Chamber and committees

We move straight to questions.

We have a couple of supplementary questions on this theme.

The committee has taken evidence from integration joint boards over the past couple of years. We have looked at their budgetary requirements and their concerns about budgets. To what extent is the Scottish Government willing to consider direct funding to integration joint boards in the future in order to further improve transparency and effective planning?

Agenda item 3 is an evidence session with the Minister for Public Health and Women’s Health and her supporting officials on the Tobacco and Vapes Bill legislative consent memorandum, LCM-S6-51, which was lodged in the Scottish Parliament by the Cabinet Secretary for Health and Social Care on 21 November.

The legislative consent process set out in chapter 9B of the standing orders requires the Scottish Government to notify the Parliament, by means of a legislative consent memorandum, whenever a UK Parliament bill includes provision on devolved matters. Each LCM is referred to a lead committee to scrutinise and report on, before the Parliament decides whether to give its consent to the UK Parliament legislating in the manner proposed.

The Tobacco and Vapes Bill was introduced in the House of Commons on 5 November 2024. The purpose of the bill is

“to make provision about the supply of tobacco, vapes and other products, including provision prohibiting the sale of tobacco to people born on or after 1 January 2009”

and to make provision

“about the licensing of retail sales and the registration of retailers; to enable product and information requirements to be imposed in connection with tobacco, vapes and other products; to control the advertising and promotion of tobacco, vapes and other products; and to make provision about smoke-free places, vape-free places and heated tobacco-free places.”

I welcome to the committee Jenni Minto MSP, Minister for Public Health and Women’s Health; Professor Linda Bauld OBE, chief social policy adviser; Fiona Dill, teams leader for the tobacco, gambling, diet and healthy weight directorate; and Ruth Foulis, lawyer with the legal services directorate.

I invite the minister to make a brief opening statement.

Thank you very much, minister. The committee has a number of questions about the LCM. On a point of clarification, you referred in your statement to nicotine products. Can I check that the bill would not cover smoking cessation products such as lozenges, chewing gum and patches?

Brian Whittle hits on an important point about some of the discussion that the committee had—I appreciate that he was not part of the committee at the time of drafting the report or taking the evidence—which was that there has to be an in-the-round, holistic look at what is required to ensure that we have adequate and easily accessible healthcare in our remote and island communities. It cannot just be about healthcare—it has to be about housing, support services and so on. We need those who make the decisions to work outside of silos. They need to work together.

As convener of the Health, Social Care and Sport Committee, I am pleased to open the debate on our recent inquiry into remote and rural healthcare. It has long been recognised that people who live in remote and rural areas face unique challenges in accessing healthcare. In recognition of that, the committee decided to undertake an inquiry to get a better understanding of those challenges and the actions that the Scottish Government is taking in response to them.

Before I discuss our findings, I thank everyone who engaged with the inquiry, including those who responded to the initial consultation on the your priorities platform and the call for written evidence, participants in the informal engagement sessions and witnesses who took the time to provide oral evidence. It was a lengthy process, covering a broad subject area, so the expertise and lived experience of patients, professionals and other stakeholders was crucial in shaping the recommendations in our report.

In particular, I extend a special thanks to the national health service staff, third sector workers and residents of the Isle of Skye who took the time to meet committee members during their external visit in April. I know that those who attended the visit found it massively beneficial, and we thank all those who took part. The committee also thanks our officials, the committee clerks and Scottish Parliament information centre colleagues for their work on the inquiry and the final report.

The original impetus for the inquiry came from a number of petitions that were shared with the committee last year, which shone a light on some of the key challenges that face our more remote and rural communities in accessing healthcare services. The committee was motivated to undertake a broader inquiry with the aim of making long-term policy recommendations to improve access to remote and rural healthcare. The inquiry was also informed by previous scrutiny during the current session of Parliament, including inquiries into alternative pathways for primary care, health inequalities and periodic scrutiny of NHS boards.

In preparing for the inquiry, we felt that it would be particularly important to hear directly from those stakeholder groups and individuals who were directly affected, to enable us to make targeted recommendations that would shape future policy in a way that best serves the needs of remote and rural communities. An initial consultation on the your priorities platform generated 179 ideas and 221 comments, and reached 218 users, comprising a range of individuals and stakeholder organisations across Scotland.

