Chamber and committees

Health inequalities and the illnesses that are driven by those are the result of social inequality so, very often, our health service is dealing with the symptoms of social inequality that manifest themselves in health inequalities. It is important that we take forward programmes such as reducing child poverty—through, for example, the Scottish child payment. All those will have an immediate benefit for the individuals concerned, but they will have a long-term benefit in reducing child poverty, which can result in health inequalities.

In addition, through the work that we do on tackling tobacco use, there have been reductions, and we want to continue to build on that. On alcohol misuse, a report that was published today by Public Health Scotland shows that minimum unit pricing has helped to reduce alcohol-related deaths by more than 13 per cent. All those factors play an important role in supporting us to prevent ill health, alongside our social policy actions to tackle social inequality. All that will be critical to supporting us in the preventive agenda in health.

No single action alone would help to address issues around population shift and make our rural and island communities attractive for people to live and work; rather, a range of actions will have to be taken. You will be aware, for instance, of actions that have been taken in some rural areas on housing, as well of measures that we are planning to take to free up housing capacity in our rural and island areas. There is a combination of factors to consider, including transport infrastructure, housing, digital infrastructure, good-quality and sustainable health services, access to education and so on. They all play key roles in helping to make our rural and island communities attractive places for people to live and stay in. They cut across all Government portfolios, and some of the work that we are taking forward in Government is on trying to ensure that we take a consistent approach to delivering them and that we are prioritising them.

I am not sure; I would have to check for you. I will be happy to come back to you once we have checked whether we are doing any work on that.

Ideally, we would be in the position of trying to address as much of the backlog as possible to reduce the risk of its becoming a safety issue for patients or staff in a building, but the challenge that we face is that capital budgets neither provide for that nor allow us to achieve it. Boards work in a dynamic environment in which they address maintenance backlogs on the basis of priority, and some of that will relate to clinical safety purposes. They will continue to work on that basis.

Alongside the need to provide new facilities and deal with the maintenance aspect, there is huge pressure on our capital budgets. I expect boards to work dynamically to identify the critical elements that have to be taken forward and ensure that matters are being addressed efficiently and effectively so that they do not interrupt clinical services or cause safety issues. We continue to try to invest in our estate as we go forward, both in maintenance and in new facilities where necessary.

Good morning, convener, and thank you for inviting me to meet the committee this morning. This is my first appearance at the committee since I was appointed as Cabinet Secretary for NHS Recovery, Health and Social Care. I welcome the opportunity to engage with the committee, and I look forward to discussing a range of vital issues in the weeks and months ahead, as recovery and renewal of the NHS and social care services continue.

I also thank the NHS boards for continuing to provide information to the committee, which has been taking evidence about their performance in recent weeks.

Ministers and Scottish Government officials regularly meet representatives of all health boards to discuss matters of importance to local people. It is my strong belief that the Scottish Government should not only fund, but should empower and enable boards to make the decisions that they feel are most appropriate to their localities and areas.

We acknowledge the pressures that are felt by boards across the country as we all continue to deal with the aftermath of the biggest shock that the NHS system has felt since its establishment some 75 years ago. We continue to prioritise investment in front-line services. We have provided an increase of some £730 million for NHS boards through the 2023-24 budget and an additional £200 million in-year support above initial plans to support the financial sustainability of NHS boards. That means that no board is more than 0.6 per cent from NHS Scotland resource allocation committee parity.

In addition, we continue to provide constant support and guidance to NHS boards to ensure that they are doing everything that they can do to provide the best possible care for people in their localities. Our new prospectus for the year ahead demonstrates our collaboration, with a key part of our plan to deliver year-on-year reductions in waiting lists being to deliver additional capacity through our national treatment centres in NHS Highland, NHS Fife, NHS Forth Valley and NHS Golden Jubilee National Hospital.

Another good example is the work that is being done to increase the workforce through hiring an additional 800 staff from overseas. That was helped by £8 million of funding in October last year. We set an ambitious target of recruiting some 750 additional nurses, midwives and allied health professionals from overseas; I am pleased that, due to the hard work of health boards, we have exceeded that target. That is the kind of joint working between central Government and local boards that I will hope will go from strength to strength, as we go forward.

I am happy to respond to questions.

Do you mean in terms of trying to reverse depopulation in rural and remote areas?

You will be aware that we are taking forward a range of work to try to make our rural and island areas attractive locations, whether through addressing connectivity and economic activity issues to make rural and island areas viable places for communities to grow and thrive, or through measures that support people to live in those areas. For example, the islands growth deal and the Argyll and Bute growth deal are about helping to reverse depopulation by putting in infrastructure to make communities attractive and to encourage people to live in them.

When I was the minister who was responsible for taking forward growth deals, a key part of what we were trying to do, working in partnership with local government, was to put in place measures that we knew would help to support the people who were already there, but would also help to make those communities attractive for people to move to and live in.

One of the big issues that was often flagged up to me was digital connectivity. The digital superfast broadband programme was all about having the infrastructure in place to support rural and island communities in order to make them attractive locations, by giving people the ability to live, to work from home or to base a business there. Although they go well beyond my portfolio, those are the sorts of measures that the Government takes, on a broad economic basis, to make our rural and island communities attractive locations for people to stay and to go to live in.

Increasing training opportunities is one part of managing the challenges. Stephen, do you want to say more about the workforce and what we are doing to recruit people?

Our individual health boards have to meet a recurring 3 per cent saving target in order to try to free up resource to invest in other parts of the health service provision and to ensure that they are using their resources as efficiently as possible. I should add that they retain that money.

We could do many things with additional financial support. I recognise that I hold the biggest part of the public sector’s budget but, as we have already heard, some boards are facing extreme pressures across a range of services. Choosing to put extra funding into the provision of mental health workers in GP practices involves taking money away from somewhere else. There is not a spare pot of cash to draw on—money has to be taken away from another service. Very few people ever say to me that I should cut money from this service and put it into that one instead because it is more valuable—all services are valuable and important.

We have committed to increasing the health service budget by 20 per cent this parliamentary session. We will continue to try to make as much use as we can of the investment that is available to us in order to maximise the benefits. I hope that if inflation comes down—although it looks as if it will not come down as quickly as we would want it to—and energy costs come down, we will see some of the financial strain that we are facing ease over the next couple of years, which will allow us to consider how we can flex some of that resource into other areas and front-line services in a way that we are not able to do at present. I hope that we will be in a position to do so, but we are also going through a period of public sector austerity, which is having an impact on our budgets.

No, that is led by boards directly, as they are close to the issues. For example, with the institute of neurological sciences at the Queen Elizabeth hospital, which you mentioned, the health board would be responsible for putting together a business case for additional capital investment in that facility. The business case would come to our capital allocations team, which looks at such issues and all the demands that come in from different boards. Again, the lead on such matters is taken by the boards, which know what their estates need and what the challenges are, and any business cases then come to the national health infrastructure board for consideration. Therefore, there is a mechanism for boards to utilise, as and when required.

On your second point about the challenges at Edinburgh royal infirmary, they reflect the fact that the hospital is now more than 20 years old and that a significant demographic shift is taking place in the country, with the population shift that we are seeing from the west to the east putting additional pressures on public services in the east of the country. That has happened over the past 10 to 15 years, and it is putting pressure on hospitals such as Edinburgh royal infirmary at the front end. Again, the board has the opportunity to look at putting together a business case for investment to expand that facility, and it would be for the board to lead on that and to submit a proposal for consideration alongside all the other health capital expenditure proposals.