Chamber and committees

I have nothing further to say.

It is difficult to evaluate because we are in the midst of the current financial year. Dr Gulhane will know that we took a very difficult decision in the emergency budget review, largely because the UK Government’s mismanagement of the economy meant that my budget was worth £650 million less than when it was set last December. On top of that, we have proposed a record pay deal of 7.5 per cent, which is far greater than any other country in the UK has suggested for its NHS staff and means that, currently, Scotland is the only country that is not experiencing nurses or any other NHS strikes this winter. We had to make some really difficult decisions; partly because of decisions that we have taken around the workforce and partly because, due to mismanagement of the economy, £400 million had to be reprofiled.

There are no easy decisions—mental health, primary care and social care are not areas where any health secretary in the world would choose to look to make savings. The impact of those savings, whether they are in primary care, social care or mental health, will only be realised as we come towards the end of the financial year. It is fair to say that we have been working closely with our GP services and everyone in primary care to see what we can do to try to mitigate the impact.

I suspect that one of the main areas of concern—this was highlighted by the British Medical Association in response to the reprofiling of funds—relates to the sustainability of funding. In the next financial year, 2023-24, I am keen to ensure that we do not lose focus on the increase that we have seen in multidisciplinary team staffing in all GP practices, both urban and rural. Recruiting more multidisciplinary staff, including advanced nurse practitioners, physiotherapists and pharmacists has been a significant benefit for remote, rural GP practices in spreading that workload in areas where it is more difficult to recruit GPs.

All of that can make a significant difference. However, I will not pretend that a cut in primary care of the scale that we have made will not have an impact. We need to evaluate some of that impact and ensure that we mitigate it as best we can in 2023-24.

I am happy to add that the Government is in agreement that the centre of excellence probably would not have an advocacy role, given that that sits with NES. I do not think that an advocacy role would quite fit in with the original thinking behind the centre.

The idea of having a rural health commissioner has merit. We have been focused on what the centre’s core purpose will be rather than on considering whether to have a commissioner. As Sir Lewis said, there is such a role in a number of other countries, so the idea is certainly worthy of consideration. However, the primary focus must be on getting the centre for excellence up and running.

You have raised that valid question before. You will have to forgive me, but I do not have the most up-to-date position in front of me. I entirely see the logic that you are deploying in relation to Stranraer and your feeling that it would make far more sense for that area to be part of the west of Scotland cancer pathway.

If you do not mind, I will take a look at the latest position. I had raised the matter with the health boards that are involved and I remember the response at the time being that many patients could travel from Stranraer to Glasgow. However, if that is not happening—if that is not people’s experience—I will want to find out why that is the case. If you are okay with that, I will come back to you—perhaps through the convener—in writing on that specific point.

More generally, as I said, the issue of a rural health commissioner is worthy of exploration. However, based on the volume of correspondence that I get in my inbox, even if we were to establish a commissioner, any expectation on them to advocate on behalf of every patient in relation to every challenge to and issue that we have with the health service would be very difficult to meet.

Patient rights are embedded in statute and guidance. We also have in place robust procedures to deal with complaints and so on. We probably need to take a bit of time before we consider further whether there could be a commissioner, or an organisation or individual, who will advocate on patients’ behalf.

The member might be aware that we have a debate later this afternoon on the mesh issue—indeed, he may be taking part. It is largely focused on hernia mesh, but I suspect that it will segue into the issue of transvaginal mesh, so I can give a further update after that, and if the member wishes for a written update, I am also happy to provide that.

The member will know that we now have contracts in place for other providers in England, such as the Spire Healthcare clinic and Dr Hashim, and the overseas contract with Dr Veronikis in the Missouri clinic is under way. I have to be careful about what I say, because we do not want to get into the territory of patient identification, but it is fair to say that patients have travelled to those providers, although I cannot tell you the locality—again, because of patient identification.

I had a meeting with a number of women who have been affected by the transvaginal mesh issue, some of whom were from remote areas, and they made a point of telling me that we could definitely improve the service for them. One woman from a remote rural health board—again, I will not say which one—told me that she was perplexed that she was offered a 9 am appointment with the complex mesh service in Glasgow. It made no sense me either that she was offered a 9 am appointment when she was travelling many hundreds of miles to get there. In some circumstances, as Sandesh Gulhane will know, the health board will pick up the costs for travel, but only in certain circumstances. Why make people go through that? They are willing to travel but do not want to have to leave the house at 6 am to make sure that they get to the appointment on time. I fed that back to the complex mesh service in Glasgow and I understand that that feedback is being taken on board.

To go back to Carol Mochan’s point, I will regularly engage with women who have been affected by transvaginal mesh, as well as some of the campaign groups and, if that change is not being implemented on the ground, I would be pretty concerned. We can definitely make tweaks in that regard to support women who are affected in remote and rural health boards.

We—the First Minister, Maree Todd and I—have tried to approach that issue with openness, honesty and transparency. I do not share Tess White’s cynical view of the Government that we have been trying to kick the matter into the long grass or to kick the can down the road. That might be her characterisation, but that is certainly not the approach that we have taken.

