 I'm sorry, I have feedback from my computer there. Good morning, and welcome to the 10th meeting of the Health, Social Care and Sport Committee in 2023. I've not received any apologies for today's meeting. The first item on our agenda is to decide whether to take items six and seven in private, are members agreed? I'm agreed, thank you. And the second item on our agenda is the first in a series of scrutiny sessions with all the NHS boards in Scotland. For this morning's session, I welcome to the meeting Ralph Roberts, the chief executive of NHS Borders, and Kathy Cowan, the chief executive of NHS Forth Valley, joining us remotely, although not quite at the moment, but we should be expecting Claire Burden, who's the chief executive of NHS Ayrshire and Arran. I'll kick things off, thank you for coming in today. By no means, we're not selecting you specifically, we're going through. Sandesh, sorry, I forgot to go to you, Sandesh, on you go. Thank you, convener. I just would like to put on to records as a gracious of interest that I have worked in NHS Ayrshire and Arran and NHS Forth Valley previously and currently. Thank you, that's now on the record. As I said, we're not singling out any particular boards, we're just methodically trying to fit in a session with every board as we continue over the next couple of years. I would like to ask both of you just now about the financial sustainability. I'm particularly interested in how the inflation has affected you and the increased costs of fuel. I think that people often forget that we tend to talk about those things in domestic terms internally in the media, that seems to be how it comes out, about how it's affecting families and obviously that's going to have an impact on you in terms of people needing your care. In terms of your operations, I'm interested to know about your financial sustainability and the impact of inflation and fuel costs that you're having on your board at the moment, so rhaiff I'll come to you first. Thank you, convener. It is a very significant issue. The overall position around financial sustainability is extremely challenging and we can get into more detail around that obviously. In terms of inflation and the cost of living, I think the point you make about the impact that that has on our patients but also our staff is an important issue that we're hearing about. In terms of our costs, it is certainly having an impact. You'll have seen from the draft financial recovery plan that we've submitted to the committee that our financial position has deteriorated over the last couple of years and going into next year and a part of that is there is no doubt is inflation. I think the figure I'd need to double check it completely. I think we're projecting about a million pounds more in energy costs going into next year so it is not an insignificant figure. I'll maybe need to just double check that and make sure that I'm absolutely quoting the right figure. But it's also not just energy costs, it's procurement costs across the board, prescribing costs are going up, some of that's to do with activity but I've no doubt that there'll be underlying cost pressures within the supply chain for medicines as well. So I think we have to recognise it is a very, very significant factor and the reality is that that is not matched by the general uplift that health boards have had over the last couple of years and going into next year. Kathy? So like RAFE, financial sustainability and value we've put together is extremely challenging. We are, however, reporting a break-even position for 2022-23 and our three-year plan that we've shared with you highlights over that period, the areas that we'll focus on. So our big focus will be in inequalities and trying to shift that resource into prevention through primary and secondary interventions and transformation. In relation to inflation we obviously have a unitary charge issue in relation to our three big estates, so Forth Valley Royal Hospital, Clackmannanshire and the Stirling Care Village. So that's linked to the retail price index and when inflation goes up that goes up. So we will see an increase of about £5.2 million absolutely in alignment with inflation. Energy costs, we are projecting a 30% increase, I don't have the exact figure, just like RAFE. I'd like to check that out, but 30% is the increase that we have in our plan. Medicines, again, subject to inflation and in terms of cost 11, like RAFE, our staff are feeling that in terms of fuel costs and our patients and we're keeping a very close eye on our patients in particular. I did not attend rates just in terms of if we're seeing trends within communities and so on. I was going to ask for that. So you're actually monitoring maybe the impact that the cost of living crisis might be having people presenting to you, as well as perhaps like staff absences? Particularly patients and our director of public health is actually looking at particularly as that linked to deprivation categories and so on so that we can have some more insight and also to think how can we be working partnership with councils and so on to help our patients get to hospital and think about how we take services to our patients. That's really interesting. Are you doing a similar thing, RAFE, in terms of actually trying to ascertain how this is impacting on your patients? We're trying to and our public health department are looking again at how they run their services and what support they can put in, how they provide greater resilience in communities, not so much focusing on individuals, but on a broader sense, how do we build resilience in the communities? I would have gone to Claire Burden. She doesn't seem to be online yet, so I'll just keep going. I'll throw her to my colleagues now. Paul Sweeney has some questions for our panel. I think that the main interest that I have is on capital investment and how that can be used to drive revenue savings in the national health service overall. I'd be interested to know what your boards have done in terms of considering how to utilise capital investment as a way of reducing revenue cost, particularly of utilities, through the introduction of investments in things like district heat networks. For example, there's a good model at the Golden Jubilee hospital where they recently introduced the Queens Quay district heat network scheme, which is in partnership with Weston Partnership Council. It stands to deliver a major cost saving to the hospital state, as well as potentially benefiting the wider community in terms of getting them off the gas grid by using the river source district heat network. I wonder whether that model, in terms of a high return on investment capital programme, could potentially be a way of conquering the current challenge of high costs in terms of utilities? Certainly, in our acute hospital, we're looking at every opportunity to reduce energy costs. I don't have the exact figures in front of me, but we did get a grant from the Scottish Government that we're implementing so that we're actually reducing the costs, particularly around lighting and heating and so on. We're taking every opportunity to do that. We're also investing significantly, as you would expect, in car charging and so on, in all of our sites to help staff and patients. I'm very committed to it. I don't have the exact figures in front of me. I apologise for that, but I'm very happy to share the schemes that we're doing. I'd be helpful. I'd be interested to know if you have a slate of proposed capital investment schemes and an actual formula that would tell you what your expected return on investment would be? Again, we do. Certainly to the board, we take our capital plan and we go through a whole series of analysis around how we use rooms, how we heat rooms and so on, and where we would invest on what would be the return on that in terms of benefits realisation. We do have that. I don't have it in front of me, but I'm very happy to share it with Cretan members. That's definitely helpful. Just on the back of that, about investments and money-saving for energy, for instance, NHS and Frees and Gallow have a £200 million hospital and they didn't put a single solar panel on the roof. Has that been assessed in NHS borders, for instance, or in other areas? To look at that kind of opportunity for whether accommodation could be made for that kind of investment in solar panels, for instance? We're certainly looking at energy efficiency projects in a variety of different ways and that will be part of them. I think that we need to recognise going back to the previous question, district heating systems. I was used to having been in Shetland in my previous job and that was part and parcel of the approach there. The hospital was on the district heating system, but those systems are not that common. There would be no opportunity in the borders. There just isn't that infrastructure locally for us to do that. But we are looking at other forms of energy efficiency. Our plan for next year has savings of about £390,000 assessed as potential from a variety of energy efficiency schemes. In the longer term, we will be looking to refurbish and replace our district general hospital in the long term. I'm talking about 10, 15 plus years. The other bit that we are very conscious of is that the overall availability of capital is quite restricted. We have a formula allocation of capital for minor schemes. The vast majority of that we have got allocated to equipment replacement, infrastructure maintenance and some of the energy efficiency schemes. But we are going to have to build long-term business cases for more fundamental redesign of our estate. I just want to bring you both back before I move on to all your colleagues. I'll bring Paul in a second. The uplift that you got from the Scottish Government effectively was for you to be reducing waiting times. I imagine that a certain amount of recovery from Covid, but you have mentioned that it was not there to be dealing with things like fuel, cost and inflation, because at the point at which it was decided that it wasn't as acute as it is right now. That's an obvious question, but I suppose that it's almost a rhetorical question, but I'm asking you for your assessment of effectively how those two factors that we've been talking about before are affecting your ability to deal with your waiting times. All that uplift is there to address the broad range of costs that we have and how they change from one year to the next. I think that it's fair to put on record that, in addition to the core uplift that we get, we have had a commitment that is going into next year. The additional cost over the basic level of uplift that we've got for the pay awards will be funded separately, so I think that it's important that we recognise that. The money that we get for access, waiting times, normally comes as a separate allocation. For borders, we've got our NRAC share of the waiting times money for next year, which is just over £2 million. The breakdown of how we were suggesting we would be spending that was included in the pack that we submitted. The other bit that is really important to recognise when we talk about the financial challenge is that there is no doubt that finances are challenging, but equally challenging is the workforce position. If you go to the headline figure in Borders Financial Plan, which is a projected overspend next year in the order of £22 million, the reality is that if you gave me an additional £22 million tomorrow, I couldn't spend it because I wouldn't be able to recruit the staff. So when we look at the challenges around access, it is as much, if not more, about our ability to attract the workforce that we need going forward and our ability to create the capacity in the system as a result of that workforce that allows us to protect our elective programme, rather than purely the money. A number of colleagues are going to look into staffing as well, but that's a really good helpful basis for that discussion. Kathy, when you're in. It's very similar to Rave. Our 2% uplift, which equates to about £12.4 million, and then our in-rack share of £0.6 million has been added to our baseline of £630 million. We have in-year allocation just over £108 million to come in, so we've factored that into the plan that we've shared with you. As Rave says, workforce is a big, big issue. We took a decision 2021-22 to invest in a recurring workforce, and that's benefited us in terms of our schedule care position. Your schedule care position is reasonable compared to other areas, but it's still a long way to go in terms of the patient's waiting. By doing that, it's given us that kind of advantage. We took that decision based on our risk-based approach about allocations coming in non-recurringly year on year, and rather than using that money non-recurringly, we decided to invest recurringly and took that decision. That's paid dividends for us, but as Rave says, we're now really all looking for a workforce together, and that workforce is very short, in particular key areas. I won't impinge on my colleagues who want to come in on staffing, particularly Paul. Thank you very much, and good morning to the panel. Just to follow on the issue that was raised around people attending inappropriately, I wonder to what extent, within the recovery plan, there was an ambition to reduce hospitals, the first port of call, by 15 to 20 per cent in terms of that review of urgent care, although Audit Scotland has highlighted that there has been a lack of progress on that. One of the first questions is, are you tracking people who attend A&E as the first port of call, and is not the appropriate setting for them? As opposed to the first part, and secondly, what impact do you feel those attendances are having on the overall budget? My background is nursing, and I did work in the emergency department a very long time ago. I'm just a bit cautious about people attending inappropriately. I think that, certainly in Forth Valley, we are very, very keen for patients who could have went elsewhere to redirect, but also to provide support and education, so that the next decision that they make is the right decision, so the right place, right time, right personnel and so on. I really worry about particularly older people who hear messages about we're really busy, and those are the patients that usually don't turn up, and I would suggest these are the patients that should turn up. We're really taking an approach that is very measured, and in terms of our triage system, when people present to the emergency department, we are very clear about a primary triage where we will quickly go through that and say, as a patient could actually go elsewhere, they could go to the pharmacy, they could go to the MIU in Stirling or whatever, and do that redirection and education, and particularly with mums and young babies, about what else is there, and then we have a secondary triage so that people are very, very quickly moved around the department to meet their need, and I think that the four-hour emergency access standard, which is a system measure, is only half of the story, even half, and behind that measure is a number of very critical safety measures, so Ralph and I, as chief executives, will watch very carefully our time to triage, so when that starts to keep up over 15 minutes, there is a safety alert within our systems, which would actually think, what do we do next? I say that in answer to your question about redirection. There are people who are repeat offenders in terms of that turning up where they could go elsewhere, but it's an approach where we're really trying to educate the public in our own space and look to national campaigns to support that. I hope that's helpful. I would certainly echo everything that Kathy has said. I want us to understand slightly better what is going on, because if you look at the overall numbers within our system, the overall numbers coming through our emergency department are only just back at pre-pandemic levels, if slightly under. I think that suggests that a number of patients are now being seen elsewhere in the system, and the ones who are coming in to our emergency department are the ones who absolutely need to be there. We've got flow and abrogation centres, so that primary care bit at the front door is streaming out some patients. There is no doubt—certainly the data I've seen, although it's not as good as I would have wanted it to—that the level of activity in primary care is higher than it was pre-pandemic. I think that we are making progress and making sure that people are seen in the right place. Our front door clinicians don't say to us that they are seeing a lot of patients that they would say were inappropriate, but, as Kathy says, the challenge for us—or our responsibility—is to make sure that when they come into the front door that we triage them and where appropriate we turn them around and signpost or move them on to other services, or where appropriate we treat and discharge or where appropriate we assess and admit and then treat, obviously. We will move on now to just talking about performance, which we've already touched on in any way. Paul Sweeney. You've mentioned it already about A&E presentations, for example, but the Scottish NHS, the Scottish healthcare system, has the highest hospital, acute hospital expenditure in any OECD country, but the lowest preventative community-based expenditure of any OECD country. It seems like an equation that is very lopsided, but, even within that, there are metrics that are quite worrying about low provision, for example, of key diagnostic equipment per capita, beds per capita, etc. Are these metrics that you tend to keep track of? For example, provision of MRI or CT scanners per capita relative to international benchmarks. Is that something that your board monitors as an active metric? I suppose that we don't probably measure it in that way in terms of our service. We're very conscious of the level of capacity that we've got in our diagnostic services and part of our access plan for next year is to bring in additional CT and MRI capacity on a mobile basis. We've also just gone through a process of replacing our MRI and we're due to replace our CT scanner next year so that they are up to date. I suppose that we focus on it in terms of the capacity and the demand in our system rather than particularly looking at it at a population basis. I suppose that, to some extent, is as a relatively small population, then that will be skewed, if you like, if we just looked at it purely on a population basis. Certainly, diagnostics is an area that we are very conscious about. We believe that we've got a very good record of performance in terms of our cancer targets and a key aspect of that, obviously, is the diagnostic stage in that cancer pathway. So we have an awful lot of focus on that and ensuring that we've got the capacity in place to deliver against the targets. Jumping to the other end of the patient, if you like, in the acute hospital setup, do you track the opportunity cost of the delayed discharge issue in hospitals and what impact that has on overall capacity to deliver community-based services? Is there almost a reflex situation where a delayed discharge at turn is denying opportunities to invest in more appropriate care settings? There's no doubt, from my point of view, that delayed discharges is a very significant issue. We monitor that on a daily basis of where our delayed discharges are, what they're waiting for, and it is a whole system responsibility. So this isn't just about social care, this is about the way in which our clinicians make decisions, the way in which we support people through the system, but we're sitting at something like 30 per cent of our beds in the borders currently occupied with delayed discharges. If you go back to pre-pandemic, we probably ran somewhere around 20 delays at any one time and we felt that was too high at that point because, in a sense, every single delay is about an individual receiving care in the wrong place, notwithstanding the impact that it has on the system. That is about an individual not getting the care that they need at the right time in the right place. We have been running anywhere between, well, upwards of 50. Yesterday we had 68 delayed discharges in our system, so that is a huge opportunity cost. The consequence of that for us is, one, the impact that that then has on our ability to have elective capacity, but the other issue that has caused for us is it has increased our overall length