Chamber and committees

You raise a crucial point. I am very clear that I will not be setting out further measures over and above what we have announced in the programme for government until we have completed thorough engagement and partnership working with stakeholders, the workforce and those who represent them. We are currently agreeing a process with trade unions.

Let me be clear that the starting point for all this work is to improve patient care. It is not about structures per se, and it is certainly not about spreadsheets. My perspective is that, over the past 20 years, staffing in the NHS has increased by 29 per cent, and an increase in investment is projected over the next spending review period. I consider that to be positive.

However, we have to recognise that that increase in investment and workforce has not kept up with the increase in demand across the entire service. Therefore, the reforms must be about working better and differently, and about doing so together. I will be engaging hand in glove with our trade unions, because we are doing this with the workforce, not to the workforce. We are relying on the workforce to achieve high-quality services, so it will need to be involved in the design phase and have input into the full business case. I am currently interrogating timescales, and we will also need workforce input on those. There will, of course, be impact assessments, and I am committed to a rigorous programme of engagement.

I know that some of the discourse on delayed discharge is about the whole system and the NHS, but we have to remember that, fundamentally, delayed discharge is not good for patients. it is absolutely detrimental to anyone who remains in hospital longer than their clinical needs require. That is reflected in the evidence on the effect of lack of movement, lack of socialisation, loss of independence and a decrease in mental wellbeing. That is the primary reason why we want to address delayed discharge, notwithstanding the important system-wide issues.

As a former justice secretary, I will step in for a moment to respond to that and will then hand back to Ms Todd.

The Misuse of Drugs Act 1971, which is almost as old as I am, was written for a different age. As you heard from Ms Todd, the substances that are now on our streets, such as synthetic benzodiazepines and opioids, pose a greater risk than others, given their toxicity, and they are becoming more novel in form. In contrast, the legislation is old and outdated.

To be clear, in the context of discussions about the Thistle centre and services like it, there is nothing that the Scottish Government—or, indeed, any Lord Advocate—can do to overturn primary legislation that has been passed by the Westminster Parliament. We do not have scope not to follow the 1971 act, which comes with great limitations, particularly regarding harm reduction, such as using equipment for treating injuries, whether it be tourniquets or other equipment to prevent wounds that result from people smoking substances. Those are practical limitations that we cannot contravene. I need to be clear about this point: there is nothing that any Lord Advocate or the Scottish Government can do to contravene the law of the United Kingdom. Instead, the Lord Advocate can, in discrete circumstances, using powers that are independent from the Government, issue statements about prosecution policy.

As the first ever Minister for Drugs Policy, I was very involved in the debate—as was Ms Thewliss, who was then an MP for Glasgow—about the excruciating journey to find, in effect, a way to land a jumbo jet on a postage stamp within our narrow powers. The framework for the Thistle centre is narrow in scope and based on evidence and extremely detailed work.

The Government’s position in support of the devolution of drug legislation is not new—it has been our position since about 2023. The legal context is important, and our eyes are wide open about what we can and cannot do, which is why we support the devolution of drug policy.

That endeavour will be over the medium to longer term. The challenge in shifting the balance of care upstream to preventative care is in managing the transition, given the immediate challenges here and now. I agree that the metrics in the immediate, medium and longer term are important, but we also need to have the courage to do the longer-term work.

Nobody is disputing the legal responsibilities of local authorities. I am a former social worker, so I am well aware of the legal responsibilities that local authorities have and for which they are accountable in relation to social care, social work, vulnerable adult legislation and looked-after children.

However, we all have a shared interest in delivering for our people. We have a fragmented care system in terms of health and social care, and we have to start somewhere. We can start with NHS simplification. There is a lot of work to be done on that, as I have outlined, but we also recognise the role of local government and the accountability that it has. We will keep that in mind as we embark on our discussions.

Local authorities clearly have an important role in discussions. They are legally and electorally accountable, and are a separate tier of government. They will be crucial in the discussions on social care.

There is also a discussion about the future of local government, as laid out in the programme for government. There are interdependencies here—we are all well aware of the interdependencies among the NHS, social care and local government. The raison d’être of public service reform is to deliver excellent public services that are not fragmented and to provide a continuum of care for our people.

I know by my mailbag and the representations that I have had from numerous MSPs and my own constituents that it is a popular option.

Let me be clear: we have 900 GP practices up and down the country, and this programme is there to complement GP practices. A simple example, which I will give for brevity, is that my mother will always want to see her own family doctor. I—as with many other people like me with busy working lives—will happily go elsewhere if it fits in the diary and I can be seen quickly and sent on my way.

That may be a question for me, because they deal with an important part of the national health and care improving flow plan.

In essence, it is about having far closer collaboration between NHS 24, the Scottish Ambulance Service and health boards and about taking a whole-system approach. For example, the Scottish Ambulance Service has become good at identifying people who do not need to be conveyed to accident and emergency—53 per cent of their engagement now involves people being treated on site or directed to another source of help. That will help us to take a grip of the flow through hospital front doors and of patient movement, but there is also work to do at the back door to deal with delayed discharge.

Fundamentally, I would describe GP walk-in services as an additional service for people to access things such as information, advice, help, signposting and a prescription quickly. That is the fundamental point for me.

To respond to Adam Harley’s very valid point about supporting GPs, there is an additional three-year investment of more than £500 million, which is over and above core primary care funding. I hope that that speaks to the value and importance that the Government and I place on GP practices.

10:15

As I said, convener, a range of works is currently under way in the Queen Elizabeth university hospital. My officials have oversight of that, and there are various assurance processes, but it is clear that the people of Scotland did not get the hospital that the country paid for. I have no doubt that the Scottish hospitals inquiry will shed crucial light on a range of issues. However, I assure you that we are actively engaged in addressing the here and now.