Seòmar agus comataidhean

A theme that has come up in many previous evidence sessions is income inequality and the fact that it prevents access to sports, especially, as was mentioned earlier, when the sport is particularly expensive to access in terms of transport, facilities, costs and equipment. What active steps is the Government taking to provide support in that regard, whether it is in the form of grants or loans for equipment or, potentially, even looking at things such as kit libraries? Is the Government looking to promote any particular measures to address income inequality as a measure of access?

I will touch on one other area: the rejection of CAMHS referrals. I note a significant increase in the pattern across Scotland in the past five or six years. In 2017-18, 11 people were re-referred in Fife; last year, it was 46. Over the same periods, in Grampian, the figure was 161 and it is now 260, and, in Lothian, the figure was 287 and is now 416. Why might GPs need to try more than once before they are successful in getting CAMHS referrals? Is that due to capacity? Are the thresholds higher than those that have been assessed by GPs as appropriate? I would be interested to get your insights on what might be going on in relation to that trend.

Are you confident that the level of re-referrals—I accept that it might be a narrow metric—will start to fall, given the measures that you have put in place, which mean that GPs are now aware of a more appropriate referral pathway? Is that what you are saying?

One point that came out quite strongly in a previous evidence session was that around 90 per cent of funding for sport in Scotland is channelled through local authorities. There is quite a highly disseminated model of funding. In that model, councils are faced with 80 per cent through central Government allocations and 20 per cent through council tax and charges.

There is a bit of pressure, to say the least, on council finances. Often, the first things to go are things that are seen as non-statutory service provisions. The focus is on areas such as social work and education, and things such as sport are seen as potentially less severe options when councils are looking to make savings or cuts.

What is your assessment of the impact of council finances on the provision of sport, particularly for women and girls and those kinds of specific facilities? What can you do to ameliorate that impact?

I know that there is a contested space around real-terms cuts from the Convention of Scottish Local Authorities. I would not want to get into that debate, because I think that the focus should be on what we can do to highlight risks in the estate that you mentioned, for example. Could things such as investment in district heating networks or capital investments be targeted? If councils are making decisions that involve a risk to the future provision of sport facilities in Scotland, is there a mechanism by which that risk can be flagged, and potential mitigating measures—for example, capital investments or targeted investments—looked at with the Government? Could there be opportunities to look at best practice in other authorities that have been able to crowd in some external investment, or where sponsorship or entrepreneurial activity has ameliorated the impact?

I wonder whether there is potential for a more developed ecosystem of feedback in relation to local government dealing with challenging situations on the ground versus sharing best practice and measures that have worked better. Swimming pools, for example, are energy-intensive assets. Could there be ways of investing capital into them to reduce the revenue costs? Is there potential to develop something there?

I note some of the points that you made about capacity and constraints. Those are a major concern. For example, you mentioned A and E departments being designed for a lower population. Do you have other metrics for assessing capacity and bottlenecks? I refer to process mapping of your services and areas of constraint around, say, key items of capital equipment such as computed tomography or magnetic resonance imaging scanners. Are those areas that you have identified as needing extra capital investment that would improve patient flow? Have you identified particular examples in your analysis of operations?

Do you think that that is effective? Could it be more efficient? Are there ways to improve it further?

NHS Lothian’s written evidence notes that you do not have a low-secure forensic unit and that there are no female high-secure beds in Scotland more widely, which means that people are being managed in units that are not suitable for them. How is your health board managing the lack of forensic mental health capacity? What could the Government do to improve the situation?

Thanks. That is great.

You have both highlighted what sound like quite impressive process improvement activities. From a cultural perspective across the health boards, how do you disseminate best practice? How do you benchmark against each other so that you are able to say, “Right. That is an excellent workstream. How do we carry that into the national picture so that we can make an impact?” Do you have a protocol or process for doing that?