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I want to pick up on the work of the COVID-19 Recovery Committee on its inquiry into dentistry services in Scotland. A number of stakeholders are concerned about those. For example, the British Dental Association said that

“uncertainty remains around whether”

the Scottish Government’s reform proposals will be enough to

“halt the exodus of dentists from NHS services”.

In my own experience, my recent check-up was cancelled for the first time ever because the permanent dentist had left the practice and it was relying on locums to cover appointments.

What is the Scottish Government doing to implement the recommendations of the COVID-19 Recovery Committee’s inquiry into NHS dental services, particularly on consideration of costing service model options?

I presume that that monitoring feeds back into the design of the services. However, trying to direct the immediate firefighting activity that goes on in an accident and emergency department towards building up that capacity might be a challenge. Dr Loughrey, do you have a view on the practical ways in which resource might be pulled out of areas in which there are people in crisis because they have not been dealt with earlier in their care journey?

It is clear from the submissions and the oral evidence that we have heard this morning that demand is at an unsustainable level and that simply inflating capacity, particularly in acute hospitals, is not an optimal solution. Relative to healthcare systems in other OECD countries, our expenditure share is much higher on acute hospitals and much lower in the primary care landscape.

How do we pivot to the fundamental restructure? How are you implementing a mechanism to monitor presentations in acute hospitals that could have been avoided had an intervention taken place in the community earlier? That could be as simple as providing heating for someone’s house, some pastoral support or whatever. How is that analysis being undertaken and how is that informing service design? How are you then responding to pull the system into the place that it needs to be in? Demand management is the key challenge.

The written evidence suggests that the rate and frequency of the reporting of performance data has been a challenge and that the process for feeding data back is labour intensive. Has any consideration been given to how that process could be streamlined so that pressure on staff can be reduced?

Is there a particular instance that springs to mind that might illustrate that point for us?

Yes.

I want to touch on some points that are made in the written submissions about potential waste in the healthcare system. The most valuable commodity in the national health service is time, but Community Pharmacy Scotland reports in its submission that

“Community pharmacists did not have read and write access ... to the patient ... record”

so they had to email or write to GPs with details of any changes. That antiquated process is taking up pharmacists’ time, and CPS says that it creates a “risk” in that patients might seek “further treatment” before their records are updated.

That is just one example. Other blockages came to light last winter that could be remedied with the support of technology. On the point about obvious waste in the system—CPS’s view is just one that has been highlighted—do you find other examples of difficulties that would benefit from parliamentary support?

That leads on quite well to my other question on the issue. I have heard, particularly from GPs in Glasgow, that people are so busy firefighting in their clinics day to day that their practices simply do not have enough time to consider innovations or improvements. That is a real frustration, because they know that digital solutions could help to alleviate some of the pressures that are facing primary care. The written submissions refer to digital care technologies such as NHS Near Me. Do any of you have views on how we can create a space not just to deploy technology, but to allow people to be trained and the technology to be embedded, particularly in primary care settings? I see that David Gibson has put up his hand.

You mentioned NHS Fife and the example in NHS Lanarkshire. When there are examples of good outputs being achieved and clear evidence that they reflect good performance, how does the system or the span of control at the Scottish level capture that and normalise it across the health board territories? There is quite a cluttered landscape—shall we say?—of management structures.

A number of the written submissions question how data from previous years has been used to evaluate the impact of winter planning and identify gaps and opportunities for improvement. It is clear that there are multiple concerns regarding last year’s plan alone.

One of the recommendations in the submission from Public Health Scotland and the Scottish directors of public health group is to

“Stop things that have not worked and not introduce anything that has not been evaluated in a robust way”.

Ahead of this year’s plan, has the Scottish Government undertaken any assessment of what has and has not worked well in previous winter plans? Can you highlight some examples?