of stay along with a number of other issues and it has required us to open additional beds, which we have struggled to staff and that's had a knock-on impact. So, as of yesterday, we had 15 additional beds open in the hospital. That was 20 up until last week and we've had eight additional spaces opened and staffed, or at least we aim to staff in our emergency department to reflect the fact that we've got additional people in our system, so it is a very fundamental issue. It certainly is, as you observed, but is there any viable mechanism that you envisaged to how you unravel that back into more sustainable approaches? It seems to be very much wrapped up in a self-perpetuating cycle. At the moment, how do we recover the situation? I think that, for me, there's two issues. One is ensuring within the health system we are making the right decisions at the right time to support people through their treatment programme and the point at which we make decisions around what sort of support they will need going forward, recognising that we discharge well over 90 per cent of our patients without any delays, so I think it's important that we remember that. We've done quite a lot of work recently in the last six months around focusing on that continuous improvement of our individual processes. There are issues in there around realistic medicine or value-based medicine, whatever phrase you want to use, in terms of the choices clinicians are making with patients around the level of treatment that is appropriate to their needs, and not being unrealistic about that. Beyond that, there is no doubt that, in my mind, there is an issue around the level of social care support that we've got. I recognise and have a lot of conversations with our social care colleagues that a large part of the driver around that is the recruitment and retention issues that exist within social care, and we have to address that as a health and care system. That's helpful. Just really not to repeat everything that Ruth Cymru said. Yesterday, in our system, we had 93 delayed discharges, and on top of that, we had just over 50 transfer weights. It does have a huge impact, particularly the recute site, and it does have a huge impact on our emergency access standard, because that is a system measure, so that does have implications. Within those figures, we have about 33 patients with AWI capacity issues that we're just thoughtful about. How do we support families through that decision-making process? Equally, I wouldn't want you to think that we're not investing in prevention or community care, because alongside that, similar to RAFE and other NHS boards, we have been particular about investing in respiratory pathways and community teams, so that we're actually treating patients at source in terms of then presenting to hospital. We've put a big emphasis on the outpatient parental and to microbial therapy, so again we're doing that in the community. We have really focused on a kind of rapid assessment and care unit, so that that's a different front door if you present at the hospital, so that we're redirecting ambulance and so on through that to treat patients with long-term conditions, heart failure, we want to do a very quick and really thorough diagnostic assessment, so that we can actually support people in the community. So our whole system approach to this is very much about prevention. I think the thing about prevention is that it takes a while to see it coming through, but it's absolutely the right thing to do. We've seen coming out of Covid, and we've still got lots of Covid around. We've got 40-plus patients on the acute site today, but one of the things that we're very keen to do is to focus on how do we support an infrastructure that actually takes account of those patients who maybe didn't present during Covid, with high blood pressure and so on, so some of the secondary prevention around diabetes, for example, around hypertension, and I think some of the acuity that we're seeing in the acute site. I agree that we rave the patients that are presenting are acutely ill, and I think we're seeing that, and we're desperately trying to sort that, but also think about prevention going forward. I just want to ask about preventative, you mentioned about preventative spend, but also preventative maintenance. We know that certainly in some health boards there are severe repair backlogs on capital investments, which can end up becoming far more expensive over time if they're not preventatively tackled. Is this a challenge in your health boards? Do you have a repair backlog that is concerning? Is it a risk that you see to be significant, or how do you approach and preventative maintenance? In our health board, we're actually fortunate, although unfortunate in terms of the conversation that we had earlier about inflation and the retail index price and so on, but we've got one facility in our community hospital estate in Falkirk and some Bellsdike issues as well, where we have got up to about £30 million backlog. We're addressing that through our capital spend, making sure that our decisions are such that we're using our estate really appropriately, and the other big area that we're looking at as a whole system with local authority and so on is our primary care infrastructure, because if we're really serious about supporting services in the community, what does our primary care infrastructure have to look like? Some of our primary care facilities are really outdated, and we've got a programme of investment, nowithstanding what Ralph was saying about capital in terms of business case development, but programme of investment to turn those facilities round. Again, looking with councils about the things that we could do jointly to use the public purse in a way that adds value. I must move on, Paul. There's a lot of members wanting to come in. I just let members know that Claire Burden has now arrived. She had some significant connection issues, so good morning to Claire. I won't bring you in immediately and trying to make you catch up with everything that you've not heard. If you can maybe just use an R in the chat box for something that you want to come in on specifically, I'll leave members to bring Claire in. Gillianne. In the interests of time, convener, my question on this theme has probably been adequately covered, so you can move on. Thank you. It's just a kind of supplementary question on the back of what Paul is asking about CT scans being available or additional capacity prevention aspects in the community. On Friday, Ralph, when we met at our usual elected members briefing, you talked about how beds are used as a covency instead of maybe what we should be looking at is the services that are delivered, like pulmonary rehab or mental health in community now, which prevents acute admissions, for instance. There's a lot of work being done looking at how we deliver things differently. I heard about a diabetes outreach bus that's being developed in Glasgow by Dr Brian Kennan, where they'll go at the Ibrox stadium, for instance, and help do some of that kind of health inequality outreach for type 2s. Is that something that you think we should be focused on? Not just looking at beds as a measurement of how successful things are, we should be looking at service delivery. Is that something that you would like to comment on? As I said on Friday, I absolutely think that we have to look at that. If you look at the way healthcare has evolved over the last, well, my career, 30 plus years, it is completely different now. So when the board of general hospital was built, it had an ophthalmology ward, we don't admit patients on an inpatient basis for ophthalmology now. It's nearly all done on a day case basis and healthcare continues to evolve in that way. As Kathy referenced, we're looking at virtual respiratory pathways, we're looking at hospital at home. In addition to the delayed discharges that are formal delays in terms of the way we currently measure them, a number of times a year, we'll do an exercise to look at all of the patients in our hospitals and what their needs really are. From that, we can see a very significant proportion well over 30 per cent up towards 50 per cent at times, people who actually could be cared for in a different way. I think we need to look very differently at that. In the boarders, we've got four community hospitals, one of which is relatively new, was opened in the early 2000s, the other three go back to 1950s and pre that in terms of age, so going back to that backlog issue that they are a significant issue in terms of maintaining the standards. But if you look at the way we're using those, there are very different alternatives that could be put in place in terms of supporting in people in the community, which is not about a traditional hospital. So I think we've got to change the dynamic around that and not get hung up on, is this a hospital bed, it's about what is the need that that individual patient slash person in the member of our population actually needs. And I think there are very different ways we can approach that. Some of the examples you've used, some of the other examples, and looking at a different way of providing care in the community. Our local council have been looking at care villages and are in the process of developing business cases for two care villages, and I think that that will change the way in which we provide support in the community for people on the long-term basis. I suspect that my other questions will come up later, but I can pause there. It's an opportunity to bring in Claire from NHS Ayrn. Claire, we've been talking this morning about financial sustainability, and I think that it's only fair to bring you in just to ask your assessment of how your health board is managing your finances and balancing your budgets, given the current strains on your finances. Thank you, and good morning. Apologies along with my ICT challenges. I have a voice challenge with the local cold, so my apologies for that. I inherited a deficit of 26 million, and we have been unable to chip in to that deficit over the last year. Very much similar themes have been shared by colleagues in that we've been unable to pull ourselves away from the additional beds in our system, and some of our ambitions for reform have been slower than we anticipated. Our underlying position is that of a deteriorating position going into 23-24. It doesn't stifle our ambition with regards to what we know what good looks like, and we have good support from system partners. As discussed again, the delayed transfers of care, getting people into the right climate is where we're going to make the greatest gains against our deficit. We have a bedbase of around 850. There's a core bedbase, but we've extended into a bedbase just shy of 1,000. We have 185 beds in the system that we need to try to remove post-Covid legacies and so forth. We, too, are struggling with Covid outbreaks, and that has been the rate-limiting factor in 2022-23. It's been a very difficult year for teams, but as a system we have a greater understanding of where we can work together to make positive inroads into that deficit. Of course, about £14 million is associated with bedbase care alone, and other pressures within the system are from medicines, energy and our infrastructure. We were talking earlier about the investment that is required in our infrastructure, so we have some ageing estate. When I came to the system, caring for Ayrshire was about preparing the system for a new hospital, and it's quite clear that that's not going to happen in the very near future. I think that there is a backlog maintenance programme and some reform that has slowed up over the past three or four years, which is obviously dramatically impacted by the pandemic that has resulted in a backlog maintenance and some underlying infrastructure weaknesses to be a little bit more exposed as we go into 2023-24. I really want to give you the opportunity that others have had to set out your challenges. Stephanie Callaghan, can I come to you for a question? Thank you, convener. Can you hear me? Yes, we can. Oh, thank you. I couldn't find my button there. Just to pick up on something that Kathy said about community pathways and teams, and certainly in this committee we often hear about the importance of early intervention and intervention care. Thinking specifically about key performance standards, are there things that we should be doing around early intervention and preventative care to ensure that that's better reflected as a higher priority? Is that fitting to this part at all? So I would say yes, and it gives me an opportunity just to build on what Rafe was saying in response to the previous question. I think that our performance framework actually counts the things that we can count, and I think that we really have to think about what else do we need to focus on, because that directs attention and what we pay attention to improved performance. I think that we are certainly in chief execs have been talking about what else could we measure in that prevention early intervention space in ways that demonstrate value, but also demonstrate where we are doing best practice, and is that something that we could share and replicate to fit local circumstances, because everything isn't just transferable with kind of A to B, but I think that that is something that would be really beneficial to actually focus on, and actually having those measures so that we could actually begin to think about how do we pay attention to those, and actually direct change and support change going forward. I think that it's a really, really important question, and I think that if we're honest with ourselves, we've had an ambition for the last, well again, probably as long as I've been in the health service to invest more in preventative care, and we haven't done that, and I think that that leads us to some really challenging policy choices, and I accept that these are difficult, but if you look at what we've done over that period, we have continued to invest heavily in acute care because of access issues, and not got upstream around preventative. We have continued to invest very significant moneys in very high-cost medicines, and I accept the argument around that for individual patients. That is obviously a very emotive and very understandable desire to do that, but that means that we are spending more and more money on some of that acute, very specialist care, and we aren't releasing the resource to spend on the preventative care, and so I think there are some very challenging policy choices in there for us as a society about how we choose to use the resources that we've got, and I think we have to get into that conversation with our communities about the type of health and care system we want in the future, and certainly my medical director was here, she would say, going back to that realistic medicine question, is that we have to make sure we have honest conversations with patients about what is realistic in terms of their long-term care, or even short-term care, depending on what their individual circumstances are, so I think there is, as I've said it a couple of times now, I think there are some very significant policy issues that as a society we've got to get into. I was going to raise similar issues to RAFE with regards to, we've made some positive inroads with realistic medicine in all care settings, and we have good working relationships with primary carers doing their best with the living well agenda through proactive management of chronic disease management patients and linking well with our community partners. I think it would be fair to say that if we were able to distribute more funds into preventative and living well agendas so that we tackle the health inequalities agenda for the London care term it will bear fruit, but, as mentioned earlier, the acute pressure does draw resources into that here and now backlog arena, but not for the want of enthusiasm through our health and social care partners and council colleagues in wanting to work this agenda with us. Thank you. Thank you. Can I now move on to talk about Covid recovery and questions from Sandesh Gohani? Thank you, convener. Can I start, Ralph, with yourself about the treatment centre? Does NHS Borders expect to be able to access the treatment centre in Inverness in the Highlands? We wouldn't expect our patients to probably go to Inverness in the Highlands, but we would expect and we do already see our patients go to the Golden Jubilee. As other treatment centres come on stream, then I think it's important that we increasingly look at that, that we do look at that resource as a national resource, and how would we get into the point where we look at the backlog across Scotland and make sure that there's as much equity in access to that as possible. Our primary focus as a board is to ensure that wherever possible patients get care locally, but we need to be realistic in our case that a number of patients will always travel outside the board as they do it for specialist treatment. I think they will increasingly do it around some of the general ones. General one talked about specialist treatment, because we all expect patients to have to travel for specialist treatment. We're talking about ASA1 and two patients who need, for example, a hip operation or a knee operation, so would you don't expect them to, when the treatment centre is online, to be going to the Highlands, you'd expect them to be going to the Golden Jubilee? I wouldn't expect them to go to the Highlands, but I would expect them potentially to go to Fife, to Lothian when that comes online to go to the Golden Jubilee. The bit we will need to get right in the borders is the balance between patients going outside the borders and the patients who we can treat locally, because we've got to sustain a trauma service in the borders and an unscheduled care service, and that requires us to ensure that we've got orthopedic surgeons, and our surgeons aren't split between elective and urgent, so we need to get the balance right, because we need to continue to make sure that those jobs are attractive for our orthopedic surgeons, so there'll be a balance of what is treated locally. I am absolutely up for a conversation around what access do we get going forward that addresses the backlog in particular, but then beyond that, what the balance of care is between what we provide locally and what we provide elsewhere. So you'll need a further conversation to find out about things like extra costs that might be associated with a 23-hour inpatient stay and the resources you might need to put into a patient going to the Golden Jubilee or going to other treatment centres? Yeah, yeah, and we need to look at that against the cost on providing that care locally as well. Okay, thank you. So I have questions about the recovery plan. From the reading that we've done, it's been suggested that the recovery plan hadn't been discussed with health boards in an extensive way. So when the health recovery plan came out, how close were you to going back to your pre-pandemic levels of outpatient elective work? I mean, I think it's probably fair to say we have been challenged to get back to pre-covid levels or pre-pandemic levels of activity. We have been running over the last three or four months at about 78, just under 80 per cent of our outpatient activity and somewhere between 50 to 60 per cent of our inpatient activity. Some of that is about capacity in the system in relation to beds, particularly in relation to the elective care programme. Some of it is about specific issues to us in one or two specialities that have meant we are challenged. So a very significant part of the deficit in pre-covid activity in outpatients, for example, is associated with ophthalmology and dermatology, and that is particularly a workforce issue to us rather than a capacity issue. Within orthopedics it's more about an elective bed capacity issue and a theatre capacity issue, so it's different for individual services. We're mixed. Cathy, can I ask you the same question? What levels are you at compared to your pre-pandemic when it comes to elective work? So in terms of our total patients waiting at 1 March 2023, we've got 4,271 patients, so we are making inroads and with that we've got 2,372 who are waiting over 12 weeks. Compared to pre-pandemic levels, where are you with the elective work? So in terms of our pre-pandemic levels, we probably in terms of percentage wise, we're certainly in diagnostics of 