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We have provided NHS Ayrshire and Arran with tailored financial support because of the pressures that it is facing. If you asked whether issues arise because my predecessor did not make decisions about X, Y or Z, I would say that my predecessor gave a commitment to increase health spending in this parliamentary session by 20 per cent, and we are well ahead of the trajectory for where we should be on that.

The decisions that my predecessor made have increased the investment that is put into health services ahead of what was planned—we are ahead of where we should be. That demonstrates the determination to provide as much financial support as possible and the urgency with which action is being taken to provide additional finance to our boards. In this financial year, there is an additional £730 million and, alongside that, a further £200 million of support.

None of that demonstrates a lack of urgency, understanding or leadership on doing what we can. However, our health service is experiencing the same challenges as other parts of the public sector are because we are going through a period of austerity, which is having a direct impact on the Scottish Government’s budget, and because inflation means that we are experiencing a significant increase in the costs that are associated with running public services, which is having an impact on those services. All of that is having an impact on our budget.

Another point that is worth not losing sight of is that we are still dealing with the pandemic’s consequences. Costs are still associated with Covid-19, but Barnett consequentials for dealing with Covid-19 have stopped, so we now have to meet those costs from core budgets.

Extra money is being provided where it is available, and that is being done earlier and more quickly, which shows urgency. However, alongside that is the fact that we must deal with a range of additional cost pressures, which are having a significant impact not just on health services but across the public sector and in society as a whole—households are also experiencing that in their budgets.

Some of that is geographically specific to your part of the world. For example, one challenge that we have around social care in my area is staff from social care going into areas such as healthcare, because they are more highly paid.

Historically, our social care workforce has been less valued than our healthcare workforce, which is reflected in the rate of pay. That has been the case for some time, and we have to try and address that. We provided additional funding to local authorities to support increases in social care staff pay partly to try to stem the loss of staff from social care into healthcare and other areas of employment where they can get higher rates of pay. We have a commitment to aim for £12 an hour over a period of time, and we are doing some work around what that timeframe will look like.

The other part is that we need to provide good career pathways for those who work in the social care setting, and provide them with opportunities to progress their career and move into other parts of the care setting. For example, someone with considerable social care experience might be interested in doing nursing, but might not necessarily have the academic qualifications that get them into a university place to do a nursing degree.

We are looking at aspects such as the nursing apprenticeship, and we are taking forward that work through the nursing and midwifery task force to look at how we can create pathways into areas such as nursing for people from social care. We want them to see that there is a very clear pathway for them to follow, but we also want to make the social care setting appear as a much more attractive professional setting for staff.

My view is that pay is a big part of that, and we will do what we can to try to help to address the issue, because, historically, social care work has been paid less and had a lower relative value than healthcare work, which has resulted in challenges around the social care workforce.

You will be more aware than I am whether there are shortages of particular labelled medication or their alternatives. We try to encourage prescribing of alternative medications that might serve the same purpose but might not be the prescribed medication that the person had previously been on.

I do not know whether John Burns can say a bit more about other aspects of prescribing. We try to work very closely with the pharmaceutical industry to smooth out issues around procurement and the availability of medication. Sometimes the challenges that we face are, as you rightly say, not peculiar purely to Scotland or the UK. They can be as a result of a worldwide shortage or other challenges. Some of that will be because of stockpiling of medication.

I cannot remember the exact medications, as it was before I had responsibility for health, but I remember some occasions in recent times when there was concern about access to certain medications—in particular, certain forms of antibiotics. I remember being involved in that and hearing a discussion in which the chief pharmaceutical officer was talking about procuring some medications in advance so that we could hold some of them in reserve, if necessary.

It is a matter of planning around procurement of the medication. Where there are concerns around supply chain issues, it can be a matter of trying to stockpile some medications where that is possible. It is not always possible for all drugs, as some of them may have a short shelf life, but it is about trying to manage those things as best we can within the structures that we have, through procurement and with the help of clinical advisers on procurement and the stockpiling of medication. Those would seem to be most appropriate ways to address the situation.

I acknowledge people’s concerns about the delays that have resulted from issues with the water supply and the ventilation system. If anything, though, the fact that those issues have been picked up demonstrates that lessons have been learned. The NHS assure service now has to sign off and approve a capital facility of that nature before it can be declared fit for use, and it has identified deficiencies and addressed those with the board. There are perhaps some lessons for the board with regard to how such a capital project should be managed and how it could possibly have avoided what happened, but the check system that we have in place has caught and identified the issue, and the appropriate measures will have to be taken.

