Chamber and committees

I agree with Douglas Lumsden’s fundamental point. In addressing some of those questions, a variety of public sector organisations have to focus more on the collective interest than on their silo interest.

Let me provide an example. I visited a new build primary school in Midlothian. The local authority, in partnership with the health board, decided to keep an existing sports centre, but, through a combined procurement—heaven forfend—it built a general practice on one end of the sports centre, a primary school on the other end, and a library and concourse in the middle. There was a separate door for the primary school, for security reasons, but people could go through a general door that led into the concourse area in which there was a general practice on one side, a sports facility on the other and a library in the middle—and a wee bit of a cafe had emerged in the foyer.

General practitioners said to some patients, “You need to go next door to the leisure centre, where there’s an exercise class going on.” Once folk had done that, they could go to the library and maybe have a cuppie before going home. There were the multiple benefits of access to GP services in the locality, access to non-pharmaceutical interventions such as exercise, access to library services and socialisation. I cannot sit here and say, “The NHS saved as follows, because there were fewer prescriptions,” but we can all look at that and say that it feels like a good outcome. When I was there, members of the public told me about the joy they got from seeing all the kids going to the library and from the hubbub and noise.

The Christie commission’s ethos that we must find common platforms for collaboration resulted in that venture in Midlothian. We need more of that systemic thinking. There are other examples of doing that—Mr Lumsden will have examples of exactly the same thing from Aberdeen—to enhance the pattern of delivery.

No.

There are a number of dimensions to that question, and one that we cannot ignore is Parliament and political debate. I cannot control what members of Parliament raise as the issues that concern them and which they want to pursue, but I sit and listen to questions and debates in Parliament daily and, to be frank, I hear members railing against what Liz Smith just put to me as a question. Members want ministers to be taking or accountable for such decisions. It is all very well to put forward the argument that we should empower the front-line professionals but, in parliamentary questions and debates, members of Parliament take a completely opposite approach.

I can give an example from my five years as education secretary. One of my biggest priorities was to encourage and support a much greater empowerment of schools and headteachers in our communities, but that did not stop members of Parliament pressing me about the performance of the education system across the board—including, if I may say so, the former Conservative education spokesperson, whom I respect and admire deeply. There is a conundrum, which Parliament must resolve, about what Parliament thinks is important and should be the subject of scrutiny.

I do not agree that the idea of prevention is not well understood or well applied. I think that the principle of prevention is clearly understood. I have given the committee the example of early learning and childcare. I think that it would be widely if not universally accepted that early provision of formal engaged learning and childcare opportunities for children is to the advantage of those children and will give them the best start in life. That is an example of a programme that has been delivered, and our local authority partners have been 100 per cent joined at the hip with us on the implementation of that programme. Once we agreed the financial arrangements, there was full-on co-operation. I think that that has been a universally accepted policy approach. That is one example of prevention.

Another example that I would give is in the field of youth justice. Ten years ago, we were seeing high numbers of young people going through the youth justice system, being prosecuted and ending up with damaging criminal records. Essentially, our justice colleagues—not just in the Government; this was a whole-systems approach involving community justice authorities around the country and a range of third sector organisations—deployed early intervention. The work of organisations such as the Scottish Violence Reduction Unit, for example, was supported to ensure that we made the earliest possible intervention where we saw young people proceeding in a direction that was going to lead to damage to society and, crucially, to their own wellbeing.

Over the period between 2008-09 and 2019-20, there was an 85 per cent reduction in the number of 12 to 17-year-olds who were proceeded against in Scotland’s courts. Why? Because we have put in place earlier intervention to avoid the situation becoming so aggravated that it would merit someone going to court. For me, that is probably one of the best examples. There will be young people among them who can make a contribution to our society, but they have faced difficulties and potentially got themselves into trouble at some stage. To be blunt, a different approach from the state has resulted in those young people being able to make a more positive contribution to society than would have been the case in the past. That is about putting the principles of the Christie commission into practice in an operational way.