86% on track to get back to where we are. As I said earlier to committee members, we have actually invested significantly in scheduled care. But my question was specifically about where were you with elective surgery compared to your pre-pandemic levels? So in terms of waiting times in specialties like orthopedics and trauma, we are, I would say, within the next six to nine months we'll be back on track and that's very clear in our recovery plan in terms of both outpatients. So the targets that have been set to get us there, 78, 52 weeks and so on, we will meet our 52 week target at the end of March. I'm just trying to ascertain the answer to the question, which was compared to the pre-pandemic levels. So it's not about the 52 week wait. I understand that, but we've got half an hour left. I've got a multitude of things to cover. You've had several questions. You've come back with the same question a few times. I appreciate you maybe not satisfied with how Cathy's answered it, but can I bring in Claire Burden to answer your question and I'm going to go to Paul O'Kane. Claire. Thank you. At its peak in 2022 we had 8,553 patients on our surgical waiting list. We now have 7,947. We're at 99% of our pre-COVID rates in outpatients and we're at 78% of pre-COVID in terms of surgery. Our limiting factors have been our critical care unit was no longer a bit for purpose in its original area and our critical care unit is where the day case used to be. Though we've had some change in baselines, we weren't at those levels at the beginning of 2022, so it's taken a good 8 to 12 months to get them back up to those rates. Whilst it's only a modest 600 swing in totals, it's positive that we've started to address a modest reduction in total numbers and a constant improvement on return to pre-COVID levels. Ambition is to be at 90 per cent of pre-COVID, which is being rate limited by the access to theatres because of the relocation of our critical care unit at Crotys. Thank you very much. I can just expand on Covid recovery plans. Audit Scotland indeed was critical of the lack of consultation with NHS boards in terms of the development of the national recovery plan. I also highlighted that there was a desire from many boards for that greater autonomy in terms of their own recovery plan. My question is, do you feel that in your own context it would have been helpful to have that more localised recovery plan that you could work to within your resource allocation? The national recovery plan has a number of headlines. They're not as similar to the headlines within Forth Valley. In terms of the actions that we are taking, whether it's investment in primary care, whether it's investment in urgent unschedule care, whether it's investment in community care, we do have flexibility about how we do that. I did refer to best practice, and it's really good to learn from each other about what we're doing. Sometimes local circumstances disable us to do things exactly the same and get the same return, because we've got a population, and maybe we're different demographics, different epidemiology in terms of presentation. In terms of our recovery plan in NHS Forth Valley, I don't think it's at odds with the national plan, and there will be a local flexibility within that. The rate limiting factor is raff and Claire has mentioned is the workforce and how ambitious we can be about that. In Forth Valley, we have invested in the workforce that we've got. You'll see from my submission that we've invested in creating more band 3 jobs, so 800 plus people moving from band 2 to band 3 because they've got the skill set to do that, and we're really trying to get everybody up to the top of the license to meet the backlog and just going back to the previous question. I'm not uncomfortable about the approach nationally versus the point. Can I just ask, Cathy, were you specifically asked by Government about workforce issues in relation to the national recovery plan? As a health board, we are asked to submit our workforce plans, which we do, and we've done that. Those workforce plans identify the gaps in specialties or the gaps in workforce and the things that we're doing. Within my own system locally, we are working with local authorities and so on to think, how do we get people into health and care? The workforce plans from health boards are on record have been shared with Government colleagues. Can I come to Rave, and then I'm going to have to move on? I've got a number of themes, including staffing, that we will need to dig into. I'm very conscious of only getting half an hour left with our panel. Rave, if you can answer that, then I can need to move on. Yeah, I'm probably just repeating what Cathy said. I've got no problem with there being a national recovery plan. I think it's helpful to see the overall policy direction that people are wanting us to take. I think that individual boards have then adapted that to their local circumstances, which will vary. As Cathy said, we have on-going engagement with Scottish Government officials on a monthly, if not more frequent basis, where issues around workforce, etc., are flagged and discussed. I think that balance between an overall direction at a national level and understanding what that means for us locally and an on-going discussion about progress is perfectly appropriate. Emma, can I bring you in just to pick up on some, I think you had some questions around the progressive recovery plan? I know that we've already mentioned it, but if you can ask your question, then we can move on. Sure, I will be quick. I had just two questions, but one we can always part for later, it's about the long Covid pathway rather than long Covid clinics that have been established in NHS borders, because I'm interested to know what's the best way to look after long Covid patients. The other issue was, again, it's going back to on Friday, you talked about the progress on recovery has required working with your registered social landlords to look at housing, to look at wider aspects of supporting people in order to practice re-ablement, which we don't use that word a lot, but it's just basically supporting people to get the best care and to get them home. Is that part of what you're doing for the progress on recovery? As we said on Friday, for me that's about a pathway that signposts people into the right care, because people with long Covid have a variety of needs. It's important that we don't run a long Covid clinic, we try and signpost people into the right service for them as individuals. In terms of re-ablement, the council and health and social care partnership have been putting quite a focus on re-ablement, and that, for me, is about reducing the need over a period of time for social care, and that will release additional social care capacity. So if we can support people as they are discharged from hospital over that initial period and then adjust their social care packages to meet their ongoing needs, then that is certainly helpful in terms of creating capacity in the system, and certainly the output we've seen from the initial work that they've done is that that has been very successful, and I would see that helping address some of the issues that we referenced in terms of delayed discharges earlier as we go forward, and that in itself will be then very important in terms of capacity in the hospitals to allow us to address some of the backlog issues. Thank you. Now some questions from Gillian Mackay on the escalation framework. Thanks, convener. In all the submissions, the all boards have obviously been escalated higher levels of the framework, and all boards have a higher than the national average level of turnover. Do you believe that the high level of turnover in your boards is linked to poor culture within the board? I personally don't, in terms of NHS borders. I think that we need to be honest with ourselves that in an organisation the size of the health service, an organisation the size of mine, there will be issues in individual services or issues between individuals at times, and we need to have appropriate mechanisms in place to address that, support people and understand what's behind that and then address that. When I joined NHS borders four years ago now, leadership was one of the issues that we have been escalated on. We were de-escalated for that partway through the pandemic. We've put a lot of work into the way in which we lead the organisation. We've done a lot of work in terms of engaging with our staff and trying to shift our approach. We talk an awful lot now about a compassionate leadership approach. We've just started a compassionate leadership programme for staff across the organisation. We've introduced what we're calling a quality management approach, which is a bit managerial speak, but it's focusing on the way in which we engage with our public, engage with our staff. I think that we are making progress with that, but I think that it would be incredibly naive of me to sit here and say that we should be complacent about that. I think that it's something that we need to continue to work on at all times because it's really important. I don't particularly think that that relates directly to the turnover issue, which I believe is more directly related in our circumstances to the age profile of our workforce and particularly the issues that people have experienced over the course of the pandemic, and there is no doubt that that has had an impact on people making different choices. Absolutely. It's very similar to rife. I know that nobody underestimates the pressure that has been on the workforce during the pandemic, and we continually say a huge thank you to our staff for that. A number of staff, during the pandemic, and as we've knocked them out of it, but as we've moved forward, have made those work-life balance choices. A number of people have taken retirement, particularly nursing. A number of people have went into new employment, and a number of people were in fixed-term contracts as a result of the pandemic, whether it was in test and particular and so on. Like rife, I don't think that the turnover is in terms of that correlation to culture. However, I think that, like rife, we are no complacent. We equally have put in a compassionate leadership programme. We have had Professor Michael West supporting us in that. If committee members follow the boards, they will have seen that I brought in an external review to our emergency department way back in 2020-21 because of poor culture, so we're no shy of that. We will absolutely take appropriate action because we want people to come to work and have a good day at work and enjoy their work and be supported in their workplace, whether that's with training, development and good leadership, and it's something that we, going forward, have significantly committed to. The culture plan is predicated on our commitment to retention, attainment, professional development and recruitment, and I think that there has definitely been some life choices as described by Cathy. We have many more people reducing the hours that they're offering. Our medical workforce has many contracts now that are much smaller than they were two or three years ago. We have 500 nursing vacancies and it's just a recruitment cycle that you are just constantly on it. I think that it would be fair to share that nationally we have an NHS reputation challenge in that within the media it's not a great place to work, people are under constant pressure, but from our experience as CEs, I have exceptionally dedicated staff who genuinely love their jobs and we don't get the opportunity to talk to that, and individually we work hard on our social medias to try and raise the profile of the dedicated people holding this together for us, but it gets lost in the other national things that are going on. As health boards we do weight the importance of the training and retention components because we desperately need, particularly us as rural boards, keeping people in our patch and having lifelong careers is absolutely what we're ready to, but we are very mindful of the backdrop of people not choosing the NHS being greatly influenced by the media. I think that if we had a concern as a leadership body this is the first year nursing has gone to clearance. The idea that we're not filling all of our university places for our future nurses is something that we need to tackle for Scotland because we need people genuinely choosing healthcare as a profession because it is lifelong rewarding. If there were a piece of work that we are really keen to work on, it's that national bit. We understand that we are in recovery and there are pockets of exceptional stress that we work through every day but there is a lot going into the supporting of our workforce. I think that the age profile is a big thing for all of us, the national position of our primary care and that we know that in the next decade the turnover in that is extraordinary to the retention and that recruitment arena is equally as important as that internal country and our visible leadership commitments. I will be the first one every time to stand up and say that they're good careers to go into and that this is not the reality in every single department and every single hospital. However, it's really important that when we are being told about these conditions by staff that we make sure that we are addressing them so that those workplaces are supportive for absolutely everyone. If I could go back to Kathy in particular about Forth Valley, which was escalated on culture pre-escalation, I spoke to a number of staff members who all told me that senior management are remote from the workforce and were rarely seen. We obviously had five respiratory due consultants resigning, all citing a toxic culture. Since the escalation, I've had psychological therapy staff in touch saying that because of the two-year waits they're so worried about patients that they're working unpaid hours. What's being done to both acknowledge the culture that staff have been working under and how is this going to be sorted going forward because it seems to be that's at least three or four departments within Forth Valley alone. I think that in terms of escalation we would acknowledge that there are issues and that we are tackling those issues. In relation to psychological therapies, we've actually been able to recruit additional staff into that area because that was an area where we had below the national average and I think when you're below the national average and you're actually trying to perform then actually there is impact. I'm actually very close to staff. I have high visibility. I think the areas that you reference are on the acute hospital site particularly and if people follow the acute hospital site you will see that we had a number of staff for a variety of reasons working not in their substantive posts but actually acting into posts. We've taken a decision to actually bring in an acting manager whilst we look to recruit to other posts to fill that space and that has enabled people to go back to their substantive posts so people like our chief nurse on the acute site and actually bringing in an additional doctor for a front door and so on so putting people back into their substantive posts. I think if you were to ask staff just now and I do regularly ask staff they would say that it feels better and the litmus test for me is also not just the staff but our staff side our trade unions where we have very close working relationships with and they say that the stability on the acute site feels so much better with that additional management capacity in that leadership. For context Cathy that psychological therapy staff member was in touch in the last 24 hours about staff working unpaid hours because they're so concerned about about patients so I'm slightly concerned about what we do until those new staff that have been recruited around posts because obviously there's often a lag between recruitment happening and I think it was it was about 12 weeks I think it said in your in your submission about that as well. So in terms of we've actually had a change with our union colleagues because NHS Forth Valley was an outlier in actually allowing people to have a months notice and recruit to that. The trade unions were really keen to support a three month so that actually gave us a huge gap in terms of case load redistribution whilst we fill vacancies that has been resolved our staff side have worked with us to resolve that so we're now in the same place that other NHS boards are in so that will certainly help us. In terms of the member of staff speaking to you I will absolutely you know follow that up we would not expect anyone to work unpaid hours to be addressing waiting times you'll have seen in our submission that we've worked really really hard to address long waits. We've continually sat in that 70 per cent performance and that was in the backdrop of no having those staff in post but I will certainly follow that up. That's great because we do not have enough time we need to talk about staffing more generally can I go to Paul O'Kane? Thank you very much convener. Looking at the information submitted you know there's a huge issue I think in terms of retention of staff not just recruitment of new staff I mean 30% of leavers are retiring in the NHS Ayrshire and Arran and we see that turnover in your boards obviously higher than the national average. I suppose just that question then about retention in the system I mean is that the significant issue I think first of all and secondly what action has been taken to try and encourage staff to stay within the system so that we don't have that twin challenge of having to recruit new staff and indeed try to keep staff in the system and I wonder if we might go to the perspective of Ayrshire and Arran first if that's possible. Programme there it's multifaceted as you can imagine. The training of staff and getting people into a position where they can see the way out from the current operating processes is genuinely the thing that's going to make the difference. Over the last three years the single disease management has stifled careers so Covid by its nature has meant that people haven't specialised and had the opportunities to specialise and in the current climate releasing people to specialise is a challenge so within our recruitment and retainment commitment is the release to people to training sorry was that right would you like something else covered Paul sorry sorry whatever can just briefly then I mean you're saying people haven't had the chance to specialise but would you recognise actually stress and burnout it is actually the major issue there is there is a lot of anxiety so if you're looking at that staff absence anxiety and stress is absolutely a key driver in that the current climate is is tough and looking after people when you are working with a five-year equivalent to a five-year backlog and the system still remaining under pressure it is without a doubt that that wellbeing programme about how we keep people fit for work is equally as important as finding careers that they can see themselves beyond the current position. So the commitment to get people training in order that they can see a future that is different from what they've got now is a really important part of the retention programme in that if you were if you and I were to walk around the any part of the health system their request is they need more staff and the second request is they need more time together and they want they need opportunities to train our healthcare professionals have had a dual of their professional development for three years and that that will have ramifications for a long a long time but as we as we do get into a position of recovery we get back to a rate by which we genuinely start chipping away at the pressures for the elective programme we will be able to support more training for our staff and we're doing a lot of work in that with Nez about the development of new roles about how we can find new career pathways for people because those people who are retiring early are making choices to take a break there's always a retention and callback but there is an appetite to come back and do slightly different things so if you've been working within the acute actually to do something different within the community with a different skill set is welcomed by our staff so we will continue to work with Nez on how we generate new posts by which we can give people new avenues to pursue giving and intervention