Seòmar agus comataidhean

I acknowledge the Audit Scotland report, and we will work constructively with the Auditor General on the findings that are contained in it.

In June, I made a statement to the Parliament, setting out what my vision for health and social care services looks like and what reform and improvement need to deliver. I think that all of us around this table, across the Parliament and across health and social care services recognise that there is a need to shift the balance of care from our acute hospital settings into primary and community care services. This budget continues that process. It provides increased spending for general practice, a substantial increase in funding to primary care services in general, including ophthalmology, and more capacity for dental services and pharmacy. It also seeks to ensure that we utilise the capital and resource funding that is available to us to make use of innovation that is coming on stream.

As part of the national conversation, last week, I met the Health and Social Care Alliance Scotland-led stakeholder advisory group that is helping us to capture patient voice. I have regularly met our royal colleges and trade union representatives, including the British Medical Association, on recognising clinical voice. We will continue to meet academics and others so that the national conversation is on-going.

We all understand what needs to happen. There needs to be a shift in the balance of care: we need to ensure that we treat people earlier, prevent ill health, stop people’s ill health progressing into the hospital setting and keep them at home for as long as possible. There is much in the budget that helps to achieve that, including the expansion of hospital at home and support to free up our hospital services through investment in social care to prevent delayed discharge.

As I set out in June—in direct response, I think, to a question from Sandesh Gulhane—the challenge was around how we do this; how we shift the resource that is needed into primary and community settings without detriment to our secondary care services. We are all engaged in trying to deliver that. This budget starts the process, and I am very pleased that we are able to start making progress, because we need to ensure that we deliver a sustainable, productive and efficient health service that meets the needs of the people of Scotland.

I thank Mr Whittle for his question, and I understand where he is coming from. There is a balance to be struck around allocating fixed pots of money towards particular areas of investment. Mr Sweeney’s question was particularly directed towards mental health services, which I understand, but we must also ensure that our boards that deliver those services have the certainty of on-going, multiyear funding. That is where Alan Gray’s point around baselining is so important.

The situation is similar for drug and alcohol services, which we have given an additional £19 million of baseline funding to provide greater certainty to those who provide the services—through employment contracts for new staff, as opposed to providing short-term contracts. Those services provide certainty and additional baseline funding, and the providers know that that funding will be recurring, which will allow them to invest in more sustainable services.

I understand the premise of Mr Whittle’s question. I will follow up in writing to give clarity on where we envisage the funding going, which will be helpful to him because it will demonstrate that the funding is going to front-line services, delivering a more efficient and productive system and ensuring that those who deliver our front-line services have greater certainty on what they can invest in—this goes back to Mr Sweeney’s point about providing certainty through our budget—based not just on one year’s budget but on multi-annual funding. That will allow services to invest in clinics and projects over not just the short term but the longer term.

I understand Mr Sweeney’s question. It is a difficult situation. Whether it is in the health and social care budget or any other aspect of revenue and resource spending across Government, providing comparators can often be difficult, when in-year revisions take place because of Barnett consequentials or other in-year changes.

Obviously, we are looking for greater certainty on what our budget will be, which would be helped if United Kingdom Government spending reviews gave a greater trajectory towards what our financial allocations will look like. We also want to ensure that we have a stable budget that is balanced over the year. Due to the impact of austerity and spiralling UK inflation, we have had to make in-year budget revisions over the past couple of years, which we want to avoid doing this year. We want to give certainty to the system about what is coming forward.

With regard to providing clarity and detail, we are more than happy to provide written confirmation after this evidence session on the points that Mr Sweeney raises about the comparisons between one budget and the next or, indeed, between autumn budget revision and budget positions.

Gillian Mackay points to what I think is the greatest risk that we have in the coming year, not just in health and social care services but across the public sector, and that is the impact that the rise in national insurance contributions will have.

We do not yet have clarity or certainty about what that impact will look like. We know that, across the entirety of the public sector, including people who are contracted to deliver public services, such as GPs, social care providers, dentists and people in the community and voluntary sectors, the cost to Scotland will be approximately £750 million. We have had an indication from the UK Government that it will cover somewhere between £290 million and £350 million, which means that we will have an immediate substantial deficit of £400 million or more.

The funding that has been suggested thus far by the UK Government is only for those who are directly contracted in our public services; it does not cover people such as GPs and social care providers and people in the community and voluntary sectors, universities and so on. We face a substantial risk. We know from social care providers, including some GPs that I have spoken to, that the rise represents an existential risk for some of them.

