 Good morning and welcome to the 21st meeting of the Covid-19 recovery committee in 2022. The first item on our agenda is pre-budget scrutiny. The committee has agreed to focus its pre-budget scrutiny on how the Scottish Government plans to fund its Covid recovery strategy and the ongoing costs associated with the pandemic as set out in the Covid-19 strategic framework. We will begin this morning's meeting discussing the work of the Scottish Government's Standing Committee on Pandemic Preparedness, which has been published as an interim report on 30 August. I would like to welcome Professor Andrew Morris, the chair of the Standing Committee to the meeting, who joins us remotely. Thank you for giving us your time this morning. Each member will have approximately seven minutes to speak to Professor Morris and to ask questions. We are due to speak to the Deputy First Minister at 9.45, so I apologise in advance if time runs on too much. I may have to interrupt members or the witness in the interests of brevity. Can I invite you, Professor Morris, to just briefly introduce yourself and the work of the Standing Committee? Professor Morris, can you hear me? I think there might be some technical issues. Put your hand up if you can hear me. He can't. We'll just wait one moment while we're trying to rectify our technical issues. I'm going to briefly suspend the meeting and we might try to reconnect. Thank you. Good morning and welcome back to the 21st meeting of the Covid-19 Recovery Committee in 2022. We were having some technical problems, but I hope they've now been resolved. Can you hear me, Professor Morris? Good morning. Can you hear me? Yes, we can hear you. Fantastic. Good morning and I'd like to welcome Professor Andrew Morris, who is the chair of the Standing Committee to the meeting, who joins us remotely. Thank you for giving us your time this morning. I'm just clarifying that you can hear me. We still have some technical issues, so I will unfortunately have to suspend again until we can rectify this, so apologies. Good morning and welcome back for the third time to the 21st meeting of the Covid-19 Recovery Committee in 2022. Apologies, but we have had some technical issues this morning, so I'm hoping they're resolved. Can you hear me, Professor Morris? Good morning, and it's a pleasure to be with you for the third time. It is. I apologise, convener and members of the committee, for not being with you in person. No, no, no. That's fine. At least we've got you now. Thank you so much for joining us this morning. I'm just going to welcome Professor Andrew Morris. He's the chair of the Standing Committee to the meeting and is joining us, obviously, remotely today, and thank you very much for giving us your time this morning. We are short of time now, so I think that members will really only have about four minutes each for a question. We do have the Deputy First Minister coming in, Professor Morris, at 9.45, so I apologise in advance if time runs on too much. I may have to interrupt members or yourself in the interest of brevity. Professor Morris, can I ask you just to briefly introduce yourself and the work of the Standing Committee? Good morning, and it's a privilege to be invited to present to you. My name is Andrew Morris. I'm a doctor. My specialty is diabetes, and I was chief scientist for health in Scotland for the Scottish Government from 2012 to 2017. Since 2014, I've been Professor of Medicine at the University of Edinburgh, but I've succonded to London for the last four years as the director of a national technology institute, Health Data Research UK. It's ironic that I've had the technology challenges today. Since February 2020, I was invited by the First Minister to be the independent chair of the Scottish Government Standing Committee on Pandemic Preparedness, and I do that on a voluntary basis. The aim of the committee is to deliver on the commission of the First Minister, which was delivered to us on 5 April, to do four things. First, to advise the Scottish Government on threat intelligence assessment and response. Secondly, to define priorities for research. Thirdly, to strengthen the response infrastructure, and lastly, to consider priorities for Scotland in the context of UK risk assessment. The work is very much on-going, and I look forward to the discussions today. Thank you very much, Professor Morris. I'll now turn to questions, and if I may begin by asking the first question. Thank you for the interim report that your committee has published, and I note that the full report will be published this time next year. The first thing that struck me was the first paragraph in the introduction that said, pandemics are inevitable and are likely to occur more frequently in the future than in the past. Basically, my question is, why is it that they're going to occur more frequently in the future, and is it anticipated that they're going to have the same severity as Covid-19? There's lots of uncertainty. What we do know is that novel human pathogens occur very frequently. I think that WHO suggests that, in the last 50 years, there are 1,500 new pathogens. Many folks say that we've been lucky that the last major pandemic to affect humanity was in 1918. In fact, since the year 2000, we've probably had six to seven major scares, whether it's SARS or whether it's MERS. The other comment is that, with the exception of smallpox, that's the only disease that's ever really been eradicated. Many others are hanging around, for example, the plague struck in Madagascar in 2017, affecting about 2,000 people and killing 200 people. We live in a world where infectious diseases are a constant threat. As we know, international travel is a big issue. For example, in 2019, pre-pandemic, there were about 1.4 billion international arrivals globally compared with 25 million in 1950. The fact that we are living with pathogens is a new pathogen. The fact that we live in a global ecosystem means that pandemics will always be a constant. That has been recognised in Scotland and the UK in terms of the UK risk register pandemics. Pre-pandemic were in the far-right quadrant. I think that this is a fact for humanity, but there's an opportunity for us to do something about it. Yes, absolutely. Thank you very much for that answer. I'm going to move to Modo Fraser, please. Thank you, convener. Good morning, Professor. Thanks for joining us. I've got one question I wanted to ask around your paper and your recommendation 3, which is about the need to develop stronger linkages to Scottish UK and international scientific advisory structures and network agencies. We saw during the two years when we had the Covid pandemic politicians in different parts of the United Kingdom taking different decisions at times, but essentially basing their decisions on scientific advice. One would have assumed that it was largely the same in different parts of the UK. Does that, in your view, point to a need for more co-operation when it comes to decisions being taken, for example, about bringing in restrictions, or is this just an inevitability that politicians will go their own way, or does it point to the need for scientists to work closer together? I think that this is a key issue. I should comment that one of my other responsibilities that I was invited by the CMO to convene the Scottish Government chief medical officer's Covid-19 advisory group. Two comments there. We met 66 times, I think, and provided 44 pieces of advice to the Scottish Government. Most important, I and others participated in the UK sage process convened by Patrick Vallance and Chris Whitty. When I was invited to participate in sage, I thought that it was really important because scientific advice is emergent, but reciprocity and collaboration on scientific advice has to be completely unified. The role of scientists is not to set policy, but to provide the best evidence, the best consensual advice that is available at the time, recognising that, during pandemics, there is a huge uncertainty. It is then for politicians to make difficult decisions about policy. I am really clear that the scientific community needs to collaborate nationally and internationally to curate that best advice that then can be acted upon by politicians. In terms of where we are in Scotland, we have excellent chief scientific advisory structures. They link in to the UK well, but, as ever, there is an opportunity to do two things. First, strengthen the structures in Scotland, and secondly, ensure that they are completely integrated, at the very least, with UK structures. Science is independent, and science is agnostic of sovereign borders, if I put it that way. I have one question that is really around the effectiveness of the spend on Covid. During the pandemic, it would be fair to say that money did not become a barrier in terms of trying to tackle and deal with Covid, but how effective it was then and how, given that we are now living much more tighter financial times, are you looking at how effective spend is or should be in terms of being prepared for further risks? That is a very good question. It is not my job to comment on the spend in the pandemic that we have just had, because there will be an inquiry and others are better positioned to comment on that, although I am sure that I might be invited to do the inquiry. The opportunity that we have with the standing committee is to think what does really good look like for Scotland in the context of a global ecosystem in terms of pandemic preparedness. What we have done is tried to do three things. First, it would be very practical. Secondly, to consider what would an outstanding pandemic preparedness system look like in the context of Scotland in terms of our health structures, in terms of the academic community, in terms of our linkage with health and social care, and in terms of our linkage with policy makers and industry. Lastly, what we have done is on-going is trying to learn from the best internationally. Moving forward, we have got to do this with humility and be prepared to learn from international examples. My sense in terms