Chamber and committees

Another interesting point that Audit Scotland made in its report was about leadership and stability in leadership. It highlighted

“a lack of stable senior leadership, with high turnover and short-term tenure”,

particularly in relation to directors of finance. To what extent is the lack of the right sort of leadership related to the inability to achieve long-term sustainability?

Good afternoon to our witnesses. I am keen to build on some of what we heard about financial sustainability in the first part of the meeting. From reading some of the work that Audit Scotland has done, it strikes me that there is a requirement for innovation in order to achieve financial sustainability. Of course, progress on that is hampered by the fact that the NHS faced serious financial challenges before the pandemic and those were exacerbated by the pandemic. To what extent do you feel that enough is being done to try to achieve transformation in the NHS in order to lead to financial sustainability?

I put that question to Professor Bell first. We could then hear from Audit Scotland.

Does Leigh Johnston want to comment on that? My question is partly based on Audit Scotland’s analysis that identified the need for that innovation to be sustainable as well as the difficulties of standing still.

In the past few days, it has been hard not to be moved by the words written in the book of Ecclesiastes:

“For everything there is a season, and a time for every matter under heaven:
a time to be born, and a time to die;
a time to plant, and a time to pluck up what is planted ...
a time to weep, and a time to laugh;
a time to mourn, and a time to dance”.

Even if we do not have faith, the poetry of that speaks to the collective experience of the past days, as people across our communities have sought to respond to the death of the longest-serving monarch in our nation’s history, and as a family has mourned a mother, grandmother and great-grandmother.

Across West Scotland, constituents have cried and laughed as they shared their memories of the Queen and her many visits in the cause of the service to which she pledged herself at such a young age, and which she carried out faithfully until just 11 days ago. Whether she was launching ships on the Clyde at Port Glasgow, opening the Tannahill community centre in Paisley or visiting factories in Irvine, people remember where they were, each word of the conversation that they had and, of course, how they felt when they met her in their own towns and villages.

The Queen was the great constant in our ever-changing world, giving a sense of certainty in a world that is all too often uncertain, and enduring with people and places in good times and bad. I was struck, when listening to the service of thanksgiving from Belfast cathedral last week, when the Archbishop of Armagh, John McDowell, said that there were two people whose deaths we could never imagine: our own and the Queen’s. That blend of constancy and touching of so many lives is why her loss has been so keenly felt, even by people who have no connection to, or belief in, a constitutional monarchy. There has been a real sense of an era ending.

In that Belfast service, we were also able to reflect on the Queen’s commitment to peace and reconciliation. Her leadership in letting go of the past, no matter how painful, and in acknowledging difference and using symbols and language as a way of showing respect and understanding, have helped to make the unthinkable become reality. As someone who shares British and Irish citizenship, I thank her for that. We all still have much to learn about the power of rooting ourselves in forgiveness, patience and reconciliation.

Yesterday, many people felt as though a door closed. Who could help but feel that sense of finality, as the haunting pipes faded beyond the doors of the abbey or St George’s chapel? Like King Solomon in Ecclesiastes, we know that there is a season and a time for everything.

Inspired by the Queen’s sense of duty, her service to communities such as those in West Scotland, and her commitment to reconciliation, let us also sow seeds of good in our time.

Requiescat in pace.

I note what the cabinet secretary said about vaccination services being as local as possible, but we know that the rhetoric does not always match reality. There have been numerous examples of NHS Highland patients being made to make 100-mile round trips, and in Inverclyde there have been numerous examples of people with respiratory illness being instructed to travel to Glasgow. In terms of delivery, it is also critical to recognise that the Royal College of Nursing is balloting for strike action, with more than 90 per cent of nurses having rejected the Scottish Government’s pay offer. What specific actions are being taken to ensure that vaccination centres will be as close to people as possible, and what further action is the Scottish Government taking to resolve the pay dispute and ensure that nurses are paid a fair wage, including those who provide vital vaccination roles?

I have a brief question about the financial effects. Previously, I asked the cabinet secretary this question, on the funding for environmental health officers to carry out the measure. I appreciate that the paragraph on financial effects states:

“Local Authorities are already funded to undertake tobacco ... work”.

I am conscious that there may be a higher number of hospitals in the city of Edinburgh and Glasgow city than in other local authority areas, so there will perhaps be a corresponding pressure on those teams. I suppose that I am just looking for an assurance that, if costs are exorbitant or add pressures for particular departments, that will be monitored by the Government and any adjustments will be made if required.

That is fair, and it is good of you to remind me of my central belt bias, which often accidentally slips out.

Given that there are no further questions, we move to item 4, which is the formal debate on the made affirmative instrument on which we have just taken evidence. I remind the committee that members should not put questions to the minister during the formal debate; and officials may not speak.

Minister, do you wish to say anything further on motion S6M-04798, before I invite you to move it?

I invite contributions to the debate.

I want to further explore the policies and objectives that relate to addressing health inequalities. Last week, Professor Sir Michael Marmot, who has previously given evidence to the committee, provided compelling evidence about the measures that have been taken in England, particularly in Wolverhampton and Manchester, under his Marmot cities model. He uses six approaches that can make a difference—and which, on the basis of reports on those cities, have been shown to have made a difference.

Last week, I said that those things are not “rocket science”; we probably all recognise them as important things to do that make a difference. They are very often offered and supported by local government and the third sector. However, we know that their funding is reducing, which is challenging, so I am keen to get a sense of how we progress a Marmot cities agenda in Scotland, particularly in our city regions, and how we can sustain funding in the six areas that Professor Marmot has identified.

It is good to hear that that meeting is taking place today and that progress on that work is being made, because the committee felt very strongly about that evidence.

I want to ask about health inequalities that are driven by poverty. The committee heard evidence from many organisations that, to some extent, the only proven policy relating to poverty and its impact has been the child payment, given the progress that has been made in that regard. It has had an impact because income goes directly to the poorest families in our society. Would the minister support a further increase to the child payment in order to tackle inequalities?