and we talked earlier about the prevention arena those people that are leaving the NHS by choice taking retirement at 55 and beyond and those pension options that we're all living with it's our belief that if we can create posts that are generally different we will have people return Can I come to Rafe and then Kathy I'm afraid that I'm not going to be able to go back to Paul for supplementary questions I do apologise but we have got another panel to come in so I can't let this overrun so if I can come to Rafe and then Kathy yeah probably compliments what Claire says I mean I think it's important that we don't jump to some single issues assumptions I think the choice for any member of staff to leave move on retire whatever that is will be multifactorial I think from my point of view some of it is about the working age of our population in the rural areas and people making choices around that some of it is about their experience over the pandemic we moved a number of staff because we had to do that and that was more or less popular depending on on the individual there are issues around there is no doubt it goes a little bit back to the culture bit which is I think that the thing I hear most from staff is their frustration at the moment that they are not being able to do the job that they came in to do because they don't feel they're delivering the quality of care that they would have previously delivered and that's about the pressure in the system and I think that's a big driver so we have to recognise it's multifactorial we need to support people through that with professional development as Claire's outlined we focus on retire and return so that we try and support people back into different roles maybe after they have retired part-time and build on their skills and then there's the fundamental bit about if we get the recruitment right then that will support retention because it will take some of the pressure off staff and we've done masses of work over the last year in terms of international recruitment and have been I think very successful in bringing international recruits into the organisation that is challenging but I think it is paying dividends and if we can do that and that reduces some of the pressure on our staff then that will improve retention and that to some extent goes back to the point I made much earlier about one of the reasons our staff particularly in the acute hospital but there'll be different circumstances in different parts of the system but one of the reasons we've got pressure is we've got additional beds open and we've had to therefore spread staff more thinly and that puts pressure on them so if we can get to the point where we closed down those extra beds that we've had available during the pandemic that will allow us to improve staffing levels and that will help improve retention but I think we have to recognise we need to work really really hard at it and in the medium term we need to recognise that that working age population is shrinking and therefore we're going to have to look differently at the way we staff our services okay Kathy come to you and you'll come to Chess White just very quickly so he's reef and Claire we're saying the pressures within the system are significant and we have been really fortunate just to give you an idea of some of the recruitment retention so out of the new nurses that we've recruited just just over the last couple of years 127 new starts are in our system and we've still got 118 within our system so that's a good measure for us and in terms of our matter scores in terms of going back to that culture we're actually up there amongst the rest of the boards in Scotland I think the other things is trying to give staff space to do things so our mental health staff have been awarded the royal college accreditation very unique accreditation because we gave them time to do that and it lets them shine and feel really proud about what they're doing and how they're doing it we've invested as I said previously in in bands of two to three and I think that's that is demonstrating a culture of inclusiveness a culture of commitment to development and those staff are staying with us similar to what Ralph was saying we have been able to secure colleagues from other countries so our international recruitment very focused not just on the employment but the welfare and the bringing of people to Scotland and their families and that has been hugely successful we've also done a bit of work around our anchor institution concept about how we actually create local jobs for local people really thinking about how we do that with local authorities and we have very recently secured a unique partnership with both our college and university where we're actually working in that space to actually bring school leavers into health and care both the health service and social care but it's a tough gig out there and I would never underestimate that and I think going back to Gillian's question the acute site in particular in Forth Valley is a tough place to work as his primary care given the demand coming through our systems and that's about respecting our staff and acknowledging that's that's what they're working in that's what they want to hear from us as leaders so that they get reassurance that we absolutely know the pressures they're working under and give them the support and training and development is one of those areas and giving commitment to protected time so that people do have a bit of downtime a bit about reconnecting reskilling and so on so I think certainly our focus is very much on one recruiting but two retaining and doing different things where staff so that their skill sets are increasing thank you thank you tess two questions my first one is to um NHS borders so Mr Roberts in advance of today we asked for a four page document you provided a document with no less than eight embedded papers and didn't provide us with what we asked for so um please so that we do as a committee have a written response from you similar to the other trust could you please provide us with what we asked for thank you I'm sorry if that didn't meet the what you were expecting certainly happy to to review that we tried to give you as much information as possible but we'll reflect on that thank you for just delivering exactly what we asked for that would be appreciated and then my second question is for fourth valley please um so sickness does continue to be an issue right across the trusts in terms of what percentage is actual physical sickness for nurses and midwives and what percentage is mental illness so burnout depression so um we do have a breakdown I don't have it in front of me as Claire said stress will be high and that absence rate there is no to no doubt about that to actually say that's all about work because we actually do significant deep dives in that there will be areas of that but the cost of living and other things other factors in people's lives are playing a part sorry that that doesn't ask the question is what what percentage please is physical illness for the nurses and midwives and what percentage is mental illness so I don't have that figure in front of me we actually have a figure and within that figure we have a breakdown of course okay if you could provide that that would be appreciated thank you thank you David Torrance thank you convener and good morning to the panel members we talk about stress and burnout but what are you putting in place for a well-being of your staff not about progressing and careers that what is actually in place for a well-being of your staff so we continue to rework can I go around with all three for a bit back for maybe take Claire first we have extensive well-being programmes and we have a very positive spiritual team who lead our our well-being programme it's a dedicated space and time with a wide range of resources in terms of access to financial advice occupational health therapy we for the for the first time as a as a result of the pandemic the legacy is psychiatric and psychological support it's rather sad that you feel that you need to have that in the level that we that we have but between the spiritual team and our professional support services they have a steady flow of flow of people the the response from staff has been very positive to the to the well-being areas that have been created with time out time out sessions within the team management structure going back to our cultural commitments the making time for teams to make use of those facilities is core parts of our commitment to professional development so I think now that we're in a in an era where distancing and so forth has as this is is diminished over the last 12 months we have been in a better position to offer breakout support and we've invested independently as teams have needed them so sadly bad events happen in the NHS by nature of the beast but and we have commissioned specific support programmes for following specific incidents or for teams have undergone a serious incident and then we've got wider stream more generic processes and services available through our cultural plan and our human resource teams where teams can commission time out so it's it's it's why ranging from that high specialist where somebody needs support into well-being spaces that they can access 24 7 into team team development programmes thank you can I ask my next pass to be brief please raff and then Kathy yeah I mean a range of support there's very targeted support for individual teams around individual incidents or issues when they happen more generally we've got staff counselling services we've got the occupation of health and safety service we've got psychological support for staff we've got a well-being group that's looked at issues around things like meals and the space that staff have got to go to we explicitly ran a workforce conference in the autumn to try and focus on our workforce issues which was attended by probably close 100 staff and was really successful and we're working up to a well-being week in June this year again to try and maintain a focus on it but I think fundamentally that go back to that point I've heard that the things staff want most of all in addition to individual targeted support where that's necessary is that sense of they are doing the job that they came in to do and so and that is about us supporting them supporting staffing levels and as claire I think said earlier trying to get back to that point where the health service is seen as a good career and is seen in that context and staff frankly have found it very difficult to go from that transition of being clapped on the doorsteps pre at the beginning of the pandemic to the point where they now feel they are under endless pressure from the public, from politicians and others and that has been a really difficult shift in mindset for them and I think we all have to recognise that and support them through that. Do you have media headlines as well? I mean I imagine that they've gone back to what you were saying before about the national conversation that we need to have the things that make the headlines are not the sort of nuance things about things going well, the role was about the waiting times and I think they are our staff say to me a lot that they are looking for the acknowledgement that we need to radically change the health service going forward and we need to change the dynamic and the conversation we're having around that and recognise that the health service needs to continue to evolve that's what they're looking probably more than anything is a recognition that we can't just go on flogging the service as it currently is and we need to change it. Thank you. Kathy, and then I must move on. Very quickly, but really can I just tell what Rafe and Claire says? We are thinking about the health service at a local level about what needs to change and actually mobilising our clinical teams to be part of that, it's really important. We've produced a wellbeing plan strategy which actually outlines all the things that we've been doing, all the things that we continue to commit to do and they're targeted or they're generic in terms of people being able to access, but there is a plan that if people, I can actually provide that or people can access it to see the extent that it is significant in terms of the investment that we've put in there. I must move on. I do want to take two other themes, one on mental health services and other than reform, however I might not be able to take all the members that I've asked to ask questions on them and do apologise. Evelyn Tweed on mental health services, I'm afraid just one question. I'll roll my questions up together then. Thank you. Thanks, convener. I'm going to direct my question to Kathy. Obviously, Kathy covers the Stirling area. I have had various constituents in contact with me regarding the CAM service at the end of the tether. I do know that things are getting better and your numbers are getting better, but what have you done to enhance the service? How quickly can we see more progress and, crucially, what is being done to help people in the period where they can't be seen that sort of 18 weeks waiting time when they are in a crisis mental health situation? So, a couple of things. If I start with primary care, we have invested or even before that, so working with council colleagues on the investment, government investment and counselling, so that actually we're taking that prevention early intervention approach so that we're not seeing escalation into the tier services within CAMs. So really starting right where kids are engaging. In primary care, we've invested in CAMs staff, CAMs workers, so that the GP has got access to that service. Most importantly, we have laid out the referral proposal about referring people into primary care and then subsequently into services. You're right to point out that we have made progress. Our focus coming out of the pandemic was to deal with our long waits. You'll see that those were significant. I'm pleased to say that we have actually addressed those long waits and I think staff are feeling really good about that because that does impact on staff when they've got children and families that they feel they're not supporting. So tackling those long waits enables us now to actually deal with the front of the waiting list. So you'll actually see very quickly us moving from a really poor position in terms of that 18 weeks to achieving the standard by the first quarter of this year in April to June. I've got two more members wanting to ask a very succinct question, hopefully on reform. Can I come to Stephanie Callahan first and then to Sandesh Gohani, and if you can direct your question as much as possible, please? Thank you very much, convener. I actually thought someone was going to add this to their question, so I apologise. I'm just wondering specifically about any recommendations that you would like to see the committee making around early intervention to ensure that that's a priority going forward. Okay, let's go round everyone quickly, Waeff. We'd probably go back to the point I made before around prioritising that, and I think that means we need to look at our performance framework and look at the way in which we prioritise that. There is certainly work we can do to focus on early intervention, but I think that requires us to look at the whole scope of our resource and make judgments about how and where we prioritise that across the organisation. Very similar. I said earlier about the performance framework and having the incentive to have standards to work towards. I think that would help us to refocus our energies into that area. I'll come to Clare. Thank you. As an open question, the ask, our diagnostic work and our technical infrastructures, the unifying of our ICT, will genuinely help us with the reconnaissance of our population. As we're working to national models to improve access to diagnostics, getting into that prevention agenda, so adding and building on both Wraiths and Cathys platforms, that would be my ask to diagnostics and technology. Thank you. Thank you, very helpful. I just want to say that, as a doctor, it is a great career to be in health, and I think I want to be clear to acknowledge that myself and everyone on health committee acknowledge and thank our NHS staff all their hard work. As far as questions go, convener, I think that I was disappointed with some of the answers that I got. I'm sure we have other questions, so perhaps we could write. We're going to write and pick up on things that we haven't had time to get to. If I could directly ask Clare about your IT infrastructure, I was very interested to hear about how you're trying to develop this all-in IT infrastructure. Very quickly as we are running over time, how close are you to implementing? Work going on for the platform, the network, so we have quite a lot of remedial work to do before our colleagues start to see it. The technical infrastructure, the platform from which we can unify our system, is the piece of work that we're doing first. The two pieces of software are the track care for the hospital, so that we take out three pieces of kit to unify to one, and our commitment to the electronic patient record, which is once for Scotland compliant. We have our health and social care partners support that they will make sure that we're all able to share that. Thank you very much. I want to thank all three of you for your time this morning. As I said, we will write to you with some of the things that we haven't managed to get to. As you can see, a great deal of things that we wanted to ask you, great things of things you wanted to tell us, but we will pause and suspend for 10 minutes for a break. Thank you. We now move on to the second evidence session that is part of our inquiry into female participation in sport and physical activity. This session will focus on community sport and physical activity. I welcome to the committee Kate Juster, the policy and influencing co-ordinator for Scotland, for Living Street Scotland. Patrick Murphy, the senior manager for social literature, leisure and culture. Cecilia Oeilam, the head of behavioural change for Sustrans Scotland. We have two panel members who are online. We have Kirstie Garrett, the Sports Development and Physical Activity Manager for Glasgow Life and Glasgow Sport, and Ewing Lowe, the chief executive officer of Scottish Swimming. We have a number of themes to cover. You might want to direct your questions. Some of them might be more general and we will go round the panel, but five panel members, not every panel member, will be able to answer every question, and we will also be here until next week. I would like to kick things off, because a number of you in your submissions pointed to lack of female role models in sport and physical activity. It struck me that there are lots of females in sport and various physical activity that are probably within that sport or a role model, but it is not so much that. It is the cutting through to people out with that sport, seeing them in the media, as role models. It is also a lack of women in leadership roles within sport. I would like to go round everyone. I would be completely hypocritical in what I have said about focusing things, but can I go round everyone and ask you what you think could be done to encourage more women into leadership roles within sport and how to promote female role models that would make all the difference? Kate, can I come to you? It is funny when we are talking about role models when we are talking about everyday walking. We know that there is quite a lot of importance of role modelling with the family and about family habit forming. It is important that walking as a means of transport and as a pleasant thing to do is something that happens within families. It is less to do with celebrity role models. There is less evidence that that is a factor there, but what we do need is women in leadership in terms of creating the structures within which women walk. When we are talking about planning and transport planning, those are important places to see more women because we see our transport and our places planned, broadly speaking, by male dominated professions. Sometimes that is very obvious. Sometimes you can see that transport is planned around a very typical male commute, which goes from home to work and back again and not around more typically female trip chaining. You might drop the kids at school before you go to work, do the shopping on the way back or drop