of how we structure this, looking forward, I do not anticipate a major new budget line for pandemic preparedness. The two principles of this are that, for good pandemic preparedness, you need a very good, strong health and care system, so that is the foundation of good pandemic preparedness. Secondly, when we look at the components of good pandemic response, I think that there are perhaps three or four areas that we can do better, and they may need a targeted strategic investment just to get them into a very good place. Thank you very much. What kind of body would the Centre for Pandemic Preparedness be? So, would it be a statutory body, a non-departmental public body? How do you envisage that looks? What does it feel like to be brought in? It is a good question. I always say that form follows function. Rather than thinking what structure is this, we should consider what functions that we are seeking that body to perform. I always say that governance follows structure, follows function, follows purpose. The work that we are currently doing is being raised as sharp to say what functions and purpose should that body deliver on behalf of the Scottish population. There are four or five principles to that. Firstly, we want that body to transform medical defences, so it coalesces Scottish expertise in vaccines, therapeutics and diagnostics. Secondly, ensuring so-called situational awareness, and that is the data piece. Early warning systems and then real-time monitoring of any outbreak epidemic or pandemic. Thirdly, we should be very tightly integrated with our NHS social care bodies and public health Scotland, because, as I said, the foundation of any good pandemic response is to have it embedded in a health system. To ensure clarity around leadership, who gets up in the morning every day and is responsible for pandemics? To my mind, this is not about bricks and mortar. It is about a centre of expertise that brings together outstanding talent that already exists in Scotland. I think that Scotland is a good place to bring this expertise and leadership together. There is a model supported by the Scottish Government. You may be aware that the rural and environment science and analytical services support something called EPIC, which is expertise on animal disease outbreaks. What the consortium does is to bring expertise together in veterinary medicine, epidemiology, genetics, physics and math statistics to deliver value to the Scottish Government. I think that it is a virtual centre that addresses policy relevant questions in peacetime as well as during emergencies. How we structure that and put the governance across it is open to consultation and discussion, but we need to be crystal clear about the functions. Professor Morris, you mentioned in your introduction that the global pandemic is one of the highest risks that we continually face. I think that we always knew that a global pandemic was going to happen at some point, such as an asteroid strike. You just hope that it does not happen during your tenure. I think that it is fair to say that most Governments, if not all Governments, were not properly prepared for it. I also think that as we watch the pandemic move across the globe, we recognise that the ages that are an issue, obesity, diabetes and other conditions, have made people more vulnerable. I wonder whether, in our preparedness in recognising that we need to prepare better, we should be considering a more focused approach in dealing with the pandemic and where behavioural science fits into it, both from a Government perspective and what we can expect to ask our population to do. There are a couple of responses to that. It is a very good question, because I think that there is a risk of complacency. We are seeing Covid subside a little, although we are likely to see another surge in the winter months. With flu, there is a risk of a twin-demic. However, there is a risk that we turn the world's attention away from the risk and that we do not do justice to pandemic preparedness. Just to be clear, I think that we need to take action now while we remember how awful this pandemic has been and feel the urgency of trying to stop the next one. We should not assume that the next one will look exactly like Covid. It could be deadly and more infectious, and it might be designed by humans, because biosecurity is a big risk. In terms of how we set ourselves up, it is about the interdisciplinarity that I talked about earlier. One of the benefits of the Covid pandemic is how we have integrated behavioural science into the physical, biomedical and computational sciences. In the early days of the pandemic, we were completely dependent on so-called non-pharmaceutical interventions, which are the things that we know—physical distancing, hand-washing, isolation. The public responded very well. As we move forward in pandemic preparedness, integration and respect of behavioural science and working with the public is going to be key to good pandemic preparedness. It is not my area of expertise, but I have been trying to learn about risk. House of Lords select committee report was published on 3 December for preparing for extreme risks for building a resilient society. There were several conclusions to that, which I think are relevant to our work. First, the UK went into that with too much self-confidence. Secondly, there is excessive secrecy. The public behaved well, and you need to inform them if you expect them to respond to risks. Thirdly, we need to challenge systems. Moving forward, I think that having exercises that test our pandemic preparedness will be very important. If we do not have exercises to test how well we are doing, we are likely to fail. Lastly, and it links to your questions, we often look at risks as discrete risks, whereas there is a concept of cascade risks. For example, before Covid, we would have envisaged the impact on exam results. It is that cascade component of risk. However, behavioural science is absolutely key to pandemic preparedness, and you are quite right to highlight it. Can I move to John Mason? I know that you raised some really valid points there, so we might have time for supplementaries after John. Okay, thanks very much, convener. Professor, if I can just clarify. This is an interim report, and I noted in your chair's summary that it says that those are important and achievable ambitions to which the Scottish Government's partners will wish to respond. Are you expecting a response from the Government to the interim report, and then that will feed into your final report? Thank you, Mr Mason. It is a good question. I am anticipating a response through this interim report. I would like to articulate next steps of how you deal with it. Is that helpful? Yes, please. I am very fortunate to be supported by a fantastic group of experts, as well as to outstanding deputy chairs in relation to chief scientist health and a dementia check, and the chief scientific adviser, who is Julie Fitzpatrick. We are approaching this knowing that we do not know everything. However, this is our initial report, and over the next 12 months we are going to do several things. First, we have set up four task and finish groups to look at each of the four main recommendations to flesh them out in terms of their purpose, their function, their leadership, their structure, governance and resource implications. Secondly, we are going to go around Scotland, because this is a Scottish report. I have suggested to the team that we hold regional meetings across so that we get out of Edinburgh. We consult in a very open and transparent way with the public, as well as the learned societies, the Royal Society of Edinburgh, SSAC, NHS social care colleagues. Thirdly, we have set up an international reference group with some of the world's most distinguished experts on pandemic preparedness. That group will meet three times. Transparency is key, so all our minutes and all our activities will be published openly. The purpose of that is that I hope that we will get to the best quality product that we can. However, I anticipate an initial response from the Scottish Government and a final response when we publish the report in about 12 months time. Okay, that is very helpful to understand the way in which you help. Yes, no, that is super. If I may just ask quite a few things I would like to ask, but you said that one of the key things is having a health system that is strong and robust to start with. Some people would say that we should have hundreds of extra beds in hospitals sitting empty most of the time so that, when a pandemic comes or similar, we are all ready for it, but there would obviously be a cost to that. Have you any thoughts about how we balance up the spending on preventative measures or reactive measures? Clearly, we are under financial pressure at the moment. If we have labs sitting empty, if we have hospitals sitting empty, there is a cost. It is a good question and there is tension in the system. However, that is why I think that we need to look at how we integrate some of this expertise, capability and resources within businesses normal and peacetime and be able to pivot as required. Let me take one example, genomic sequencing. You will recall that the PCR test is like molecular photocopying, and it, for the diagnosis of Covid, told us whether you had it or not to be able to follow how the virus is mutating. You need to do sequence. That is part of core pandemic preparedness. In peacetime, we should be applying genomic sequencing to other respiratory pathogens, because it can help to support excellent quality-based care in normal NHS services. However, to have that capability, you can then pivot during the times of the pandemic so that it is ready, primed and can respond rapidly, rather than having to build it from scratch. What we learned in the pandemic is to build on what you have, rather than start new initiatives. Tricky decisions will have to be made, but across a raft of capabilities, we should be asking how we can bake this into an excellent NHS and public health system for Scotland. Finally, a