Chamber and committees

We have previously discussed the services that have been provided for long Covid, including some of the pilots that have been taking place in England and how some of that could inform our learning here in Scotland. I know that some health boards have looked at that and learned from it. For example, NHS Greater Glasgow and Clyde has been using some of the long Covid funding to bring in paediatric occupational therapists to work specifically with children who are experiencing long Covid, and also, where necessary, using paediatric physiotherapists to support those children.

Health boards are trying to adapt their services to make sure that young people who are experiencing long Covid have access to clinical teams that can provide them with the support that they require, and they are using some of their core funding to design such adaptations. NHS Greater Glasgow and Clyde, for example, now has some paediatric services to address the needs of young people with long Covid.

If the member has an individual case that he wants me to look into, and he wants to share the details with me after this meeting, I am more than happy to do that. Long Covid does not just affect adults; it also affects children, and services are being designed that will make sure that we also meet the needs of those young people.

A big part of that is because we have to deal with the backlog that built up during the pandemic. During the pandemic, a lot of our elective and diagnostic procedures had to be stopped and that resulted in a significant backlog that we are having to manage within existing capacity. New people are being added to the lists, but we are still dealing with the people who were already on the lists. That accumulation has made the situation extremely challenging and it will take some time for us to recover to the pre-pandemic levels.

Also, in some areas, the level of referrals has increased quite markedly. For example, we have seen a significant increase—of almost 45 per cent in some areas—in the number of referrals to our cancer pathways, which is way above what it was before the pandemic. We are having to deal not only with the backlog but, in some areas, with a significant increase in the number of referrals into those diagnostic pathways, which has an impact on waiting times overall. You will be aware that boards are making steady progress, particularly around long waits—we have seen a steady decline in outpatient and in-patient long waits—and we are continuing to work with boards around that, but it will take some time for us to be able to get back to pre-pandemic levels.

We are also working through the Centre for Sustainable Delivery on a programme of work to ensure that we are maximising capacity in our services. The centre is carrying out work with a new digital tool to consider how we can maximise the use of theatre times, which could potentially give us an additional 30 per cent capacity. Through the Centre for Sustainable Delivery, we are trying to get consistency across boards around how they maximise capacity and the use of resources in their existing services, because some of them are not operating at their pre-pandemic capacity and we need to ensure that we get greater efficiency there.

The issue involves that combination—the history, the increased referral rates and our trying to ensure that we maximise the capacity that we have in the existing system in order to use it to its full potential.

As I said earlier, we are taking forward a programme of work to tackle the backlog and waiting lists, but we can see that significant progress has been made across a range of specialities, and we are working with boards to support and sustain that.

Our healthcare system is experiencing challenges with the recruitment of staff in the same way that the health system across the UK is experiencing real difficulties. Some specialities are not just causing difficulties for the UK; there are global challenges because of the lack of specialists in those areas. However, we are taking things forward. For example, the fill rate in our speciality recruitment programme is at 93 per cent, which is a higher fill rate at this point of the cycle than we have ever been at previously. We have another fill rate to go, and it will be finalised in November, so we are making very good progress towards being an attractive location for clinicians to come for training and support.

Our NHS, however, will experience very significant challenges this winter. What are we doing to address that? We are expanding things such as the hospital at home service and see-and-treat programmes with the Scottish Ambulance Service. We are working closely with our health boards on the preparations that they are putting in place for their A and E departments, which often feel the brunt of these challenges.

We started our winter planning programme earlier than ever before. One of the first pieces of work I commissioned when I took over the portfolio was our winter programme, given the very challenging winter that we went through last year. We have taken forward that planning jointly with the Convention of Scottish Local Authorities and, just a few weeks ago, we had a winter summit that brought together all the key stakeholders in health and social care from across the country with the decision makers to look at planning and managing some of the challenges that we will face in the course of the winter.

It will be a challenging time. I am not going to shy away from that fact and I am not going to kid on that it will not be difficult and that things will be perfect. However, we have brought forward the planning and done it in a joint way that we have never done before to try to mitigate some of the challenges that we face.

You will be aware that we were starting our Covid vaccination and flu vaccination programmes earlier, so some of that was already at an earlier stage than in other parts of the UK. As a result of the new Covid variant, we brought forward the Covid vaccination programme for those who are more vulnerable, but we were always one of the first parts of the UK to move forward with the winter vaccination programme; I got my flu vaccine just yesterday. Anyone here who intends to get the flu vaccine or the Covid vaccine, please take up the offer that is being made.