in on a relative that you care for on the way back. Transport does not support that. The ways that, for example, we see parts being planned, women have a closer attention on safety, and we quite often see that that is not supported by the places that we are walking through. That is certainly the time with me. As a rural person, that radial journey is just into the centre of town, and it does not take into effect that you might have to go elsewhere before you even get to your work. Patrick, from your perspective— Yes, I think that the report does reflect that, but I do think that there is lots of really, really good work out there just now, especially for young leaders in and around programmes such as active schools and programmes in local authorities, especially in and around the care experience scenario. I do think that there is some really, really good work there where females will be—we will see that bleeding into the narrative about them then coming in and being role models and leaders in their local communities. That is everything from sports leadership sessions at primary schools, right through to walk leaders, right through to leaders in sport, in positions that actually make an influence. I am quite positive about that. I would like to echo what Kate said about transport planning and urban planning, needing more female leaders and more female perspectives. I also wanted to mention a campaign that Sustransisran called Anchi Cycles, which was based on workshops with teenage girls across the country looking at the barriers to being more active physically in their local environments. That has progressed into a social media campaign where the young women are leading on content about them being physically active. It is proving that locally-based initiatives that empower young women to be physically active can really have quite good impact and it showcases what is possible. As you were speaking, I am reminded that I asked a teenage person in my life why girls do not do as much physical activity. She said that because your pals do not, that is a peer pressure. Something like what you are talking about is that it seems to be okay to be taking your bike to school or whatever than more girls might actually do it. Can I come online and speak to Kirsty first of all? Hi there, thanks for inviting me along. With regard to role models, we have an example where, unfortunately, just prior to lockdown Covid in late 2019, we established a programme called Energise Her and the brand was I, she can. The Energise programme was about insight, training and support to engage and attract a wide range of females to have arrived at activities within their community. Within that Energise programme, we also had mentors, female mentors that would share their skills and knowledge to empower others and hopefully excite young women and girls to get involved in sport. As part of the programme, we had to activate hers. Again, it was people who came forward that we trained and supported from different sports clubs and organisations and helped them to support them and deliver projects and activities within their community. There was a small fund attached to that to the value of about £1,000, so we definitely saw the need for role models in communities and that is why we were out to our network of clubs and organisations to take that project forward. A real mix of women came forward, it was co-produced. It was women from what you might say a performance centre sport, right down to people who weren't involved in sport when they were at school or PE, so a genuine mix. It carried on into 2020 but unfortunately Covid came, so we are now just trying to go back to reinvigorate that programme. We do have that programme in place. Another part of role models that we are celebrating this year is Glasgow's European Capital of Sport 2023. For the month of February, we celebrated women and girls in sport months. Basically, over the months, we celebrated all the activities that were happening in the city from sports clubs and organisations just so that they can raise awareness of the communities of all the things that are going on. We put out regular tweets and newsletters, etc. Hopefully, they understand that there would be more young people who would know what was happening in their community, young women, and therefore take part. Role models for us are really keen. What we are also looking at as a part of European Capital of Sport is hopefully that we are going to meet our heroes so that young women and women can identify people that they aspire to or look up to and hopefully meet them. For example, we had a young woman meet a heart of her hero, a Scottish player, Jen Beatty. Therefore, we are trying to develop opportunities throughout the year for women and girls to get involved in the activity. With regard to the different roles, I am a sports development physicality manager and I am a female. I am pleased to say that I have roughly about 100 members of staff and that there is quite a nice split between 50-50 of male and female. Within our own organisation, I am comfortable to say that we have a split of male and female that are strong roles that are in communities in helping people to get involved in sport and physicality. Thank you for inviting me along. I am just picking up on that very last point that Kirsty was making there. I am conscious that I am a male in the subject matter. We are very conscious of that even coming into this committee meeting today. There would have been another member of the team that we would have liked to bring along to this, but it is committed elsewhere, so I have not put up with me today. However, in that leadership piece, I am sitting as part of a senior management team of which there are three out of the five senior management teams that are female. We have three members of the board out of 10 who are female. We are just about to have a president who is going to be female for the organisation in Scottish swimming, which is a fairly prominent role to have. From a swimming perspective, you need to be able to see it and understand it and believe it to be able to want to participate in it. We are probably quite fortunate in that swimming is a popular activity and, from a recreational point of view, there are probably more females than males who participate in this particular activity. From a membership point of view, we sit in the region of about 63 per cent, 64 per cent of our membership is made up of females. If you look around to the leadership roles of people who have influenced that membership base, from a workforce point of view, 63 per cent are female. From an official point of view, 62 per cent are female and, again, 62 per cent are females. There is a female drive across the sport, but, in other aspects, picking up a little bit of comments that have already been made of, I am very mindful of first impressions and getting people involved in the sport and even interested in activity and leisure, and when a sport is full stop, it comes from quality experiences. Active Schools, as I mentioned earlier on, is quite a prominent activity to be able to get people to introduce leadership roles. For ourselves, we have taken it a step further with a young volunteer programme, which is particularly trying not just gender but also ability and also ethnic minorities. We have tried to get involved in this young leadership programme. We have developed leaders of the future and there are quite a high percentage of females involved in that programme, and it is driven by a female. Other aspects of sports from that are to see it and do it piece. We are mindful of some of the names that people might be familiar with, such as Hannah Miley, a very prominent successful Scottish swimmer who has got an MBE for promoting services for girls in women's sport. He is very active in that kind of world of promoting all the values of being interested in activity. Others are coming through, such as Katie Shanahan, the curstail and no Katie's name. They are role models, along with Tony Shaw from Aberdein, who is a para athlete and is an ambassador for us in our Lent a Swim programme to encourage youngsters to get involved, so not just a female aspect but also a disability aspect of anybody who can get involved in this activity. We are working where we can, but we are very conscious that there is more to do, given the challenges of, I suppose, getting any part of the society-involved participation as a non-going challenge, but particularly girls and women. Pulse Meany, you have a couple of questions on this. I recently met with Boxing Scotland, who are based in Glasgow, and they told me about their work in trying to get women and girls into sport, particularly ones that are traditionally male Dominate, such as Boxing and Football. If you do not get young people into sport early in life, it is harder to strike up that engagement once they are young adults. Do the panel have a view on what steps can be taken to encourage women and girls in sport at a young age, especially in ways that encourage them to participate and stay involved in physical activity in the longer term, and how you make that introduction to sports that are traditionally male Dominate to light boxing? Was it picked up as a Glasgow rep or not? I picked people on that because it was about sport rather than just physical activity that I bring in, Kirsty. Thanks for that question. With regard to sport, we actively work with any sport's Government-in-body clubs that want to work with Glasgow life. For example, we would work with Boxing Scotland and introduce them to maybe our colleagues in active schools in Glasgow City Council in trying to see a range of activities that can happen within the school environment, or more so create those links from the school to the club. We have examples of that that go on in the city, so we do not really work with any Government-in-body that wishes to work with us and make sure that we can support them getting into the school environment or supporting the young people in the school to move in to see a club environment. That is basically what the club development team does, is trying to ensure those connections. What we would do is just ask for the person to contact myself and then we would take that forward. We also have in Glasgow sport a physical activity finder, so we promote that as well. We encourage all sports clubs and organisations in the city to sign up to that physical activity finder. If you put in your postcode all the clubs within your area would then become visible, or vice versa, if you put in that you want to do boxing again, if you put that activity and then all the boxing opportunities in the city would pop up as well. Again, we try to make sure that people are aware of this activity finder, so therefore they can find activity in their doorstep or a certain sport. With regard to boxing, we would actively encourage them to support active school programmes, etc., to try and encourage young women to get involved. There is another element in there in terms of females in that specific sport that you mentioned, Paul, on the teenage drop-off at that kind of 13-14 age bracket, especially on specific sports, which is very difficult to combat. Again, that leadership role plays into that, but I think that what is critical here as well as recognising where sports are in their state of readiness or where clubs are in their state of readiness as they approach their communities. Quite often they can be quite intimidating places, they can be places that are not ideal for people who are vulnerable or people who are not confident. It is as much on the sports and the clubs themselves in terms of their state of readiness as well as that convergent access about the teenage drop-off. That is really helpful insights. I think that it is that balance about passive advertising of availability versus engaging groups that might, particularly young women, who might not feel comfortable and intimidated by a sport like boxing, to taste it and have a go at it. Maybe that opportunity through the active schools provision is something that could be looked at as an opportunity. That certainly sounds interesting, and certainly we have heard stories before about young people in PE classes, for example, who have been split into groups to have stereotypical different sports. Girls would go off and do dancing and the boys would go off and do football. Stereotypical streaming of different sports can be extremely counterproductive. Is that something that you have observed happening and how the activity schools programme could help to address some of that, where it is a non-traditional engagement? At the moment, to take the football example, the Scottish Women's Games has never been in a better place. Five of the top premiership teams now have full-time positions. They are all full-time, all the players. That is a real positive, so there are going to be some seriously really good role models coming out of that. I think that PE has a place of work to do in and around that co-production collab about where people's positive destinations are. I think that that is a real challenge. There are also some really positive things happening in and around that transition between boys playing netball and girls playing football. That is happening, so I think that we are in a good place with that. That is good to hear. Kirsty? I will say to give an example. We have a boxing club in the Southside, so Southside Boxing Academy, for example. Through our support and funding, through our club and officials award, Antonia was able to secure a Boxing Scotland level 1 course qualification and therefore started to deliver boxing within the Southside Boxing Academy. It is things like that that we also support, so a female will want to become a coach. There are opportunities, as I say, through our funding to ensure that more female coaches are visible within our communities. I would like to move on to talking about issues that have come up in many of our submissions about safety and harassment, putting women and girls off physical activity and sport, and questions led by Tess White. Thank you very much, convener. I have three questions. My first question is to Patrick Murphy, please. Patrick, how could sports environments and changing facilities be improved to ensure that women and girls feel safe? Firstly, it is really important to note that at the moment one of my main roles in my job is in and around the efficiencies and our estate shrinking to be able to deliver all the sports and physical activities that we do across swimming pools, golf courses and everything else. Then there is a second challenge in there about what you have just noted there about the physical environments. It is really difficult at the moment, especially with an ageing estate. You know that you have an ageing estate that is in some situations not fit for purpose and not fit for purpose for certain groups and certain diverse elements of the community. I think that that is a real challenge in the round of funding and finance at the moment for us. That is a huge issue. A direct question to Ewan Rowley. At the weekend, a swimming coach said to me that there is a huge issue right now in swimming in that mixed changing rooms that girls don't feel safe and particularly with mobile phones. He said that girls are being put off swimming now and also including at elite level because pictures are being taken of them in swimming mixed changing rooms. What are you going to do to keep women and girls safe in swimming? It is interesting. I would be quite happy to follow that one outside the committee's offering a bit more detail around that one test. It is important to keep in mind that we have safety and wellbeing of all participants at the heart of everything that we do, particularly in light of a five-pointed to the white review and to gymnastics across the UK. A lot of that is encouraging people to come forward and discuss any issues or concerns that they may have. To help to facilitate that at a local club level, we operate with each club that must have a wellbeing protection officer in place to help to promote at least one wellbeing protection office in place to help to promote safe environments. That includes the particular point that you are suggesting. There is the use of mobile phones, which is a challenge in the area. I mean that from a societal point of view, it is a challenge in the area when you have apps in place now that encourage youngsters to take snaps and photographs at any given opportunity. That is a challenge for any sporting context and never mind just swimming to be able to deal with. To mitigate that use of mobile phones, we have a mobile phone use policy, which we encourage or do not encourage. We ask clubs to adopt and many of them do and they reinforce that through their committees and with their members about appropriate use of mobile phones. That is for many venues, particularly the inside of a changing space. We are doing what we can and being able to promote the needs to make sure that mobile phones are used in the right way where at all possible. On the changing aspects and changing billage side of view, there is, as just as Patrick has outlined, undoubtedly one of the challenges that sport and leisure is facing at any level. It is the upkeep, maintenance and ability to run a good-quality service with funding situation and funding problems. We have the rise in the increase in the energy costs and the workforce issues that many of our partners will be aware of are contending with at the moment. That makes it a challenging situation for any council or trust to provide good-quality experience, as they might perhaps like to, given the financial burdens that are in place. That would include changing environments. What I would say around the changing environments is that there most definitely is not something that we, through Sports Scotland, typically support sports and or local authorities and leisure trusts with guidance to refer to around design and build of changing spaces. Typically, the more modern approach that has been for a good number of years is to have changing villages to open to all. That is with the right intent to make them as inclusive as possible. Inside of that, I am aware that, in some circumstances, depending on authorities, there are options to be able to secure lockdown, particular protections of those changing villages for a particular user group if that is required and needed, but that is very much up to local operators to build to mind those situations. I do think that there are mitigations in place in their tests. A lot of those things are probably down to local decision makers. I do not mean that in a negative sense. I mean that there are needs to understand the communities and how best to work with inside of the mitigations that are in place to provide the right experience. I am not pleased to hear your good earlier comments and happy to pick that one up at later date. I do not either answer from Patrick O'Newn film me with trust and confidence, so it is a very simple answer with a very simple question with a very long answer, not really getting to the number of the problem. My next question, convener, if I may, is what measures could be introduced, and this is for Cecilia, please. Cecilia, what measures could be introduced to improve reporting and investigation of harassment, bullying and abuse in community sport? In community sport we work on physical activity in communities. In terms of reporting and investigation, that is something that we would like to see reduced. I am not sure I can speak for just to improve reporting, just any thoughts on how to improve reporting of harassment and bullying in community sport, any thoughts? We can follow up separately afterwards, if that is okay. Coming from such a chance, maybe it does not have much to say in this area, but yeah, we do not work with community sport and as such we kind of promote physical activity every day walking inside. I was just wondering if you personally had any views. So, can I maybe come to somebody who is actually more involved in sport? Kirsty, you might have some thoughts on this. Anne Ewing, as well. When it comes to working with clubs and organisations, we try to make sure that they are inclusive as possible and safe as possible. It is sometimes very difficult to do that, but we do have in place training and education, be it through the Government body or local authorities, or like ourselves, Glasgow Life. We have all done courses in safe hands, in