lot of this is co-ordination and connectivity, rather than huge new investment. It is about alignment of expertise and alignment of capability on a Scotland-wide basis. We avoid duplication and waste in the system. It is about efficiency as well, but it is a difficult equation. That is not a doctor's question. I am conscious that we have about three minutes, but I am going to bring Brian Whittle in for a very brief supplementary. I am delighted to get the opportunity to ask a question. If we ask a clinician how we are going to prevent the spread of the pathogen, they would say, do not go outside and do not meet anybody else, and that will definitely prevent that from happening. There is a tension between the pure health science, if you like, of dealing with a pandemic against our continual learning of the non-covid-related impact of the Covid response, and we are continuing to learn that. How is that being baked into your thought process and the development of this study? The non-covid-related harm. I am keen that our commission is to focus on the health risks, but it is right and proper that we have awareness of the wider societal and economic risks. I think that, as part of our work, it would be right and proper that we attempt to do a cost-benefit analysis of pandemic preparedness. That is tricky. I looked at the literature and there are very few studies internationally that have evaluated cost-benefit of an economic evaluation of infectious respiratory disease at scale. However, moving forward, I think that that is something for the Government to consider is how to balance the cost-benefit of not only the health interventions, but the economic components. It will be part of our work, and I think that it should be, but we will be seeking external advice. I thank Professor Morris for his evidence and giving us your time this morning, and apologies for the technical issues that we had in the beginning. If you would like to raise any further evidence with the committee, please do so in writing, and the clerks will be happy to liaise with you about how to do this. I will now briefly suspend the meeting to allow Professor Morris to leave. Good morning. I now move to the second agenda item, in which we will conclude our pre-budget scrutiny by taking evidence from the Scottish Government. I would like to welcome to the meeting John Swinney, Deputy First Minister and Cabinet Secretary for Covid Recovery, Simon Mer, Deputy Director of Covid Recovery and Public Sector Reform, Andrew Watson, Director of Budget and Public Spending and Christine McLaughlin, Director of Population Health. Thank you for your attendance this morning, and welcome. Deputy First Minister, would you like to make any remarks before we move on to questions? Thank you, convener. I'm grateful to the committee for the opportunity to discuss a number of matters relating to our recovery from the Covid-19 pandemic and our preparedness for any future waves. In February 2022, the Scottish Government published a revised strategic framework that set out our long-term approach to managing Covid-19 and its associated harms. The strategic framework was published as we entered a calmer phase of the pandemic, and I'm pleased that, for the most part, we've remained in this calmer phase for some time. Covid-19 might not be at the forefront of everyone's minds in the way it was last winter, but the Scottish Government remains prepared to respond appropriately and proportionately to any new waiver variant that could emerge. The strategic framework supports the Scottish Government to manage future threats through adaptations to our behaviours and physical environments, as well as through effective vaccination and treatment. Ongoing surveillance of infection levels and potential new variants will also support our management of future threats. It is important to note that we are progressing well with ongoing booster vaccinations, and those in the most vulnerable groups will have been offered an appointment by the start of December. I'm confident that the strategic framework ensures that we have the necessary resilience and preparedness to meet any potential challenges that we might face in the months ahead. The Scottish Government's Covid recovery strategy, which was published in October 2021, focuses on addressing systemic inequalities and supporting those most disproportionately affected during the pandemic. The Scottish Government has been working closely with local government and other partners to pursue this agenda, and we are progressing pilots in Glasgow and Dundee to target support aimed at reducing child poverty. Since the Covid recovery strategy was published in particular in recent months, rising inflation, the worsening cost of living crisis and the inaction of the UK Government has made it even more critical for the Scottish Government to focus its efforts on supporting those most in need. The fiscal environment that we find ourselves in presents significant pressures. For example, inflation means that the Scottish Government's budget is now worth around £1.7 billion less than it was in December 2021. Despite those real and significant challenges, the Scottish Government is taking action to help, including extending and increasing the Scottish child payment to £25 in November, freezing rents and introducing a moratorium on evictions to protect the roofs over people's heads this winter, expanding free school meals, widening the warmer homes fuel poverty programme and freezing rail fares until at least March 2023. That is in addition to the almost £3 billion in support that is already budgeted for and an existing £800 million of relief for business in this financial year. Recent announcements from the UK Government regarding energy prices are welcome, but do not go far enough. They certainly do not materially change the Scottish budget positioned in the current year, and we face a challenging period ahead financially. We are undertaking an emergency budget review to assess any and all opportunities to redirect additional resources to those most in need, to reduce the burdens on businesses and to stimulate the Scottish economy. The Scottish Government will publish the emergency budget review in the week commencing 24 October. Any changes to budgets through this or other measures that we have already taken in the year will be formally set out to Parliament in the budget revision process, as is the standard approach. I am very happy to answer any questions from the committee. We intend to conclude this session by 11am, so members will approximately have 10 minutes each to ask questions to the Deputy First Minister. We should be okay for time this morning, however, I apologise in advance if time runs on too much and may interrupt members or the witnesses in the interests of brevity. I will now turn to questions. If I may begin with the first question, Deputy First Minister, could I ask you to please provide some more detail on the scale of the on-going Covid-19 spend? The on-going Covid-19 spend is primarily focused on arranging measures. It is focused on the surveillance activity that is under way, which is looking at some of the elements such as the ONS survey, the routine testing within GP surgeries in the wider healthcare system and in the care system. We are funding those elements to enable us to have that intelligence. There will be routine approaches around other elements of the intelligence gathering, such as wastewater analysis and the ONS infection survey, for example, and the wider work that carries on in relation to the activity of the test and protect arrangements that we have in place. Just in the previous session this morning, we had Professor Andrew Morris, who has published the interim report on pandemic preparedness, and there are four big-tick recommendations in that interim report. Will the recommendations of the interim report be reflected in the next budget? Obviously, we are at a stage in which we are in the formulation of the budget, but the recommendations that have been made from the standing committee on preparedness are recommendations that we will consider carefully. Work that Professor Morris is leading is very significant in making sure that we have the necessary level of external challenge—obviously, there are other elements of challenge, Parliament and this committee are principal elements of challenge in that respect—to ensure that we have in place the necessary arrangements. Obviously, the recommendations that come from the standing committee will be provisions that we will look at very carefully as we take decisions about the approaches that we take. In this financial year, we have forecast expenditure of about £485 million on all the aspects of the activities in relation to Covid. We will be reflecting on those points as we consider the composition of the budget for the next financial year. I know that you have briefly touched on that in your introduction, but following the UK's fiscal announcement last week—we will not get any further information to the 23 November at this stage—with the Deputy First Minister to be able to update the committee on any changes to the Scottish Government's fiscal timetable and the Scottish Government's approach to budget setting. It is a very live issue just now, convener, because I have to take forward dialogue with the finance committee to agree a timescale. The protocol between the Government and the committee and the Government and Parliament requires us to negotiate a timetable for that. Obviously, the fact that we now know that there will be another UK statement of some sort, I think that it is unlikely to be a budget on the 23 November. I think that it is more likely to be a provision and assessment about the condition of the public finances and the debt reduction arrangements that are required. I would be surprised if it is a full budget in late November, but we will accompany that and get the OBR analysis of the fiscal measures that have been taken. From that, we will then be able to engage through the Scottish Fiscal Commission and undertake their work, and we