Chamber and committees

We know without a shadow of a doubt that investing in prevention is cost effective. The challenge is dealing with the here and now while also increasing investment activity upstream. That is why we need to be laser focused on tracking where resources go.

You talked about GP walk-in services, but I think that your point is broader than that. Quick or same-day access to care—wherever it is, and whether it is through pharmacy first, GP walk-ins or NHS 24—is preventative, and it can save a life, because things are being picked up.

The GP walk-in programme will be evaluated extensively for its value for money and the impact it has on other parts of the system. A benefit of that programme is that it is trialling different models, as experiences are quite different in different parts of the country. In the Western Isles, for example, the walk-in programme was focused on the visitors to that area, and that helped to ease pressure on the local GP services. The programme is about complementing our fundamental primary care provision and our 900 GP practices the length and breadth of the country.

Some GP walk-in centres have been busier than others. The centres in Cardonald and Wester Hailes have been busy. It is interesting that there are different patterns of attendance in different areas. The Lochee centre is a really interesting example, because initially the focus there was on a particular practice. There are now plans to extend the programme to all of Dundee or an even bigger catchment area, but originally in Lochee, the focus was on a particular GP practice in an area where there were a lot of health inequalities and therefore a higher rate of attendance at accident and emergency.

It is really important that we have space for innovation, but the fundamental point is that quick or same-day access to care, advice and treatment has the potential to save lives. We have to treat it very seriously and not as an add-on.

I will happily correspond with Mr Middleton on the detail, but it is important to put on record that many of the projects are opening on a phased basis. That is so that we do not destabilise the system, which could cause everybody to compete for staff, for example.

Regarding the point about meeting need, the feedback that I have heard from Ms Todd is that, in Shetland, despite some local scepticism, the centre has been working very well. An apposite point, given some of the discussions about men’s health this week, is that the location of the Shetland GP centre means that men who are taking the kids to sport or football on a Saturday, or whatever day of the week, can raise health concerns while they are there that they perhaps would not otherwise have pursued.

I will begin by speaking more broadly about the NHS estate and our capital resources before coming to the subject of the Queen Elizabeth hospital.

In the next decade or so, we will invest £10 billion of capital in NHS infrastructure. It is important to recognise that, by 2029-30, Scotland’s capital departmental expenditure limit block grant will reduce by 5.7 per cent in real terms in comparison with 2026-27. That has been compounded by historical real-terms cuts to the block grant by the UK Government, so there is a lot of pressure on capital investment. That makes it more important than ever to develop a whole-system NHS infrastructure plan. There are various projects in the infrastructure development pipeline, including both hospital and community health projects that have been committed to. Over and above that, we have asked boards to complete risk assessment reviews and there will then be a strategic needs assessment of the whole NHS estate. We must deliver as much as we can for all of Scotland.

A risk assessment will have been carried out for the Queen Elizabeth, as for other hospitals, and any new priorities will be considered. If members will forgive me, I will be quite judicious in my comments because I am conscious that there is still an inquiry going on and I do not want to say anything that could be perceived as interfering with that process.

Where there are infrastructure needs, we are working hard to address those. When I engaged with families recently, I spoke about our commitment to having a new bone marrow transplant unit. I know for a fact that remedial work is ongoing at the Queen Elizabeth hospital and that my officials take a keen interest in that and have close oversight.

My officials may want to add something.

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.