The UK Government has rightly sought to raise revenue, but I do not believe that it understood the implication of choosing to raise that revenue from employer national insurance contributions. That is evidenced by the fact that we still do not have clarity in terms of what it describes as the mitigations relating to the damage that the move will cause. It could have chosen other ways of raising the revenue that is required to start to unpick austerity. It made the wrong choice, and that will have potentially catastrophic implications for not just health and social care services but public services in Scotland and across the UK. That is why I hope that committee colleagues will unite with the Scottish Government in saying that the issue must be quickly resolved at source by the UK Government, so that we can provide certainty to those employers—our GPs, social care providers and so on—that are seeking to make employment decisions right now but have no certainty about what their national insurance position is going to be.

Some of those providers will be disproportionately impacted because of the nature of the route that has been chosen by the UK Government, such as those with a higher number of staff who are paid at a lower salary rate.

One of the other issues that I believe is going to be problematic is that those who are contracted to provide more than 50 per cent of their business within the public sector will not be eligible for some of the relief that the UK Government has proposed. That, again, serves to illustrate to me that the move has not been properly thought through and that the UK Government has chosen the wrong area from which to raise revenue.

Again, I underline that the UK Government should raise revenue to invest in public services to start to undo the damage that austerity has done. The revenue that has been provided to the Scottish Government through the budget is very welcome—it starts to make progress. It does not answer all the questions from the Scottish Government or, indeed, other Governments. I genuinely believe that the UK Government went down the wrong route on raising revenue and that there will be clear and stark unintended consequences that it will have to resolve—and quickly.

Yes, I absolutely recognise that, but my point is that, when someone does not need an appointment, it is difficult to understand whether they would have needed an appointment in the first place.

Our preventative activity is about reducing the overall level of interaction with secondary care services, in particular. We want to reduce the level of acute admissions and to stop the escalation of people’s ill health. All that is wrapped into what we are seeking to do in the budget, especially with the £200 million that we have set aside for reducing waiting times, addressing the efficiency of flow in the system and reducing delayed discharge. That involves providing capacity to our social care providers and our primary care providers.

The issue is not only about general practice. We have a huge opportunity with ophthalmology in the community and from encouraging greater utilisation of our pharmacy first programme. A range of interventions are available. However, I again point to the fact that not all prevention will be achieved through health service intervention. Mr Whittle and other members have spoken about the importance of our sporting and leisure facilities, as well as that of cultural and other public service interventions.

Part of the discussion that we will be having with IJBs is about the deployment of the £100 million for improving the delayed discharges picture and ensuring that IJBs have the resource and certainty available to them to allow investment in care packages and care home support.

Mr FitzPatrick asked what my expectation would be. The reduction in the levels of reserves that Alan Gray has just narrated meets the fact that there is pressure across the public sector. I do not think that anyone would expect there to be high levels of reserves sitting there when there is fiscal pressure across public services. Those things need to be balanced. I acknowledge Audit Scotland’s report in that respect, and the Auditor General’s concern about ensuring that there is financial sustainability going forward.

We must continue to work with our partners in local government and health boards to ensure that there is funding sustainability for our IJBs so that they can continue to meet service demand and be sustainable over time. We need to ensure that that is a smooth process. Alan Gray talked about ensuring that the allocated reserves are there to allow investment over time and allow some of those multiyear projects to be delivered.

Sandesh Gulhane is right that there is an oral health inequality, but it has reduced substantially. I hope that Alan Gray has access to the figures. Child oral health inequality has reduced substantially. We have seen a reduction in the number of children who arrive at dental services with cavities, so the childsmile programme has clearly made an impact and reduced inequalities.

The reason why we have invested in general dental services and reform of the funding for NHS dentistry is to ensure that our dentists find carrying out NHS work more attractive. That is also why, in the budget, we are investing in increasing the number of dental training places so that we can increase the number of dentists coming into the system. We are increasing the number of Scotland-domiciled dental places by 10 because we recognise that it is an incredibly competitive environment for potential students to go into and we want to ensure that we maximise the number of dentists who come into the health service.

I am happy to provide greater detail on the reduction of childhood dental health inequality in the follow-up correspondence. The information gives a good summary of the progress that has been made and the impact that childsmile has made. I think that Mr Gulhane will welcome that.

I have set out the £2.2 billion allocation in the health and social care portfolios. The wider Scottish budget will take social care provision to almost £6 billion—across the wider spend that is contributing to provision—but the direct funding that comes from my health portfolio will be £2.2 billion.

We are looking at a wider cross-government infrastructure investment plan, to be delivered after the UK Government’s spending review in the spring. Once we—as we hope we will—get multi-annual funding and greater certainty around the capital position, that will allow us to have greater certainty around our capital plans.

I and others across Government wanted to make sure that we are able to take forward capital projects and to lift the pause on health capital spending. That has been illustrated through the investment in the Belford hospital, the eye pavilion and Monklands hospital. Monklands is in my constituency, so I am recused, from a Government decision-making perspective. Those are important areas of investment that we need to take forward. The capital investment that comes through the budget allows those projects to progress, but the big decision-making points will come after the UK spending review and publication of the infrastructure investment plan thereafter.