Chamber and committees

Indeed. Citizens assemblies are one of a number of different ways to achieve that objective. What key lessons have been learned from them?

Good morning to all our witnesses. I am very grateful that you have, collectively, brought to Parliament the issues around health in rural Scotland, as they are very important.

I start by posing some questions to Mr Baird in respect of his petition, which urges the Scottish Government to create an agency to ensure that health boards offer fair and reasonable management of rural and remote healthcare issues.

Mr Baird, I am sure that you are familiar with the broad arrangements in Scotland, whereby there are 14 regional NHS boards and, since their establishment in 2014, 31 integration authorities. More recently, in 2020, the remote and rural general practice working group published its report on “Shaping the Future Together”. The Scottish Government accepted all the report’s recommendations, including the recommendation—perhaps the most relevant one—to commit to the development of a national centre for remote and rural healthcare in Scotland.

I mention that because it is important to give a backdrop. Following on from that, I have two questions for Mr Baird. I will put them both together.

First, how could the Scottish Government reform the way in which the NHS and social care are currently organised so as to better address the needs of remote and rural constituents and populations? Secondly, will the development of a national centre for remote and rural healthcare for Scotland help to address some of the issues that you raise in your petition?

I did not quite understand why you did not find acceptable the suggestion, which you say that you had already considered anyway, that each board should have a member whose role would be thus. Why do you not want that? Although that might not be the whole solution, I would have thought that it might be part of it.

I have listened with interest to what the petitioners have said. I will mention two issues. One is that Mr Sinclair and our two online witnesses call for reinstatement of local provision of services, whereas Dr Baird calls for a slightly different additional model of advocacy. Both arguments have a rationale behind them. I understand that, but our job is, to some extent, to play devil’s advocate.

I will put this to Dr Baird to see what his response is. Rhoda Grant, Emma Harper, Colin Smyth and I represent constituencies that are largely or partly rural, so we are performing an advocacy service of a sort in the casework that we do. I expect that we all take that job very seriously. It is a big job, and we each represent tens of thousands of people. How on earth can one centralised body hope to advocate for the interests of people throughout the country who live in a plethora of differing remote communities, each of which has its own particular needs, problems, interests and challenges? How could one centralised body effectively perform such an enormous role? How would it be accessible to people? Is there a risk that it would be just another faceless organisation, adding to the number that exist already?

I am sorry that I am putting it a wee bit provocatively, Dr Baird, but I am trying to make a point, as someone who takes advocacy for the remote and rural areas in my constituency seriously. It takes me a day properly to go over a case with an individual, if I want to do it justice. We need to really listen in order to be able then to represent and articulate that individual’s concerns properly. It cannot be done quickly and we cannot cut corners. It is inevitably, and rightly, time consuming. How on earth could a national agency be efficacious?

I do not think that you said you welcomed the national centre for remote and rural healthcare—or perhaps you did—but you said that it was a step in the right direction. Could that new body be set up in such a way that its remit could take up the issues that you have raised? We can raise that with the Scottish Government following this meeting, if you and your colleagues think that that would be a good idea. Would that be a step forward?

I am putting to you that that new body could be tasked specifically, in law, with the remit of addressing the access issues that you raised. It may not operate perfectly in practice, but if we clearly define the remit, duty and tasks that the new body should perform when setting it up then, surely, if we task it to address inequities of access for people who live in remote and rural Scotland, that would at least give the opportunity for things to improve.

Thank you for your answer—you have covered a lot of territory. I will pursue some of the points that you made. Your petition calls for an agency—presumably, that means one agency, if I have understood it correctly. How is one agency going to deliver the kind of advocacy that would be required from the bottom up?

As I understand it, you are suggesting the establishment of an agency not to deliver or procure service provision, but to advocate that services be provided more effectively to people who live in remote and rural areas, and to ensure that inequities in access are addressed and not ignored, with no stonewalling or gaslighting. If that is the case—I put this to you as a devil’s advocate, I suppose—would it not be more efficacious, in respect of achieving what you wish to achieve, to have an advocate for the rural voice on each health board?

Would that be perhaps be a different way to proceed, rather than the establishment of one presumably centrally based agency, or wherever it is based? It would have to be based somewhere. Would that be an alternative model that would not change the way that health boards operate, because they would include an advocate among their number with a specific remit to make sure that remote and rural issues are not overlooked and are addressed? I put that to Gordon Baird and the other petitioners, because you are all covering interlocking aspects of the issue. Would that be a better model than having one agency that would inevitably operate on a high level?

So the headline figure of £9 million needs to be reduced by various factors. Although the cost was incurred in pursuit of a project that has been shelved, the expenditure is serving other valuable purposes for HIAL—I understand that.

Are you able to say what you expect the price range for the sale of New Century house to be in relation to its purchase? Would the sale, as you seem to imply, further reduce the £9 million cost by perhaps producing a profit?

That completes my questions. I think that I just lost the last word or so of what you said, but I hope that everybody else heard you.

Yes; I concur.