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Ms Mackay strikes right at the heart of the clear challenge that we are facing in the health service and in how we move forward with reform. If resource was aplenty, of course I would be looking to invest far more in primary care services to help with the prevention work and in community and voluntary sector organisations that are doing incredible work across all disciplines.

As part of mental health awareness week last week, I saw some of that work from a mental health perspective in Aberdeen Football Club Community Trust’s work on the changing room extra time initiative. That is incredible work to prevent more acute presentation. If resource was aplenty, we would go there.

Ms Mackay is right that we have to continue to sustain services, but we also need to drive change. That is where I hope that we will all be able to come together to discuss how we move human and financial resource to ensure that we are improving people’s health in the first place.

That will be most acutely felt in rural and island communities. Paula Speirs talked about the fragility of some services, because sometimes they are provided on a small team basis and, if one person moves on or retires, the service is compromised. We need to continue with the workforce planning perspective, but we also need to look at prevention. Supporting people through hospital at home in rural areas, for instance, is an important innovation. The community care model that treats people as close to home as possible has better outcomes, but it also prevents further deterioration in their health that requires greater intervention in the acute settings, which is what we want to avoid.

As Ms Harper will be aware, there are particular challenges around those in island communities being able to get to the mainland to access services. That means that they often need to travel by plane, which is incredibly costly and requires quite a bit of logistical planning. Ms Harper asked a direct question on whether we would review the situation for people in other rural areas, such as Dumfries and Galloway—the area Ms Harper represents—and the Borders. I am always happy to keep the arrangements under review.

I am cognisant of the financial challenges that are being faced by patients at the moment amid the UK cost crisis and, when it comes to being able to provide any extra funding, Ms Harper will understand the financial fragility that we are living with in government. I am always happy to continue to consider the situation. If Ms Harper has individual examples of where things have proved to be problematic I would be happy to hear about that, in order for us to have an informed review.

Mr Gulhane will be aware of the Scottish Government’s reaching 100 per cent—R100—programme that invests in broadband and supplements digital connectivity as an area of UK Government responsibility. The roll-out is going well and rural communities are being connected in a way that they would not have been had it not been for the Scottish Government’s investment. Work is also being done on mobile connectivity by some of the service providers.

I am racking the back of my former economy briefing brain, but I would be happy to ensure that colleagues in the economy portfolio furnish Mr Gulhane with more information on some of the work that is being done with service providers in rural and island communities to improve the availability of mobile internet connectivity. He is absolutely right that making sure that those areas are able to access digital services is critical, especially when that innovation will be most needed by and will be most appropriate for some of the rural areas.

I appreciate the opportunity to speak to the two Scottish statutory instruments relating to the regulation of independent healthcare in Scotland.

First, the inspections regulations will allow any suitably trained inspector who is authorised by Healthcare Improvement Scotland to inspect medical records. Currently, the regulations state that Healthcare Improvement Scotland can draw on medical practitioners, registered nurses, pharmacists, and registered dentists to inspect medical records during an inspection. That change will enable Healthcare Improvement Scotland to be more flexible in its approach to conducting independent healthcare service inspections.

The second SSI is the modification order, which has three distinct purposes. First, it will widen the definition of an independent clinic, so that Healthcare Improvement Scotland will regulate clinics where services are provided by pharmacists and pharmacy technicians. That will not include pharmacies that are already regulated by the General Pharmaceutical Council or services that are provided under NHS contracts.

Secondly, the order will amend the definition of “independent medical agency”. That provision will now include services that are provided by dental practitioners, registered nurses, registered midwives, dental care professionals, pharmacists and pharmacy technicians. The updated definition will also regulate wholly online services that are based in Scotland. I believe that to be a particularly urgent and important change.

The final purpose of the modification order is to enable Healthcare Improvement Scotland to cancel the registration of independent healthcare services that fail to pay their continuation fees. The inability of HIS to remove services from its register means that, at present, services that repeatedly fail to pay their fees can continue to operate in Scotland. Making that change is likely to have a positive impact on the willingness of providers to pay the fees that they owe and the provision is intended to be used as a last resort.

We have engaged with stakeholders and the wider public throughout the development of the modification order and our public consultation received support for the changes.

The SSIs that are being considered today will ensure that HIS continues to have the power to effectively regulate independent healthcare providers in this growing sector.

I do not think that there is a particular issue in respect of ensuring that we have greater cyberresilience in remote and rural areas. Having grown up in an island community, I know that when a system fails, physically going to a clinic or hospital service is more challenging, because of travel time, transport connections and so on but, from a cyberresilience perspective, I do not think that rural or island communities are any more likely to be targeted by criminal gangs, such as the one that targeted Dumfries and Galloway, than other communities would be.

I could not say for certain, but the work is on-going.

I have nothing further to add than what was discussed in the debate.

I move,

That the Health, Social Care and Sport Committee recommends that the National Health Service (Scotland) Act 1978 (Independent Health Care) Modification Order 2024 be approved.

That the Health, Social Care and Sport Committee recommends that the Healthcare Improvement Scotland (Inspections) Amendment Regulations 2024 [draft] be approved.

No—I have not said that. I was talking about the issues that we face regarding the workforce challenge. It would be remiss of anybody not to acknowledge the impact of making migration to the UK harder and the impact that Brexit has had. Indeed, I think that Mr Macaskill, who represents social care providers, would make those very points, too. Of course we have a responsibility to continue to deliver for social care, and we will continue to do all that we can, which is why we are looking to implement the national care service so that standards can be raised and can become more consistent—both for those working in the service and for those we are providing it for.

When decisions are made for us that are not in our interests and that are detrimental, of course I have to point those out, and Mr Gulhane will understand why I would need to do so. There was a 10 per cent drop in our workforce off the back of Brexit, and the new migration rules will make it much harder for social care providers to employ social care staff. It is understandable that I would wish to make such a comment.

We are working with the specialist advisory group at the moment on the stage 2 amendments, and we will be providing them to the committee as soon as we can.

I have already given the example of ScotGEM, where we have people coming through a training system that is dedicated to serving remote general practice. We are improving the situation with regard to GP numbers, which I think are up by 256, or 257, in recent years, and we have a record number of GPs—1,200—in training. I recognise that we need to go faster in order to meet the target. That is why, over recent years, we have added new GP training places to the system. I hope that, through the record level of GPs in training and the work that we are doing with ScotGEM—as Stephen Lea-Ross and Paula Speirs outlined, and as I highlighted—a large number of those new GP entrants will go into the rural communities that we wish to see continue to be sustainable.