will obviously be able to pursue a budget thereafter. All of that leads me to the conclusion that it is highly likely that there will be a Scottish Government budget published before the end of the calendar year. There are a couple of areas that I would like to explore. I will first follow up on the convener's first question, which is about the strategic framework. We have taken quite a lot of evidence over the past few weeks about the ongoing costs of Covid-19 and preparedness across the public sector for potential future variants coming forward or a rise in cases. For example, the NHS has to maintain investment in vaccination, in surveillance and in PPE. You mentioned the figure of £485 million in the current year. I appreciate—I would not expect it to come up with any numbers—but projecting ahead, would you expect in next year's budget a similar figure to be required or something lower? What is your thinking about the level that the public sector would be required to invest in against the risk of a future outbreak? It is a fascinating approach from Mr Fraser to say to me that he does not expect me to come up with a number and then ask me to come up with a number. I suppose that God loves a trier, but it is clear that we must continue to make provision. That is not a provision that we can consider that is satisfactory to address. There will be on-going commitments to what I would describe as a precautionary regime that we have in place. Today, we have an enhanced level of biosecurity and PPE use compared to pre-pandemic, so that will have to be sustained ffiscally. We will have to retain sufficient intelligence-gathering capability to give us the confidence to be able to properly address the issues that you have just been addressing with Professor Morris. I will not be pinned down on particular numbers today because there is a lot of work yet to be done, but the committee can expect that there will be on-going provision to support Covid. It has to be of a commensurate scale to enable us to be confident that we have the measures in place to protect against any resurgence or any mutation of the virus. Covid has not become part of the firmament of society yet, because a lot of other viruses and conditions are routinely handled within our public service provision. Covid is still in a category of its own, and therefore funding will need to reflect that. Thank you very much. I appreciate that you cannot be the figure on it, but it is interesting to get your understanding that there will be on-going costs. We heard in evidence—we took evidence, for example, from COSLA about some of the pressures on their budget. We heard something similar from NHS representatives. Would you expect there to be, in the budget for next year, a specific budget line about additional resource being put in, for example local government or NHS trusts, to reflect the issues that you have just highlighted? The issues of funding provision, for example, on Covid, for example, on local government, I would not expect there to be a distinct budget line, because I am trying generally to move away from the overprescribing of the local government budget. I would be surprised if local government was seeing anything to the committee other than the fact that they would like to have as much flexibility over the budget as they can to meet the outcomes that local government and the Scottish Government are interested in achieving. That very much is reflected in the joint work that we are taking forward on the Covid recovery strategy. For completeness, I should say that the board that supervises the delivery of that strategy is jointly chaired by the Government of COSLA. I chaired it alongside the President of COSLA. It is a really valuable joint endeavour that we have. I think that the best way to address the point that Mr Fraser raises is to recognise that, for both the health service and local government today, they are under enormous financial pressure. Mr Fraser's committee will be familiar with the statements that I have made to Parliament since Parliament returned in the summer. In exercising my temporary responsibilities for financial management within the Government, it is clear to me that we are facing enormous financial strain in this financial year as a consequence of the effect of inflation. That will be affecting inflation and public sector pay costs, and that will be affecting every budget across the public sector. What I can say is that I expect to be dealing with intense pressure within the public finances, and I also fear that I will be dealing with some reduction in public expenditure when I look at what the chief secretary is now saying is likely to be the approach to create financial stability, but there will need to be reductions in public expenditure to provide that route map to financial stability. Obviously, I very much regret that, because that will add to significant pressure with which we are already wrestling. You mentioned public sector pay. The resource spending review envisages public sector pay being held at 2022-23 levels. That is prior to, of course, the increases that have been agreed, but even at that level it anticipated that if overall total public sector pay was to remain the same but with some increases in pay rates, that would unfair a reduction in headcount across the public sector. If that is to happen, where is the reduction going to come? That will obviously be a material factor within the budget. Mr Fraser is correct that the resource spending review envisages a reduction in public sector employment over the course of the spending review. We have to live within our means and the public sector workforce has grown during the course of the pandemic and we now need to take steps to ensure that that is sustainable or that the level of public sector employment is sustainable within the resources that we have available to us. It will obviously be a product of the discussions that are taken forward in relation to the budgets that are available for individual areas of public expenditure and from that will flow the implications for public sector employment. There is, of course, an additional variable beyond the resource spending review, but there are two additional variables. One is whether the resource spending review is actually sustained in the resources that we have available and, just now, I think that it would be reasonable to assume that public spending at English departmental level, which is what matters in terms of our availability of funding significantly, is likely to reduce, given the difficulties in the sustainability of the public finances that are currently being experienced. The funding that is available to us may well be reduced from what we expect. Secondly, we are dealing with much higher inherent costs as a consequence of the paydeals in this financial year, which are much higher than we envisage them to have been. Thirdly, is the point of real uncertainty that we have about the period for which we have to deal with much higher inflation. We do not yet have the answer to that question, but it is material to the financial volatility with which we are wrestling just now. I have constituents who have contacted me who, for example, are employed in the tracking trace programme. That programme is coming to an end, so contracts are up. Those are people who were previously working in the public sector and will no longer be working in the public sector, and I think that that is understood. There might be a need to re-energise that at some point, but that will be a loss of headcount. That is understood, but do you anticipate when you are talking about potential headcount reductions in the public sector going beyond that? Essentially, it is impossible for me to answer that question just now without certainty over where the budget is heading in the years to come. I will not know the answer to that until I see the outcome of the UK Government's statements on 23 November. It depends on what information we get at that stage. This is a genuine point of anxiety for me, because we saw a fiscal event on Friday, which did not give us a complete picture of the financial information that is necessary. If we get another repeat of that in November, I will be trying to construct a budget that will be based on a number of variables that might include significant risk for us. If I do not know firmly what is the expected budget of the UK Government for 23 November, that adds significant variability and uncertainty into the budget that I have to set for that period. We will have clear answers to that question when we get through the budget process. NHS Fife board met on Tuesday in the finance director. He reported that the Scottish Government was in discussions with the board to claw back Brexit on the brain Covid funding that had been allocated. I wish we could claw back Brexit to Mr Rowley. Covid funding that had been allocated earlier this calendar year. You have IGB boards, for example, sitting with millions in reserves. Can you confirm that the Scottish Government has notified health boards that they want that money back and what the thinking is around that and what that funding is going to be used for? I can confirm that the Government is engaged in dialogue of that type with IGB, with integrated joint boards. We have got to make sure that the resources that are available to us to meet the financial pressures that we face. Mr Rowley will be familiar with the statement that I made to Parliament in early on September. We have to make sure that whatever resources are available to us are able to be utilised to meet the enormous in-year pressures that we face during this financial year. Those discussions are under way. I think that some of the discussion that took place at the board with my understanding and the concerns that board members raised are around the lines of recovery. At a time when they are trying to plan as they understand that NHS Fife have or are resubmitting a further recovery plan, they are making the case for further funding and further resources. At the same time as that, you must acknowledge