Seòmar agus comataidhean

Again, I understand that being a query and an area of interrogation for the committee, but the Government has not taken a position on that as yet.

I note that those questions were considered by the previous panel, particularly in relation to prosecution policy and investigations. We have considered Mr McArthur’s equality impact assessment. Depending on the consideration that the committee gives to those questions, further work may be required post stage 1. However, at this stage, I will rest there.

Good morning, colleagues, and thank you very much for your invitation to give evidence to the committee on what is, as I am sure that you have found throughout your evidence gathering, a very sensitive and emotive topic.

As I outlined in my memorandum to the committee in September, the Government is taking a neutral position on Liam McArthur’s bill at this stage, and it is for the Parliament to decide whether it supports the general principles behind the bill. Given that, I am not in a position to comment on assisted dying in principle or on the individual provisions in the bill, beyond what I have already outlined in the memorandum.

It is important that I, as lead minister on the bill, and the Government, remain neutral while the Parliament carries out its scrutiny. However, my officials and I have been closely following the evidence that the committee has gathered over the past few months. The work that you have been doing and the evidence of stakeholders will play an important role in supporting our decision making on any amendments that we might wish to lodge, should it pass stage 1. I also look forward to reading the committee’s stage 1 report when it is published.

This is a hugely complex, emotive and contentious topic, and it remains my hope that, regardless of our personal views, we as MSPs will be able to work together across parties to ensure that the debate continues to be handled with the sensitivity that it requires and deserves. I am grateful to the committee for the respectful way in which it has handled its scrutiny thus far, and I thank you again for inviting me to give evidence on this important issue.

I am happy to bring Ms Crossan in to give further detail. A lot would be dependent on the service model that is put forward. I know that the British Medical Association has raised questions about the model and how it will be established. The point that you raise is correct.

That would be a financial undertaking and we would need to consider that, should an amendment of that nature be made. It would be for others to determine whether such an amendment would be within the scope of the bill. I recognise the work of the likes of Miles Briggs, and we are considering how to ensure that palliative care support is as extensive and equitable as possible as part of our strategy. The work that we are doing in that vein, as well as supporting our hospice sector and our health and social care services, aims to ensure the availability of palliative care at the point of need.

I thank Mr Whittle for his question, and I understand where he is coming from. There is a balance to be struck around allocating fixed pots of money towards particular areas of investment. Mr Sweeney’s question was particularly directed towards mental health services, which I understand, but we must also ensure that our boards that deliver those services have the certainty of on-going, multiyear funding. That is where Alan Gray’s point around baselining is so important.

The situation is similar for drug and alcohol services, which we have given an additional £19 million of baseline funding to provide greater certainty to those who provide the services—through employment contracts for new staff, as opposed to providing short-term contracts. Those services provide certainty and additional baseline funding, and the providers know that that funding will be recurring, which will allow them to invest in more sustainable services.

I understand the premise of Mr Whittle’s question. I will follow up in writing to give clarity on where we envisage the funding going, which will be helpful to him because it will demonstrate that the funding is going to front-line services, delivering a more efficient and productive system and ensuring that those who deliver our front-line services have greater certainty on what they can invest in—this goes back to Mr Sweeney’s point about providing certainty through our budget—based not just on one year’s budget but on multi-annual funding. That will allow services to invest in clinics and projects over not just the short term but the longer term.

There is progress on both, and we are happy to set that out in a letter to the committee after this session.

I acknowledge the Audit Scotland report, and we will work constructively with the Auditor General on the findings that are contained in it.

In June, I made a statement to the Parliament, setting out what my vision for health and social care services looks like and what reform and improvement need to deliver. I think that all of us around this table, across the Parliament and across health and social care services recognise that there is a need to shift the balance of care from our acute hospital settings into primary and community care services. This budget continues that process. It provides increased spending for general practice, a substantial increase in funding to primary care services in general, including ophthalmology, and more capacity for dental services and pharmacy. It also seeks to ensure that we utilise the capital and resource funding that is available to us to make use of innovation that is coming on stream.

As part of the national conversation, last week, I met the Health and Social Care Alliance Scotland-led stakeholder advisory group that is helping us to capture patient voice. I have regularly met our royal colleges and trade union representatives, including the British Medical Association, on recognising clinical voice. We will continue to meet academics and others so that the national conversation is on-going.

We all understand what needs to happen. There needs to be a shift in the balance of care: we need to ensure that we treat people earlier, prevent ill health, stop people’s ill health progressing into the hospital setting and keep them at home for as long as possible. There is much in the budget that helps to achieve that, including the expansion of hospital at home and support to free up our hospital services through investment in social care to prevent delayed discharge.

As I set out in June—in direct response, I think, to a question from Sandesh Gulhane—the challenge was around how we do this; how we shift the resource that is needed into primary and community settings without detriment to our secondary care services. We are all engaged in trying to deliver that. This budget starts the process, and I am very pleased that we are able to start making progress, because we need to ensure that we deliver a sustainable, productive and efficient health service that meets the needs of the people of Scotland.

Emma Harper is absolutely right. Looking at the health budget in isolation misses the cross-Government impact on, and contribution to, our health and wellbeing. She pointed to the example of a choir, and various organisations do incredible work for people that would not ordinarily be seen as a health intervention but which clearly is. I am thinking of Scottish Ballet’s work, which I was able to see when I was culture minister, as well as that of a number of cultural organisations that help with our physical health and wellbeing.

Community and voluntary organisations do incredible work in our communities. I am thinking of the national mission to reduce drugs deaths. In particular, there are phenomenal organisations that support individuals who have a drug dependency and their families. Those organisations are able to reach parts of our community that statutory services are unable to reach. There is a range of other interventions across various specialties, including cancer charities that do incredible work to support individuals. Those organisations provide a level of service that goes above and beyond what is provided from a statutory perspective.

I am clear about my appreciation and understanding of the central importance of our community and voluntary organisations; they supplement and add value to statutory interventions, and they can deliver services in an incredibly efficient way. I am very appreciative and cognisant of their impact. Since I have been health secretary, I have always encouraged our boards to continue to support community and voluntary organisations so that they can support the work that, as Emma Harper pointed out, makes a difference in individuals’ lives.

Mr Torrance is absolutely right to raise the issue. Multiyear settlements for Government would be incredibly helpful, and I hope that the spending review will deliver greater certainty for us. However, as I said to Mr Whittle and Mr Sweeney, I recognise that that is also incredibly important for our boards and for our community and voluntary sector partners, who help to deliver services. We want to do more in that area. In the proposed budget, we have baselined more of our budget and have provided greater certainty for mental health services, as I have referenced, and for alcohol and drug partnerships.

That is exactly what Mr Torrance is asking for and suggesting would be right for our public sector. I hope that I gave a pretty detailed answer to Mr Whittle on why that is important. However, certainty on the majority of our funding, which is the block grant, is the greatest barrier to that. The more certainty that we have on that front, the better. In that regard, I pray in aid the capital position. We have had increased capital investment from the UK Government for this year, but our longer-term trajectory makes it difficult for us to have certainty on the multiyear position. When you are building a hospital, in particular, or with other capital infrastructure projects, you need multiyear certainty, because capital investment is required on a multiyear basis.

I hope that that gives Mr Torrance clarity on why providing as much certainty as possible beyond a one-year budget settlement is so important.