Seòmar agus comataidhean

That is a major concern for me. Since coming into post, one of the areas that I have had the greatest concern about is the rise in agency and locum costs. In some areas, that cost is unavoidable, and we need to invest to ensure service continuation. However, I want to take a longer-term approach, and I hope that some of the reform discussion that we will have later this month and, going into the rest of the year, the reform and improvement work can focus on how we make sure that we have the culture and management structures in place that allow greater flexibility for workforce so that we are attracting and retaining staff.

We have a number of areas of intervention including bursaries and golden hellos to try to attract people to rural and island areas in particular on a sustainable basis, so that we can avoid the need for locum and agency cover. That cost increase over recent years is a major concern for me and one that I wish to tackle.

I would be happy to follow up on that in writing, and Paula Speirs wishes to come in on that.

Integration has happened at a different pace in different parts of the country. There are some good examples of integration working well, as I was able to see, for instance, in Shetland, where there has been very strong integration in health and social care across all levels of public sector delivery, which allows decision making to be informed on the basis of service delivery. I point Ms Maguire and the committee to that very good example. There are other areas where levels of integration could definitely be better, however, and that is part of the reason why I believe that the national care service is the right thing for bringing things forward from a service delivery perspective.

I am conscious that Ms Maguire is looking at the wider issue of service delivery around social infrastructure, housing and childcare, for instance. I believe that that comes from the discussions that are taking place on an integration basis. Where we can improve on that, obviously we will.

First, I am pleased to hear that the committee was in Skye last week. Initially, there was a suggestion that I might have joined you there for that evidence session, but I am very pleased to be here this morning and grateful for the opportunity to discuss what is a very important issue for me, having been born and brought up in Orkney.

Like other colleagues around the table, I understand well the importance of delivering health and social care services in rural and island communities, and I also recognise the challenges therein. I am very much looking forward to seeing more of the work that comes through from the committee, and I am very grateful for the work that you are doing.

I will bring in colleagues on the progress that has been made off the back of the centre’s establishment, which has had financial support from the Scottish Government.

The centre has also led to the development of a rural and island workforce recruitment strategy by the end of this year, because the Government recognises that, for all elements of the health and social care service, but particularly in rural and island communities, the workforce is critical to ensuring that we can deliver services. Having that strategy is critical, and I believe that the task and finish group is meeting right now to discuss continuing that work. I do not know whether colleagues wish to add to that.

That points to some of what I was referring to in response to Ms Mackay.

The use of innovation in our health service is going to be critical. Some of that is already in place—Ms Harper spoke about Near Me, which is currently in use—but there is more that we could do to ensure that we continue to utilise some of that innovation to a greater extent.

We also need to look at some of the innovations with regard to digital technology and the advances—if they are ethically used—in artificial intelligence. Critically, we need to ensure—as Ms Harper was driving at in her question—that that is done in not only an ethical way, but an equitable way, so that those who are in remote and rural areas can benefit from such innovations if they choose to do so, and take advantage of that way of working.

I am very keen to use innovation—as I have set out, it will be central to our being able to see reform and improvement in our health service in a way that maintains capacity and the opportunity for caring by those—the medical professionals and staff who work across our health service—whom we task with supporting patients coming through the system.

Like Ms White, my thoughts are with the family of the little girl to whom she referred. Those incidents are tragic examples that we wish to avoid, and everything that we do as a Government, and as health boards and services, is to try to prevent such situations from happening.

Ms White is correct about the pressures on the Ambulance Service and about those pressures not being unique to Scotland. Unfortunately, we have seen the type of ambulance stacking that we saw at Aberdeen royal infirmary elsewhere in the UK, too. That is partly due to the significant increase in demand that we have seen. We are seeing a clear increase in demand on our ambulance services. We also need to have those services in the right place to respond to incidents such as those that Ms White spoke about.

We have made a significant investment in our Ambulance Service to support an increase in the number of practitioners and paramedics working within it to respond. We are also working with boards on how they can make sure that the flow at their hospitals is working better.

That goes back to the point that I mentioned about the importance of social care to our health service. It is important that we get our social care services working for the people who need them, but delays in social care also have an impact that goes all the way back through the hospital, right up to the front door, where ambulances are stacked outside because of the pressure in the hospital. That pressure is not necessarily in accident and emergency, although that is sometimes the case; it might be about accessing beds in the hospital.

We are making investments in all areas of the system to relieve that pressure. We can see that that is working, but it needs to move faster in order for us to see continued improvement in the services that we have available to us.

A significant number of people who would be considered to be in the delayed discharge category are adults who have incapacity, which is an incredibly complicated area. I will take up Ruth Maguire’s invitation and encourage people to ensure that they have power of attorney arrangements in place, as well as arrangements that allow for people to get access to the health and social care services that they need. As a Government, we are looking to introduce legislation on adults with incapacity in order to make sure that we are improving the system and the services for it. My colleague Jenni Minto has responsibility for that bill and we are looking at it during this parliamentary term.

The orders do not cover that area, but we are looking to introduce legislation that would cover it, because I share Dr Gulhane’s concern about it.

The orders will widen the scope of regulations that are already in place, but we are looking to expand what is covered through legislation, as my colleague, Jenni Minto, has already outlined to Parliament.

The Scottish cosmetic interventions expert group’s phase 2 recommendations include the introduction of legislation to regulate the administration of non-surgical cosmetic procedures. Following the 2020 consultation on the regulation of those procedures, our initial priority, from a clinical safety perspective, was to consider regulating the administration of dermal fillers. As we are aware, if they are administered incorrectly, they often cause long-term damage that can be reversed or limited only by the urgent administration of specific prescription-only medication.

Because of the number of non-surgical cosmetic procedures that are now available, we are working with our stakeholders to consider the potential scope of further regulation that is needed within the area. The stakeholders include: healthcare professionals who represent the British College of Aesthetic Medicine and the British Association of Cosmetic Nurses; hair and beauty industry representatives; environmental health officers; and HIS. Their input is hugely valued.

It is also worth noting that part of the phase 3 recommendations of the interventions expert group was to consider independent services that are provided by other healthcare professionals who are not currently included in the “independent clinic” definition. Our work today to add pharmacists and pharmacy technicians is an important step forward, but I absolutely share Dr Gulhane’s concern. We are working to expand some of that regulation to take in the areas of concern that he set out.

That goes beyond what is in the orders that are before us today, but I would be happy to have a further conversation with Dr Gulhane about the on-going work that we are doing on expanding regulation of cosmetic procedures, including the detail that Dr Gulhane is looking for, which is part of the consultation and discussions that we are having with stakeholders.

I am happy to reiterate what I set out earlier: I share Dr Gulhane’s concern and the work is on-going. The regulations take us a step forward, but it is imperative that we continue our work to widen regulation of that area. I am happy to come back to the committee with more information on the on-going work on that.

Motions agreed to,

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.

Yes. I co-chair the nursing and midwifery task force. There are areas of work that it is clear that colleagues on that group are keen to expand on, and given that recruitment and retention is obviously a very strong and live area, there will be a crossover between the work on the strategy and the work of the task force.

To follow up on Mr Sweeney’s question whether social care will be covered by the strategy, the advisory group includes the Convention of Scottish Local Authorities, Scottish Government officials and health board representatives, so social care will be covered.