Seòmar agus comataidhean

I note those comments on Mr McArthur’s endeavours. It is for the Parliament to decide on the bill at stage 1. We would then need to consider our position on the basis of what we have set out prior to the stage 1 debate, including what I set out in the memorandum. We would explore any opportunities should the bill pass stage 1.

I heard the evidence that was given earlier and I note the debate that is being had and the points that have been put across. I hope that Mr Gulhane will accept that I cannot put forward a position on the matter; it is for the committee and the Parliament to determine. As the lead minister on a bill on which the Government has taken a neutral position, I cannot influence people’s consideration of the issue in any way.

Emma Harper is absolutely right. Looking at the health budget in isolation misses the cross-Government impact on, and contribution to, our health and wellbeing. She pointed to the example of a choir, and various organisations do incredible work for people that would not ordinarily be seen as a health intervention but which clearly is. I am thinking of Scottish Ballet’s work, which I was able to see when I was culture minister, as well as that of a number of cultural organisations that help with our physical health and wellbeing.

Community and voluntary organisations do incredible work in our communities. I am thinking of the national mission to reduce drugs deaths. In particular, there are phenomenal organisations that support individuals who have a drug dependency and their families. Those organisations are able to reach parts of our community that statutory services are unable to reach. There is a range of other interventions across various specialties, including cancer charities that do incredible work to support individuals. Those organisations provide a level of service that goes above and beyond what is provided from a statutory perspective.

I am clear about my appreciation and understanding of the central importance of our community and voluntary organisations; they supplement and add value to statutory interventions, and they can deliver services in an incredibly efficient way. I am very appreciative and cognisant of their impact. Since I have been health secretary, I have always encouraged our boards to continue to support community and voluntary organisations so that they can support the work that, as Emma Harper pointed out, makes a difference in individuals’ lives.

Mr Torrance is absolutely right to raise the issue. Multiyear settlements for Government would be incredibly helpful, and I hope that the spending review will deliver greater certainty for us. However, as I said to Mr Whittle and Mr Sweeney, I recognise that that is also incredibly important for our boards and for our community and voluntary sector partners, who help to deliver services. We want to do more in that area. In the proposed budget, we have baselined more of our budget and have provided greater certainty for mental health services, as I have referenced, and for alcohol and drug partnerships.

That is exactly what Mr Torrance is asking for and suggesting would be right for our public sector. I hope that I gave a pretty detailed answer to Mr Whittle on why that is important. However, certainty on the majority of our funding, which is the block grant, is the greatest barrier to that. The more certainty that we have on that front, the better. In that regard, I pray in aid the capital position. We have had increased capital investment from the UK Government for this year, but our longer-term trajectory makes it difficult for us to have certainty on the multiyear position. When you are building a hospital, in particular, or with other capital infrastructure projects, you need multiyear certainty, because capital investment is required on a multiyear basis.

I hope that that gives Mr Torrance clarity on why providing as much certainty as possible beyond a one-year budget settlement is so important.

That is a challenge. We need to ensure that we fairly remunerate our incredible staff and that we incentivise people to choose careers in health and social care even when some of their skills could be deployed in other parts of the public sector or the economy.

I am very proud of the fact that we have provided pay deals—not just this year but in previous years—that mean that, for the majority, our health and social care staff are the best paid in the UK. We have made sure that our consultants are paid competitively compared to consultants in other parts of the UK, and we have matched UK pay review body recommendations for many, including our general practitioners.

Ms Mackay is right that balancing that to ensure that we deliver service sustainability is an important consideration. However, we need staff, including front-line staff, to be able to deliver against the clear objectives that I have set out in relation to the budget. Those objectives are: to reduce delayed discharge, which means increasing social care capacity; to increase the accessibility of primary care and general practice; and to reduce waiting times. We will need to buy greater provision, which means greater investment in staff. There is always a balancing act to be done. That is why we have set out clear support to our boards around the 15-box grid that I referred to in order to achieve recurring financial savings and service improvement to maximise the capacity of clinicians and staff and so that the productivity and efficiency of the system are sound.