child protection, etc., in safeguarding vulnerable adults. Ideally, what you would expect is the club to have good governance, good finance structures, but also good code of conduct within their club. Therefore, if an incident was to happen, the young person or the person who knows exactly who to speak to would take it down an appropriate route, which might involve a Government body to be involved or involve ourselves, Glasgow Life, depending on what the actual circumstances of the incident have been. However, we would expect that our sports club and organisations do have a code of conduct and best practice and fair play, etc., all within their structures, so as to make sure that these can be dealt with at a local level. If not at a local level, then it is good to see a Government body on ourselves. I would like to ask Kate and Cecilia, from the perspective of quite a lot of women and girls, even if they are not involved in structured physical activity, to cut out the few bits of physical activity that they get by opting not to walk places, opting not for safety and harassment reasons. I count myself as one of them. I have very few opportunities to be physical, but when it comes to the winter months, you need to make the choice whether to walk home or walk to a place or whether you do something that you feel is safer. I come to Kate about how we tackle that and then Cecilia to back up. We all know that women are, in general, less physically active than men. Everyday walking is one of those things that has the potential to be absolutely transformational in terms of moving a huge number of people from not being sufficiently physically active to get those mental physical health benefits to being sufficiently physically active. It is something that we can do every day as part of our routines. It does not take a lot of time, it does not take equipment, it does not take new learning, but we have this problem where women feel less safe simply walking to work, girls walking to school. The issues around it are very complex because there are a lot around perceptions of safety as well as actual safety and the way that women and girls are trained to take responsibility for our safety and to be blamed for any lack of safety. There is a lot to be said about how we change the talk around women's physical safety and public spaces, but there is also a lot to be said about changing the facts about how we as women and girls experience public space. Yes, harassment needs to stop. It needs to be taken seriously at every level and that is work for men and boys to do as much as it is for women and girls to do. The other thing is, and I am going to come back to this every time you come to me, I am going to talk about design and planning. That is why we are invited to educate. When we choose to walk or not to walk, we are making an assessment of the space that we are going to walk through. There are different assessments made by different people. One of the things that women and girls will look at is who is there, but also who is there who might potentially be a problem, but who is there to safeguard them. So things like passive surveillance, which is if you are walking through a space, might people be looking out of their window and seeing anything bad that might happen to you. That is extremely important in women and girls and others who experience disproportionate harassment when they are making a safety assessment of the places that they are walking through. We need that lens to be represented every time a new street, a new development, a new active transport route is planned. We need to make sure that the people who are doing the work are competent to make that assessment, whether that is their training, whether that is through rigorous consultation, whether that is through doing equality impact assessments adequately, which in this area is absolutely not done. There is huge amounts of evidence that equality impact assessment around planning is appalling, inadequate to meet basic standards. Harassment in public places can be built in and we can build it out, but we also need to be talking about behavioural change around how women are treated. We are entitled to be safe in every space that we want to go to. That is work for women and girls to do in terms of searching that right and, for example, reporting harassment, but it is primarily work for those who are carrying out the harassment to do to stop it. Thank you and can I bring in Cecilia? Yes, so I was going to mention some of the things that Kate mentioned about safer infrastructure. More women report closer passes by cars when they are out-cycling. That is quite a lot of evidence about that. A segregated cycle infrastructure would help that situation. Better lighting in areas where public spaces where women and girls might be walking at night. As Kate mentioned, passive surveillance at eyes on the street is possible to have places overlooked by other buildings so that there is more vigilance in natural vigilance in that area. I will come to colleagues in a minute, but I will think about the one time that I took my bike in from my village outside Aberdeen into the college that I used to work in. The cycle paths were not meant for the commute, they were meant for leisure, so they went down by the river. You think that, at wintertime, you would not put yourself in that. That speaks to what you were saying about the paths that have been built. Those paths were segregated but also covered in places where there is more infrastructure around them. I see that in Aberdeen City, and you must see that across the whole of Scotland. There is evidence that some cycle paths feel very unsafe and are very unsafe if they are not being used by a lot of people. That happens at late at night in the dark in winter months. I want to bring in—I think that you and you want to come back in? Yeah, I think of threat here slightly. I just want to come back, I suppose, on the points that were made around the dissatisfaction of response. I mean, I would curstly highlighted very well typically what happens in the governing body from a club and a membership point of view. If clubs are expected to have codes or practice in place, they are expected to have wellbeing and protection officers in place. They have behaviours that are expected, and there are corporate governance sides that governing bodies would expect clubs to behave and have in place to make sure that complaints are handled appropriately, concerns are able to be raised, etc. Those things are in place across governing bodies. From a membership point of view, those things do exist. As curstly has highlighted on certain occasions, where issues or concerns are raised, they are managed and dealt with with a leisure trust or with a council if that is appropriate. My question directly back is, what do you expect if that is not a satisfactory answer? Can I come to Paul Sweeney on this issue of safety and harassment? I think that a major factor in all of this, convener, is planning, and an important part in making women and girls feel safe. I know that such trans evidence sites to just 39 per cent of women in Scottish cities feel safe cycling in their area, for example. Planning can be a male-dominated space. It can often be very confrontational and egocentric space in many ways. Do Living Street Scotland and such trans have any suggestions on how we can make sure that gender concerns are considered and that women are adequately consulted on planning decisions in the area that act of travel, particularly with respect to the new development plans that we draw up by local authorities in the wake of NPF4? We did some research a little while ago on the use of equality impact assessment in planning at a local level. The national guidance is great. It embraces equality. The further you get to literal street level, the closer you are to street level, the less likely it is that there will be adequate equality impact assessment done. We looked at 20 specific things like snow-clearing plans, or it was for specific developments. We found four equalities impact assessments that were available for those 20 projects. We found, for example, an example where a project had gone to a planning committee. It was a regeneration committee. The council worker has the required equality impact assessment being done. No, it went straight through the committee. At the moment, the powers that are available, the requirements that are stipulated, are not being met at even the most basic level. Planning committees could up their game and require that this kind of work is done, but there is also very much a role for both initial training of those working in planning. That will take time to come through, so we also need to hit continued professional development hard. We need to make a generational change in planning because there is a lack of cultural competence, I think it's possible to say, in planning, of understanding of equalities. The point about public sector equality duty is that equalities impact assessment is supposed to be done by the people who are doing whatever the project is, but that's not being done and they do not demonstrate an understanding of what that would involve. I just wondered if you had any ways of trying to codify this so that there are more clear rules and design for urban spaces and whether there are exemplars that could then be created as national standards? I think that the national standards in many cases are fine. It's the fact that they're being ignored that's the problem. I don't know if you wanted to come in on this. I was just going to mention that we've got figures that show that only 13 per cent of UK transport professionals report that they always consider gender in their day-to-day work, whereas 46 per cent never consider it and 41 per cent somewhat consider it. In Scotland, transport has the lowest proportion of women represented in senior positions within the public sector, so it's 6.25 per cent. That carries on, or that has the knock-on effect of gender perspectives not really being considered. In terms of involving more women in transport planning, it's the way forward. That sounds like it. Emma wants to bring in on this. She wants to come in on this specifically. It's just a quick question. Thanks, convener. It's for Cecilia specifically. I've just had a quick look at the Sustrans, and there's toolkits about creating better spaces. Safety is mentioned, but it's safety about reducing the speeds of cars. However, the toolkits don't seem to specifically look at considering planning for safety as in protection or support for women. Am I missing that, or is it just something that in the toolkits and in the information, it doesn't seem to mention that? Am I just missing it? We've got some research underway at the moment about safety in public space, so it's not appeared in the toolkits just yet. Okay, so that's underway. Okay, thank you. Sandesh, you wanted to come in on this specifically. Thank you, convener. I wanted to come in specifically about mobile phones that was raised earlier. With more and more people taking videos in the gym, and I'd imagine in other places as well, and posting it online, directly to Kirsty and Patrick, but obviously if anyone else wants to come in, do you have a specific social media policy when it comes to your spaces, because I do think that can make people feel very uncomfortable? We'll go to Patrick first and then go to Kirsty. Yeah, we don't have a specific social media policy, but we have obviously code of conduct and management rules in the round what's appropriate and what's not appropriate, and a reporting mechanism beyond that in the round child protection and adult protection actually as well. So that's in place. There's a real difficulty in managing that because people come in and out and they have their own personal property and what they do and how they deal with it, and that's in the round staffing and training staff and making sure that they are challenging behaviours in the round those public spaces. So that's where I think local authorities, leisure trusts would sit with that. Can I come to Kirsty? If you have anything to add, Kirsty, if you don't, just tell me. We do have a social media policy, but it's for staff, employees of Glasgow life, so they undertake responsible social media content going out and manage our comments etc, so therefore we have it for staff, but I don't believe we have it for the public, but I could look into that. Okay, thank you. We're happy to take anything that if you don't have the hand just now if you want to follow up. Sandesh, I'm going to stick with you on inequalities. Thank you. So one of the things I'm very keen about is knowing about, if you don't know where you stand with the number of people from different ethnicities, it's very difficult to make improvements, so my first question is very simple. Do you know, Patrick, that you're breakdown of people from different ethnicities? In some of our elements of our business we do, in some of our elements of our business we don't, so I'll break that down for you. We have a number of health intervention programmes that are co-produced by health and social care, where we have everything from which SIMD you're from, right through to your protected characteristic, so in some instances yes. In other instances, for example, a casual user using the gym or using the swimming pool, we wouldn't have that because there would be a pretty simplistic way about removing barriers to allow people to access, so you wouldn't be asking all that ream of questions in and around even some of those basic health questions to the diversity questions as well, so no, we wouldn't have it for our entire estate. So for example, we have 319,000 people in South Lanarkshire. We know that we have about 25,000 of them on memberships, but there's a number of casual users as well, so that would be that. Have you split and not happened? Fair enough. I'm particularly keen to hear about swimming, convener, because I think there is generally a bit of a problem when it comes to ethnicity and people wanting to take up swimming. I don't know exactly why that is, but do you know your ethnicity breakdown for memberships and what policies are you putting in place to increase people participating in swimming who are from ethnic backgrounds? Thank you. Assume that that was for myself, so yes, I'll pick that one up. The challenge is getting meaningful data, and I mean that from the point of view of every year, we request the membership to complete equalities data, which provide both equally as Partix Highland SIND information and protective characteristics. We have some information, but it's not rich enough, I would suggest, to allow us to make informed views about particular measures that we want to put in place. We have revisited the particular questions that are asked on that membership return, which is an annual return, and that's currently coming back in at the moment. The redesign is to be able to get more accurate information so that we can put measures in place. Our tax rounds of qualities is directed at the first kind of experience primarily through the Learn to Swim programme, in and working with our partners in trying to encourage as many people to get involved in the sport as possible. The challenge that we have is understanding the user groups needs and equally those whom we can't reach yet about where those particular characteristics that they want to get involved in the sport and what activities we do put in place. We work with a number of different leisure trusts and local authorities who support programmes that are put in place to pick up particular groups, but we have challenges ahead for sure. Finally, if I could go to Kirsty, what do you have in place when it comes to trying to promote Glasgow Life, sorry not Glasgow Life, when it comes to promoting women from ethnic backgrounds to participate? I think that I mentioned earlier that in terms of February, the month of February, that was that month where we were promoting all activities around women and girls in sport, and that was to include all people from Black, Asian and minority ethnic groups as well as people with disabilities. We actively encourage the promotion of all activities for women and girls, and in particular the Black, Asian and minority ethnic communities. I am fortunate enough to have, within my team, a cohesion team that looks at our equalities team at the call of that, who can champion and lead in the equalities diversity inclusion agenda. We are very proactive in trying to ensure that we promote the Black, Asian and minority ethnic communities in Glasgow and the opportunities for them. It is not perfect, but it is something that we are focusing on as an organisation. What I would say is that all local authorities and leisure trusts would be able to tell you their workforce in terms of the make-up of their workforce. I think that it would be important to know via the community planning framework that all local authorities and trusts will be working with their neighbourhood planning areas and around the areas of community or areas of interest of those communities to work with local authorities in the round. That may be women, and it may be in and around a holiday hunger agenda. It could be any kind of agenda, and I think that the neighbourhood plan is one of the good ways to find out what those communities of interest require. I wonder if I can ask about socio-economic issues for women and girls in sport. We had a response from Lanarkshire Health and Social Care organisations that told us quite clearly that physical activity sport is costly. That presents a challenge in targeting subsidy and targeting access from reduced rates. Things like that can make a huge difference. I suppose that in the context that we are in just now, particularly with local authority budgets, being increasingly pressurised, I suppose that I would be interested in maybe Patrick's take initially on how we can do some of that but with a reduced resource. What I would say is that currently we work with Lanarkshire Health and Social Care partnership just now in and around social prescribing. Some people call it GP referral, some people call it physical activity prescription, it's all the same thing in and around health professionals, GPs, practice nurses, physios, where at the moment if someone comes along, anyone and presents their GP, they would get a four-week free pass. Again, that just knocks down the line, that element of, well, at some point you're going to have to pay, but again, working with my colleagues here and some of those other green space programmes, physical activity doesn't need to cost anything, as we all know, so I think that's a fairly obvious thing to say. I think that social prescribing is an excellent gateway, stroke pathway into that and then there are concession schemes and that is in and around individuals being able to get some funding or the concession scheme itself giving a discounted approach to it. At the moment, if you looked at someone accessing your facilities today, it would be £12.50 a month to swim every day or go to the gym every day, that would be your costs just now for an adult. So half of an adult price, which would be £25, a concession would be £12.50, so that's in real terms. In a previous life, I served on the word of a cultural analyser trust and certainly the challenges and the tension, I think. We always had was reviewing those, that charging and the eligibility criteria for concessionary rates. I mean, have you found that a particular challenge? Haven't you changed the margins of that and maybe more people moving out with those opportunities for concession? Very much so, Paul. At the moment, our concession is 50 per cent, but with those challenges we're talking about down the line, it's looking like it's going to go up a little bit from the 1st of April, so that is constantly a challenge in the round-up. Did I see Kirsty's signalling to me that you wanted to come in, Kirsty? I'm just... No, no, that's fine. I'm going to pose a question to Kirsty if I may, just on a slightly different topic that's fallen on from Dr Gohanney's points about black Asian minority ethnic women and girls. I just wanted to, to my extent, Kirsty, you mentioned a number of initiatives in February trying to look at some of those areas. To my extent, have you, in Glasgow Life, went and sat down and spoken to people from communities about their needs and about what could be delivered that would help? Because, as it was, the