Chamber and committees

We will always do everything that we can from a communications perspective to help to alleviate those pressures. Let us be absolutely clear: GP practices are open, and people can get face-to-face appointments. Some people prefer to have a Near Me video consultation or, indeed, a telephone consultation. I phoned my doctor a couple of weeks ago because I had a bit of an eczema flare-up. That was very easy; I did it in between meetings. I got the ointment that I needed, and that did not take away from my work day. Many people might, like me, prefer doing that, but a number of people would prefer a face-to-face meeting.

GPs are working extraordinarily hard, as everybody in the NHS is, and we owe our GPs at the primary care level all the thanks in the world for the incredible work that they have done. Any suggestion that they are not seeing people face to face because they do not want to is false, and I absolutely reject it. However, a number of members of the public, particularly in our elderly population, want to see a GP face to face. Some of the guidance published today will make that easier.

Thank you for that excellent question, which raises an issue that is at the heart of what we are planning for and doing at the moment.

The decisions that must be taken are difficult, but they are not unique to Scotland. That is no consolation for your constituents or mine who are waiting for a procedure or are waiting a long time in the A and E department in the Queen Elizabeth university hospital, but it is fair to say that these challenges are being faced across the United Kingdom. Although you are right to note that Scotland’s A and E service has had challenges in terms of its performance, it still remains the best performing A and E service across the UK. Again, of course, I accept that that is no consolation to our constituents.

You ask what is being done. The immediate priority is to get through this crisis. We need to reduce community transmission as best we can because, if we do that, we alleviate the pressure that is put on the NHS by Covid. At the moment, we have more than 700 Covid patients in our hospitals. That might seem like a low number but, if you add that to all the other services that the NHS provides, it all begins to add up.

Today, Public Health Scotland should publish some guidance that is focused on primary care and general practitioners in particular. I hope that that guidance will enable more face-to-face consultations to take place at GP surgeries. I know that GPs are already seeing people face to face, but I suspect that, like me, you have been contacted by many constituents who are saying that they are finding it difficult to get face-to-face appointments. That guidance, along with the further investment in primary care that we will make, will help the situation at that end.

I do not need to tell anyone in the committee just how challenging the situation is with ambulances, given the demand on the Scottish Ambulance Service. We have just increased our investment in the service and are already seeing that pay off. I think that more than 60 people were recruited to the service in the north and north-east of Scotland last week.

We are doing what we can on the acute side, including increasing bed capacity and putting in place the NHS recovery plan. No doubt we will come on to this, but the back end is also important, because there are increased levels of delayed discharge. We are working to put in place rapid units that can make the assessments that are necessary in order to get people back into their communities. That includes considering whether it is possible to have a bridging care plan in place that meets those people’s needs for a period of time and allows us to work closely with the local authority, the health and social care partnership or the integration joint board to ensure that we can make a full care plan available for that individual.

In short, the point that I am making is that the NHS recovery plan, backed by a £1 billion investment, takes a whole-system approach. There is no point in trying to tackle the situation in A and E on its own; we will have to tackle the entire system if our efforts are to have any effect.

I am not surprised that Ms Mochan gets to the heart of the issue, given her experience before she became an MSP. It is clear from her raising those very issues in Parliament that she has an understanding of the area.

I am extremely focused on ensuring that we weed out some of the inequalities that have existed in the system. It might sound a challenging thing to say in the middle of a global pandemic but, because we have to remobilise and rebuild from the pandemic, it presents an opportunity to do that in a way that might not have been possible before.

We have the very ambitious target, which I think is achievable, of halving childhood obesity by 2030. We are going to do that through a range of actions. We have to make healthy food easier to access for people who live in the areas of highest deprivation. I clearly remember that, 10 years ago, when I was on the Public Audit Committee before I was a minister, we went into the heart of Drumchapel and had a session at the health centre there. One of the users of the centre said, “Don’t you politicians come and lecture me about healthy eating when I have two or three takeaways right beside me and they cost half what it would cost me to go to a supermarket to get a healthy meal”. She was right to put that challenge to us.

In the past 10 years, we have managed to make some progress and we have seen some of the effects of that. We have also commissioned research in order to understand in a lot more detail how health systems can support pregnant women. After all, we want to do this as early as possible pre-birth and to focus on children in the early years to see whether, for example, we can put more interventions in place to ensure that they eat well. We have made £650,000 available to NHS boards and community projects to work with families in order to prevent childhood obesity, and in the current financial year we will invest £3 million in improving young people’s weight management services.

