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?

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?

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 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.

We should all continue to call for additional efforts and initiatives to support the recruitment and retention of clinicians and other NHS staff. For example, the Royal College of Physicians of Edinburgh highlights that it would welcome a review of the NHS estate to ensure that medical staff have access to hot food during night shifts and adequate rest and changing facilities. We know that one of the biggest barriers to that is staff not being able to leave a ward to access such facilities in the first place, so we need to ensure that work on safe staffing is progressed at pace.

As a front door to the health service, a thriving general practice not only brings direct benefits to its patients but serves to protect the entire NHS. Without general practice, the rest of the health service would be overwhelmed and the NHS as we know it would simply not exist. There are obviously pressures on urgent care in many health boards. In the short term, we need to have enough staff and capacity to deal with what is coming through the door. In the medium and long terms, we need to help GP services to ensure that they can see people, to prevent them from turning up at accident and emergency unnecessarily. GP out-of-hours services should also be supported and strengthened as a vital piece of the urgent care landscape. There is a hugely dedicated team that takes on that role in addition to other responsibilities.

The entire system is interconnected and interdependent, but that should not provide us with excuses for not tackling the big issues or not having big conversations with service users, unions and stakeholders.

As Sandesh Gulhane rightly said, we need to look at alternative routes into medical careers, to take care of short-term and long-term workforce issues. However, we also need the UK Government to play its part. For example, if they are given indefinite leave to remain, international medical graduates could be part of the workforce for a long time to come.

Elena Whitham’s contribution prompted a thought that I do not think we have covered today. We have all set out national aspirations, but that assumes that all our health boards are facing the same challenges equally. We know that that is not the reality, so we need to tailor approaches to ensure that they have the support that they need.

We need to see change in the short term to build clinician and patient confidence, because, if they do not believe that things are going to get better, it will be an uphill battle to continue reform. We need to see a realistic timetable from the Government for how and when things will change, and we need to know that we are not going to see just another round of constant meetings and talking.

We must continue to prioritise a preventative approach, to alleviate the pressures on our NHS and enhance the general health of our population. To continue with a preventative approach means building on strong progress such as minimum unit pricing and work on banning disposable vapes.

Increasing the number of medical school places across Scotland would be an important step towards addressing workforce challenges, but those increases must be matched by an urgent expansion in training posts for all who require them, across all specialties and in all parts of Scotland. Failure to expand training opportunities can lead only to extreme frustration in the medical workforce and will undermine attempts to retain doctors in the NHS.

We must also listen to our junior doctors and new nurses to ensure that the training process is improved so that they do not burn out. They will be our clinicians for generations to come and their experiences must be taken into account, because some of those are not good. They do not get shifts when they should, or they miss major life events to ensure that people get the right care, and that is just the tip of the iceberg.

Like other members, I will touch on mental health. Mental health problems are strongly linked to health and social inequalities. Those living in the most deprived areas are three times more likely to end up in hospital due to mental health issues than those living in the least deprived areas. We need more and better general practice in all areas of profound socioeconomic deprivation, to reduce the ill health and mortality that those services can influence.

We must also look at the treatment mix in mental health to ensure that it reflects what the population actually needs. Very soon, many young people who have known only talking therapies in the support given by their schools will transition to adult services. We do not have that balance or that provision of cognitive behavioural therapy in adult services. That is one example of a long-term issue that we must look at now to ensure that services are fit for the time when more young people enter adult services.

The outcomes for a number of other conditions could, with investment, be radically improved. Closed loop diabetes kits undoubtedly have positive benefits for users and reduce potential complications. Thrombectomy can literally save the life of someone who has suffered a stroke, as well as preventing disablement and reducing NHS spending. At the moment, that is only a 9 to 5 service in many places, creating a lottery that depends on when a person has a stroke.

I will briefly address the amendments to today’s motion. Green members will abstain on both. The Conservative amendment would remove some good things that we added to the motion, and, although we support the majority of the Labour amendment, the number contained in it is so incorrect that we cannot support it.

Overall, I have been pretty disappointed by this debate. If we are to have a grown-up conversation, we must all give up our politically entrenched positions. There have been some good ideas, but people do not want a good idea that is wrapped in a party political broadcast. We must be better than that.

I thank all those who sent briefings ahead of the debate and look forward to the conversations that are clearly needed—and wanted—about what the NHS needs, so that it can deal with its current challenges and ensure that it is fit for the future.