Chamber and committees

On metrics, in Scotland we spend considerably more money per person on health than happens in England. I do not know if this is still the case—perhaps you can tell me: following the Covid pandemic, we found that the English waiting list numbers went down more quickly. How do we compare with England on the metrics for waiting lists and so on, noting the fact that we are spending more per person?

Not on the budget: we will come back to those points as we consider a number of issues affecting women’s health and long-term conditions, for instance. If your officials find anything of interest, though, that would be welcome.

10:00

It would be helpful if you could write to the committee, as it is a broad area. We can consider whether we wish to come back to it.

We are running out of time. Before we move on from public service reform, do you have any estimates on the cost of reorganisation? Police Scotland and other bodies have had reorganisations in the past, so there is an indication that there will be a cost to doing that. I am not asking for a figure; I am asking whether the work that has been done gives an indication of what the cost might be over the next couple of years during the reorganisation.

That is helpful.

We are very short of time. We have a few more questions on health and we want to keep a wee bit of time for sports funding questions. Jack Middleton has questions about prevention in relation to drugs and alcohol.

We are running out of time, but Adam Harley has a question on capital investment.

I want to circle back to your comments about the emergency medicine issue, which issues such as delayed discharge touch on. You mentioned that social care is not directly under your remit, but, at the same time, we are looking to what is happening in relation to local authorities, and the budget is presumably looking to that, as well. Local authority budgets have been constrained for a number of years, and people have seen the effect of that in the social care that is provided to get people out of hospital—we all know of cases where somebody could not get a care package in time.

You have pointed out that some areas are managing to do that better than others. I visited NHS Borders and was impressed with what it has done—I was shown the figures and the metrics on that. I also note that it is working closely with the local authority. Of course, it has the advantage that its area is the same as that of the local authority, so there are no arguments about whether their budgets are meant to cover the same area.

Obviously, you are looking towards what is to come later on—we will come back to the major issues around the reorganisation of health boards—but I would like to hear your thoughts about how social care can step up. I take the point about staff, but a lot of that is to do with people not getting paid enough or only getting paid when they are actually at a house, rather than when they are travelling to the house. Everybody agrees that we need to treat staff better so that we retain them—and so that we can ensure that we have them in rural areas, which is another issue. Obviously, that involves working across health boards, local authorities and the IJBs, which exist for that purpose. Can you tell us something about what the intentions are for IJBs in the reorganisation?

That would be helpful.

This is not really to do with capital investment, but I am reminded of the fact that NHS Borders said that it was working across three systems, between the allied health professionals, the GPs and one other service, which I cannot remember just now. Obviously, there will be a cost in getting them all on the same system, but there are also savings to be made. It was suggested to me that we could get rid of paper prescriptions, which would save a lot of money and save GP practices having to have a full-time person printing them out so that GPs can sign them. Is there any prospect of that happening?

That concludes your two hours here, cabinet secretary. Thank you for a comprehensive discussion of where you are at, and for giving us information and further issues to follow up. I thank you and your officials for attending. Have a good day.

11:27

Meeting suspended.

11:34

On resuming—

Thank you—I am sure that we would welcome sight of that report. Several of us have been shown the impressive research that is done by the Parkinson’s group that is part of the University of Dundee’s faculty of life sciences. It gets people coming from other countries—never mind from Scotland and the rest of the UK. My point is that it does not need to be a health board. In fact, that would not work for many of the rarer illnesses for which there is less funding. However, I take your point and would be delighted to see that report.

Cabinet secretary, you read my mind when you said that we would be moving on to public service reform—we have got there, an hour into the evidence session. It will be no surprise that everybody has been concerned by suggestions that the risk assessments and business case for the health board reforms have not been well evidenced. You could refute that, which would help us, but, if it is the case that they have not been well evidenced, when will those issues be addressed?

In addition, how will that fit in with consulting with others? There is a three-month period for consultation, but our constituents and organisations ask us, “When do we get asked?” We say, “Well, I do not think that it is like that for the health boards.” We would like clarity on that. Will there be an opportunity for people to feed in, or is it a done deal that there will be a health board for the east and a health board for the west? People want to be clear on whether they will be given information and whether the consultation could be extended for those who think that they have something to offer—those with lived experience or professional organisations.

I will follow up on that, and I ask that you be specific for the benefit of the people watching and so that we know what is and is not up for discussion going forward.

If my memory is correct, the last time you were here, you did not say that it was definitely going to be east and west health boards, whereas it now sounds as though you are saying that. If that is the case, we can move on from there.

From speaking to people who are involved in the subnational planning, I know that some of it seems to have gone really well—you have referenced some of that—but it has also shown that people would have real difficulties travelling for things for which they would not have to travel as much at the moment.

I do not know whether information on who is on your programme board is public and available to people, but it would be useful to see who is dealing with the risk assessment and the business plan.

Is there any room for manoeuvre in relation to that east and west structure? If not—and this has been reported, so I feel that I can say it, although it might not be right—there is a supposition that because NHS Greater Glasgow and Clyde is the biggest health board in the west and NHS Lothian is the biggest one in the east, they might naturally be the ones that would encompass all the others. There is an issue there in that those boards have not necessarily always performed well.

It has been said that the chief executive officers for the new boards would be appointed from outside the usual suspects—I think that I can say it like that—and that the roles would not just go to the nearest person. Some people might say that a completely different view is needed and that if you are going to do this, perhaps you need somebody from industry who has reorganised companies. I am not saying that; I am just asking what the remit is.