knowledge of the barriers will be most acutely and most correctly told to us by the people who have that lived experience. I wonder to what extent have you had engagement? We have engagement all the time with our communities and specialist sports clubs and organisations. For example, we have community sports hubs, so in Glasgow we have 21 community sports hubs that across the 23 wards, and they roughly have about 100 organisations, clubs of about 10,000 members, so we actually, the job of the officers to go out and actually find out what are the needs of the club, but also the community. I'm speaking more specifically about women from a baby in background who are engaging or not engaging in sport. I'm wondering to what extent does Glasgow Life have any focus groups or have engaged with Muslim women's organisations, just as an example in terms of speaking about what their particular needs are? An example that we had is part of the February wards of women on wheels. It's predominantly a women's group that's a Muslim woman, but I did mention beforehand that we have a team, a cohesion team, who are tasked to make sure that they engage with the Black Asian minority ethnic communities, but it's not only that team, it's the wider team, so, if we identify community groups and organisations, we will then go out to that community to find out what their needs and aspirations are. We work with all the things that Glasgow and Afghanistan united and we help them to do a women's empowerment programme. We have significant staff on the ground who are in their communities, our 23 wards, to make sure that we do and can engage with groups that are potentially not at this moment in time involving sport or physical activity. In terms of what you talked about, the social economic challenge, you're absolutely right. It is a really difficult landscape that we're moving into with costs of living, et cetera, but there are things like we have health walks, which are free, so we have health walks that are 54 walks throughout the week. They are run by volunteers. The majority of the walkers are female at 73 per cent and also the volunteers are 74 per cent of our women. We also have clothes walks and clothes walkers when we train organisations for them to take walks forward, so we might train the link workers and help the social care partnership. We might train up Afghan United, et cetera, so we'll train organisations that wish to be trained and therefore they can then deliver walks themselves with their own communities of interest. That's a relationship that we have with PASS for all, and it's been established for a significant length of time. There's provision in the city for free, but it is challenging. We try, where possible, to do targeted provision for people that maybe have challenges around that social economic background. A bit like Patrick, we do have membership, which are full memberships and also concession memberships. If somebody is on universal credit or income support or job seekers or pension carers allowed, we then have a concession for individuals to access our Glasgow club, which currently has 29,000 people as members. In full enough, the people that pay monthly are 57 per cent of female. There's good information there that we're happy to share about our Glasgow club and our 29,000 members. Before we move on to talking about infrastructure, town planning and more depth. It might just be a question for Kirsty or Patrick. It's about wheelchair rugby. Rugby is really becoming everybody's playing it. It's really becoming very important for women to take up as well, but wheelchair rugby is quite a leveler because disabled folk can play non-disabled folk and you can have mixed teams, mixed genders as well. Is that something that is growing or can be pursued to basically really looking at level of playing fields and encouraging folk? Yes, we already have a relationship with the city and they have used their venues in the past, be it the Emirates Arena etc. We do have a relationship with the wheelchair rugby and have done so. Even a member of our staff in Glasgow life is involved with wheelchair rugby. Under the cohesion team that I talked about, we also have a focus on disability sport, so to ensure that we have involvement with people with disabilities in any type of activity and be it a physical disability learning, we try to support all people, young people and adults. We have been involved with wheelchair rugby in Glasgow. I think that most local authorities will have a sports council, which is the third sector, committee members, volunteers and most of them will also have a disability element to that, so we have that in South Lanarkshire. Our approach is going to be slightly different in that we are not going to go right in there with the rugby specifically. We are going to have a wheelchair multi-sport club and if that could be because it could be wheelchair basketball or it could be. That is going to be our approach and our branch, the Sports Council branches, funded by the local authorities are funding the chairs for that and that will be in the local authority setting and it will be inclusive to all anyone who can come along, as you say, able bodied as well as because there is often, especially in the female scenario as well, a sibling opportunity there to bring along a sibling, which is great because you are right that it is an absolute leveler. I remember that there was an advert on the telly where it showed people playing wheelchair rugby and at the end of the game an able body person stood up and walked away and joined them, so doing it with siblings is something, maybe it is a question for the media folks when they come in front of us as well to look at highlighting that. For the record, I will not be playing it because it is really rough. It used to be called murder ball and now it is wheelchair rugby. You can count me out. Right. Are most heavily subscribed in terms of members, I wanted to ask questions. Sorry, my clerk has just reminded me that I completely and utterly ignored that Luke Ewing wanted to come in before we move on. Ewing, apologies and you come. Thanks again and I suppose sticking with that inequalities piece and the question that is raised tonight. I can probably share the view from sitting outside a council or a leisure trust around. The biggest thing that is probably going to be facing the leisure and physical activities sector from an inequalities point of view is affordability and cost. That obviously is related to the circumstances that we are having to endure as a country at the moment. We are picking up signals from our sports, we are selling to our clubs that are preparing for increased costs to their access to any particular venue to the region of between 10 to 15 per cent for some and more and others. One example last week was a particular area that was going to increase the club let costs for their members by the stage of 107 per cent that it would work out at. So their club fees would increase from £33,000 per year to well over £60,000 per year, which is just not affordable. Those are pressures that are coming to operators because they have to have some affordability to be able to provide the service. That, unfortunately, with increased costs, is going to be passed on to members of the community at some point. That is going to be one of our biggest challenges that we are going to face from the inequalities point of view, going forward with simply affordability. From my own sport point of view, when we are one of the country's top participation sports, with a high percentage of females involved in that particular activity either through the membership or through recreational participation, when you start to see goals closing, that will have an impact on the health and wellbeing of the communities and the country at large. So I think that that is something that we need to be mindful of, I suppose, just for the better. I am going to push on that as well because we had a conversation offline about this, that swimming is one of the physical activities in sports that women do in later years as well. Would you agree with me that this particularly would be a problem for older women who might not be doing high-impact stuff but would actually be swimming right up until their later years? I would and I say that because of the uniqueness of the properties of water. It does have weight bearing properties, if you like, so that makes it quite accessible to genuinely all ages, all abilities, whether there is from the elderly to the un-firm to people who are coming from injury to those who haven't got any alternative, other form of physical activity, because they are unable to access or unable to take part in any type of activity. Being in water provides a number of different unique properties that allow people to be physically active. In particular, the kind of proportion of girls and women who take part in the activity is a concern when you start to see the threat of pool closures ahead. We have a lot of members who want to ask questions on facilities infrastructure and town planning, so bear in mind that we have only got 25 minutes left and we have another thing to get to as well. I am going to bring in David Torrance, followed by Gillian Mackay. Thank you, convener, and good morning to everybody. How can community sports facilities be better improved to allow female participation? The reason I am going to come at it is just examples like booking times, when it makes it a lot safer for them, because a lot of these community facilities have long-term mail bookings, and participation in female sport like football has increased to find it very difficult to get into community facilities. How can we improve that? I am not sure that I understand your question. I think that most facilities will be online in the booking facilities, so that is really equitable. A lot of these clubs, especially when I play with walking football, have a long-term and where at a time it is very accessible to us all, where there are any other groups, especially female groups, coming in. They are getting the real late times at night, the nine or the ten o'clock bookings. That is not my understanding of what is out there just now. As I said, if you are talking about club lets and casual bookings, it is very equitable that anyone could book online to do that, so I do not see that being… I think that I know what you mean in terms of traditional… We will get 10 taxi drivers at the John Knight Sports Centre in East Kilbride, and they have got the six o'clock slot in the half-had for 25 years, but they still need to go ahead and book that on an annual or 12-week basis. Especially around local 40 community centres, where, in many cases, weekends are shut and participation from those groups finds it very difficult to get facilities like that. Yes, I am sorry, I disagree. I do not think that that is an issue for accessibility and people being able to get the slots that they would like or want. I would probably disagree when they come to Five Council. The best example that I could give is when you are offered a summer holidays for seven weeks over community halls are shut. How would you actually get women to participate in sports, especially when it is a good weather? That is really challenging if the facilities are closed, but I think that, certainly at Kyrstyr you can speak as well. We have a 52-week year operation, six o'clock in the morning until 10 o'clock at night, in most sites. The availability is there to book slots and go and do physical activity. What we also have in place in Glasgow is part of my team. We have community venue programmers, so ideally if an organisation has come to us like a sports club or a woman and they are looking for a particular time or slot, the programmers will look across the estate to try to find a suitable venue at a suitable time. It might also mean that we are moving somebody out of a venue to something else because that space will be better used by that group of organisations. You might say, yes, if there was a young man playing football at peak time but the kids were going to be playing at nine o'clock at night, that is not good use of the space and time, so there would be negotiations and conversations with organisations to try to programme our venues more equitably moving forward. We do have people who look at that. It is important, but yes, there can be challenges because some people have had lets for a significant amount of years. I am not necessarily wanting to budge, but we try to do it through our programmers to make sure that it is an equitable approach and that it can be difficult. In terms of Glasgow Life, our sports venues, like Patrick said, are open pretty much 52 weeks a year, morning to night, so hopefully we can find availability for people. I know that everybody else will talk about the physical buildings and things like that, but I wanted to cover the social infrastructure that we need for people to be able to have time to be active. That comes back to what Kate said earlier about if you are trying to drop the kids off at school, do the shopping and come back. When have you actually got time to go and take that meaningful either walk, cycle, go and participate in a class in a local authority setting and things as well? Everybody might not have an answer in terms of their own work experience, but I wondered if anyone had a reflection on what changes we need to make. For example, my party is a big advocate of a four-day working week alarm. We have people more time to focus on things that are important to themselves. We need to look at caring time and things as well. Does anyone have thoughts on some of those social infrastructure pieces that we need to facilitate women and girls being able to have time to take care of themselves? It is an enormous question and it involves addressing things like care burden and how households are structured. It goes right to the very root of everything that we do every day. Simple things like, you can travel actively to work if you have time to get there via active travel or via public transport, which is a huge facilitator of active travel because very few people have the bus stop outside their house and outside their work. For example, you have to drop your kids off at 8.50, which is usually when primary schools start and you have to be at work at 9. That is not generally something that is feasible. For example, we need to be talking about things like softer starts to the working day so that you can work more flexibly so that you can do that. A lot of it is around not just changes so that things are structured more equitably so that women and girls do have that space in their lives that men can often take for granted, but understanding that there will always be people who struggle to find that space in their lives because caring is a thing that happens, having children is a thing that happens. So how do we build that social infrastructure? How do we build the working day? How do we build... I mean, this also comes back to planning because actually if your shops are a five-minute walk from your house, you will walk to them. So social infrastructure, but what underpins that is physical infrastructure and very literal planning. A fundamental change in how we do everything in society but just a small one for a Tuesday morning. Yeah, we have a current programme just now that we're working with a Clyde Gateway in the Rodden and Canvas line area working with two local schools and again not working in isolation in that we're delivering the childcare so we're helping a programme as I say called Clyde Gateway deliver the childcare programme so that allows that individual to either work longer or even search for work and that's a free programme and that's just about to be scaled up across in one of the more rural areas to pick up on your point earlier because some of those rural challenges sometimes are even more exacerbated aren't they in that area as opposed to the urban area like the Rodden and Canvas line. So I think we put a report in the alum along with the committee report in the alum with that so there's some statistics in there I can't quote them but they are in the report. Thank you. Gillian, is that you? Yes, I think so. Can I bring in Stephanie Callaghan? Thanks very much, convener. I want to ask about making spaces for women and girls because we do know that parks play equipment in public spaces for older kids, teens and adults are currently designed around the people meal so it's really interesting to know about the Glasgow feminist town approach and I know there was a great motion at South Lanarkshire as well about recognising and structured play for older children rather than just an activity for younger children. So my question is to Kate Kerster-Patrick, have any examples of older girls, teenagers and women successfully co-designing public spaces where that's increased the use by women and girls and certainly feel free to send in any further examples that you might come across there as well but I should perhaps mention that I was a member of the sports council at South Lanarkshire and that I've known Patrick Murphy too many years to mention. Thank you. Thank you, Stephanie. I don't know who wants to come in first to Patrick maybe since you were mentioned. It's a great question around the examples of where there has been this co-design with them. It's not looking like it but I'll go to Patrick first and then I'll come to Kate. I'm not aware of planning however we have some really good examples as I mentioned I think in my first babbled answer in around care experienced children and they co-produce some of the programmes that I mentioned earlier in around active schools and leadership stuff so that's the only example I would give. I will check for you though as well in terms of the co-produced green space stoke other unstructured players in South Lanarkshire. It sounds like Stephanie is already making some recommendations for the report that we're going to do but Kate, when you shook your head that there wasn't- I'm not aware of any, I'm actually wondering whether Celia might have more to say because us transdates quite a lot more in this kind of design space than we do. Yeah, examples I can think of are not in the UK so- So there is precedent elsewhere that we can potentially learn from. Yeah, it's something that maybe we need to factor in in our recommendations around this. It's maybe worth saying that we know from street design that it is economically much more helpful to get it right the first time than it is to go back and fix the mistakes that we've made. Disabled people in particular being brought into design spaces to say please don't mess it up in the first place is very valuable and I think again when we're looking at participation in public space that would apply too. Yeah, thank you, thank you. Can I come to a question from Emma Harper? Or not, Emma? No, I'm okay actually, I think I'm okay. I'll go to Paul Sweeney then. Thank you, convener. I was conscious that the leadership of South Lanarkshire Council yesterday called for the Scottish Government to consider the creation of a swimming pool fund similar to that announced by the Chancellor of the Exchequer for Swimming Pools in England last week. In the first instance unit of Scottish Swimming, are you a supporter of those calls and do you have a view of Scottish swimming on how such a fund could be used to improve facilities and support the needs of women and girls? Ewan? Thank you. In answer to your question, are you a supporter of those calls? Yes, we are and I've actually written to the First Minister and the Minister for Sport likewise to suggest that the Scottish Government consider following a similar route of two-phase approach, which is supporting providers and operators of swimming pools, particularly local authorities and leisure trusts directly, with some form of energy relief in the short term but equally the longer-term piece, which I think is a more active support that is needed is to have a broader look at some of the net zero requirements and ambitions of the current Government to invest in the infrastructure properly over the long term to secure leisure facilities and swimming pools. Thank you very much. We might have a view on why South Lanarkshire took that step. Because of the current circumstances, our operating budget is £38 million for everything that we do from the zoo right through to the nine swimming pools and golf courses. Of that, we bring in about £18 million. The other £18 