Chamber and committees

I am more than happy to examine the issue. At my meeting with representatives of the BMA, they raised a number of issues on which they thought the Scottish Government could take action, one of which was the issue that Dr Gulhane mentioned. All of these things undoubtedly come with a cost. There are a number of issues that the BMA and the Royal College of General Practitioners have raised where they think that the Scottish Government could help with retention. We are working closely with the BMA, the RCGP, the Academy of Medical Royal Colleges and Faculties in Scotland and others. Where we can, we will do that. Where those powers exist elsewhere, we will of course work constructively with the UK Government.

I have mentioned that my relationship with the Secretary of State for Health and Social Care is a constructive one. He has promised to consider the issue and to come back to me on it. Where we can take action, we will look to do that. If that involves an additional financial ask, of course that is a decision that we must weigh up in among the other recruitment and retention issues.

This answer will be slightly unhelpful, but I hope to be able to give a little bit more detail on that next week. We were due to have our debate on the NHS and social care this week but, because of the need to have a parliamentary debate on the certification scheme, which was rightly brought forward, we will be having that debate on the NHS next week. I hope to say more next week about our strategy on long Covid and about what we are considering doing to bolster the local response to the long-term effects of Covid.

We are currently trying to ensure that the pathways that we have provide care as close to home as possible. That does not rule out the possibility of setting up long Covid clinics—health boards could do that tomorrow if they wanted—but the model of long Covid clinics does not necessarily work everywhere. In NHS Highland, for example, there may be challenges in having a long Covid clinic in one part of the Highlands given the travel and the distances that require to be covered, which could cause problems for people suffering the long-term effects of Covid in other parts of the Highlands. That one model does not always fit, although that does not mean that it does not have merit. I reiterate that, if a health board wanted to create a specialist clinic, it could do so.

The point is that there is a current referral pathway, and there is an implementation note with GPs on the long-term effects of Covid. Essentially, using existing services, we are trying to get people the best treatment that they can get in the long term, and as close to their home as possible. We are also trying to understand more about long Covid, which is why we are investing in research. Our understanding of long Covid and of the long-term effects of Covid is evolving day by day.

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.

In relation to out-patient activity, you are right, it will take us the parliamentary term to reach that 10 per cent. In relation to additional in-patient and day-case activity, we hope to get there by 2022-23, so I hope that we will get to that 10 per cent a bit earlier. The significant increases in diagnostics are important.

I missed part of your question, but was it on particular pathways or referral pathways? Forgive me, my connection seems to be timing out.

In relation to our cancer pathways, we are already trying our best to get early diagnostics, which is a key part of trying to alleviate the pressures on the system. We know that if we get people that care earlier, particularly in relation to cancer treatment, they have a better chance of recovery, which means that they will be less likely to end up in our hospitals for longer. Our early cancer diagnostic centres are clearly a part of that. The earlier that we can get people referred into the system, such as early cancer diagnostic centres, the better chance we have of alleviating that pressure and seeing more people through the system. Obviously, we already have some of those early cancer diagnostic centres up and running.

We know how important that is for patients, customers and everyone in society. Whether we are talking about an app that gets Uber Eats to deliver food to a person’s house or an app that is linked to a public service such as health, ethical and secure storage of the data that the app gathers is hugely important.

One of the first meetings that I had as health secretary was with our cybersecurity team, who had brought in an external consultant who was helping us to work through the security in our NHS systems. They are doing a good amount of detailed work.

We are going to publish a refreshed digital health and care strategy that will commit to the development of our first ever dedicated data strategy for health and social care, and will include detailed consideration of how to increase our citizens’ trust in data sharing, and of how to ensure that there is transparency in the system. We need to unlock the value of health and care data in a way that ensures that the data can be safeguarded and that there is full transparency over how it is used.

The security of the data is important; cybersecurity testing has already been carried out for all the other major systems, including Near Me. With regard to our Covid certification—which is a very topical issue—we will ensure that we have up-to-date security provision in place, particularly when the app is ready to go live at the end of this month.

Those are really important questions. We are looking proactively at how we can further incentivise out-of-hours working, because we know how challenging that is and how important it is to the recovery. As Ms Mackay will appreciate, we have to work with the trade unions and staff-side representatives on that to ensure that they are comfortable with what is being proposed. We are looking to finalise a lot of the detail on that.

An important issue that Ms Mackay touches on, which I am happy to say more about if we get into this in more detail, is wellbeing. Wellbeing is important not just for out-of-hours staff but for everybody. My first visit as health secretary was in Lanarkshire, and I was blown away by the testimony that I heard from healthcare workers and NHS staff more generally. As members can imagine, I spoke to porters, cleaning staff, doctors, nurses and everybody in between, and they all told me the same thing. It did not matter what their job was, they were knackered. They were really tired because of the past 18 months. That is why we are investing £8 million in their wellbeing. For brevity, I will not go into detail right now, but a whole range of services is available, some of which are very specialist. If we are going to ask NHS staff to help us with the recovery, which is vital, we are going to have to make sure that their wellbeing is paramount.

It goes even further than that. In effect, it will give relatives of care home residents rights that are akin to those of care home staff. Of course, the final shape of Anne’s law will be up to the consideration of the committee and the Parliament as a whole, but those rights will be embedded in statute.

I seem to have lost my connection. I heard you say that you had spoken to the BMA.