Chamber and committees

That is a pertinent question on the wider issues that are beyond the control of the health and social care service in rural and island communities in being able to attract and retain staff. Mr Torrance rightly points to the issue of housing. I know from the most recent conversation that I had with NHS Highland about the situation at Portree that it is looking at what it can do from a housing perspective to support staff with their housing needs.

Wider measures such as the Scottish Government’s investment in the rural delivery plan and the emergency services key worker housing funds that we are bringing forward are designed to give local areas the ability to invest in ensuring that the social infrastructure is there to support people living and working in those communities and that those communities continue to be sustainable.

There are also wider political issues around attracting and retaining social care staff in particular. Mr Torrance and the committee will be aware of the recent decision of the UK Government to make it harder for social care staff to come to this country to work by stopping the dependants of those social care workers from being able to travel. Obviously, we are not in control of immigration and the decisions that are taken for us are having a detrimental impact on our ability to attract people to come and live and work here. Everybody is well aware that the impact of Brexit on our social care workforce was a near 10 per cent reduction in our social care staffing, almost overnight.

All of that strikes at the heart of the ability of social care providers to provide the services that we need them to provide, which has a knock-on impact not just on the people who we need to be providing those services for but on the rest of the health service, because there needs to be a clear flow through the health service and, if one part is under significant pressure, in this case social care, it has an impact elsewhere.

Paula Speirs would like to come in on the back of that.

It is the single island authority model. We are looking at what is possible with regard to local government and health boards working more closely together. Advanced discussions are going on with the island groups, with various levels of interest being expressed by those authorities.

In rural areas, there are more examples of that coming through.

Obviously, I am conscious of the need to ensure that we have as equitable access to health provision across Scotland’s geography as possible. Mr Sweeney points to an important conundrum on recruitment and retention. Typically, accident and emergency clinicians look for a fast-paced, ever-changing environment. That is what they thrive on. When I shadowed some accident and emergency shifts, that is what many of the A and E consultants told me. That is what drove them to go into accident and emergency, as opposed to any other specialty.

I have friends and family who use the Balfour hospital in Kirkwall. Far fewer people go through the accident and emergency department there than any of the accident and emergency departments in the central belt, for instance. That will have an impact on the attractiveness of the department. That is part of the reason why we have come through with the initiatives that Stephen Lea-Ross spoke about, to try to get people to specialise in remote, rural and island healthcare as early as possible. That means that they will probably take a more multidisciplinary approach to their training and will understand what they are going into. I hope that they will be more willing to stay in a remote and rural setting, understanding the fact that it is a very different environment from an accident and emergency department elsewhere.

I am also cognisant of the situation in Portree, which was a sad incident. My condolences go to the family of the person who lost their life. We are working with NHS Highland on bringing back 24-hour urgent care to Portree as quickly as possible.

I have not directly discussed the issue in relation to AHPs, but I am more than happy to take it away for Ms Mochan and report back. Indeed, I should probably be having such a discussion, so Ms Mochan’s suggestion is useful.

It is absolutely central, because we cannot have a sustainable and improving health service without a sustained and improving workforce. I am very proud of our incredible workforce. In the past 14 weeks, I have been able to see some of it in action. As health secretary, and previously as a user of the health service, I have seen the fantastic work that our workforce delivers.

On interaction with the workforce around reform, I am keen to hear directly from the workforce, its representatives and the trade unions on setting out how we move forward in a sustainable way and how we make sure that we continue to see improvements. I am keen to hear from the workforce about its ideas for changing how the health service works to make it more responsive to the needs of the people of Scotland and to make sure that it continues to be sustainable.

Having discussed the issue with people over the past few months, I know that that must be about making sure that we prevent ill health. The public health work that we are doing is of critical importance in making sure that we have a healthier population, in stopping the continued escalation in demand that we have on our health service and in making the shift on the flexibility of our employment patterns. We have seen some of that in the implementation of changes under agenda for change over recent weeks. That is where we will need to go, but that has to be informed by discussions with the workforce, which I am committed to having as part of the reform discussions.

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.

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.