convener asked about training and awareness in local authorities. A lot of best practice guidance has been written over the past 10 years. What are the panel’s thoughts on the quality of the guidance, and on how it is or is not being used in local authorities? There is a lot of nodding going on. I will pick Donald Macleod first, if that is okay.

How do we balance the need for accountability and the need to capture high-quality data, and how can we have flexibility to adapt and improve indicators and targets? I take on board that many of the targets are not being hit at the moment. How can we use the data so that things are more realistic for people?

Is there any data that we should be capturing to inform the targets and indicators that we are not capturing now? If there is, what data should the Government capture?

I begin by extending my gratitude to the workers who make up our NHS—those who spend their lives making sure that we get the care we are entitled to when we need it. That includes every single worker who is involved in the running of our services, from nurses and GPs to cleaners, cooks and ambulance drivers. The same goes to the countless carers who keep our social care system afloat. I hope that that serves as a reminder that there is no NHS and no social care without those people, and that their tireless contributions must continue to be valued.

There is only so much that we can cover in the chamber today, and I acknowledge that this should be the start of a wider conversation. We need to be clear that the work to fundamentally reform and improve our services must come on different fronts and that each set of issues will require different timelines.

I also believe that we cannot have a candid conversation about reform without acknowledging the context in which our health and social care systems exist. We cannot ignore the injustice of Brexit and the impact that it has had on our workforce. It has gutted our services and our ability to retain talented individuals. The fiscal constraints that have been placed on us due to austerity from Westminster, the ripple effect from the pandemic, an ageing population and the high burden of non-communicable disease put the NHS in Scotland in a particularly fragile place. We have to acknowledge that that is the reality that we are operating in. However, that does not absolve the Government from its responsibilities. I brought those factors up to inform our dialogue and to have an open and frank conversation that is based on the reality that we face, because it is all too easy to ignore their collective burden.

Reform must focus on a more sustainable healthcare system through performance improvement, prevention, providing quality services and maximising access. The preservation of a publicly owned system that is free at the point of use is non-negotiable. We must not allow ourselves to be buoyed by a false narrative that privatising key aspects of our NHS would fix its difficulties. Scotland has fought hard against privatisation since devolution, and I urge the cabinet secretary to continue that fight. I was pleased to see that reflected in the motion.

We have to focus on prevention, reform and waiting times as targets to help to solve the issues that we currently face. First, I will focus on prevention. We cannot prevent all ill health from ever happening, but given that we recorded 53,000 deaths in 2021 that were attributed to non-communicable diseases, the nation should aspire to reduce preventable ill health to the lowest level possible. That would put a real value on health and ensure that everyone has a good, healthy life for as long as possible. That will reduce pressure on the NHS overall.

That is not a quick fix, and it will not necessarily show up quickly in statistics but, over time, the little bits that we can all do will take pressure off the NHS and improve many lives across the country. For example, yesterday, I attended the Walking Football Scotland and Chest Heart and Stroke Scotland tartan teapot trophy event at Heriot-Watt University, as did the Minister for Social Care, Mental Wellbeing and Sport. The number of people taking part in walking football is phenomenal, with around 90 teams due to play in its Scottish cup competition later this month. It has benefits for players’ physical health. Many people who play are older and have stopped playing five-a-side football for a variety of reasons. The different style of play helps to keep them active for longer when they might otherwise have given up sport. It also contributes to better mental wellbeing and prevents isolation. I was reliably informed yesterday that, if people wanted to, they could play walking football five days a week. The sport is hugely accessible for those who have retired and could become isolated. It is a lot harder to do than it looks, though. We need to ensure that such organisations and initiatives have the funding that they need to deliver services, because the reach of many of them is far beyond anything that we in the Parliament could design.

We also need to invest in GP services. Securing the future of our NHS and improving the health of the people of Scotland fundamentally depend on increasing the number of GPs. Short-term fixes where need is particularly acute must be complemented by long-term strategic planning from the Scottish Government to tackle the severe workforce crisis. We also need to see protected learning time being established for GPs and their teams. I am pleased to see that aspect being included in the Government’s motion, and I thank the cabinet secretary for our conversation about it. We all know that having too little time is a huge barrier in primary care. At the moment, learning and improving knowledge has to fit in with everything else that happens in a general practice surgery. I am sure that much of that learning happens in clinicians’ own time. Allowing time to update and share knowledge can only serve to provide better outcomes for patients.

We also need to ensure that the action that the Parliament takes to create a good food and drink environment will offer people a real choice in improving their health. As I have said on previous occasions, some actions that we need to take to achieve that will involve a whole-Government approach. As we know, poverty is a great barrier to good health, so establishing a universal basic income and putting more money in people’s pockets has to be part of that. However, taking action to encourage reformulation of products, ban disposable vapes, reduce smoking and tackle other health-harming products has to be part of the landscape, too.

We also need a public health levy to ensure that, at a time when funding for services is tight, we are ensuring that sellers of products that damage health contribute to the services that pick up the pieces. I was hugely pleased that, in this year’s budget, we secured a commitment to explore establishing such a levy. It is essential that work happens quickly on that. Given the current financial situation, and the acute need for public services, it would be negligent of any Government not to maximise the funding that comes into such services. Having such a levy would be a relatively easy way to do that.

There is so much work to do in individual specialisms in secondary care that will need to change quickly if we are to get waiting lists down. However, I believe that a fundamental part of the reform agenda for health must focus solidly on reducing ill health overall. I again extend my deepest gratitude to the tireless workers who drive our health and social care services. Without them, we have no NHS.