Chamber and committees

First and foremost, we have seen effective deployment of technological solutions throughout the pandemic. We have talked a lot about the Near Me video technology that exists; I am sure that we will continue to do so. The number of consultations that are now taking place using that platform is a positive thing—it shows that practitioners and patients have confidence in the system.

I am relatively new to my post, but my observation is that we still have a fair way to go when it comes to interoperability of our digital systems. David Torrance was right to reference the national digital service that was established in 2018. As he said, that will deliver the national digital platform. We have always been up front about the fact that that will take some time, but the pandemic has undoubtedly delayed some of the necessary work. However, in effect the aim remains the same. The key aim is interoperability—using different information systems, devices and applications to access information and ensuring that we can integrate it in a co-ordinated way. The system must work across organisations, regions, NHS boards and national boundaries in order to transfer information seamlessly and to optimise interventions for individuals.

A range of actions have been taken and are being taken. I can go into more detail on any of them, if you want; I can write to the committee on that, because the list of what we are doing across various systems is quite lengthy. We are making progress but, clearly, some of that progress has been affected by the pandemic.

Thank you not only for the question, but for disclosing how the issue might have affected you personally and other families that you might know well, who have a child who has autism.

If you do not mind, I will take that question away and consider it further. I would be deeply worried if I was to look into the data in detail and discover that rejected referrals were disproportionately affecting children who have autism. If that was happening, it would give me a real level of concern and I would have to look at why that was happening.

Donna Bell, the director of mental health and mental wellbeing, might want to add something.

I thank Ms Tweed for speaking about her own experiences. I do not take it lightly when people share their health experiences; it is a difficult thing to do, particularly when standing in a parliamentary chamber.

Our women’s health plan goes into some detail on how we will do that. However, the best thing that I can do for Ms Tweed is give her detail of what the implementation board will seek to do, because the implementation of the actions will be different in different local health board areas. One size does not always fit all, so there will be different pathways to referral. The diagnostic side of endometriosis is something that we have to concentrate on. Funding will be available for that, including through the investment that accompanies the women’s health plan.

The implementation board will be absolutely vital to that work. Ultimately, it will decide on the best way to implement each of the actions. I can promise Ms Tweed that some of them will be short-term actions, but, equally, some of them will be long-term actions. I cannot wave a magic wand to improve things overnight—I know that that is not the expectation. However, particularly with regard to endometriosis, some of those actions will be taken at speed, because we know not only just how much women suffer but how many challenges there are around the diagnostics.

I am happy to write to the committee in more detail on implementation of the women’s health plan, if that is acceptable to Ms Tweed and the committee, but it would be helpful if I could do that at a time when we have a bit more detail about the implementation board.

Forgive me, but I do not have that information to hand. I will get an update on that research and write to the committee.

My concern around cervical screening involves some of the issues that my colleague Maree Todd updated Parliament on before the summer recess. She will provide Parliament with a further update shortly. My concern is that we do not allow the issues that she addressed then, as unfortunate and regrettable as they are, to detract from the importance of women coming forward for cervical screening. We know what a positive impact the cervical screening programme has had on detecting cervical cancer early, which leads to earlier treatment and, in turn, a more positive outcome. Therefore, I do not want those issues to detract from the positive benefits of the screening programme.

As I said, I do not have the most up-to-date analysis of that research, which is still being undertaken. When we have that, I will be happy to write to update the committee.

I agree. I should have said in my response to Evelyn Tweed’s question that one of the actions in the plan is to commission endometriosis research. You are right to say that a number of people—clinicians and women—want to know more about the condition and understand it better. The research is there to develop better treatment and management, and, hopefully, a cure. That is one of the actions that are part of the women’s health plan. I hope that that gives you some comfort.

Annie Wells is right to say that the issue is not just one of physical health—it is absolutely also about mental health.

I vividly remember a conversation that I had, during a visit to a hospital, with a nurse who was quite senior and worked in the high-dependency unit. As somebody who is not a clinician, I had wrongly assumed that someone at her level of seniority in nursing would, unfortunately, have seen a number of people pass away during her career but, actually, she had not. However, at the beginning of the pandemic, the high-dependency unit was overwhelmed with so many people coming in that the amount of death that she saw at that stage was greater than she had seen in her entire career. She said that that had had a huge impact on her mental health. Maybe I am stating the obvious, but that is something that had not registered with me, as a non-clinician. I agree entirely with Ms Wells’s assessment that there is a huge mental health impact on staff.