The utilisation of innovation to free up clinical time and the advent of the theatre utilisation tool, which is delivering 20 per cent increased efficiency in our theatres, represent more examples of how we can ensure that every penny and every pound that we invest in the health service go further. That helps to ensure that the investments that we are making in our staff, which I am proud to make, can continue and can be sustainably achieved in the future.

I accept that that will continue to be challenging, but it is important that we continue to push for maximum efficiency and productivity in our health service. We need to make sure that every penny and pound that are invested go as far as possible. That is why we have the national conversation, through which we are working with our clinicians—to ensure that reform and improvement are clinically led and managerially enabled—and which is about reducing the areas of low clinical benefit.

It is about making sure that we successfully deploy polypharmacy reviews. We know that the cost to the health service of people who are on multiple prescriptions—10-plus prescriptions—is about £350 million a year. A lot of work is going on to reduce the potential harm that can come from that. Polypharmacy reviews are important in reducing prescribing rates and making sure that we continue to practise realistic medicine in delivering better outcomes for patients. Those are some of the areas that boards can look to and that are in the 15-box grid that we provide to them.

It is also about more positive innovations, rather than feeling that service detriment can come from such decisions. It is about embracing innovation—a point that I know Mr Whittle is particularly interested in—and making sure that we free up greater clinical capacity to deliver the parts of care that can be delivered only by humans and the care, compassion and loving approach that our clinicians deliver. There is a range of areas that our boards can look to.

I recognise that delivering recurring savings will continue to be challenging, because we have asked boards to do that in recent years, too. However, as Mr Whittle said, it is vitally important for the public to be able see the £21 billion budget being delivered as efficiently and effectively as possible and delivering the greatest bang for its buck.

In the 35 seconds that I have available, I will agree that we need to shift to a more preventative model. We have provided a real-terms increase to local government, with more than £1 billion extra in the budget.

I recognise that, as is the case with the health budget increase, there will still be pressures across local government—of course there will be. We have had a decade and a half of austerity that has eroded the potential for investment in our public services. However, the 2025-26 budget directs funding to public service investment for exactly the reasons that Mr Whittle has set out. I very much recognise the extent to which health is affected by many other portfolio spending areas. Mr Whittle gave the example of the role that local government plays in providing leisure facilities and sporting facilities. I hope that the budget will help to support those facilities and that the impacts that he has suggested will occur are not an inevitability, because of the investment that we are making.

Measuring prevention is, by its nature, difficult, because it is difficult to know what you have stopped happening.

However, I recognise Mr Whittle’s point. We can look to a number of areas. For example, we are working with the British Medical Association on how we can get more data through from general practice. Primary care is where the bulk of the preventative activity in health spending occurs. Because the provision of primary care is contracted, it is difficult to have a clear picture of where improvements are happening. That said, according to the most recent figures that are available, the number of GP appointments has gone up substantially. In October, there were 8.3 million interactions across the entire multidisciplinary team in general practice, which represents an increase of almost 900,000 on the previous month. The number of such interactions has gone up by a substantial amount year on year.

We know that the level of engagement has increased and that we need to increase capacity. We need to work with the BMA on how we can record what those interactions are doing so that we can have a greater understanding of what they are preventing. That is what Mr Whittle is asking for, and I know that the BMA is up for that and that it wants to continue to provide the answer to those questions.

A huge amount of work is being done by the chief medical officer, along with clinicians, on cardiovascular disease prevention. That is an area that we are seeking to prioritise this year, for all the reasons that Mr Whittle has set out.

A number of conversations are on-going with local government and health boards around social care provision and national care service reform. We have obviously paused stage 2 of the National Care Service (Scotland) Bill to allow for consideration among political parties, as well as discussion with local government. We are looking at what is possible in the budget, with the £100 million that is there, to improve the picture in delayed discharge. I expect a substantial amount of that funding to go into social care provision and to arrive at IJBs in one way or another, whether that is through health boards directly or through local government.

We recognise that we need reform and that we need to improve financial transparency and accountability, and to take account of the service user and carer voices in the process. All those matters are part of our discussions and considerations with local government and other political parties about the next stage of the National Care Service (Scotland) Bill and how we will deploy the £100 million that is there to improve the delayed discharge picture.

There is progress on both, and we are happy to set that out in a letter to the committee after this session.