First, we have always said that we want the right person to be appointed. That is important, because we envisage the women’s health champion being in place for a long period, and we do not want to get the wrong person. As you can imagine, because of their calibre, the people who have applied for the position have many other commitments, so we have to be absolutely sure that they are able to provide the necessary time for that exceptionally important role. There is a discussion to be had about the time commitment that is involved and people’s other commitments. Everybody who has applied and everybody whom we have interviewed for the role is of incredible stature, is incredibly busy, and has other commitments. We have to work around that and ensure that they understand our expectation of the role.

Secondly, although the role of the women’s health champion is absolutely important, the fact that the champion has not yet been appointed does not hamper our progress on the women’s health plan. I could give a range of initiatives that we have taken forward. As you know, the women’s health plan contained 66 actions, and we have already progressed a range of them—I think that I have already referred to some of them. I could give members a list of a number of those actions, but I will not do so at this point. If you want that further information, I would be happy to write to the committee. I do not think that the lack of a women’s health champion hampers us from being able to make progress.

Thirdly, the direct answer to your question is that the Government hopes to make an announcement on the women’s health champion within weeks as opposed to months. We are very close to doing so. As I have said, there are just some i’s that need to be dotted and some t’s that need to be crossed. I think that we will have an excellent women’s health champion if we get things over the line and in place. The intention is to get things over the line in weeks as opposed to months.

Yes.

No—it is definitely not, and should never be, the norm. In Tess White’s articulation of her question, she referred to the fact that that was an extreme measure taken by NHS Grampian, and I never want to see it as the norm.

Objectively, I think that, if we all take a step back, we can agree that the festive period—the few weeks running up to Christmas, the Christmas period and the first week of January—was among the most difficult periods, or probably even the most difficult period, that the NHS has ever faced, certainly in the course of the pandemic and, I would argue, possibly in its entire existence.

There were really difficult choices to be made, including the pausing of elective care, which I will highlight before it is mentioned. I do not want to see that happen. The constituents who write to me and to Tess White, and to every member around the table, are suffering because of a last-minute cancellation, again, of an operation for which they have already been waiting a year or more. We do not want extreme measures.

Tess White is right to say that the workforce is exhausted—I will not argue with her on that. I speak to many people on the front line, and they tell me about the exhaustion, so I am very grateful for all that they do and for the fact that many of them responded to that particular call.

However, I would not simply be aghast if that were to become the norm; I would not allow it to happen. It was an in extremis measure that, I hope, we will not have to repeat. Nevertheless, it is important that local health boards are given flexibility to make those difficult decisions.

Again, Sir Lewis Ritchie might want to add to what I will say.

I have often been asked about a number of cottage hospitals from which, unfortunately, we had to take staff during the height of the pandemic to send them to large acute sites, and whether there is merit in bringing them back on stream to help us with the social care challenges that we face. I have raised that issue with the chief officer in Dumfries and Galloway in particular. Her response was very interesting. She said that the staff who were taken from particular cottage hospitals can offer more hours of care to more people receiving care at home. Instead of being able to look after 10 people at a time—I am making up the numbers for the sake of illustration—they were almost doubling that and were able to look after and provide care for almost 20 people in their own homes.

Cottage hospitals play an enormously important role within our health and social care services. Decisions about where the balance of benefit is in staffing and the care that the staff can provide have to be made at the local level.

I think that both my colleagues want to comment on that.

I will hand over to the CMO shortly for him to add his clinical expertise, but it is fair to say that they are well understood. One of the most difficult decisions that was taken during the pandemic was the decision to pause elective care, and there is no doubt about the effect of that. If someone is on a waiting list, the effect of cancellation is not benign. People deteriorate and decondition. We are seeing people present sicker and with higher acuity, and that deterioration and deconditioning are contributing factors to that.

I regularly speak to orthopaedic surgeons in particular and to the Scottish collaborative orthopaedic trainee research network—SCOTnet, as it is known—and they often tell me that there is no doubt that given the difficult but, I would say, necessary decisions that were taken during the pandemic, people on waiting lists are deteriorating and deconditioning, particularly if they are on long waiting lists. That is why, when I announced certain targets in the summer, the focus was on those long waits, because we know that people who wait for excessively long times for elective care will come to harm. There is no argument from me on that. My goodness—when we speak to people who suffer with chronic pain, we can really understand from their perspective how detrimental that is to them, and I will not pretend otherwise.

In the context of the winter pressures, Evelyn Tweed will be aware that three health boards have taken the decision to have a time-limited pause on elective care. I stress the term “time-limited” because, although those are local decisions, I have made it clear to those health boards—they understand this and there is certainly no argument from them on it—that the measure should be in place for as little time as possible, given all the impacts that pausing elective care can have.

That is also one of the reasons why we did not move the entire NHS to an emergency footing during the winter. Some people called for us to do that, and I understand where those calls came from. However, if we had moved the NHS to an emergency footing, as we did during the early days of the pandemic, instead of three health boards pausing elective care, all 14 territorial boards would potentially have done that. That would have had a severe impact on people up and down the country.

Please forgive me for again giving a fairly long answer to a short question, but I hope that that gives you an understanding of the situation. I will bring in Dr Smith.