Seòmar agus comataidhean

Yes, I think so. There is always an ambition to invest much more in preventative healthcare where we can. That is challenging when we are in a very difficult financial environment and given the significant demand that services are facing. Notwithstanding that, however, we should do that where we have the opportunity. We have committed to exploring issues around a public health levy over the next year and I think that, if its introduction is agreed to, it would provide an opportunity for investment in other areas of preventative spend.

We should also recognise that innovation in technology can play an important part in some of the preventative approaches that we pursue. I mentioned the work on diabetes. New digital technology could have a real impact in reducing the side effects that people can experience as a result of diabetes and in helping them to live more healthily. We know that that will have a preventative effect in the future because of the benefits that come from it. We know that the use of AI in radiography can help to identify issues at an earlier stage and allow for earlier intervention, which could further reduce expenditure in the future.

Technology and innovation can play a really important part in ensuring that we do more in the preventative space, and any additional investment that might come through a public health levy in future years to support that would be very welcome.

You are right that mental health services are about 8.8 per cent of our expenditure at present and I hope that we will have those services at 10 per cent by the end of this parliamentary session. That will depend on future budgets and the availability of finance, but it would certainly be our intention to do that. As I said earlier, however, there has been a very significant uplift in mental health expenditure since 2020-21. The level of Scottish Government investment in the area has more than doubled, but 10 per cent is still our ambition. We are at 8.8 per cent and we need to look at whether budgets in future years will allow us to continue the increase to achieve a 10 per cent allocation.

It is an operational issue, so I would expect it to be dealt with by boards. They have a whole executive team, so if there was an issue around safe staffing in a particular ward, I would expect that to be escalated through the board’s local management structure—eventually, I presume, to the director of nursing and, if necessary, to the chief executive.

If a wider systemic problem was being experienced and it was brought to our attention, we would certainly want to raise that with the board. In terms of day-to-day operations, it would be the responsibility of the individual board to deal with the matter. However, if there was a wider systemic issue, I would certainly be concerned about that and I would want to take action if there was a problem in a board.

Eventually, it will be a self-funding model, but the proposed arrangement will operate for the initial couple of years, in order to get the regulatory process up and running. As the workforce expands, it will be a self-funding model, which is the way in which most of the regulators now operate. The proposed arrangement is part of the initial process to support the GMC in taking on the regulatory role.

At present, PAs are unregulated. In Scotland, we have a very small cohort of around 150 of them operating in the NHS. Back in 2016, we issued direction around the type of role and the scope of role that could be held by a PA in NHS Scotland, so that is already defined. As the GMC takes on the regulatory function, it will be responsible for setting out the relevant definitions and the terms of those definitions.

I understand the concern. I will ask Nigel Robinson to say a wee bit more about the practical application of the process and how the GMC might address some of these issues.

We are looking for the national board to take forward that work. I will let Scott Wood say a bit more about that, but we need to ensure that there is a consistent approach.

By and large, we do not get a Barnett consequential for social care. There is no direct Barnett consequential for that in the way in which there is for health.

There are a couple of different routes through which money flows into social care. We provide funding to local authorities. Some health boards will invest in social care provision alongside some of the central funding that we provide for social care. That is largely for things such as pay uplifts. The scale of financial demand in health is markedly different from that of social care. Obviously, healthcare gets the lion’s share of the funding. We have made a deliberate decision to ensure that we increase investment in social care, particularly in staff, in order to increase or sustain the capacity of the service, because we know that it is under significant pressure.

One of the things that it will be absolutely essential to deliver as part of our reform programme is a national care service through which we can ensure that there is a greater consistency of approach to the provision of social care and that that aligns with the NHS much more effectively. We can see variation across the country, and that impacts on how social care services are received by individuals who require social care support and on the performance of the NHS.

Going forward, we will need to see even further investment in social care, and we will also need to see service reform. A national care service is going to be critical to ensuring a much more consistent approach to how social care is delivered and provided in the country, and one that aligns much more effectively with the NHS and helps to support it. Further investment and service reform are going to be critical.

That is a legitimate concern to raise. As I mentioned to Dr Gulhane, we are taking a measured and evidence-based approach to the use of PAs and AAs and where those will sit in NHS Scotland and our workforce development. Scott Wood can say a wee bit more about that, because it is important that we ensure that the important training environment for our junior doctors is not compromised. However, I believe that it can all be managed in a proper programmed way, with a clear sense of where we see the role of PAs and AAs sitting and where they can add value to our healthcare system. Scott, do you want to say a bit more about that?