Moreover, as I said, we will work constructively with the UK Government, where we can. As you know, it has responsibility for television advertising. I welcome its commitment to banning junk food advertisements before the 9 pm watershed, but I want it to go even further and look at how online advertising of less healthy food and drink can be restricted, too. In fairness to the UK Government, it is keen to work with the devolved Administrations on such shared issues and agendas.

That is a long-standing issue that was raised by a number of people in the previous parliamentary session, too. That is why we set up an independent group to consider in detail the issue of rejected referrals. An audit was done of rejected referrals and a number of recommendations were made in 2018. We accepted all the recommendations of that group. We have implemented the service specifications for CAMHS, which set out the standards of service that children, young people and their families should expect, and we have funded boards to implement that specification. Within that specification, a clear expectation is set out in black and white that services should be appropriately re-engaged, where necessary.

As I said, we have provided about £15 million of additional funding to local authorities to deliver locally based mental health interventions and wellbeing support for five to 24-year-olds. Those services are linked closely to CAMHS, so signposting can be ensured. That means that, if a referral is rejected by CAMHS, the individual is not just left to their own devices but is signposted to one of those local interventions.

Ultimately, decisions about whether referrals are accepted are not for ministers to make; those are important clinical decisions. However, I hope that no young person would be left without any support whatsoever, given the mental health challenges that they might be facing.

I apologise for not answering that part of Mr O’Kane’s question; I was not trying in any way to be evasive.

I have seen the report on non-communicable diseases that was published yesterday. It will take time to look at the recommendations, but I will give considerable weight to anything that comes from the British Heart Foundation and the many other charities that were involved in the report. I will give the report my attention.

Emma Harper has a track record of speaking about issues relating to diabetes and her own personal journey in that regard. There is probably little for me to say other than that I agree with her.

On social prescribing more broadly, there was a committee report on the matter in the previous session of Parliament. In the 2020 programme for government, we included a commitment

“to establish a short life working group to examine social prescribing of physical activity”

and sport. The group’s remit will be to

“identify and communicate examples of best practice, and co-produce resources for practitioners”.

The establishment of the group has been delayed by the pandemic—which, I hope members agree, is understandable. However, my officials are currently considering how we will take forward the short-life working group, which will look at the predecessor committee’s report and its recommendations on social prescribing.

Ultimately, that is the position that we want to reach. Of course, we have to remind ourselves that we are in the midst of a global pandemic and that there are important infection prevention measures still in place. GPs are seeing patients face to face, and we want them to increase the number of those consultations, with focus being on the people who are in most need. However, ultimately, the short answer to the question is yes—we want to get to that position.

I should point out that in surveys that we have conducted we have found that more than 80 per cent of people prefer digital or telephone appointments with their GPs. There might be lots of reasons for that—perhaps such appointments interfere less with people’s days, for example. However, for those who prefer face-to-face consultations, we want to get to a position at which they have that opportunity. I will say, however, that we have to be mindful that we are still in the midst of a global pandemic and are still contending with a highly transmissible virus.

First, I am entirely at your behest, convener, but I can stay on for an extra half an hour, to 11.30 am. I know that you have other committee business to get on with, but I just want to say that my time is not so constrained, so I am happy to stay in front of the committee for as long as is necessary.

On the women’s health plan—[Interruption.] I am sorry—my daughter just dropped my crutches.

The women’s health plan, which sets out 66 actions, contains short, medium and long-term implementation goals. Short-term delivery means within one year, medium-term means one to three years and long-term means three or more years. We plan to establish an implementation board; that will be key, because we all recognise that a strategy is only as good as its implementation. In fact, writing the strategy is often the easy part. Implementation will be vital. The implementation board will look at key milestones and measures of success; we hope that it will meet before the end of this year and that its implementation plan will be finalised by spring 2022. [Interruption.] Please forgive the interjection.

I hope that that reassures Ms Mackay. I am happy to provide more information in writing, if she needs it.

Thank you, convener. I recognise the role that you have played in relation to the women’s health plan and in getting us to this point. I know that you have often felt like a lone voice, having spoken about the matter for many years, so I am really pleased that it has entered the mainstream consciousness. That is why our women’s health plan is so important.