As I have said, if anything, that demonstrates that we have learned lessons from previous experience of facilities that were about to be opened and problems that were identified. In this situation, the problems have been identified at an earlier stage in order to be addressed. Of course, that has resulted in some delay, and it would have been better if that had not happened in the first place. I expect us to look at what we can learn from NHS Grampian’s experience in taking the project forward, but I am reassured that the NHS assure process has captured and identified the problem to prevent its being embedded even further at a later stage in the project.

As you will be aware through the inquiry, funding is allocated to health boards through the NHS Scotland resource allocation committee formula, and is distributed on the basis of population share, geography, deprivation factors and so on. That approach has been taken for some time now and continues to be taken. As has been the case historically, we also provide tailored support to individual health boards if they face financial issues in-year and require financial support as a result. In the short term, therefore, if NHS Grampian requires additional financial support, we will try to provide it, if the funding is available.

Equally, we will continue to make progress with our use of the NRAC formula. I know that NHS Grampian has raised the issue of parity. As I have mentioned, we have already provided another £200 million in this financial year to try to close that gap further, and we will continue to try to do that in the medium term, too. We will, through the combination of short-term tailored support and the move towards NRAC parity, try to manage the issues for boards including NHS Grampian.

I am surprised by that, because I do not get such feedback when I talk to boards about the financial challenges. They readily acknowledge that we are aware of the significant pressures that they are under, so I am surprised if some have given you the impression that you described.

I think that I understand what you mean. Are you talking about providing more money?

You raise a really important point. A big part of some of the challenges that services have experienced in recent times has involved managing public expectation of services that are available and awareness of the most appropriate route to access them, whether that is at primary care level or at secondary care level.

We have set out a commitment to taking forward a national conversation, part of which involves the design and provision of healthcare services into the future. That includes how people access healthcare services: when it is appropriate to make a GP appointment and when it might be more appropriate to see a community pharmacist, a musculoskeletal physiotherapist or an advanced nurse practitioner, rather than a GP. It might sometimes be right to attend a minor injuries clinic. Thinking of my experience with constituents, I note that people will consider when they should go to minor injuries and when they should go to accident and emergency, so there is a question around how people understand the best route for them and when they should access emergency departments. There is a need for us to provide on-going dialogue, explanations and information about the best route to accessing the type of support and assistance that people may require at a particular time.

Turning to one of the things that we have introduced more in recent times, we have used NHS 24 to try and manage some of the challenge that we are experiencing in emergency departments in particular. The ability to contact NHS 24 allows people to speak to a clinician or advanced nurse practitioner, who is able to prescribe medication and have a discussion. They can then facilitate the person’s prescription, reducing the need to go and see a GP or attend the emergency department. We want people to understand and be aware that those initiatives are available to them, and they might be the best route for them to use.

It is not about doing one thing or the other. There is a need for us to continue a discussion and explore with people the options that are available to them and what might be the best option for them should they require to access healthcare services, whether digital, primary or secondary care.

I do not think that we will ever reach a point at which everyone will know the route that they should take. We will always have to provide an explanation to support people to make the right choices. I do not think that we have cracked it as well as we could. We could probably do more to help people to understand how they access their services.

Part of the future redesign of services is about engaging the public in the process of deciding what health services will look like and how they might want to access them. For example, I expect to be able to do much more digitally in the future, but I know that, for some people, particularly older people, that might not be the right route or tool for them. There will always be a natural transition as some people make more use of digital while others do not, and we need to make sure that we give people the options that best meet their needs as and when necessary.

Earlier, I mentioned that the burden of disease over the next 20 years is projected to increase by some 20-plus per cent. If we are to address that, we need a very clear focus on prevention, to try to reduce some of that burden of disease—in particular, as our population gets older and people live longer. The measures that we take on prevention—the public health measures, the immunisation programmes, the screening programmes—all play a critical role in that. That requires action at both primary and secondary care levels.

There is no doubt in my mind that we have to make sure that we do as much as we can around the prevention agenda if we are to manage what will be a very significant increase in the disease burden that we will experience over the next 20 years.

I do not know, but I am happy to check whether we have that data. I will come back to the committee on that.

On your wider point, I think that there is a lack of public understanding of the treatments that people can get from a community pharmacy. That is understandable. Let us say that someone has an eye infection and is thinking about making an appointment to see their GP. If they have a mild eye infection they could go and see their pharmacist, who will be able to prescribe a medication that can treat it appropriately. You mentioned inhalers for folk who have asthma or other airways diseases.

There is still a lack of understanding and recognition of what community pharmacies can provide, which is why there is a need for the on-going education of people around what is available through pharmacy services, which are a key part of our primary care services. We need people to use pharmacy services rather than just taking the traditional route of making a GP appointment. By using the community pharmacy, they could be seen more quickly and probably much closer to home.