Chamber and committees

I have a supplementary point. I know that you visited Milton to discuss the issue first hand. Perhaps there is an issue with how schools engage with the problem. It might be useful to engage with the schools that have catchment areas in the relevant communities, to get an understanding of whether they have detected the problem and have measures in place to address it or whether they, similarly to the police, feel powerless to deal with it.

There might be a similar thing with teachers experiencing similar issues, which might be useful to understand.

The procurement side of the issue is of particular interest, given the recent failure to achieve success in the latest phase of the procedure. It seems that breaking it down into phases is an inefficient method of delivering the programme, and I wonder whether a continuous mobilisation for road construction approach is necessary. If it is about improving the route by dualling rather than constructing a new road, that would comply with our goals around climate change and so on.

It is about road safety on an existing route, but how the Government delivers the programme is critical. There are other examples around the world. I had the opportunity to visit India recently, and I was on the world’s highest metalled road, in the Himalayas. It was delivered by a state corporation called the Border Roads Organisation, which mobilises a national mission to deliver strategic road networks in India. That is just an example of how the Indian Government is delivering that mission as a continuous programme. It does not stop to procure each phase, which introduces huge stop-start inefficiencies. It knows what its national road network will look like and builds it over a continuous period.

I wonder whether we need to look at the fundamental sanity of the current approach. Railways have achieved significant efficiencies by having continuous rolling electrification. The teams do not stop between phases; they just run across the network, putting up the pylons and running the cables. A similar approach for the strategic road network and the trunk road network could be an interesting proposition.

I agree with the proposed actions, and I have some familiarity with the petitioner’s case from press coverage—I think that it has had quite a high profile in recent months.

I will make one additional point. The university in question—the University of Glasgow—is not affiliated to NUS Scotland, so it would be appropriate to also ask that university’s student representative council to make a submission, simply because the institution is not under the ambit of the NUS.

There are some major structural issues here. Most notably, in Glasgow, there is no common housing register across all the registered social landlords in the city, so having visibility of adapted housing is challenging and often involves making numerous duplicate applications to various housing associations. That has been a massive public policy failing since the stock transfer in Glasgow, and it has never been addressed in 20-odd years. That is one aggravating factor.

I would also highlight recent engagement that I have had with hospices in Scotland. There was a pretty harrowing exhibition at the University of Glasgow recently, which was called “Dying at the Margins” and which I think is due to come to the Parliament later this year. It presented case studies of people who could have lived out their final days at home but who, because of accessibility issues and lack of willingness of housing associations, councils and housing providers to make adaptations to housing, ended up in hospitals or hospices—often inappropriate settings where they did not want to spend their final days. That was pretty shocking. Often a pretty mercenary calculation was made that, if someone was going to be alive for only another few months, there was no point in paying the money to make adaptations.

There is an aspect of how palliative care is managed in the home, and the hospital at home concept, that merits consideration. The issue causes huge costs to the NHS as a result of delayed discharge. People who are terminally ill are in acute hospital wards, which are a highly medicalised environment and probably not appropriate for them. There are all sorts of aspects that introduce great costs that are not being dealt with. There is a bit of system failure in relation to ensuring that adaptations are efficiently and cheerfully carried out where needed.

A number of hospices were involved in the production of that exhibition. It might be useful to solicit their views on what policy changes need to happen. That might open up a pathway to other stakeholders that are engaged in the policy area. Marie Curie would be an obvious first stop for those discussions, because it was certainly an anchor organisation in the production of that exhibition and it has highlighted to me this critical issue in the community.

Yes. It was at the University of Glasgow, and I believe that it is due to be displayed at the Parliament.

Cabinet secretary, you mentioned that prevention is critical to controlling overall cost pressures on the NHS, yet the NHS in Scotland has the lowest share of preventative spend of any Organisation for Economic Co-operation and Development healthcare system. One way to address that is through the mental health challenge that this country faces.

In the 2021-22 programme for government, the Government committed to a mental health and wellbeing service for every GP practice and 1,000 new roles to support community mental health resilience. Despite health and social care partnerships planning for the roll-out of those services and the vital role that such community-based support provides in preventing mental health crises from reaching an acute situation, implementation has not yet started. Will you explain why that has not happened and why it has not been a bigger priority, given that it was in the programme for government?

The NHS Greater Glasgow and Clyde chief executive cited the particularly shocking example of the institute of neurological sciences in Glasgow, where the maintenance backlog has come at a human cost, with 17 incidents of patient death or harm in the past five years. The board has also spent £3 million on private surgery for patients, so it is clear that there is a business case for accelerating or expediting investment in that particular infrastructure, given the cost already associated with the backlog in terms of patient deaths and the cost of private provision to make up the difference.

There are also structural issues to address. NHS Lothian has stated that the Royal infirmary of Edinburgh’s

“accident and emergency department was designed for a population of about 85,000”—[Official Report, Health, Social Care and Sport Committee, 6 June 2023; c 6.]

but it is actually seeing around “120,000 to 130,000” people coming through it, so the physical infrastructure is struggling to cope. Do you have a national risk register that you personally oversee to demonstrate where we need to prioritise capital investment, based on those metrics around patient safety and clear structural challenges? Is that something that is reported to you and on which you can take personal action?

I recognise your point that finance is tight, although you have a relatively privileged position, in that your area has the biggest expenditure by the Scottish Government, with a 6 per cent cash and 3 per cent real-terms increase in the projected budget for the next financial year.

We know that when we do not aggressively pursue opportunities for savings and prevention, we end up incurring costs somewhere else in the system. One area that we have identified in our discussions with chief executives is NHS 24, which has seen a 580 per cent increase in calls based on an annual rate of calls that are associated with mental health problems, and where dental health calls have also significantly increased, with 67,000 calls made in 2022-23 in comparison to just under 30,000 in 2019-20.

The pressures are visited elsewhere in the system, which seems unsustainable in view of those figures, which certainly shocked us when we heard them. Do you recognise that we need more investigation of where we can aggressively pursue opportunities for savings and push that prevention spend because costs will otherwise be incurred elsewhere?