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Yes, it does. I am aware that Dumfries and Galloway has benefited from the ScotGEM programme. I raised the issue at the last meeting of the four nations’ health ministers, where we discussed recruitment and retention issues—in particular, issues in our more rural areas. I highlighted the ScotGEM programme to the other ministers and I have offered to share our information on how the programme operates and the benefits that we have had from it. There is interest in looking at how the ScotGEM programme has worked.

On your latter point, it is still our objective to achieve the 10 per cent target within the current parliamentary session and to take that forward over the next three years.

I do not have the information on the specific measures that you asked about to hand, but I would be more than happy to come back to the committee to give it some more detail about specific measures that we are looking to take to address the consistency of service provision.

John Scott made a range of recommendations in his report, and we accepted all the key ones. Implementing some of them will require changes to primary legislation and I hope that we can aim to introduce primary legislation during the current parliamentary session to give effect to some of the measures that will be needed to do that.

Good morning, convener. Public Health Scotland continues to monitor Covid-19 levels and is testing for the new variants. That is largely being carried out through people who have been admitted into our hospitals, who might present with symptoms, and that is being used to inform our approach to how we continue to manage Covid-19.

Members will be aware that the decision was made a number of months ago, in line with other parts of the United Kingdom and countries globally, to manage Covid-19 in the way that we would manage any other seasonal infection. That continues to be our approach, but we are monitoring very closely any changes to the pattern and rates of infections. That will inform any further decisions that we make about any changes to our approach that we might have to make.

We will also continue to keep in place a range of testing arrangements for individuals who are being discharged from hospital into social care settings, for example. We have taken a slightly different approach on that from some parts of the UK in order to maintain a level of vigilance. That means that a level of testing is still taking place for vulnerable categories of patients, particularly if they are going to be transferred into social care settings.

We are engaged with the chief medical officer, who is engaged with the other CMOs across the UK, and work is being taken forward through the genome sequencing process, which is, obviously, operating at international level. I do not know the full clinical details around that, but work is being carried out to test the impact of the existing vaccination programme against the new variant.

I also understand that vaccine producers are monitoring whether they have to make any amendments to their existing vaccines, but all that work to monitor the on-going situation is being taken forward across the UK and globally. At this stage, we are still waiting for those reports to come back, but there is a level of vigilance in place to ensure that our decisions are made on an informed evidence base.

Our social care staff are critical in supporting and sustaining our health and social care systems, which are interlinked and are key to each other. The social care setting has traditionally been undervalued, which has been reflected in the rate of pay within social care compared to that in healthcare.

We have taken forward a programme of work to make social care a more attractive working environment and to reflect the value of our social care staff, which has resulted in an increase in their pay. Pay has been increased to £12 an hour over the past two years. We have already taken it up to £10.90, and the pay increase in the sector will be equivalent to more than 14 per cent in two years.

The objective behind that is to make care a more attractive profession and to support the retention of social care staff to make the sector more resilient. The principal objective is to try to get more people into care and to support and encourage those working there to remain there in future by providing them with better pay.

Any form of industrial action is hugely disruptive to our NHS, not only to staff and to the management process but to patients. To see that, we only have to look at England, where there has been repeated industrial action and where I believe that more than 7.5 million patients are on waiting lists and that almost a million procedures and appointments have been cancelled as a result. That is the immediate impact, and there will be a cumulative impact caused by backlogs in the system.

The system and staff are already under enormous pressure and adding persistent industrial action to that demoralises staff even further and makes them feel undervalued, bringing all the challenges that go with that. My deal with the junior doctors involved acknowledging and recognising the real challenges that they face because of pay erosion, and we managed to negotiate an agreement with them to avoid industrial action.

My big concern with industrial action is that it is not only disruptive to patients but demoralises people who work in the system even further, which has consequent challenges, and puts people off working in the NHS as a result of the disruption and difficulties.

There is a monetary cost to settling those matters. However, we would create even bigger challenges for ourselves if we did not try to address the issues. The challenges that we would have faced from industrial action would have been even greater—they would have been worse—than dealing with the financial challenges arising from the pay settlement.

NHS Education for Scotland will take forward work on the centre, which was announced last week. Given some of the specific challenges that we have in rural areas around the delivery and sustainability of primary care, as Tess White talked about this morning, the first two years of the programme will focus on primary care, which will be the centre’s initial priority. The centre will start that work as of October.

The burden of disease will continue to increase during the next 20 years by something in the region of 21 per cent, largely because of the demographic shift that we are experiencing as the population gets older. We need to do a number of things to tackle that burden of disease, one of which is to make sure that we are implementing all the right preventative measures to reduce the impact that lifestyle options can have on health. All the public health measures that we take to improve people’s health will be important.

Secondly, we need do all that we can to tackle the social inequalities that drive health inequality, including by tackling poverty and reducing child poverty. Those are key factors in helping to ensure that we focus on preventing ill-health because of social inequality.

Thirdly, we need to continue to develop and adapt our services to meet the increasing demand from older people and people who have multiple conditions so that we can manage their long-term conditions effectively in a way that improves their health and allows the health services to be sustainable.

Prevention is critical, but we also need to adapt our services to meet the increasing demand that we will face as our population gets older. We will also need effective integration between our health and social care services, given that they are critical to one another, particularly in helping older people to manage at home by giving them the support and assistance that they require.

I will probably bring in John Burns to say a bit more about some of the work that we do. The particular challenges that the rural boards face are that they can experience difficulty in recruiting specialist staff because the number of patients that they deal with in some departments means that positions are not so attractive to the staff who need to be recruited to them.

There are a number of reasons for that. For some time now, clinical care has been undergoing ever-increasing specialisation and has moved away from being provided on a more general basis. The general physicians whom we had many more of in the past are becoming fewer and more specialised. That has driven behaviour that results in clinicians wanting to work in specialist centres where there is much more throughput so that they can see the range of patients that they are looking for and build up experience and so on. That is much more challenging in our rural boards, especially given that the population levels are much lower and the boards are not able to sustain the same services.

For a number of years now, we have been putting in place arrangements for managed clinical networks in which we can use clinicians in some of our bigger centres to provide clinical support to boards in our rural and remote areas. Sometimes that involves their going out and holding clinics in those areas, and sometimes it is about supporting clinicians in those areas in their decision making and reviewing of patients. That is one of the ways in which we support our rural and island boards so that they can sustain services. Of course, that sometimes means that patients have to come into the larger clinician centres for specialist care and interventions.

John Burns can maybe say a bit more about some of that work, which has been on-going for some time now.