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For clarity, I have already set out that there is clear demand for capital investment in the health estate. I recognise that and want to make progress. I recognise that our health service is still impacted by the effects of Covid—particularly on waiting lists—as we continue to work through the cancellations that occurred during the pandemic and work through the current backlogs. Additionally, individuals are now presenting at general practices and consultant clinics with more complex comorbidities than they did pre-Covid.

Part of that is, understandably, because we asked people to pause some elements of their care, and we are catching up with some of that now. During Covid, as we were literally confined to our own homes, we started to discover more about ourselves. As a result of greater awareness being raised, we are now, rightly, presenting to services and asking more questions about our care.

Regarding our response to Covid and the way that the health service has changed, it needs to deal with the backlogs, recognise people’s greater awareness of their own health and keep up with the changing ways that people who have more complex issues present to services.

The three documents that we published earlier this year are all about those things. The operational improvement plan is about the immediate operational demands that we need to address. The population health framework is about how, on a population basis, we need to be better at planning for our wellbeing and need to move upstream to a more preventative model. I recognise that it is not only a health service issue that needs to be answered. We must recognise the Organisation for Economic Co-operation and Development’s point that 80 per cent of the drivers of ill health—environmental factors, social factors and the drivers that come from poverty—are outside the health service’s responsibilities, and that is exactly where the Government’s prioritisation is going. We also need to address how, where and when we deliver our services. That comes through in the third document—the service renewal framework—which is more about the structural reform that we spoke about earlier.

Covid has had a profound impact on our health and social care services, which is why we need to make concerted, targeted and determined efforts to work through such challenges.

I need to defer that and come back to you in writing. I do not currently have that information, but I will ensure that that is part of the correspondence that comes back.

Yes. I understand that, and that is the constant dilemma between local and national decision making. Where we rightly expect there to be local decision making and priority set at a local level, the compromise is a level of variance.

To answer the first part of your question, although our territorial health boards are independent legal entities that are responsible for the delivery of services in their jurisdiction, yes, I bring them together at a national level and ensure that there is shared understanding of best practice, resolving challenges and ensuring that there are treatment pathways available and that we blur the boundaries between health boards.

I will give you an example. We recently changed the way that we deliver planned care services, so that we have national treatment centres that people are referred to from territorial boards and regional treatment hubs, because we recognise that ensuring that treatment is delivered in the fastest way possible sometimes means delivering at a national rather than a regional or local level. That is where our regular interactions with board chairs and chief executives ensure that there is greater co-ordination. I expect that in planned care, in particular, but also in some acute services. The service renewal framework will allow us to have better co-ordination of services between board boundaries than we have right now.

It goes back to the point that this is about specialisation rather than centralisation. On the point about patients having to travel, the national treatment centre initiative has demonstrated that it does not always have to be patients from rural areas travelling to the central belt. The national treatment centre Highland is a good example of patients travelling north from parts of the central belt. As someone who is originally from Orkney, it pleases me greatly that we have that level of co-ordination and that, rather than people having to travel towards the central belt, a level of service is being delivered in some of our more rural communities and is serving their interests, too.

A balance needs to be struck. Sometimes, we might need to take decisions nationally on diagnostic or treatment pathways; at other times, it is for local boards to determine how best to deliver and to serve patients in their areas, and they sometimes work in concert with other boards. Regardless of whether it is us, in Government, who help—whether through a cancer pathway or specialisation, or by ensuring that we provide neonatal services for the sickest babies—a condition must go through an assessment of need.

In response to your exact questions, convener, it is about ensuring that we provide a service that is specialised but that does not restrict people’s access to it. Careful consideration has to be given, and public consultation and clinical input must be involved, to ensure that we provide the best services for people.

Mr Ewing and I, along with GPs in his constituency and with Mr Mountain, have corresponded and met repeatedly on the issue, and I well recognise the concerns that have been raised. I recognise the case that he has raises, but he will forgive me, because I clearly cannot comment on it.

Access to the whooping cough vaccine is clearly very important. Given the geopolitical discourse that has taken place this week, I encourage any expectant mother to access a vaccine that they are eligible for. As we approach winter, we should also take the opportunity to remind colleagues that they should take up the vaccines that are available to them, because of the preventative benefits that they offer. Vaccines are among the best public health measures that are available to us.

Mr Ewing asked why the contract change happened in the first place. In the lead-up to 2018, a request came from the British Medical Association during the GP contract negotiations. There is flexibility in the contract for local boards to take alternative measures, which, as I have made clear in my work with NHS Highland, needs to happen. There has been an assessment of the situation in Highland, and there will be flexibility in offering vaccination clinics, which GPs will lead on.

I have corresponded with Mr Ewing on the issue, and we are currently in discussions with the British Medical Association about its future funding provision and the services that it provides as a result. If requests come from the BMA again, we will consider them.

Convener, I thank Edward Mountain for raising the issue, as he has done in correspondence with me, persistently ensuring that the needs of his constituents in the Highlands are across my desk on this issue and on others. As he will understand, I well know what that trip from Wick to Inverness looks like—I commute it regularly—so I well understand the challenge of accessing a service, even in Raigmore, for patients elsewhere in the Highlands.

A review of the national provision of vascular services is on-going. An interim position is in place at the moment to support the acute need for support for Highland vascular services. We are looking to move to a model that would ensure better vascular provision not just for the Highlands but across Scotland, to be delivered on population-based need while also understanding the clear points that Mr Mountain raised about travel within the Highlands and between the Highlands and other parts of the country. I will be happy to correspond with Mr Mountain on what that review is looking at.

On the cancer front, we work very closely with the Scottish cancer network, the Scottish Cancer Coalition and individual cancer charities that either help to fund and support research or are looking for us to provide that research funding. Cancer Research UK has a large footprint in Scotland. In its most recent session in the Parliament, it recognised that Scotland leads the world in many aspects of its cancer research work.

I am incredibly grateful for the work that is done by health boards and clinicians as well as by the academic community and industry to consider novel cancer treatments and diagnostic opportunities. We look to see that work continue to advance through the triple helix approach.

Through the work of the Less Survivable Cancers Taskforce, I am conscious of the need to ensure that, for some of those cancers that are hardest to detect and are less survivable, earlier interventions and novel treatments are developed. We continue to work with that group and the stakeholder organisations to help to deliver that.

One of the most experienced, shall we say.

I thank Mr Ewing for his advocacy on behalf of Mary Ramsay, who was on “Good Morning Scotland” this morning, giving very good testimony about the situation. I represent a constituent who has had essential tremor for some time, and I know that an ultrasound service, such as the one that Mr Ewing mentions, is being provided in Tayside. I recognise that travelling for treatment is a challenge for some people. If someone cannot get to Tayside, for whatever reason, the potential for travel to Liverpool or London is available, although I imagine that most people who are able to get to Liverpool or London are able to get to Tayside.

I will keep under review whether that provision needs to be broadened beyond being a specialist service in Tayside. We will work in concert with National Services Scotland, and, if it were found that a service had a level of demand that would merit provision being expanded beyond one specialist service in Scotland, that is something that we would consider.

I will need to check that. I am not aware of the answer, but I am happy to provide a response.