Chamber and committees

Yes—that is a completely fair comment. The consultation process—or lack thereof, thus far—has been frustrating. We will, no doubt, go into the matter in more detail with members’ questions, but the fundamental point and central concern is the difference between consultation and consent. Where we have, as the UK Government recognises, devolved competence in certain areas—the challenge, of course, is that we have competence in other areas, too—our simply being consulted as a Government is not good enough, particularly when it comes to the scrutiny processes of Parliament. This is about consent.

I should also point out that, from my conversations with the Welsh Government and the Welsh Minister for Health and Social Services, Eluned Morgan, I know that she is very much in the same space. The Welsh Government is frustrated because, in areas of devolved competence, it is being told that it will be consulted instead of its consent being sought. This is a very important issue not only for all of us who believe in the devolution settlement, which I suspect is everybody around the table and online, but for parliamentary scrutiny, as you have rightly pointed out, convener.

As I have come to find out, the regulation of healthcare is an extraordinarily complex landscape. Some of that regulation sits in the reserved space and some it sits in the devolved space, depending on the body that is regulated. The bill’s provisions form part of a much wider programme of reform of professional healthcare, which the UK Government is taking forward with the support of the devolved Administrations.

I know from my conversations that the statutory regulators, who would obviously be most affected by that, are generally supportive of the principles of reform. Therefore, I do not have any particular concerns in that area, but we always keep an eye on those matters as they progress.

Quite frankly, that is a significant concern. That is one of the areas that we think requires consent rather than just consultation. For example, we have robust measures in place when it comes to pseudonymised—depersonalised—patient data. However, at the stroke of a pen and through mere consultation of the Scottish ministers, that depersonalised and anonymised Scottish patient data could be used in a very different way. I have real concerns about that. That is why it is imperative that we are not just consulted and that our consent is sought.

I do not have a concern about trying to create policy across the four nations in many areas. I think that it makes sense to take, as best we can, a four-nations approach to advertisements for less healthy food, for example. Actually, I believe that the UK Government has not got that issue right; it thinks that it does not need an LCM, but we believe very strongly that it does. I can go into more detail on that later, if anyone so wishes. That said, the policy is one that I can agree with. In a number of areas in the bill, taking, as best we can, a four-nations approach would make sense. However, the Scottish Government’s position—as I have said, the Welsh Government takes a similar position—is that, where policy affects our executive power as ministers, which has been agreed by the UK Government, we cannot be treated simply as consultees. Our consent must be gained. Indeed, that is a fundamental principle of the devolution settlement.

There would not necessarily be huge differences. We are all looking to restrict that advertising online, where possible. As I have said, there are a number of provisions in respect of which it would make sense to have a four-nations approach. That is one of them, for very obvious reasons. However, the principle is that we and the Welsh Government, for example, believe that those are areas of devolved competence and that if we concede that principle on online advertising, it could have an effect on other areas of public health policy above and beyond that. We are all—including Ms Webber, of course—defenders of the devolution settlement, so it is important that those principles are robustly defended by all of us.

It is just a very brief one, convener.

I thank the committee for inviting me here to discuss the United Kingdom Government’s Health and Care Bill. The bill broadly comprises three elements: provisions of the NHS England long-term plan, measures in response to Covid-19 and a rolling back of some of the competition elements of the Health and Social Care Act 2012.

The proposals in the long-term plan, which have been in development for a long time, are not contentious for us, because their effects are confined to England and the English national health service, although we are, of course, always worried about domino effects. Other provisions in the bill have not been as long in development or subject to the usual consultation, and some of them will affect Scotland.

In my LCM, I recommend that Parliament not grant legislative consent to the bill as it stands. The UK Secretary of State for Health and Social Care would be granted powers to act in Scotland without having to seek the consent of the Scottish ministers, even where the actions would impact on delivery of healthcare, which is the responsibility of the Scottish ministers. Moreover, some provisions ignore the reality of there being a separate NHS in Scotland and could, if unchallenged, enable the secretary of state to treat the NHS across the UK as a single unitary entity. That is unacceptable.