million is the funding from the council, which is constantly reducing. Again, I'll mention that that doesn't work moving forward, especially on some of the things that Paul was talking about, some of the pressures in and around our communities and how they want to access and use our facilities. All of those things coming together is just so that we absolutely support some sort of relief, which would allow us to move forward and allow us to keep people using our facilities, especially women, and those from vulnerable backgrounds. Keeping those facilities open—I apologise, Paul, but keeping those facilities open is also about making them sustainable as well. I probably won't press you in on this, because we've seen that there are areas in the UK where they're doing something different about how they're heating pools. That is an opportunity, potentially. As I say, it builds into equalities. More women swim right up until the end of their lives than any other sport, but they're also very costly to keep open. However, if we do something in sustainable space, we could possibly do that. Euan, I've got to throw back to you. Euan, for example, for the committee, I do understand that, in some areas, some operators are facing a doubling, if not tripling, of the energy costs associated just with swimming pools alone. Probably no surprise is one of the higher energy users currently of a leisure side. However, there are rapid increases in tech and investment in renewables, which will reduce. The example that you're talking about there, convener, is a data hub company that is effectively storing data. If it understands us, it exudes a lot of heat, so that heat has actually been put to good use to heat the water, like in a swimming pool. That has been evidence down south that that is working. There are a number of other sites from passive house technologies that are being developed, such as the pool design, building design, and energy use from air temperature to circulation, to plant room, if you like, for the example of heating water, to also to filtration and use of chemicals, which are all advancing to reduce energy costs full stop. That technology is there, and there is an opportunity to invest in that. I wanted to give that on the record, because that technology is very exciting and could be an answer to quite a lot of problems. Tess, do you want to go in on that? I mean, if I can just build on that, and for the reasons that have been mentioned why it's so important, is this something, finding the technologies, whether it's solar panels on the roof or the one that we've just talked about, is that something that Scottish swimming can actually explore further? Ewan? Yeah, thanks Tess. We've actually just commissioned a company to, we cannot just try to understand the actual landscape of pool positioning at the moment across the country, but map that against actual need for communities of right size of pool, right shape of pool, for those particular user groups in local communities. The third part of this batch piece of work that we're looking at is to evidence and to provide some case studies of examples of renewable usage or new check, which could reduce energy costs for operating swimming pools. We're trying to get some case studies to evidence to government in a larger sense that this is worthy of investment. I am aware that this is a world in European problem and our European partners are likewise investing in renewables for particular leisure centres and with that to reduce the burdens of energy costs for swimming pools and this is an advancing sector. Thank you. Right, we are rapidly running out of time but we have a couple of members that want to pick up on good practice and the ways forward. Questions led by Evelyn Tweed and then Sandesh and then we're going to have to wrap up, I'm afraid. Thanks, convener, and good afternoon panel. I'd like to ask Ewan my first question, emphasising the fun factor of sport is important, but with women's professional sport not being taken as seriously it seems like there's a need to simultaneously work on access to elite sport, if desired. How can the two things be balanced and not occur in isolation from each other? We're to begin on answering that question. For what I understand and there is, as it goes back to some degrees to role models and perception, we are fortunate from sport I'm involved in to have a number of very successful at the world Olympic medal and Paralympic medalists who have lived in Scotland and are performing at a world stage in Scotland or from a Scottish base. I suppose we are empowering those kind of role models. If I use the example that I used earlier on of Tony Shaw who's a world medalist, she's our ambassador for the medalist swimming programme which is part of that point of the ambassadorial role around the fun and engagement and all the early experiences of why you bother getting involved in activity in the first place. Tony is great at sharing out that knowledge and experience that she does have. We are mindful of particularly that fun and engagement point to go back in reference to the young volunteer panel that we have. We are listening to our youngsters who are keen to change almost if you like or keen to put on other aspects of the sport that are less formalised competitive angles but more of a how do we just have a jumper for goalposts engagement in the sport and enjoy the fun aspects that go with that. There are other examples that should be used around the world. There's a goes from changing the profile of the activity itself. There was a series called the International Swimming League, which is a performance-based profile for elite swimmers, but with that came razzmatazz, lights, cameras and different social media engagement. It brought some more of the fun aspects of why people love best about being involved in swimming to life. There are probably opportunities on that side of things that we can perhaps look at in the future. My second question is for Kirsty. It's about ensuring good representation of women in coaching. In one of Kirsty's earlier contributions, she mentioned coaching, but do you have any really good examples of good initiatives to make pathways to coaching more accessible? I suppose that I mentioned earlier the energised programme that we had. That was about insight and training and support to engage and attract a range of females to a variety of activities that they would then deliver within their community setting. That energised programme was co-produced with the women that were a part of that. I mentioned the fact that there was Activate Hers, so they got additional training and support from my team so that they could deliver projects. We also put funding around that. Another good one was mentoring. We aligned people so that they could share knowledge and experience and practices so that they could empower them and give women the confidence to take part in sport and deliver sport and physical activity in their community. There is a difference between sport and physical activity, so we have a traditional sport. There are coaching badges and qualifications, but there are things that we do around physical activity such as the health walks and we do training in that. We have coaches and officials in our training team, where we try to identify young women as well to take part in physical activity and sport coaching. We also deliver with our colleagues in active schools a modern apprenticeship programme. It is about trying to get young women and young men involved in sports, coaching and activity and hopefully on a pathway to employability. We have a modern apprentice programme that we deliver with our colleagues in active schools. There are opportunities for engaging with young people in the school setting to try and get them into coaching, but we are also engaging with people in the community setting as well. I have to say that I have not before, but we are going through challenges in the city, like Patrick Seddon in Glasgow, because with the pressure on the public sector funding and reducing it, it means all those fantastic things that we can do that are at risk in terms of moving forward. It is important that we continue to invest in those activities, otherwise we will see a huge increase in health and financial inequality, not only in Glasgow, but in other cities. It is important that we recognise the pressure on the public sector funding around sport and physical activity, not only for our venues but for our communities. I have to go to Sandish for the final question. Two concrete answers, Evelyn. One is in the round. We have a dance festival every year, and there are 18 high schools in South Lanarkshire that all come along. They are mentored by dance activators, their young leaders and young girls. They go into the schools prior to the dance event and they build capacity, and they are volunteers. That is a brilliant example. The second example has a parliamentary motion, and it is through the UN and our organisation, and it is in the round. Young people have been identified as swimming teachers. This is a great model, because we have talked about those lifelong benefits. Young people have been identified as swimming teachers. They are given a free £550 to do their swimming teachers qualification level 2 to allow them to teach, and then those young people go and are employed as well. While it is a university or college or whatever they are doing, it is a great model of practice. That one has a parliamentary motion. Thank you. Sondesh, the final question to you, and we must suspend to allow a change over in the panel. My question is for Kirsty. £17 million was spent upgrading Tullcross swimming pool, but it is now being closed with eight other sites. What impact is that going to have on the community in getting women and girls into sport? Also, what are you doing to further improve the access for women and girls into facilities and into sport? In terms of Tullcross and the impact, it was mentioned, as someone else said, pools take money to heat and maintain, but the challenge that we have had in Glasgow life is in terms of recruitment of staff in order to run our venues. We have seen a decrease in people applying for jobs that will do things like pool lifeguards, et cetera. We are trying to do new opportunities to get people into training to get pool lifeguards publications and then secure a job with Glasgow life. There are different things here. There is a financial side that is challenging because it is the cost to run pools, et cetera, and the recruitment of staff to run our venues. There are two things here. What we are trying to do is to improve women into our venues and take part in activity. I mentioned, beforehand, that we have a Glasgow club of 29,000 members with predominantly female 57 per cent. When it comes to developing venues in those sites and refreshing them, we engage women to make sure that they feel safe environments and feel welcoming environments. What we also do is listen to women to see what else they want to get involved in. We do group sessions and group activities. We can go to the gym alone or take part in classes alone, but we will also do group activities. Therefore, women do not feel that they have to just turn up themselves. There are different things here. There is a financial side that is challenging to keep our venues open, but there is also the staffing side that has a challenge for us as well. However, we are trying to improve our facilities and engage with people as best we can to make sure that it is inclusive as possible. We have rapidly run out of time. We could have spoken to you for an awful lot longer. If there is anything that you feel that you wanted to maybe have drawn to our attention that you have missed and you are quite happy to receive that, we are going to suspend very briefly to allow a change of our panel, but I want to thank our panel members for that. Welcome back to our fourth agenda item today, which is consideration of an affirmative instrument. That is the Health and Care Staffing Scotland Act 2019 amendment regulations 2023. The purpose of this instrument is to make ancillary provision to connect some technical errors in the 2019 act, which arose due to amendments that have been made to the bill during its parliamentary passage. The Delegated Powers and Law Reform Committee considered this instrument at its meeting on 28 February this year and made no recommendations. We will now move on to an evidence session, but the Minister for Public Health, Women's Health and Sport and supporting officials of the instrument, and once we have all our questions answered, we will have a formal debate on the motion. Our witnesses are Mili Todd, the Minister for Public Health, Women's Health and Sport. Welcome to you. Accompanied by the minister, we have Sarah Cartwright, the policy officer for Health and Care Staffing Scotland Act implementation team. Joining us remotely, we have Cecilia McCulloch, the listor for the Scottish Government. I invite the minister to make her statement. Thank you very much, convener. The Scottish Government is committed to ensuring appropriate staffing in the NHS and care services to enable the provision of safe and high-quality services and the best outcomes for people using them. In 2019, the Parliament passed the Health and Care Staffing Scotland Act to provide a statutory basis for the provision of appropriate staffing in both the NHS and care services. That enables a rigorous, evidence-based approach to decision making relating to staffing requirements and supports an open and honest culture that engages staff in those processes. Among other things, the 2019 act inserts new provisions relating to staffing in the National Health Service Scotland Act 1978 and the Public Services Reform Scotland Act 2010. Implementation of the 2019 act was paused to redeploy personnel and resources to the Covid-19 pandemic response. A new implementation team was convened last year in the Cabinet Secretary for Health and Social Care announced in June that all provisions of the act would come into force by April 24. As part of the implementation work, the act was reviewed and six technical errors were identified. During the passing of the health and care staffing Scotland Bill through the Parliament, numerous stage 2 and stage 3 amendments were made. To ensure that the amendments were properly reflected throughout the bill on some occasions, that required inserting or amending cross-references to other provisions in the bill. In the majority of cases that was completed but in six instances, those updates were not made and the act contained those errors. Those now require correction to ensure that amendments made to the bill by Parliament are properly integrated, ensuring that the act can be given full effect on the intention of the Scottish Parliament delivered. The instrument makes ancillary provision under section 14 of the 2019 act to achieve that. The First Amendment ensures that the obligation on health boards and the common services agency for the Scottish Health Service, commonly known as NHS National Services Scotland, to raise awareness among staff about procedures for notifying any risks that they identify that relate to staffing levels under new section 12IC of the 1978 act extends to all relevant aspects of that notification procedure. The second amendment ensures that the obligation on health boards and NHS National Services Scotland to raise awareness among staff about the procedures put into place for the escalation of risks under the new section 12ID of the 1978 act extends to all relevant aspects of those escalation procedures. The third amendment will ensure that each health board and NHS National Services Scotland must, under section 12IL of the 1978 act, provide employees with information about how it is identified and taken all reasonable steps to mitigate the risks as part of the common staffing method. The fourth amendment will ensure that the Scottish Ambulance Service Board is under a duty to report annually to the Scottish ministers under the new section 12IM of the 1978 act, how it is carried out its duties under new sections 12IE, 12IF, 12IH and 12I of the 1978 act. Those are the duties to have arrangements to address severe and recurrent risks, to seek clinical advice on staffing and to ensure adequate time is given to clinical leaders and relating to the training of staff. The fifth amendment will ensure that the Scottish Ambulance Service Board has regard to guidance, issued by Scottish ministers under new section 12IN of the 1978 act, about carrying out of its duties under new sections 12IE, 12IF, 12IH and 12I of the act. The two amendments relating to the Scottish Ambulance Service Board will largely bring it in line with other health boards and special health boards delivering direct patient care in terms of its obligations in relation to staffing. The final amendment relates to the review and redevelopment of existing staffing methods by Social Care and Social Work Improvement Scotland, better known as the Care Inspectorate. Under new section 82C of the 2010 act, the amendment ensures that the Care Inspectorate may, in a revised staffing method, require persons who provide care services to put and keep in place appropriate risk management procedures in the same way as it could when developing a new staffing method under section 82A. Stakeholders, including representatives from health boards, relevant special health boards, NHS national services Scotland, local authorities, integration authorities, healthcare improvements Scotland, the Care Inspectorate, professional bodies, trade unions and professional regulatory bodies have all been invited to participate in working groups preparing the statutory guidance to accompany the 2019 act. As part of that process, the proposed changes detailed in those regulations were circulated for comment and no objections were raised. In conclusion, convener, I fully support this instrument as the means of correcting technical errors in the health and care staffing Scotland act 2019, ensuring that it can be given full effect and the intention of the Scottish Parliament delivered. I am happy to answer any questions that members might have. With that, we move on to item 5, which is the formal debate on the affirmative instrument in which we have just heard evidence from the minister. I remind the committee that members should not put questions to the minister during the formal debate, and officials may not speak in the debate. I ask members if they have any questions. Thanks, convener. It is a historical question. It is just a comment to clarify that those technical amendments will help to allow staff to understand that they can raise issues around risk associated with staffing or staffing concerns as we go forward. The staff that work in NHS Scotland, and I am a former employee, I need to remind folk that I am a former nurse for NHS to Fraser and Galloway, but those amendments will allow staff to understand that they can raise issues around risk. I am just going to look at other members' comments on that before I ask the minister to deal with them all that. I suppose that the technical amendments had to be made to the tidying up exercise, if you like. Is it still the minister's view that the timescale of 2024 and April 24 from the cabinet secretary is still the timescale to which the Government is working towards for full implementation? Thank you very much. We are still working to the same timescale. In fact, the working groups on implementation have been working according to the will of Parliament, so expecting those technical amendments to be made is a point that is worth understanding. To Emma Harper's point, yes. Some of those amendments were absolutely intended to empower staff to ensure that staff knew what the process was for identifying risks and who they should report them to. They really are simply technical amendments that ensure that the cross-referencing within the act is accurate. That makes sure that the will of Parliament and the intention of Parliament is now in the act. If you are content, I am happy to move the motion. The question then is that motion S6M-07988 be approved. Are we all agreed? We are all agreed. That concludes the consideration of the instrument. At our next meeting next week, we will continue our scrutiny of NHS boards, as well as taking further formal evidence as part of our inquiry into female participation in sport and physical activity, but that concludes the public part of our meeting today.