Chamber and committees

There were no significant works and there was no major disruption to services. In the few areas where work was needed, it was done as part of normal routine maintenance work.

The capital budget for the Baird hospital and ANCHOR centre projects is what was originally agreed. Within the overall project—

Yes, I think so. There is always an ambition to invest much more in preventative healthcare where we can. That is challenging when we are in a very difficult financial environment and given the significant demand that services are facing. Notwithstanding that, however, we should do that where we have the opportunity. We have committed to exploring issues around a public health levy over the next year and I think that, if its introduction is agreed to, it would provide an opportunity for investment in other areas of preventative spend.

We should also recognise that innovation in technology can play an important part in some of the preventative approaches that we pursue. I mentioned the work on diabetes. New digital technology could have a real impact in reducing the side effects that people can experience as a result of diabetes and in helping them to live more healthily. We know that that will have a preventative effect in the future because of the benefits that come from it. We know that the use of AI in radiography can help to identify issues at an earlier stage and allow for earlier intervention, which could further reduce expenditure in the future.

Technology and innovation can play a really important part in ensuring that we do more in the preventative space, and any additional investment that might come through a public health levy in future years to support that would be very welcome.

You are right that mental health services are about 8.8 per cent of our expenditure at present and I hope that we will have those services at 10 per cent by the end of this parliamentary session. That will depend on future budgets and the availability of finance, but it would certainly be our intention to do that. As I said earlier, however, there has been a very significant uplift in mental health expenditure since 2020-21. The level of Scottish Government investment in the area has more than doubled, but 10 per cent is still our ambition. We are at 8.8 per cent and we need to look at whether budgets in future years will allow us to continue the increase to achieve a 10 per cent allocation.

It is an operational issue, so I would expect it to be dealt with by boards. They have a whole executive team, so if there was an issue around safe staffing in a particular ward, I would expect that to be escalated through the board’s local management structure—eventually, I presume, to the director of nursing and, if necessary, to the chief executive.

If a wider systemic problem was being experienced and it was brought to our attention, we would certainly want to raise that with the board. In terms of day-to-day operations, it would be the responsibility of the individual board to deal with the matter. However, if there was a wider systemic issue, I would certainly be concerned about that and I would want to take action if there was a problem in a board.

Eventually, it will be a self-funding model, but the proposed arrangement will operate for the initial couple of years, in order to get the regulatory process up and running. As the workforce expands, it will be a self-funding model, which is the way in which most of the regulators now operate. The proposed arrangement is part of the initial process to support the GMC in taking on the regulatory role.

At present, PAs are unregulated. In Scotland, we have a very small cohort of around 150 of them operating in the NHS. Back in 2016, we issued direction around the type of role and the scope of role that could be held by a PA in NHS Scotland, so that is already defined. As the GMC takes on the regulatory function, it will be responsible for setting out the relevant definitions and the terms of those definitions.

I disagree with that, and it would be unfair to suggest that waiting times for CAMHS have not been reduced. There has been a very significant reduction in waiting times for CAMHS, and in particular of the build-up that developed over the course of the pandemic. Staff across our child and adolescent mental health services are working really hard to address the waits, and we have seen very significant reductions in them. Of course, where there continue to be extended waits, that is not acceptable, and that is why work is still being undertaken to address the issue.

However, anyone who looks at the course of the mental health budget over the past couple of years cannot avoid seeing that the budget has, in some cases, more than doubled. That has allowed for a significant expansion of services and an increase in capacity of those services, which we are now seeing the benefits of in terms of the waiting-time reductions that we are achieving in CAMHS services overall.

I recognise that challenges remain in delivery of mental health services. Notwithstanding that, very good progress is being made, and the sustained increase in investment that we have made over the past couple of years is making a difference.

Let us look at where we are with A and E at present. We have seen an improvement this year compared with where we were last year. We are continuing to work with health boards to sustain further improvements.

You will be aware that one of the major challenges that we have with A and E performance is flow from A and E into hospitals. A significant part of that is caused by delayed discharge. Despite the fact that around 98 per cent of all discharges from hospital take place on time, the 2 per cent that do not have a significant impact on flow into hospitals from our A and E departments. This year, we saw a reduction in the number of delayed discharges compared with where we were last year. I want to ensure that we do intense work this year on what more we can do to reduce delayed discharge, because we know that that is critical in supporting the flow into our hospitals.

We are doing a second element of work on reducing the level of demand at our A and E departments. For example, the work that the Scottish Ambulance Service is doing through its integrated clinical hub is reducing the number of people who have to be conveyed to our A and E departments, and that is as a result of the investment that we are making into that service.

We are doing work to improve those things, but demand is significant. I believe that we can still make further progress, and I am determined to ensure that we do that during the next year. We will continue to focus on the areas that we know will improve the performance that we get in our A and E departments and across our unscheduled healthcare system. We are making progress, but there is certainly much more to do, and there is determination to ensure that we do it.

We have, I think, five health boards at stage 3 of the escalation process. It is important to emphasise that providing tailored support to boards that are experiencing specific financial pressures is not new. The mechanism has been in place and has been used at various points over the years. Clearly, though, we are in a very challenging financial environment, so we have boards that are under extra pressure.

I will get Richard McCallum to say a bit more on a couple of areas that he has just touched on. One area is how boards manage their staffing. There is the use of agency staff versus bank staff and the issue of recruiting staff. The second area is prescribing. There are marked variations among boards in prescribing and in the costs associated with it. Although we might procure a lot of the drugs in Scotland centrally, prescribing variations can have an impact. The chief pharmaceutical officer is doing work to ensure that we do as much as we can to get greater consistency in prescribing, because that can also address issues around the costs associated with prescribing.

Richard, do you want to say a bit more on some of the other work that we are taking forward to give support around financial sustainability?