 Rhaol! Rydw i'n ffawr, neu ddechrau'n dweud. Rwy'n meddwl yn Government Poland ac i chi'n ddweud eich eu gwaith i'r prif wedi'i gael i fynd, yn ddangos i highlighterau, yn bach i ei hoffaeth gyda'r gweithredu o'i newid y dyfnodau ac i chi'n ddhefnol. Felly, yn fynd i'r gwaith crasgau, awrod o'r ddigwydd, er mwyn i rydym yn sgolledd, faeth eich ddyn publishedeidol, oedol i chi i'n gofyn bach i'r ddigwydd, er mwynurwyr, wrth gwrs, o Nu naen nhw'n 06 April, yn gyffredinol â dda. Fy hwnna, geistiffau angen i ddechrau'r Sesiad ac oedd o'r content Ffgolwyr ac uch chi i'w sgolwyr gweithio ar gyfer, ac mae hi angen i'w'r Comitie Stephen Boyle, yn wahrj ears sy'n ardalio y Lyfe Ffgolwyr. Felly mae hi. Fe gennychai nhw, rwyf yn fawr ac yn gweithio ar gyfer. Fy cael eu bod yn fanlygiadol,wyr companiesur, Jeremy Blyhar, Direc Hwy, Yn Baldwch, Lee Johnson, I invite the Auditor General to give a brief opening statement. Thank you very much, convener. Good morning, committee. Delighted to be with you this morning. My report on the NHS in Scotland for 2021 turns our attention to the recovery and remobilisation of NHS services while acknowledging that it remains under severe pressure from the pandemic and the backlog of patients that have built up over the past two years. The NHS at the time of the publication of our report was on an emergency footing and the path of the pandemic remained unpredictable and I think it's fair to say it's likely that it still does. The Scottish Government and the NHS are planning the recovery from the pandemic but the scale of the backlog of patients will make this challenging. The NHS also needs to reform. Services were already delivered in an unsustainable way before the pandemic and the Scottish Government must therefore focus on transforming health and social care services to address the growing cost of the NHS together with supporting its recovery from Covid-19. This will be very difficult against competing demands of the pandemic and an increasing number of other policy initiatives including plans for a national care service. The innovation that we have seen during the course of the pandemic shows that positive change can happen quickly and effectively and this momentum has now to be maintained. The Scottish Government has published its NHS recovery plan last year and is also developing a care and wellbeing portfolio within the Scottish Government. That is expected to provide a strategic direction for reform but it also needs to involve the public in deciding how future services will be delivered. Workforce availability and workforce wellbeing are the most significant risks now to successful reform. Staff wellbeing, of course, has been hugely affected by the pandemic and the NHS recovery plan makes ambitious commitments, placing significant asks on the workforce already suffering from both fatigue and risk of burnout. The recovery plan makes several commitments that require significant growth now in the NHS workforce on top of already existing staffing commitments. A new health and social care workforce strategy was published in March. It remains the case that plans to recruit staff will be challenging to achieve and we know and have reported previously that the NHS has historically struggled to deliver all of its staffing ambitions. Finally, we highlight the uncertainty surrounding the long-term financial position of the NHS in Scotland. Under the new care and wellbeing portfolio, the Scottish Government plans to bring financial service and workforce planning together in one place. That has the potential to make the NHS more sustainable but those plans remain at an early stage. The key to financial sustainability remains a clear focus on the Scottish Government's long-standing commitment to transform how health and social care services will be delivered together. I am joined by my colleagues Lee Johnson and Derek Hoy from Audit Scotland and together we look forward to answering the committee's questions this morning. You have outlined some of the main points of the report in terms of the challenges that we know the NHS is facing and some of the potential learnings that have been from the pandemic. Can you be more specific when you were doing your work? It is quite obvious. A lot of what you have said and a lot of what is in the report is that there is no surprise to any of us. We have been hearing this since we convened and obviously well before that about the challenges that there are for the NHS, particularly in the emergency footing in most places. Given that health boards are responsible locally for how they manage their health board, do you see that there is an opportunity with some of the reforms that are taking place at national level to have some of the health boards that you have identified as having particular challenges brought into line with those that seem to be managing better? I will bring Lee Johnson in amongst Lee, who is one of the authors of the report, in particular looking at some of the forward aspects of how reform will be delivered in the NHS. It is the case that you suggest, convener, that there is not a uniform picture across Scotland either. Through some of Audit Scotland's reporting over many years, we have produced what we call section 22 report, statutory reporting, on a number of health boards that highlight some of the challenges of those boards, whether those are in terms of leadership, financial position or governance matters. There has been some consistency, if I can put it in those terms, of which boards have been in that bracket and which and those that have not. In terms of the reform, that is one of the key planks that we make in the report that, rather than looking to recover to what we think was an already unsustainable position, both in some local context across health boards and more nationally, the opportunity for the Government to grasp reform. In the report, we highlight some of the examples that we have seen over the course of the pandemic, but they need to galvanise those on a consistent basis and spread that learning and innovation across all the areas of Scotland and all those services. We point to the ambitions, particularly around the care and wellbeing portfolio, to give the Government some of the strategic capacity that it is looking to generate some of that consistency