What are we doing about it? There is £8 million going into wellbeing, across a range of initiatives. We have the 24/7 national wellbeing helpline, the national wellbeing hub, coaching for wellbeing and the workforce specialist service. All those resources are being used, and used well. We know that the national wellbeing hub has been used more than 115,000 times by health and care staff, and that the workforce specialist service—the clue is in the name—is being used as well.

With regard to protected time, I am absolutely open to that discussion. I am more than happy to take that suggestion away and discuss it not only with health boards, but with our trade unions and staff-side representatives. I am certainly open-minded on that point. It would obviously come with some challenges, given the current pressures on the health service that we have all spoken about, but if we want our NHS to recover, staff wellbeing must be at the heart of that.

The additional funding of £2 million that we allocated to support the primary care and social care workforce should help local teams to secure time for reflection and recovery to meet the identified needs. That funding could also be used for locum cover and backfilling costs. On the broader issue of protected time for wellbeing, I am happy to look at what more we can do in that regard.

If it is okay, I will pass that question over to the national clinical director. Ms Callaghan is absolutely right. When it comes to the more challenging cancer pathways, we look at the most common cancers. The largest cause of preventable death is smoking, and cancers associated with smoking, of which lung cancer is one. I will ask the national clinical director to say a little more about lung cancer specifically.

I could not have articulated the conundrum better myself. That is the challenge. Providers are weighing up incredibly difficult factors. My colleague Kevin Stewart and I have had a number of meetings with family members of people in care homes. It can be sensed from them just how difficult life has been over the past 18 months.

Nobody in the Government and—I say this with absolute confidence—nobody in the care sector wants to keep relatives from visiting a loved one. We understand the challenges of the past 18 months. That desire has to be balanced with considerations to do with what we know is a complex residential setting that involves older people, who we know are more susceptible to the most serious and severe effects of Covid. That is why our clinical director, Public Health Scotland and our other clinicians keep close to the social care sector and advise it regularly on what can be done safely.

However, I will be honest—the circumstances that we find ourselves in at the moment, with high levels of community transmission, are having an impact on our care sector. At the last count, yesterday, I saw that more than 120 care homes have an outbreak of Covid in them. That is not an insignificant number. Therefore, difficult decisions have to be made. I can promise you that Kevin Stewart and I are looking at the situation on a daily basis in an effort to ensure that the rights of relatives of care home residents are paramount, while considering the complex safety issues that are involved in care homes. In addition, of course, we have made a commitment to introduce Anne’s law in the first year of the parliamentary session.

That is a core element of our NHS recovery plan. We have been up front and honest about the situation. We have increased the number of graduate places for medics year on year and we have increased training places for certain parts of the workforce. We are doing all that to increase recruitment as far as possible. However, that will not be enough. We have said in the plan that we will look to conduct ethical international recruitment—I emphasise the word “ethical”, because we cannot drain resources from parts of the world that need those resources.

For example, I have had a good conversation with the Academy of Medical Royal Colleges and Faculties in Scotland, which is helping us and will no doubt be a help in relation to ethical international recruitment. The plan also shows that retention is a hugely important part of what we are looking to do. In my conversations with the British Medical Association and the Royal College of General Practitioners, for example, they have stressed the point about retention.

Some of that is within our gift and we are, of course, working hard to see what we can do, but some of it is not within our gift. I have already had exchanges of letters and conversations with the Secretary of State for Health and Social Care, Sajid Javid, with whom I have a good relationship. As members would imagine, it is a frank relationship, but it is a good one. I have already mentioned the fact that pension changes that have been made by the UK Government are an adverse disincentive for those in the medical professions, particularly doctors and GPs. As I said, some of that is within my gift, and we will work hard on that, but some of it is not.

Recruitment and retention are important, and domestic recruitment and ethical international recruitment will be part of our plans.

Forgive me, I do not have a note of all those countries in front of me. However, it is not uncommon—a number of European countries have vaccination certification schemes. I will not stray into the politics too much, but they are often countries that have Governments that are centre-left or left-of-centre, or have liberal parties in power. As the convener rightly said, there has been some worry about the encroachment on people’s civil liberties, but a number of the countries that have brought in certification schemes have politics that I would say are more left or left of centre.

It is not an unusual step to take, and I also say to Emma Harper that, across the European continent and in other countries far beyond Europe, we have seen certification schemes incentivising vaccination. In France, as soon as the certification scheme was announced, there was a huge spike in the number of people looking to get vaccinated. Therefore, I am hoping that we will see something similar here.