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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.

You touched on the sort of thing that we can do to make those areas attractive. Obviously, NHS Scotland has an apprenticeship programme that recruits individuals into a range of non-regulated professions, including estates department staff. That is one thing that we can do.

The second thing that we can do is ensure that staff have good terms and conditions. Thirdly, we can provide alternative pathways into the regulated professions. That could be done through earn-as-you-learn programmes and by providing apprenticeships into programmes that are presently dependent on having a university degree. We could also allow folk the ability to flex into other professional groupings using the skill set that they have—for example, advanced nurse practitioners do some prescribing work.

All those measures play a part in helping to meet some of the challenges. Terms and conditions, training opportunities and routes into training for AHPs and others all play an important part.

Recently, I had a really good discussion with the Royal College of Podiatry, which talked about how important apprenticeship programmes could be for individuals who might already have a career but who want to move into podiatry. They could be allowed to flex into that career through earn-as-you-learn-style programmes. All of that could have a significant impact.

A pilot project that the Royal College of Podiatry is running with NHS Greater Glasgow and Clyde has been really successful in delivering that, so I agreed to take that information away and consider how we can do more of that kind of work. That is the sort of thing that we need to do much more of in an effort to move folk into the regulated and non-regulated professions.

It is clear from looking at some of the capital investment that we have made recently in national treatment centres, including in one in the Highlands and the Baird family hospital and ANCHOR centre in Aberdeen, as well as our investment in a new hospital in Orkney, that there is not a preconceived view that more things should be centralised. That is not the approach that we are taking. Where we can make the investment to deliver such services in rural settings and to provide the right infrastructure, we are doing so. I am simply acknowledging that there is a trend towards specialisation in the clinical setting—that is an international trend, not just a Scottish or UK trend.

That is why, as John Burns rightly said in response to an earlier question, our rural health boards are among our most innovative health boards because they have to think about how they can deliver services in different ways. We will continue to do what we can to support them to achieve that. I mentioned the Baird and ANCHOR and the new NTC in Highland, which are examples of our determination to deliver as much as we can in some of our more rural areas in Scotland.

However, we must also acknowledge the need to deliver services that are clinically safe. There might be occasions when it is not possible for us to deliver all the services that we would want to deliver in some of our rural areas, and people will require to travel to urban areas. That is not a new thing—it has always been the case that some people from rural areas have had to travel—but there is an increasing tendency towards that, given the specialisation that has taken place.

We want to see more people being treated at home. We are expanding the hospital at home programme so that more people get clinical care in their own bedroom and their own home, never mind in the local hospital. We have more than doubled the funding for that—we have increased the funding by £400 million to expand the programme further. That has a particular benefit for patients in rural areas.

We need to continue to recognise that it is a dynamic situation, to which we need to continue to adapt. Given the particular challenges that we face around our rural communities, we must be innovative. I will do everything that I can to support our rural health boards to deliver the best service that they can in their local areas.

I do not think that we have given money to health boards to build their own accommodation. I am sure that some partnership work has been done in the past with health boards and local housing providers around what can be done to support them in making affordable housing available to the boards but, again, that is outwith my portfolio. I would be more than happy to check with my housing colleagues what specific work they are doing with boards to address affordable housing issues. Of course, there was a time in the past when we had accommodation for staff in the NHS, but that obviously changed many years ago.

I will check with our housing colleagues around any specific projects or programmes that they have taken forward. I know that programmes have been developed in some rural settings that are about bringing together public sector investment, which is health, housing and wider community investment, and trying to utilise that money in a way that helps to deliver more infrastructure in an area. However, I am not sure whether there have been specific programmes to provide housing for staff who work in the NHS. I think that it will be a more general programme.

I just noticed that you seem to have a particular focus on him, but let me try to deal with some of the issues.

Obviously, investing in mental health is a priority for the Government, and there has been significant investment over the past decade or so. There is a financial aspect to the specific workers that you mentioned. The biggest challenge is in managing all the competing demands within the NHS budget. Financial constraint is limiting our ability to run forward with the programme as it stands. When financing becomes available to us, we will be able to do so. You will be aware that we provide other projects in support, such as link workers, who are very valuable in GP practices and help to signpost people, including those who have mental health conditions, to other services. The principal reason for our not being able to take forward that programme is a lack of available finance for us to extend it in the way that we would have wanted to.

Of course.

Yes, but we must also keep in mind the fact that capital investment is a very expensive exercise to undertake right now, because of the huge capital inflation that we face. Construction inflation is running way ahead of standard inflation—it is up in double digits—so that has had a significant impact.

Our capital budget has been cut by around 5 per cent by the UK Government, which has had a direct impact on us. The value of what we have is less and buys us less, because of construction inflation, so we must be very nimble on our feet and focused on how exactly we maximise the investment that we are able to make to deliver on the right capital investment projects. In my view, boards are not slow to flag up where they need capital investment and what that might look like. I would certainly never discourage a board from bringing forward a proposal but, equally, our boards understand the financial pressures that we are under, and things might not happen according to a timeline that they would ideally want.