of experience. If I may convener, I would like to bring Lee in just to say about some of the lessons learned and how that good practice and some of the forward thinking is being developed. In terms of the boards that we have identified that are getting additional support from the Scottish Government that have been struggling, it is fair to say that across the board a number of the boards are struggling in terms of their financial position going forward, in terms of the efficiency savings that they have been making. There has not been a focus on that throughout the pandemic. Obviously, the Scottish Government has funded the unachieved savings and fully funded all of the NHS boards throughout the pandemic. As we move forward, we need to see the more medium-term and longer-term financial planning coming back into place so that we can fully understand the future financial position of those boards. There are opportunities across the board, as you said, convener, in terms of the innovation that we have seen throughout the pandemic. For example, things like near me and the opportunities that that offers, particularly some of our more rural NHS boards in terms of trying to provide services that are more accessible for people in those areas, but also enable them to deliver more affordable services as well. As you mentioned, near me and Stephen wants to come in as well, we have been hearing quite a lot in some of our other inquiry work around patient expectation. I am just wondering, in terms of the work that you did and the scope of the work that you did and who you spoke to, if that really came out. Obviously, we have had historic issues with waiting lists, particularly for elective surgeries, for example. Given that we are still in an emergency footing, we have still had some backlogs hung over from pre-pandemic. Did patient expectation come up a lot in the work that you did when you were speaking to the people that you spoke to in the course of your inquiry? As we have clearly set out in our report, it is very important that the patient is at the centre of any changes in the way that services are delivered, both in terms of what their priorities are going forward. However, as those services change and the way that services are delivered, it is clearly communicated to the public as well. I think that what we did see is that there has been an evaluation of new me. That was clearly one of the findings that it does not suit everybody, for example, that type of service delivery, if you like, and that there has to be a choice going forward as well. I think that it suits some people, but then we get into all the questions around digital inclusion. Obviously, some of our more vulnerable members of the population still want to have that face-to-face contact with their healthcare. However, one of our key messages in our report is that patients and the public need to be at the centre of any service changes going forward. Once those changes are implemented, that all needs to be clearly communicated so that people are very clear about how they can access services going forward. I think that, for absolute clarity, we did not interview members of the public in terms of compiling our reports drawn from a range of sources and interviews with health board officials, Government officials, review of evidence and so forth. However, I think that Lee strikes on the main point that, as all of the innovations that have been identified and touched on in some of those Exhibit 7 reports, near me being a very clear one, we are unlikely to revert to stepping back from some of the digital technologies. We note importantly the Government's plans for a digital strategy later this year, bringing in some of the data gaps and evaluating all of that on a regular basis. At the heart of that will be what are patients' experience and expectations of the services that their voices heard and their shape the future reform of the NHS in social care in Scotland. I want to bring in some of my colleagues who have questions around this. I can remind whoever. Thanks, convener. Yes, Mr Boyle. Welcome for coming along today. It's nice to see you face to face as well. It's been eight months since the Scottish Government published its NHS recovery plan, but what's your assessment of progress that's been made, if any, since its publication? We all understand and you've rightly stated that there's no quick fix, but this is the opportunity for us to reform, rather than to recover to the pre-pandemic levels. Statistics coming out of the NHS, when it comes to A&E, cancer, delayed discharges, diagnostics, all remain bleak, so do you think that their plan is working? Good morning. We're very clear in the report recognising that the NHS remains at the time of publication on an emergency footing. The challenge of tackling the Covid pandemic was writ large, while we were compiling our audit work. We also note that the Government began to turn its attention to the future, the recovery and the reform, and that it has received submissions from the health boards. I'll turn to Lee again in a second just to say a bit more about the assessment of what the individual boards are stating. Our assessment, on an overall basis, is that it is an ambitious plan that will be both centred on recovering a backlog of services. In the report, we looked to outline, for a number of specialties—not all of them, if I can get the exhibit correct—just to set out exhibit 4 for the committee's attention, some of the impact of the pandemic on seeing an increase in demand, a reduction in activity, and, therefore, by consequence, increasing weights for patients. On top of that, the committee, of course, will be familiar with that. There will be many patients who would have been anticipated to present for services who haven't, so the scale of the backlog itself also remains uncertain. Our assessment, as I say, is that it is an ambitious plan centred and predicated on recruiting, training, retaining enough medical nursing professionals to deliver the scale of backlog that will be needed to be tackled. Therefore, it is probably not possible at this stage to give a definitive position, whether it is on track or not. I think that one note before having to Lee to say a bit more is that we welcome the Government's commitment to publish an annual