that social care is in a bit of chaos in terms of the impact that it is having on the hospitals where people are bedblocking. You have massive waiting times in communities for care packages. You can understand where people are looking at. It does not seem joined up in terms of local recovery plans to try and tackle the social care crisis, to tackle the crisis within the NHS. At the same time, the Scottish Government is saying that we want to claw back the money that you have. What is the difference with the Covid funding being used for recovery? How do you define what is Covid recovery? All those things are joined up. Mr Rowley and I have probably talked about this issue as much as we have talked about any other issue over recent years. We have congestion in our A&E departments, which the A&E data on Tuesday demonstrates to be the case. Part of that is to do with congestion in our hospitals in general. It is not straightforward to get people out of A&E into other parts of hospital if they need to to stay there or if they need to go back home because they may need care to support them at home. We have congestion in our hospitals. In the community, we have challenges over the availability of care packages, not because of a lack of money but because of a lack of people. We have low unemployment and staff shortages in the care sector. Obviously, we have just taken a decision in partnership with local government to substantially increase pay for low earners in the local government sector, which I know is an issue that matters very much to Mr Rowley. That is part of a measure to try to boost the attractiveness of many of those occupations so that we can attract more people to expand the number of care packages that we are able to provide and that we can provide more care and support to individuals. All of that is interrelated. Some of the work that we are undertaking is designed to improve the attractiveness of professions so that, as a consequence, we have more people around, which helps to boost morale so that people feel less tired and exhausted by the work that they are having to do. As a consequence, the system attracts more capacity and we can therefore handle more cases in a more efficient fashion. However, the common theme of all of this is that it has to be paid for and that we are simply trying to use the resources that are available to us to make sure that the system is well supported financially to enable it to operate efficiently. I do not intend to get drawn into the social care discussion, but given that you have taken me there, the IGBs are sitting away with millions that are now going to be clawed back. The question there is, so I understand that you want to take that money back out of the reserves. What is that money going to be used for? In terms of planning, let us look at Fife again. Fife now is over 60 per cent, and I think that 62 per cent of social care provision at home is provided through the private sector. Less than 40 per cent of care at home is provided in Fife directly through the council. The issue in terms of recruitment and retention is that that is 60 per cent being provided by the private sector. That is where the greatest problems are because the pay in terms of conditions that the Deputy First Minister knows. The inequality between the pay in that sector and the pay within the public sector is massive, and they cannot recruit an example of that 25 pence of mileage allowance for care workers delivering that 60 per cent of care. In the public sector it would be 42, 43, whatever it is, pens per mile. You can imagine during the fuel crisis how those people struggled even more private companies have told me that staff were leaving and they could not afford to pay the petrol to get to the clients. We know the terms and conditions in the qualities this year. My point to you would be unless you addressed that or bring the whole thing back in-house and tell councils to deliver the care at home in-house, you are not going to tackle that problem. My final point on that is what I cannot see is a joined-up strategy sitting there right now and a joined-up plan to actually finance that. By the way, the NHS Board in Fife are reporting that they are about £10 million in the red projected right now, so you can see where board members are thinking, while they are clawing back millions at the same time as we are in the red, at the same time as our services and our other chaos, I just cannot see the joined-up approach implanted. If the Government was to direct local authorities to bring all of that work in-house, a number of members of Parliament from a number of different traditions would be saying that that is the Government centralising things once again. I am not looking at anyone in particular, but we have to acknowledge that there is a degree of local decision making that is required here, but ultimately a health board and a local authority working together through an integrated joint board have a duty to ensure that the needs of individuals are met and they have to make sure that they have a sustainable service in place. The points that Mr Rowley put to me are all entirely legitimate points, but it might encourage a decision locally to be able to take more of this in-house to enable some of those issues to be better addressed. In some cases it might have to be brought in-house because there won't be the private providers to deliver the alternative services. I come back to what I said in my earlier answer. It is all joined up in the sense that it has ultimately all got to be paid for and we have got to make sure that the resources are available to us at a time of intense financial pressure. Mr Rowley went through a whole series of real, tangible pressures that our public services are under. I do not dispute any one of them, but it is a measure of the scale of financial challenge that we face. I have just been to the social justice committee this morning and I told the committee that after having served for nine years as finance minister through the financial crisis, through the period of austerity of the Conservative and Liberal coalition, I thought that I had seen challenges in public spending. They are as nothing compared to what I am now wrestling with in my temporary period as finance secretary today. The situation is much more grave and I am very pessimistic about the outlook on public expenditure, given what I am hearing from the UK Treasury overnight on revisions to public spending. The chief secretary told me on Friday that he hoped to stick with the comprehensive spending review allocations for future years. I am now seeing departments being asked for savings immediately. That makes me very fearful for what lies ahead, because if that changes at a UK level—sorry, an English public expenditure level—that will have a negative effect on us. I am going to go to Mr Mason and once we go around members, I will come back to you. I think that we are now at the stage where, whether I ask you a question at the finance committee or hear similar questions, we are very much overlapping this committee with the other committees. To build on the whole cost side of things, we had evidence—I know that it has been mentioned already today—that going forward we have higher levels of PPE, for example. There may be labs that were built or created during Covid, which were moth-balling and keeping in place. How do we get this balance right? It is back to the question of preventative spend. So much preparing for another pandemic is preventative spend, which is a good thing, but we have the pressures that you have just been discussing with Mr Rowley. How do you see it going forward, not just this year but in future years? How do we get the balance right between being prepared and reacting to what is happening now? It is a very careful risk judgment that has got to be applied, but it is not the only risk judgment that has got to be applied across a range of different projects in the public services. So we have to—nobody would thank us, given the experience that we have had between 2020 and 2022, if our level of pandemic preparedness was not adequate for the challenge. There are lady poolers convening a public inquiry on the pandemic, and one of the questions that she will explore is pandemic preparedness. That will look at what the Government was doing before Covid struck. A global pandemic was one of the top risks in every annual risk assessment that the Government has ever produced. It was right up there. The question is, to what extent are you prepared for it? My answer to Mr Fraser, in the earlier part of the session, was designed to say that there are certain things that we will be doing operationally of a routine level that are now stronger than our provision pre-pandemic, so PPE provision and biosecurity measures are in that category. There will be surveillance arrangements that are stronger than they were in the past. If that is all done and we do not have a pandemic, we could be exposed to criticism for spending public money on stuff that was not going to happen. Alternatively, people could say that that is a reasonable assessment of the level of risk that society faces and that the Government is right to prepare on that basis. That is the type of approach that I would like to see us planning for. Making sure that we are prepared, but also that we have the capacity to increase our footprint, should it be necessary? That is a reasonable answer. I think that, going forward, in eight, five, ten years, there will be a different lot of politicians around the table on the whole. How willing they will be to put resources into preventative spend, I do not know. We mentioned Professor Morris in his report. Is the Government, considering the interim report, is the Government responding to him at this point, or are they waiting for the final report? We are obviously engaging with Professor Morris. We have a number of discussions with Professor Morris. I do not want to characterise it as we are simply waiting for the end of a process. That is an on-going dialogue to understand what questions