We are doing what we can to plan for the winter and the challenges that inevitably will lie ahead. We are also trying to put in place programmes of work to deal with the large number of people who continue to wait extended periods for treatment, while we also deal at the same time with the recruitment challenges that are being experienced not just in Scotland but across the whole of the UK, particularly in certain specialities. So far we have made good progress, but we still have to do a lot more.

The responsibility for the delivery of primary care within the local area, and the contract, is directly with the health board. I would expect the local community to engage with the health board, and the health board to engage with them, around how they are addressing the issue of concern around ensuring adequate general practice services in their area. I would expect the health board to be proactive in doing that. If it is not and there is a need for it to do so, I would be more than happy to ensure that it engages with the community in Braemar. It is important that there is a level of local understanding of the most appropriate way to deliver services locally in the primary care setting.

Some of the additional finance that we are making available for the increase of pay rates, for example, will obviously benefit those organisations in the voluntary sector in relation to the payment of their staff. All parts of social care will benefit if we can retain and recruit staff—the independent, voluntary and public sectors.

We need to make the career environment attractive to individuals, so the rate of pay must reflect that. Would I like to go further on pay in the social care sector? Absolutely. However, we have to operate within the current financial environment. The reality is that £12 per hour is a significant uplift, but going beyond that would create significant financial challenge across the portfolio.

Offering the right pay is one aspect of making the environment attractive to people. As I mentioned in answer to Paul Sweeney, another is creating good career pathways. As you will know from your own pathway, that is critical to supporting not only social care but healthcare in general.

I do not know where the 2,000 figure from the BMA comes from, or from what analysis. I understand that groups such as the BMA lobby and push for what they think is the best approach. I always engage with the BMA in a meaningful way, and, in fact, I think that I am meeting it to discuss primary care this afternoon.

We will continue to look at what more we can do to support primary care as a critical part of our healthcare system, which will be under even greater demand in the years ahead, given the demographics that we have as a country and the disease burden that we face. I will always look to see where there is more that we can do, and engage with the BMA around the issues that it raises to understand the rationale behind the calls that it makes.

The challenge is that people can choose to leave general practice at different points in their careers. It is not always the case that they choose to retire when they get to retirement age; some might choose to do so earlier. The challenge, therefore, is trying to plan to ensure that we have the right intake into medical education and the right cohort of specialities available to allow people to specialise after their foundation years and to do all that in a way that reflects future need and demand.

Moreover, the vast majority of our general practitioners are independent contractors, and they can choose to change the hours that they work, retire earlier and so on. There are variables in there that we cannot always control, but we have to try to balance the system to ensure that the training and education and the move into specialities are sufficient to meet what we think will be the intended need. At local level, the health boards, which have the direct contracts with general practice, will be monitoring the situation and trying to put in place the right arrangements that might be necessary, should the numbers of GPs in their area change or should there be a significant increase in their population, to ensure that they have the right level of services to meet local demand.

The challenge is that if we try to do what we think should happen in Grampian, say, remotely here in Edinburgh, we will not always get that right, because we will not be as close to the community as we need to be. That is why designing local services is best left to local health boards, because they can engage with local communities, understand exactly what is needed locally and therefore try to design the most effective services. It is about trying to balance the system at a national and a local level, and to do so over the long term. It is challenging, but it is exactly what we are trying to do.

Yes, that is our intention. We are engaging with the unions, in particular, to manage implementation. I think, from the discussions that have been had, that there is a desire on everyone’s part to deliver implementation within that timeframe, but in a way that does not create unintended problems for existing NHS staff. So far, our engagement with the unions has been very much about trying to get the balance right. I do not know whether Caroline Lamb has anything more to say, but that is still our intention. We are just trying to ensure that we take the employee side with us in order to get the balance right.

Yes, it does. I am aware that Dumfries and Galloway has benefited from the ScotGEM programme. I raised the issue at the last meeting of the four nations’ health ministers, where we discussed recruitment and retention issues—in particular, issues in our more rural areas. I highlighted the ScotGEM programme to the other ministers and I have offered to share our information on how the programme operates and the benefits that we have had from it. There is interest in looking at how the ScotGEM programme has worked.

On your latter point, it is still our objective to achieve the 10 per cent target within the current parliamentary session and to take that forward over the next three years.

I do not have the information on the specific measures that you asked about to hand, but I would be more than happy to come back to the committee to give it some more detail about specific measures that we are looking to take to address the consistency of service provision.