I have had a written response to my concerns from Edward Argar, the minister who is leading on the bill, and we are due to speak tomorrow. I hope to see some movement from the UK Government, but until I see willingness to respect the devolution settlement, I am not in a position to change my recommendation to withhold legislative consent. If the UK Government makes suitable amendments, I will bring forward a supplementary LCM.

I look forward to going into the issues in more detail with committee members.

A carve-out is certainly an option that could be discussed. However, there could absolutely be an advantage in working on a four-nations basis in a number of areas, as I have said throughout this session. I have no difficulty in doing that; I do not have any ideological opposition to that, at all. However, as Gillian Mackay rightly said, there are real concerns about how Scottish patient data could be used. It is therefore important that the Scottish ministers are not just consulted. Their consent is required so that, if they have concerns about how that data is being used or about its confidentiality and personalisation, they can effectively stop any practice that they think is not within the values and ethos that they espouse when it comes to data protection.

For me, the important point about international healthcare—I am going to sound a bit like a broken record, but it is important for me to stress this—is that that is an area in which it makes perfect sense to adopt a four-nations approach. From a policy perspective, I absolutely would like to do that. However, from a principle perspective, the Scottish Government and the Scottish Parliament should have a say on such arrangements, because they impact on devolved competence. They impact because it is accepted, including by the UK Government, that reciprocal arrangements—people coming from overseas to access our healthcare and Scots going abroad to access healthcare internationally—are within our devolved competence.

We would not want the UK Government to enter without our consent an agreement that could affect Scottish patients, the Scottish public and the Scottish health service because of people from outside accessing our health service. It is not good enough simply to be consulted. We might then raise issues and concerns, but they could be ignored by the current UK Government or a future one. I know that we can sometimes get into a space in which we think about only the current Governments, but we have to think about future proofing the legislation. It is really important that we are not just consulted on those issues and that our consent is gained. That is a significant concern for me in relation to international healthcare.

I thank Evelyn Tweed for that important question. I suspect that she is not alone among MSPs and that every one of us receives difficult cases in our inboxes and at our advice surgeries from desperate family members on the criticality of their children’s mental health.

I have a number of things to say on this, but I will try to be brief. I can go into more detail if Evelyn Tweed or other members want me to. First, I note that we are investing in services that I would say are pre-CAMHS, in that they are designed to be accessed at a much earlier stage, before people get to the point at which CAMHS crisis intervention is needed. That programme of local interventions is, again, designed to be suitable for whatever the local need is. For example, it might be different in Stirling compared with Selkirk or other parts of the country. That investment is important.

Some of our approach in the area will include ensuring that we have the appropriate services in place in schools. I am happy to expand on what we have done to ensure that we are getting more and more resource into schools.

As Evelyn Tweed will know, we set up a CAMHS task force that gave us an evaluation of the service and made recommendations, and we are investing quite significantly in CAMHS—some details of that are included in the NHS recovery plan. Some of that investment will address staff recruitment. We intend to provide funding to increase recruitment to CAMHS by 320 additional mental health workers. That increase in the staff cohort will undoubtedly work.

I will be honest here: the wait for CAMHS treatment is unacceptable. We are not meeting the 90 per cent standard at the moment and I am afraid that we were not meeting it before the pandemic, either. We have therefore invested additional funding of £29.2 million to NHS boards specifically to target CAMHS, with £4.25 million of that being focused directly on those who are currently on the CAMHS waiting list.

There is a lot more that I could say but, for the sake of brevity, I will hand back to Evelyn Tweed, who I am sure has follow-up questions.

If it gives any comfort to Ms Callaghan, I point out that we have extremely regular contact with people on the ground. We can set all the national policy in the world, but we know that local delivery partners are key to what we are trying to do. That is why our investment is hugely focused on local delivery partners at NHS board level, IJBs, health and social care partnerships, and community-based and third sector organisations. They were doing good work pre-pandemic—let alone the good work that they have done during the pandemic. If it is any comfort to Ms Callaghan, I give her an absolute assurance that every single cabinet secretary and minister works closely with our local delivery partners. The Deputy First Minister co-ordinates a lot of that work.