the committee is looking at and what is the likely direction of travel that will come out of that. Arising out of that, we will take steps to ensure that we are responding appropriately, rather than waiting until the end of the process to make a formal response. Another area—we took evidence—we have quite a lot of varied evidence, but one was from the OECD. The whole issue of what a resource spending review is, and its suggestion was that it is slightly different in Scotland and the UK from other countries. Other countries seem to be more of an emphasis on examining what you are spending money on at the moment. I do not know whether you saw any of that or have picked up on any of that, but I wondered if you felt there was any validity in that, the point that the OECD was making. I think that one of the challenges of deciding our priorities in public expenditure is about assessing what is the most effective use of public expenditure at any given moment in time. I think that we have to be open to that debate because the world changes, life changes. We did not have a pandemic until 2020, and we are having to provide in our budget in 2022-23 for £485 million for pandemic activity. I think that it is important that public expenditure decisions keep pace with the needs of the time and the agenda that the Government is pursuing. However, I think that, for completeness, I would have to say that having that discussion is not straightforward, because if I was to say, right, we are not spending £485 million on pandemic preparations, if I call it that, or instead going to spend £50 million, I think that there might be a lot of folk saying, what on earth is Swinney doing cutting the pandemic preparedness by £435 million? I am not sure that Mr Mason has been served in this Parliament and in Glasgow City Council. He will be familiar with the debates about public expenditure. There is not a queue of people queuing up to say, let's stop spending money on that and spend money on that. That is many of the issues that I have rehearsed with the Social Justice Committee this morning. Do you think that in practice it is different in other countries, or are they just facing the same issues in a slightly different way? I suspect that we all face the same dilemma, because nobody has ever got more money than they actually require, so it is always prioritisation that has to be undertaken. I suspect that other countries probably do not find it any easier than we do to stop spending money on one item to spend it on another. However, the process that I am having to go through just now in my statement to Parliament on 7 September was a very clear example of that. I am having to exercise a very challenging judgment about prioritisation. When we look at the impacts of Covid, and we continue to learn—as I am sure we will—the impacts of Covid, we know that the effects of Covid are disproportionate on the older population, on those with conditions like obesity, diabetes and poverty. We have an on-going learning in that. I have had this conversation with myself before and with the health secretary about the potential here, out at the back of Covid, and the learnings from Covid to look at the way that we deliver health and how we tackle health inequalities. On many levels, that is a very good target to have, not least of all for those who experience it, but there is also a positive cost in tackling health inequalities. I wonder whether the Government is considering exactly that. I think that we have had positive conversations about that. What are the Government doing out of the back of Covid to look at the way in which we deliver health services and other services that will tackle health inequalities? A lot of the thinking that needs to be done has actually been done, and it was largely done by the Christie commission all those years ago. I do not think that we have a question to which we do not know the answer. We do know the answer, and the answer revolves around prevention and early intervention. If I can then translate that into the questions that Mr Whittle has put to me about the role and approach of the health service and the approach that is much more about encouraging people to live a healthier lifestyle, to be active in addressing their weight, to be active in addressing how they manage any conditions or experiences that they have, all of that is a crucial role for the health service. I think that we know all that approach, and that is reflected in our wider public health policies, where we will have measures around minimum unit pricing of alcohol and some of the advice about dietary issues and all those kind of questions. It is all part of our agenda. I think that what Covid has the opportunity to do is to essentially force us to face up to that. It is almost the kind of turning point moment where, because of our experience in Covid, we all think that we can do things differently and we should do things differently. I can almost prompt a reset moment. The Covid recovery strategy was designed to really provide the vehicle for that to happen. If you look at elements of the Covid recovery strategy, a fundamental part of that is a lesson from Covid that if we deliver person-centred public services, we will make more impact on individuals and our likelihood to deliver better outcomes. That was our experience during Covid. For example, during Covid, because of the restrictions, households who faced difficulties were not able to be contacted by the multiple agencies that would normally be knocking on their door to offer them support. What we deduced during that period was that people liked that because they built up a relationship with the one trusted person who was coming to their house who, instead of turning up and saying, I am from the council and I can offer you this and I am from the health service and I can offer you that, turned up and had a conversation that said to people, what do you need? How can we sort things out? How can we do things better for you? It might have been about food, it might have been about access to particular public services, whatever, but people had a better experience of that. The Covid recovery strategy is designed to get us into that mindset and that mode of delivery to try to do it. The programme board that I chair, along with the president of COSLA, which involves representation from a range of different public services, is designed to help us to drive that agenda. Indeed, the pathfinder approaches that were taken in Dundee and Glasgow provide very good learning about how that can be done. I think that the reason I decided to take this line of questioning is the fact that the Christchurch commission report has been out for some time. Quite frankly, I think that it is a failure of all of us in this place that has not been implemented in the way that it should have been. The evidence to the health social care and sports committee around tackling health inequalities noted that the Covid pandemic had exacerbated health inequalities that were already on a rising trajectory. I was concerned that we were going to go back to business as usual. I hosted a health inequalities reception a couple of days ago and one of the deep end doctors described it to me in a way that I have not heard it before in terms of the way that we deliver health services that are designed and demand not on need. I am warned by the thought that perhaps we have an opportunity here to grasp the hold of the way in which we deliver health services to tackle this kind of health inequality. I just want to know whether the Government is really committed to doing that, because, as I said, you will know of the inverse care law here, that 20 per cent of our population do not access healthcare, and they are the ones at the most need. How is the Government tackled that? Any reading of the Covid recovery strategy would say that the big lesson that the Government takes from Covid is the necessity, the imperative of tackling inequality. That is reflected in the contents of the programme for government, as was set out earlier on this month by the First Minister. Those issues matter in two principal respects. The first is in relation to the point that Mr Whittle concentrates on, which is about changing provision to make a difference to the experience of individuals. That is absolutely correct and to generate better outcomes. There is a direct relationship to the issues that Mr Rowley has raised with me in a second observation, which is that all of that work is critical to reducing demand on the health service. If people are presenting at A&E inappropriately, because they are not generally healthy and looking after themselves and all the rest of it, that is an interaction in A&E, which is unnecessary if I can use that word. If they were better supported within their community and within their own home, they might be able to avoid making that journey to A&E. If they do not make that journey to A&E, we have one less person adding to the pressure that is already on our hospitals, so it is critical to the efficient operation of our public services. It is the direction of travel that you yourself have said that it is the direction of travel that you would like to go. The Cabinet Secretary for Health has said exactly the same. The truth of the matter is that we are an unhealthy nation. In the Cabinet Secretary for Health's own words, we are getting sicker, which is compounding the problems at A&E. I am really looking for some action here, what the Government is going to take to tackle that health inequality, because we have talked about this a lot. The committee reports have been around a long time. I am more optimistic about the taking forward of the Christie commission than Mr Whittle is. I think that a lot of good stuff has been done over the years. I am not going to sit here and say that everything has been done or that as much has been done as I would have liked to be in the case. I think that a lot of proactive early intervention work has been undertaken, but we need to do more of it. The Covid recovery strategy and the focus on specific