Following the initial consultation, the committee decided to focus its inquiry on assessing two key areas of Government policy that were designed to improve access to healthcare in remote and rural areas: namely, the recently created national centre for remote and rural health and care and the Government’s forthcoming remote and rural workforce recruitment strategy. The more detailed call for views that followed received a total of 70 responses. Those helped the committee to identify a number of common themes, which it then explored further in formal evidence sessions.

One key theme that was echoed by respondents and witnesses was the need for training and development opportunities for healthcare staff that were better geared to the specific needs of remote and rural areas. Given the nature of work in those areas, there was broad agreement on the need for a more tailored approach to delivering education and training to the healthcare workforce. I welcome the Government’s response, which acknowledges that need and outlines what it and NHS Education for Scotland are doing to improve the availability, suitability and flexibility of local training and development opportunities through the work of the national centre. I hope that that will be further reflected in the forthcoming remote and rural workforce recruitment strategy, the scope of which the committee would like to see significantly widened.

More tailored training and greater development opportunities are a prerequisite for tackling recruitment and retention issues in remote and rural areas. At the same time, our inquiry has highlighted the impact that a lack of affordable housing is having on recruitment and retention, and we have concluded that resolving that issue will require a collaborative approach, involving NHS boards, local authorities, professional bodies and other key stakeholders.

The report also outlines various opportunities to disseminate examples of good practice more widely and to pursue innovative solutions, not least improving use and availability of digital infrastructure, where appropriate. I hope that those recommendations will be reflected in future policy.

I appreciate what Sandesh Gulhane is saying about the difficulty in recruiting GPs and other healthcare professionals to remote and rural areas. Does he see the impact that policies such as Brexit and the hostile immigration policy have had on attracting overseas medical and nursing personnel to Scotland and the rest of the UK?

—which will mitigate Westminster Labour’s cut to winter fuel payments for pensioners and the callous two-child cap. The rest of the Labour group backed those two policies, which will right the party’s wrongs. Does the First Minister agree that, if Labour members want to tackle child poverty and support our pensioners, they should support the budget, with or without their leader?

Liam McArthur has raised a really interesting point. As a committee, we heard about some of the advantages of living in and the attraction of moving to remote and rural communities as well as the difficulties that people faced. In particular, we heard about students who were keen to work in remote and rural areas but whose opportunities to do so were somewhat limited, if not completely curtailed, because of the lack of accommodation. The Government should consider that issue further.

Another common theme was that the design of services and service delivery often fails to meet the particular needs of remote and rural areas. I therefore welcome the Government’s commitment to explore ways of designing systems and services that are more flexible and responsive to local needs and that combat silo working. In concluding its inquiry, the committee is a confirmed advocate of a whole-system approach.

The committee also heard extensive evidence of the specific challenges associated with implementing the 2018 general medical services contract in remote and rural practices. In light of that, the report calls on the Government to explore the extent to which a revised, more flexible approach to implementing that contract might improve the sustainability of rural general practitioner services and the financial viability of remote and rural practices.

As I mentioned, the report outlines significant opportunities for improving services in remote and rural areas through better use of technology and digital infrastructure. Our inquiry has concluded that that has the potential to streamline service delivery and cut down waiting times for patients waiting for face-to-face appointments. Regrettably, digital infrastructure in remote and rural areas remains unreliable and the committee looks forward to seeing concerted action by both the United Kingdom and Scottish Governments to remedy that situation.

The robustness of data collection and research could also be greatly improved, which would allow the impact of specific policy decisions concerning provision of remote and rural healthcare services to be more clearly measured, ensuring that future policy is effectively targeted. The committee looks forward to seeing progress in that area and hopes that improving access to, and sharing of, research and data across healthcare teams will be a key area of focus for the national centre.

In the time allowed, I have been able to give only a brief flavour of the wider range of issues that have been touched on by the committee’s inquiry. I know that we all share a commitment across the Parliament to improve the health and wellbeing of people across Scotland, regardless of where they live. The inquiry has highlighted the myriad challenges that our remote and rural communities face in accessing healthcare. I look forward to continuing to scrutinise the work of the Scottish Government and other key decision makers as we seek to improve the quality and availability of health services in our remote and rural communities for the benefit of patients, staff and the wider constituencies that they serve.

I put on record my entry in the register of members’ interests: I hold a bank nurse contract with NHS Greater Glasgow and Clyde.

I move,

That the Parliament notes the conclusions and recommendations contained in the Health, Social Care and Sport Committee’s 13th Report, 2024 (Session 6), Remote and Rural Healthcare Inquiry (SP Paper 654).