To be frank, that is the $64 million question. My response is largely about the thinking that is in the Covid recovery strategy. We have been explicit in that strategy that the atmosphere, ethos and thinking that brought public servants together in spring 2020 to deliver solutions are now required to meet the wider fundamental challenges in the Government’s programme of addressing child poverty and the climate emergency.

Those two substantive themes will not be resolved in neat little compartments. That will require collaboration and co-operation, the sharing of an ethos and the transcending of boundaries. At the heart of the Covid recovery strategy, we make the point that that is what we need to encourage.

What I am trying to do in the Covid recovery strategy is empower people and give them encouragement, authorisation and permission to take that approach. I do not think that we can underestimate the degree to which people might feel the need to be given permission. I should maybe have included that point in my answer to Mr Lumsden’s questions. The sense of needing to be given permission might be an impediment to people making progress in the way that we are discussing.

Highland Council decided that, with regard to the integration of health and social care, the health board would take responsibility for either adult care or children’s care and the local authority would take responsibility for the other one—I cannot remember which way round it is. When I was speaking to a care worker in the Highlands, I asked what the biggest impact of that had been for her. She said, “It means that I can do what I need to do for the member of the public I am supporting without fear of being bollocked for spending health board money on a local authority priority.” That is about permission. For that woman, all this grandiose architecture meant that she could focus on the member of the public she was supporting and do the right thing as opposed to thinking, “Well, doing this will involve spending money that is not really in my bailiwick, because the local authority or whoever should pay for that.” We have to get beyond that kind of thinking.

It is frustrating, and it is difficult to justify why that is the case. That applies to examples of not only innovation but routine service improvement, when relatively straightforward steps could be taken to improve performance but are not widely taken by all public authorities.

We take a number of steps to address that. For example, our work through the Scottish Leaders Forum is designed to bring together public authorities to enable them to learn lessons and improve performance. There are organisations in the national health service that are designed to deliver improvement across all boards. Local authorities have collaborated to establish the Improvement Service, and they draw on the lessons from it. The Government funded the What Works Scotland venture, which was designed to apply academic analysis to work that was undertaken to implement the Christie commission recommendations and to share that learning more widely across public sector systems so that organisations can tap into it.

As you will appreciate, ministers have—understandably—more or less influence in certain areas of policy and delivery. Ministers do not have operational control of local government, so it is for local government, through democratic decision making, to decide how to respond to such challenges. With other public bodies, such as health boards, ministers have much more direct opportunity to place obligations on them to perform.

I think that we could do with a broad range of people who have different expertise and capabilities coming forward for our public bodies.

I do not think that that stops the focus on performance in general, but it might be an obstacle to generating the necessary shift in activity or focus to enable that. There can be a mismatch between the things that we measure and the things that we want to achieve, which are often two different things.

No. I will continue with my Scottish Enterprise example. If I sent a letter of guidance to the chair of Scottish Enterprise and then saw that the organisation was not going in the direction that I wanted, the first conversation would be between the chair and I, in which I would ask what was going on.

The board is accountable for the direction of the organisation and delivery of its purpose. The SMT has to turn that into operational reality. The board is just as responsible for and accountable to direction from ministers as it is for addressing issues that are entirely the statutory right of ministers to set out.

There has to be a balance in all those considerations. There is a necessary place and purpose for accident and emergency services to operate in a highly efficient fashion, because that will deliver the best patient outcomes. The challenge is to ensure that the system works more effectively, so that people are able to get accident and emergency services quickly when they need them. Although we support vibrant and effective A and E services, we also have to have effective social care packages to avoid cases ending up in A and E unnecessarily because no social care package was available for the home.

The lesson is that we need to consider the questions on a whole-system basis. When I was questioned about the Scottish Ambulance Service and answered for the First Minister a few weeks ago, all my answers were about the fact that the challenge is a whole-system challenge. It is not just about the compartment that we call the Ambulance Service. What goes on in a range of other compartments in our public services affects the Ambulance Service compartment. Collaboration and co-operation of the style for which the Christie commission argued are central to resolving some of the more high-profile questions, such as ambulance and A and E waiting times.