tangible measures about how we might do that is the focal point for that activity. However, the crucial point—I have aired this in the committee before—is that we have to remain absolutely focused on the central purpose of that activity, which is to reduce inequality in our society, because inequality was in existence pre-Covid—it got worse during Covid—and we have now got to use Covid recovery to address that. I would like to go back to the evidence sessions that we had last week. We had Sarah Watson from Cosland. Her comment was not only as demand for services is increasing, but all of the crises that are out there in social care, business support and all sorts of areas that local government, but the cost of providing services is huge because of inflationary pressures. Mary Spowage spoke about the UK fiscal event that has just happened in the 23rd. Obviously, she was speaking before the fiscal event that happened. She said that there are huge implications for the Scottish budget of the UK Government to fundamentally decide to change devolved taxes in England, which we now know has happened. It could not mean that there is a boost to income for the Scottish budget envelope, but we do not know how much detail we will get about the spending plans, which could have also consequentials. Not only is there huge pressure, but also huge uncertainty. I worry about the amount of detail that we will have to be able to give more certainty to both the Scottish Government and local government. I listened to the chief secretary this morning. I do not see any more clarity other than the fact that those spending decisions are going to be tight regardless of whatever envelope budget may come to the Scottish Government. Could you expand on that for us to understand? Certainly. The fiscal event on—to give a complete picture—there has been growing pressure on the public finances for some years. The statement that I gave to Parliament on 7 September is a statement that I was not obliged to make. I volunteered to give it because I wanted to be transparent with Parliament about the gravity of the public's spending pressures that we face. We are operating in a fixed budget. I, by law, cannot revisit tax during the financial year. I cannot borrow for day-to-day spending, so we have a fixed budget unless we benefit from any consequential funding because of changes in English departmental public spending during the year. I went to Parliament and announced over £500 million of spending reductions and changes to be open with Parliament about the gravity of the difficulty that we face. That is a product of rising inflation and pay costs that are far in excess of what we expected because of the inflation. That is where we are. That is where we were last Thursday. On Friday, we then had the fiscal event, which in this financial year generates a positive Barnett consequential of £35 million to the Scottish Government, which is from changes to stamp duty in England. In subsequent years, there are further Barnett consequentials, but there are changes in tax interactions between Scotland and England, and there are plenty of voices demanding that I make the tax changes that the UK Government has made to deliver those in Scotland. When we look forward, we have some line of sight about the tax position, but I am not at all confident as I sit here today that that tax position is going to hold because I think that there is huge market volatility in the last 48 hours. It has been horrific, so how that will all hold, I think, is anybody's guess, and it doesn't look like it's getting any more stable this morning. The chief secretary to Treasury told me... When you say that tax position won't hold, can you explain what you mean? You mean they might have to reverse that? Of course. If the UK financial system is going to collapse, they'll have to change it. It's a mess this morning, an absolute mess, a total mess. I've never seen a hint like it in my life. How that will prevail, I have no idea. Add to that then. Why is that happening? It's because the markets don't believe the UK any longer believes in fiscal sustainability. If the UK Government wants to prove to the markets that it still believes in fiscal sustainability and it wants to protect that tax position that it set out last Friday, it's only got one place to go reducing spending, which is why you heard the chief secretary on the radio on the television this morning... Forgive me, why Mr Fairlie heard the chief secretary on the radio on the television this morning talking about the need for departments to tighten their belts and what that translates into plain English is spending cuts. The chief secretary told me on Friday that he hoped to maintain the comprehensive spending review fiscal envelope for the remaining period, but I now hear a message which is about further restraint. I can't see how that further restraint will happen without it having a negative effect on the budget in Scotland. The outlook for our budget, I think, is pessimistic. We also heard from Dr Lucas Hart last week that the policy engagement led for the wellbeing economy alliance. Stressed importance to the Scottish Government using existing devolved tax powers to support provision of further services and that the Scottish Government may struggle to address inequalities with the current funding envelope set out, but he also said that I'm a bit surprised that this kind of funding limitation is so readily accepted. If there are powers that the Scottish Government has in terms of local taxes, there are possibilities to think outside the box and challenge the idea that this is the money that we have. Are there areas that you're not thinking outside the box? Mr Fairlie should know me well enough to know that I'm thinking inside and outside the box on a constant basis, but let's take a couple of those themes. The witness that Mr Fairlie Sights talked about local taxation, the Government has legislated to enable local authorities to exercise a workplace parking levy, for example. That's not exactly what has been universally welcomed by all shades of opinion in this Parliament. That's the concept of a visitor levy. Again, it's all about giving power to local communities to make their decisions. We get encouraged to empower local authorities and local communities and then we get criticised when we try to empower such local communities, so I don't think that it's a straightforward question. In relation to the resources available to us, we obviously have tax powers that we can exercise. My ministerial predecessors have taken decisions about tax rates, which are different from the rest of the United Kingdom. I wholeheartedly support them. I think that they are the right decisions that have been taken. Again, they are not universally popular. We have used tax powers. I can't do that during a financial year, but the law prevents me from doing so. Those options are available to us, and I have to reflect carefully on the fiscal event of Friday and what it has thrown up in relation to public taxes, as I have determined what will be the position of the Scottish Government. The other thing that Dr Hart said was that we know that council tax reform is well over due. We know that council tax is well over due because it is very regressive. We know that the Scottish Government has powers over income tax bans that it hasn't made a lot of use of, which I'm not quite sure if I understand what you mean there, but perhaps you might. Even if there are good reasons for that not being looked at in more detail, the spending review is a five-year spending review, so I was surprised that more information on raising finances was not there. Is that a criticism? I don't think so. Obviously, people might want us to do more on tax than we're prepared to do, but we've got to look at all the aspects of the fiscal sustainability of individual tax decisions. I think that there's a difference between, in terms of the composition. If we basically had had tax powers and had just used them in exactly the same way as the United Kingdom Government, then I could see why that criticism was valent, but we've not. We've had a barlow of criticism for the different decisions we've taken on tax. I think that they've been entirely reasonable and appropriate decisions, but we've got a lot of criticism for so-doing. I'm not really buying that criticism at all. On council tax, I would accept that I've been an advocate for alternatives to the council tax, but there's never been a parliamentary majority to actually put any of those alternatives into practice. We're going to be doing some work on looking at local taxation to try to build wider agreement around what a reform package might look like, and that will be taken forward during this pandemic. Can I say firstly that in terms of, and I do understand the real risk that we now face in terms of public service cuts, I think that you and I will stand shoulder to shoulder with millions across the country in opposing those cuts if that's the route that they do take. Regardless of that, our services are in crisis right now. Really what you're confirming to me is that the millions of pounds of reserves that are sitting in IGBs across the country is now going to be clawed back into the centre, and how that's to be spent—I know it's one-off spent—would be important to know. Crucially, there does not seem to be a joined-up plan at the local level to deal with the crisis that we have in health and in social care. It's okay saying that councils can take or start to put some of the provision for home care back into the public sector. The only reason they put it out was because it was cheaper, and the only reason it was cheaper is because the pay terms and conditions of the workers—and that's why we can't get carers now because they've treated them so appallently. You can't just pin bit it onto the council. We have the IGBs, councils and NHS boards. Somehow you need to instruct them to come together in a totally transparent way and produce local plans that show us how they're going to tackle the crisis in health and social care