Chamber and committees

My understanding is that the NRAC formula, which you mentioned, is under review and could be altered. Where are we with that? When will the findings be ready to be published, for instance?

I have a supplementary question. I want to give an example of sustainability or supporting people to avoid hospital admission. Folk with chronic obstructive pulmonary disease or asthma can be helped to improve their lung health by going to a local choir, for instance. We know that that helps with pulmonary rehabilitation. How do we recognise the importance of, for instance, the third sector, in helping COPD patients or people who need lung rehabilitation to avoid admission to hospital?

Good morning, minister. I am interested in the vaping issue, as I am co-convener of the cross-party group on lung health, and ASH Scotland has come and presented to us. I am thinking about how retailers seem to be everywhere now—taxi drivers are selling vapes and online food companies will sell vapes as part of your food delivery. How will retailers be educated on or supported in the change in the law?

Parents need to realise the damage that nicotine does to their children. We hear about kids who are so anxious that they cannot sleep, and when they try to withdraw from vaping, they have withdrawal issues. There are total health impacts for young people who vape, so I welcome this legislation, but how do we make sure that retailers are aware of it, and how do we curtail the number of businesses that are selling vapes?

Good morning. The overall budgets of some territorial boards are increasing in cash terms by 14.2 per cent, but some—including NHS Borders, NHS Dumfries and Galloway, NHS Highland, NHS Orkney and NHS Shetland—are receiving increases in their budgets above 14.9 per cent. I am interested in the decisions that were taken to increase the budgets for those territorial boards. Were they taken to support reductions in waiting lists, to address delayed discharge and to address other aspects?

I have a quick question about digital and innovation. Earlier, I spoke about pulmonary rehab, which I know is being delivered remotely, which is good for rural areas. I would like to hear from you about artificial intelligence and how it will link to the budget in the future.

Thanks.

Thanks.

I thank Neil Gray for highlighting that. I know that it is a complicated issue, and that the interchanges between various health boards and pathways are complex.

I welcome the report, and I thank the committee members, clerks and the people who gave evidence. I also commend all the health and social care staff for their compassion and commitment to the people in their care, and I look forward to the Government’s response.

As a member of the Health, Social Care and Sport Committee, and as a representative of rural Dumfries and Galloway, I am pleased to speak in the debate about our inquiry into healthcare in remote and rural areas. I remind members that I am a registered nurse and that I was a clinical educator for remote and rural NHS Dumfries and Galloway.

Our inquiry focused on many issues that relate to the challenges of providing healthcare in remote and rural areas. Members of the committee visited the Isle of Skye, for example, and we took online evidence, including from persons in my South Scotland region—people who were aligned with the Galloway community hospital action group, and a former GP who was also the previous chief medical officer of the Galloway community hospital in Stranraer.

I cannot cover everything in the report in the six minutes that I have—maybe I have more than six minutes now, Presiding Officer—but I welcome the fact that the committee convener covered lots of information from the inquiry, including the GMS contract flexibility needs. I will highlight some of the key issues that came out of the inquiry. The committee made recommendations on education and training, recruitment and retention, how services are designed and delivered, primary care and multidisciplinary team working, and the importance of the third sector.

As we have heard, one prevalent and prominent issue was the lack of housing. That is a challenge not only for full-time workers but for people who are assigned a placement in remote and rural areas as part of their training. As I said, that has been highlighted by many. Dumfries and Galloway Council and Scottish Borders Council recently declared housing emergencies, and that certainly impacts on the ability of the health boards in both areas, and of both councils, to recruit and retain a health and care workforce.

However, I know people who work in NHS D and G and live south of the border—who, for example, commute from Carlisle to Dumfries. One team member told me that they chose to travel to Scotland from England because the pay is better, the patient to staff ratio is better and the NHS service performs better. I can say that as a person who lives near the border and has had people give me such testimony about why they choose to live in England but work in NHS Dumfries and Galloway.

I highlight the success of the unique Scottish graduate entry medicine programme, about which I made an intervention earlier. ScotGEM is a four-year graduate medicine programme that trains healthcare professionals with a primary degree in health or science to work as generalists in the NHS in Scotland.

I was a member of the Health and Sport Committee in the last parliamentary session, when the then cabinet secretary Jeane Freeman took forward the legislation that allowed ScotGEM to proceed. The programme has a specific focus on rural practice, and we know that GP training, recruitment and retention are not just a Scottish problem but a global problem. Closer to us, Ireland is experiencing the same reduction in GP numbers in its remote western places. ScotGEM has proved to be very successful for NHS Dumfries and Galloway. I am a member of the British-Irish Parliamentary Assembly, and, in BIPA debates, I have cited ScotGEM as a model that could be replicated in Ireland. That has been welcomed and people have been positive when they have heard me speak about it.

Will the cabinet secretary comment on the success of the ScotGEM programme? Does he have figures for GP retention in rural areas once ScotGEM GPs graduate? We need to talk up some of the good-news stories.

As Colin Smyth knows, we have worked on that matter together with the minister, so I am aware of what was highlighted in the independent review with regard to having a midwife-led unit. There have been real recruitment challenges, which we have highlighted. It is an on-going issue that we are working with the minister to address, and I welcome that work.

I am conscious of the time. During the informal evidence session in the inquiry, the committee heard about issues to do with cancer pathways, including the fact that people in Stranraer and Wigtownshire have to go to Edinburgh for radiography, for example, although Glasgow is closer. D and G’s cancer pathway is linked with the south-east cancer network, which sends people to Edinburgh for radiotherapy, for instance, for part of their treatment. We have been asking for patients to be given a choice. Some people might choose to go to Edinburgh if they have family support there, but others might choose to go somewhere closer to home. The issue has been on-going for more than 20 years, and people have been campaigning about it. It will be interesting to see whether any progress can be made, including looking at the optimal place for people to receive services and offering people a choice as the bottom line.