Our next item of business is an evidence session on Scotland’s railways. In March last year, the committee held evidence sessions with rail industry stakeholders and the Scottish Government in advance of ScotRail’s transfer into public ownership, and we agreed to keep a watching brief on the issue.

The purpose of today’s session is to take stock of ScotRail’s first year in public ownership, considering issues such as industrial relations, fares and usage, and the future of the rail industry in Scotland.

I am pleased to welcome on our first panel Mick Hogg, who is the regional organiser and lead officer for ScotRail and Caledonian Sleeper at the National Union of Rail, Maritime and Transport Workers; Gary Kelly, who is the organiser for Scotland and Ireland at the Transport Salaried Staffs’ Association; Kevin Lindsay, who is the district organiser for the Associated Society of Locomotive Engineers and Firemen; and Robert Samson, who is the senior stakeholder manager for Transport Focus.

I thank you very much for accepting our invitation; we are delighted to have you here. We have allowed about an hour for the session.

We will go straight into questions, and the first ones will come from Fiona Hyslop, who is the deputy convener.

We will come to the subject of ticketing later. You are obviously passionate about it, so you will get a chance to come in on it.

Yes. That would fit logically.

Who is that aimed at? It can be aimed at only one person.

I will take an intervention if I have time.

We need teams that are probably a little bit more advanced than those we have in the local community. That is why, in the Highlands, we have the pre-hospital immediate care team that can deploy if it is needed to provide care at home when local doctors are not able to. I give way to Christine Grahame.

To ask the Scottish Government what its position is on whether orthopaedic appointments and surgeries, when they do not require the use of general anaesthetic, should be carried out in local community hospitals. (S6T-01410)

The national treatment centre is a great addition to the Highlands and we all appreciate it up there. However, patients in Caithness welcomed orthopaedic surgeons travelling to Caithness general, for example, to carry out minor surgeries and to review cases. That meant that they did not have to travel all the way to Raigmore, which could take two hours. An orthopaedic surgeon could carry out a series of, say, 40 case reviews on his list over a period of two days. Surely that is good use of the surgeon’s time and national health service resources.

It is about not only adaptations to the home but making sure that the correct equipment follows the patient to the home. That has been a problem across the Highlands. Has that been a problem in Mr Sweeney’s area and does he think that more work should be undertaken on that?

I welcome the debate. At a time when our health service is in crisis like never before, patients need smart and resourceful solutions that do not compromise their care. That is exactly why the Scottish Conservatives support the hospital at home programme, provided that care at home will free up capacity in our hospitals. Initiatives such as the programme are vital for reducing hospital admissions for elderly patients, especially those who prefer treatment in the comfort of their own homes.

I will give credit where it is due, because it is important to do that. People who benefit from the programme are far more likely to avoid hospital care and care home stays for up to six months after acute illness. That is good news. It saves our precious hospital beds and creates space for all the other patients—patients who often sit on long waiting lists—to receive the treatment that they need.

However, that is why it is disappointing that the Government failed to deliver on the promise to double the capacity of the hospital at home programme by the end of last year. I question how many patients would have benefited but have not because of that failure. We need to address that question because, although the programme can make a difference, it is only a partial solution to the hospital backlog that has grown under the SNP.

Indeed, hospital at home services are not appropriate for every patient. Much like the roll-out of NHS Near Me, they can act as a complement to, rather than a replacement for, acute patient care. The stark truth, however, is that the programme will not solve the problems of delayed discharge. We know that 1,700 beds are still being blocked every day, that the effects on the patients involved are soul destroying and that the situation leads to increased waits at A and E, as well as lengthy delays for vital procedures.

My colleague Dr Gulhane mentioned in his speech the SNP’s promise to eradicate delayed discharges in 2015. Every health secretary since has failed miserably to do that and—let us be honest—patients are paying the price. Former health secretaries who broke their promises include the First Minister and Deputy First Minister. It is not good enough.

I will make a few points on what I heard from speakers in the debate.

I appreciate the cabinet secretary’s points. I wonder whether he should reflect on the fact that he and the health services should ask not whether we should do hospital at home but whether we can do it. Let us make it possible. Let us urge doctors to ask that question.

We should remember that, although there are risks to sending people home, they might not be as high as keeping them in hospital. When my father was waiting to go home, I was told clearly that there was a risk in sending him home. He was dying. We knew what the risks were. Let us make it possible where we can.

Dr Gulhane also mentioned the importance of delayed discharges. We must work harder at sorting those out and ensure that, when patients go into hospital, there are people there who ensure that their discharges happen and that they go out at the right time. That might require the patients to give them power of attorney over medical decision-making processes.

I was taken by Paul Sweeney’s comments about supporting the principle of the programme and the importance of social care being there to step up when the need comes for the person to go home. It is also important to remember the point that he made that it will not be suitable for everyone. Not everyone can afford the extra cost of going home and of a sensible care package at home that might require extra heating and other use of electricity.

Alex Cole-Hamilton recognised the staff shortages. We all recognise that and understand that, to make this work, we have to recruit additional staff on top of the staff whom we see already in the system.

I agree with Clare Haughey that high-quality person-centred care must be at the centre of all this. That is really important. She also made the point that we need to increase funds. What about the extra kit that is needed, which is a point that I raised with Mr Sweeney? It is really important that we make sure that we have the kit to follow people when they are at home.

I thank the member, and I accept her qualification of the point, but the point that I am trying to make is that extra funding will always be required because caring for people at home brings additional costs through extra staff and extra equipment and all that. We need to be responsive to the fact that a cost is involved.

Oliver Mundell and Finlay Carson made a point about the importance of cottage hospitals and the part that they can play in helping patients step down from hospital services and allowing them to go home.

Christine Grahame started off her speech by talking about the extra equipment that would be needed but that then dropped away. I might have misheard her, but I thought she made a point about the importance of having teams that can help people at home.