The implementation of the strategy will be critical. As I just mentioned in my answer to Ms Mackay, the implementation board will ensure that key milestones and measures of success are established.

We are already working at local health board level, because if we have a strategy at national level that is not there at the local level, it will not be delivered. Key to the effort will be the women’s health champion that every health board will have in place. The champions will drive forward strategic change at local level. They will promote the women’s health plan where that is needed, and they will support a network of local women’s health experts and leaders.

We hope to appoint a national women’s health champion next year. At the moment, though, we will ensure that we have local structures in place, because what will work in a menopause clinic in one part of the country might be different to what will work in another—urban settings versus rural settings, for example. We want to leave what a menopause clinic should look like largely to local health boards, and we will have a specific person in each health board to drive change and ensure that it is happening at local delivery level.

Again, I will try to give a flavour of the position, and if Mr O’Kane wants me to give more detail on a specific point, I am more than happy to do that.

First, we know that many of the health inequalities that our constituents face are linked to poverty. That is why the role that the Deputy First Minister has in relation to Covid recovery is important. He is convening weekly meetings between and across portfolios, at which cabinet secretaries and ministers can work closely together. We have always done that, but the meetings enable us to do it with extra energy and additional focus on ensuring that we are working in a cross-portfolio way and not compartmentalising our efforts or working in silos.

For example, the work of the Cabinet Secretary for Education and Skills has an impact on my portfolio and, in turn, that impact could end up having an impact on the justice portfolio. We all know the interlinkages that exist. From a Government perspective, I assure Mr O’Kane that we are working on these issues across Government in a way that has a determined focus, and that is helped by the role that the Deputy First Minister plays.

We also know that the pandemic has not been felt equally. It would be wrong to say, “We are all in it together”. Although that has some truth to it, some people have undoubtedly been hit far harder by the pandemic than, for example, somebody like me who, thank goodness, is in a comfortable position in terms of their health—notwithstanding my challenges at this moment—and their financial circumstances.

We are absolutely focused on ensuring that, when it comes to recovery, some of the inequalities that have existed in the system are weeded out. How will we do that? The women’s health plan is an example of that, with its 66 actions that look to address women’s health. We know that one aspect of women’s health is that women face greater inequalities when it comes to their health. We are also looking to publish shortly our immediate priority plan for race equality. That will go into a level of detail about how we intend to work through the inequalities that exist among our minority communities. We know that black and minority ethnic communities are often hit harder when it comes to health inequalities, particularly when compared with their white Scottish counterparts. We are taking a range of actions.

Mr O’Kane rightly mentioned some important health interventions in areas from smoking cessation to plans to tackle obesity, particularly among children. I will not go into detail on those unless Mr O’Kane wishes me to, but I have been concerned throughout the pandemic about some of the work that we had done and good progress that we had made around smoking cessation, lowering alcohol consumption and tackling obesity. I am afraid that we have not been able to make progress on some of those things during the pandemic because of the immediate need to deal with Covid. I am very keen—and have been working hard—to ensure that we are now focused again on some of those important public health interventions.

The work on ACEs is something that I, as Cabinet Secretary for Health and Social Care, and my ministerial and Cabinet colleagues pore over regularly, and it informs many of the interventions and initiatives that we look to bring forward; after all, ACEs impact not only on health.

We are, understandably, focusing on health in this discussion. However, I should say that when, as Cabinet Secretary for Justice, I saw who was in my prisons and who was in our care at Polmont young offenders institution, it was hardly surprising—although, of course, it was deeply disturbing and regrettable—to find that the number of ACEs that people in our prison system had had far outweighed the number that had been suffered by the average person in the population outside prisons. Adverse childhood experiences not only have massive health impacts; they also have negative and adverse impacts right across society, let alone on the Government’s priorities.

I assure Ms Callaghan that we give considerable weight to the research and evidence on that. I know that some of the evidence can be controversial and that some people have criticised the adverse childhood experiences model. However, the Government believes in the general principle that if we intervene as early as possible pre-birth—I am thinking of initiatives that I have already mentioned, including the baby box—to give every child the best start in life, we have a better chance of weeding out the inequalities that undoubtedly have the health and other societal impacts that Ms Callaghan has rightly highlighted.