update on the progress against the recovery plan in terms of supporting transparency, managing patients' expectations, public scrutiny and all of that feels in the right place. We also set out in the report our very clear plan to undertake further work in this area. It is very likely to be part of our report on the NHS in 2022 that we will track and monitor progress to support the committee in Parliament's scrutiny. I turn to Lee, if you are content, just to say a bit more about the recovery plans for boards. Lee, when you come. Yes, thank you. Yes, again, as we outlined in our report, I think the boards in terms of their remote remobilisation plans had a number of concerns about their ability to recover and remobilise services. We have seen them play out, if you like. One of the major things that they were worried about was the uncertainty about how the pandemic would continue or not. Obviously, in late summer, early autumn, the boards were starting to turn their attention to recovery. We saw the new variant appear, and it just took their attention away. We saw the pressures that the hospitals were under, with all of the winter pressures as well, and that continues as we speak that those pressures are there. It takes that focus away from that ability to remobilise. I think that one of the other issues that they were very concerned about is workforce. There are a number of aspects to that. Both their ability to recruit is sufficient numbers. Obviously, the on-going pandemic has affected the capacity of their staff because there have been high levels of sickness, so that has also reduced the capacity within hospitals. The on-going infection control and prevention measures that they have had to have in place further reduce the capacity within healthcare settings to deal with the number of patients that they would like to be. One of the other key findings that we outline in our report is that the Scottish Government introduced a clinical prioritisation framework. Basically, those people who were in more urgent need would be seen more quickly, but we have yet to see the data from that being published. We made the recommendation that we would like to see the data from that, both in our 2020 report and in our 2021 report. It would provide transparency to both the public and provide assurance about how NHS boards are dealing with the backlog of patients if we could see the data related to that clinical prioritisation framework. Mr Boyle mentioned earlier, and I might not have the exact wording right, so hopefully I will give you a just—you said that the NHS consistently failed to deliver on all of its historic staffing ambitions, and then you also stated that the new recovery plan is predicated on recruitment retention of staff, so staffing is obviously key to that. However, do you get a sense, I suppose, that what the recovery plan sets out is the reform that is required, and it is not just tackling the issues that we have that are long-standing with staff, because that is quite different by bringing about the reform that is needed versus tackling our recruitment challenges? It is a very important distinction that you make. It is not about recovery to where we were before the pandemic. My predecessor and myself since taking on this role have both noted that the NHS operated in unsustainable financial position service challenges, changing demographics in the country and the unsustainable nature of the delivery of services. The report also touches on—I will address your very direct question, actually—the challenges in recruiting staff, retaining them and using the Government's word in its own report about nurturing the experience that people get while understanding that it has been an incredibly demanding period, unprecedentedly so for NHS workers over the past two years. We note the report that the NHS has historically struggled to deliver upon its staffing commitments. Exhibit 6 sets out some of the challenges and aspirations in terms of the workforce that existed before the pandemic. In addition to that, some of the staffing aspirations to deliver the recovery plan. We do not yet know how successful those would be. I mentioned one of my earlier responses. We welcome the transparency and the commitment to publish annual progress updates. That is really important for parliamentary scrutiny, for the public to understand how progress is being made. However, the distinction between recovery and reform is a vital one. We look to emphasise that in the report. I hesitate to use the opportunity to reform as we look to rebuild services. The detail of the Government's plans for a national care service will clearly be very important to what reform looks like in respect of both health and social care services. We do note some caution, Ms Webber, in terms of the capacity of the NHS to deliver upon all its ambitions for reform, while at the same time looking to rebuild and recover services. We note that that is clearly part of our on-going work. However, it is probably a bit early for us to be definitive about whether the Government is yet in a position. That is why, to say that the aspirations and the intention of the new care and wellbeing portfolio in the Scottish Government will be key. It is identified as being the driver, the capacity to deliver those reforms. We will continue to work on that area. Thank you, convener, and good morning to the auditor general and colleagues from Audit Scotland. In the context of social care and the national care service, I am interested in how those two things sit alongside one another. You prepared a report in January on social care, in which you highlighted the scale of the challenge in social care. I think that that sits alongside the pressures that we are seeing in the NHS. We know that delayed discharge and blockages further up at the other end of the scale are caused often by a lack of availability in terms of care packages. I am interested in the sense that you said in your January report on social care that the Government needs to go faster than the five-year timescale envisaged for a national care service in order to take action to perhaps alleviate some of those issues. Is it your feeling that there are things that can be done now in order to alleviate the issues that we are experiencing in the NHS and to provide