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We are in discussions with NHS Grampian on the point to which Ms White referred and the particular example that she highlighted, which she has also raised in the chamber. We have been working with NHS Grampian to look at what it is doing. That includes work to improve the flow through the hospital so that we are not seeing ambulances stacked up outside.

The national centre for sustainable delivery is doing work to look at how we ensure that those who are in our hospitals actually need to be there and at how we can improve the delayed discharge picture so that we have hospital beds available. Ultimately, that is at the heart of why we have had delays, certainly in Scotland. I cannot speak for the rest of the UK, but that is certainly what I am picking up here. If we are seeing delays in ambulances being able to turn around at hospital, that is largely because of a lack of availability of beds.

We are using the centre for sustainable delivery to identify patients who can be discharged and get them discharged as quickly as possible, and thereby bring down the average hospital occupancy time. We are also working on that with our local government partners. I work closely with Councillor Paul Kelly of the Convention of Scottish Local Authorities, and we have agreed on work that is to be done across Scotland on giving people patient discharge dates, discharging before noon and weekend discharge. We are looking at everything that we possibly can to get people to where they should be, which is either at home or in the community, rather than in hospital.

We are also doing more focused work with our health and social care partners in Grampian on whether anything further can be done to improve the delayed discharge picture and to improve integration in NHS Grampian. I would be happy to update the committee on that work.

That is under active consideration, as Ms White will understand, given what happened on Skye recently. Sir Lewis Ritchie undertook a review of the services on Skye; with him, I met NHS Highland, and I expect to have a delivery plan from the board for how that review and its recommendations can return to implementation. The review was implemented for a period, but there were issues with sustainability, for the pertinent reasons that we have heard around attracting and retaining staff in rural and island communities. I am keen to ensure that Highland can deliver on that.

That is a microcosm of what we need to see to a much greater extent across the country. We are working with our rural boards in the areas that I have set out, which include supporting our workforce and supporting the work that NHS Education for Scotland is doing to provide education and training so that urgent care services in remote and rural areas can continue to be sustainable.

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.

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.

No. We consulted the British Medical Association and others directly on the implementation of the 2018 contract. It is obviously very difficult to bring forward something that takes a one-size-fits-all approach, while understanding that there will potentially be an impact of that.

That is partly why we are working to ensure that we have multidisciplinary teams coming through; looking at the primary care improvement plan; and providing investments so that we continue to see further investment in primary care in rural communities. It is also why we are continuing to support initiatives such as ScotGEM, which is about encouraging people who are going through medical training to specialise in rural general practice. We recognise the need to ensure that we continue to support rural general practice.

As I said, I was born and brought up in Orkney, and I recognise the role that general practitioners play in rural communities. Those general practices are anchor institutions, and they are a critical element of the sustainability of those communities. I am passionate, therefore, about ensuring that we continue to support rural general practice so that it is sustainable, and so that we continue to have a primary care service in rural and island communities to prevent further ill health among people who might otherwise end up in secondary or acute care.

That is part of the reform and improvement discussions that I hope to bring forward later this month. I will be looking to work with all parties, and others who are represented around the table, to ensure that we take forward the best ideas for how we can put the NHS on a sustainable, improved and recovering footing as we move forward.

It is about making sure that we continue to see a sustainable workforce for our rural and island communities. It is in development; we have already set out the fact that some of the work is very much live. The focus is on ensuring that we continue to see a supportive and encouraging workforce strategy that ensures that we have a strong recruitment and retention policy for rural and island communities.