that's then running into a crisis in our hospitals, that's then running into a crisis in an accident emergency, and we have people queued up for hours on hours in ambulances. We can no longer ignore it. We somehow need to instruct these bodies to come together and produce a plan that tells us how they're going to tackle it. Would you not agree? I actually do agree with that because there is a direct relationship between any congestion, delayed discharge and social care in the community. These are three directly linked propositions. I think what Mr Rowley fairly puts to me is, are they as connected in local planning because ultimately it's people that are in there in those three categories, A and E, delayed discharge, social care, they're people. We've got to make sure that services revolve around people, that they're built around people as opposed to delivered in little compartments where, and I don't mean any criticism of anybody with the language I'm just about to use, but A and E deals with A and E. I suspect there's lots of A and E staff who would love there to be more activity in social care because it might actually allow them to get around the A and E department slightly more easily than they are able to do just now and that their day might not be quite as up against it as it every single day is. The A and E folk will be focusing on the A and E problem in front of them but they need the rest of the system to be dealing with the social care issues so that the A and E problem becomes not as significant as it is and so there has to be cohesion amongst that and the players in all of this are the local authorities, the health boards, the integrated joint boards and the care providers. Those are the people that have the key to all of this and there are arrangements in place to ensure that planning is undertaken to deliver those services in a cohesive way. I think that the challenge that we face just now is that the work that is going on is not delivering the outcomes that we need to deliver because A and E is too congested, delayed discharges are too high and social care provision is not as extensive as it needs to be. What is driving that? Amongst all of this, unemployment is at 3 per cent. I deduced from that and Mr Rowley mentioned it earlier on inadvertently but I am afraid that we will go back to Brexit because I cannot speak for fife, I do not represent the kingdom of fife but I represent the county of Perthshire and if I was to go into a care home in my constituency prior to Brexit I would have encountered a lot of people who would be working there who would come from Eastern European countries. Lovely people, faithfully looking after our loved ones in our community and delivering home care packages and I can think of folk as I sit here, folk that I know well and they have now gone back home because they did not feel welcome after Brexit. Our working age population, Mr Rowley knows, does not need me to tell me, our working age population has been declining for 20 years and it has now got critical because of the population. We have temporary respite after the expansion of the EU in 2004 and with all those years where folk came here, made their homes, contributed, looked after our loved ones, played the partner community and then we took part in the folly of Brexit in 2016, had it inflicted upon us and as a consequence we have lost those people from our populations. That is a big factor. I do not think that money is the problem, it is the availability of people just now, that is the biggest problem that we face. Except from what Mr Rowley has said to me, there is maybe not all the cohesion that we need and I will take that issue away, I will give the committee that assurance. I will take that away. I discuss this all the time with the health secretary because he understands that relationship between A and E, delayed discharge and social care, just as much as I do. We totally accept the analysis of the problem, but we do not have all the people that we need to make sure that we can deliver that connection. If we can make it more connected, I will endeavour to do so. I do not have a magic solution to the people question because we have committed folly in our decision making. I fancy putting a question to you, cabinet secretary. I put to Professor Morris this morning, and you alluded to it yourself that a global pandemic is in the high risk category continually and has been in the high risk category before. My analogy was that we know that anastorily is going to hit the earth at some time, so we just really hope that it does not happen during our tenure. Governments across the world have been shown that they were not as prepared as they perhaps could have been for a pandemic. As we watched the pandemic move across the world towards us, we started to learn that, as I said before, age and obesity and diabetes and other conditions, more vulnerable conditions were much more affected by Covid. In hindsight, in hindsight, in 2020, we will have to use that as we plan forward. Whether or not we can use that information and be more focused on how we prepare for a pandemic in the future, given that we recognise that vulnerability had such a huge impact on Covid outcomes. Are we able to slun down our approach looking back? I am deadly serious when I say that literally every—we have an annual risk assessment that is undertaken, and every year I have been a minister. A global pandemic will have been in that top category. I can remember conversations that we have had before around different resilience tables in Government saying that we must be due to a pandemic sometime soon, but it was always there. Surely, when it comes, it came with absolute ferocity as any pandemic will come. To go back to the point that Mr Mason put to me earlier on, we have to be ready for—in that risk, if you take the top risks that the Government assesses that we are exposed to, a global pandemic will be one. Increasingly now, cybersecurity risks are up there, and then we have the natural issues that we have climatically in Scotland in general of winter weather, flooding and the enhanced level of threat from climate change. We have to have a level of preparedness for all those things, so we will have different flood resistance plans—flood alert systems—that give us advanced warning of circumstances that might be coming towards us. We judge them to be appropriate. We cannot build flood defences in every single community to protect against every eventuality. We can make a risk-based assessment of where they are required. I was down in Hoiq just the other week, and there is huge construction works going on on schemes to protect from, I think, River TV in Hoiq, where there has been flood damage in the past, so there we are responding to risk. When it comes to a pandemic, fundamentally, there are a lot of things that the state can do, so the type of steps that Professor Morris will have gone through with the committee this morning, the type of expenditure that we undertake, the surveillance measures that we have in place—those are all part of our equipping ourselves to be able to deal with those situations. However, there will then be individual preparations. We know one big lesson from the pandemic that the healthier you are, the more you will have the capacity to resist the pandemic. At personal level, that should say to me how many times you have been out running this week, John Swinney. Well, we have got to Thursday, and I have not been out yet. I ascribe that to the burdens of office. How do we all take the steps to keep ourselves as healthy as possible? That is material to dealing with some of the issues that Mr Rowley was putting to me about congestion in our public services. The more I can keep myself healthy and away from A and E, the best thing that I can do for A and E is to stay away from it and keep myself healthy. There is a societal and individual level that we have all got to take forward. If I could just find another one of my pet likes, and this is the application and deployment of technology and the way in which technology helped in the way that we tackled Covid, where are we with that? I am on record of seeing that we are way behind the curve in healthcare tech and in the way in which we could deploy that. Are the Government considering a deployment of technology as part of pandemic preparedness? I think that I would have to reserve my position specifically on pandemic preparations. If I need to give any specific information to the committee, I will write to the convener about that point. On the use of technology, there is a huge role for technology in the management of healthcare. If I can get information on my fitbit thing here about my health condition, just based on me voluntarily having that information and being able to monitor my health and other factors, then surely at a system-wide level we can find ways of ensuring that we have the support that technology could bring towards us in that respect. I met a really interesting company yesterday who is involved in the use of sensors that are placed in people's homes to assess their movement and the steps that they take to monitor vulnerability. Is somebody getting up at the right time? Are they moving around the house enough? Are they putting the kettle on? Are they cooking? Is there a need for support to give early indications? If we can get support to that person at the earliest presentation of vulnerability long before they come anywhere near a care home, a GP practice or an A&E department, that allows us to deliver better outcomes for that individual and enables us to operate fiscal sustainability. We are veering slightly off the budget scrutiny agenda, but that concludes our consideration on this agenda item. I thank the Deputy First Minister and his officials for their evidence today. The committee's next meeting will be on Thursday, 27 October, when we will consider a draft letter to the Scottish Government on our pre-budget scrutiny. That concludes the public part of our meeting this morning, and I will now move this meeting into private. Thank you.