social care more quickly? Would those be things like paying conditions of staff, further recruitment of new care staff and looking at care packages across the country? Yes, you are correct in your analysis of the joint paper that I and the Accounts Commission published earlier this year on the challenges facing social care in Scotland. As we mentioned already this morning and do so in that paper, the ambitions around the national care service, whatever shape they come in and how that will be delivered, are a number of years away. We also highlight at the same time that there are some very severe pressures already facing Scotland's social care sector that cannot wait for the structural change that comes from a national care service. You mentioned, Mr O'Kane, some of the factors that might help to alleviate that, whether it is fair work practices that build on some of the recommendations from the failure review into adult social care. Acknowledging that it will be difficult for those two things to exist about the structural change and the integration of health and social care services a number of years down the line while tackling the very real challenges that exist in that sector at the moment. Of course, as you suggested, this is not a system that operates on isolation. The NHS relies upon social care to deliver for all of Scotland's patients. I think that, just seeing some of the data during the course of the pandemic in respect of the delayed discharges that you mentioned, we look to capture some of that in the report about a very clear reduction in delayed discharges. I am not drawing any conclusion about the appropriateness or value of that, but delayed discharges dropped significantly in the early part of the pandemic, but we are now back up largely to where we were in pre-pandemic terms. I do not wish to underestimate the scale of the challenge, and I think that I am careful in trying not to do so about the challenges of recovery, reform and transformation. However, one last comment that I would make is that, as the committee I am sure will be familiar with, last year was the 10th anniversary of the Christy commission report and the aspirations of that group to reform a more preventative based care public service delivery model and the sense of missed opportunity that had not come to fruition. We look to set out in January's paper, again referencing that, but highlighting the interconnectedness and urgency of some of the challenges that are facing Scotland's social care. You have also got some questions on workforce planning, so just carry on after you have asked the question on this theme. Good morning. Thank you for coming. I want to turn attention to long Covid. I would like to ask about the work that is going on at the moment within NHS Scotland on long Covid. Over 90 clinics in England are none here in Scotland, as far as I am aware. I would like to know what, through your work you have seen for the work that is going on and how long Covid is being addressed, but then also what plans you are hearing about and seeing for long Covid clinics or long Covid treatments for patients as far as reform of the NHS, because this is obviously a huge area with over 100,000 Scotland suffering. Good morning. We note in the report the impact of long Covid and recognise that the term refers to a range of factors and symptoms and the Government's funding commitments. I will maybe bring in the colleague Derek Hoy to say a bit more about the longer term plans that the Government has set out. We also know, as you suggest, the difference in scale between some of the investment plans elsewhere in the UK relative to those in Scotland. I think that it is fair to say that there is work under way at an early stage in terms of long Covid, but there is probably a limit of our ability to be clear, but I say terribly much more than we have done in the report about the Government's plans to evaluate it to invest further. It may be a line of inquiry that the committee wishes to pursue with the NHS and the Government more directly. I will pause the moment and invite Derek Hoy to say a bit more about our work in this area. As you said, we have not gone into a tremendous amount of detail on long Covid in this particular report. We know that there are two branches of action that the Scottish Government has taken just now, so it is funding a range of research projects into long Covid. That will also take about a time for the results of that to come to fruition. As you rightly pointed out, as far as we know, there are no specific clinics in Scotland. The Scottish Government has decided to take a different approach whereby they do not see a one-stop shop or a single approach as being the way forward. They take a different approach, which will be more centered towards the patient and the expected services to basically wrap around the patient. That is the terminology that they have used. It is very much a different approach to what we are seeing in England. That is a policy issue, and that is at the end of the day. We do not want to comment on that too much, but the approach seems to be that they will try and deal with long Covid within the existing scope of the services, rather than putting something specific in place. That is a long term approach. Obviously, it is still at quite an early stage and we will have to see how that develops. I hope that we will be able to do some more on that in the future. Fandesh, we would like to continue on the workforce planning. Absolutely. Thank you for that. That is certainly very interesting and not quite what I understood to be what the plan was to happen. I am very interested to hear that long Covid is still at a very early stage. Moving on to workforce planning, in 2019, you or your predecessor pointed out that the Scottish Government's commitment to recruit 800 GPs will be all but undone by people leaving the profession. Is there enough focus on retention, and do we need to see more ambition if we are really going to get a grip on workforce planning? You are right. Audit Scotland has produced a number of reports on the NHS workforce over the years—GPs, nursing and other services. That led us to the overall judgment that we make in the report, and I touched on that in my introductory remarks about the historical struggles that the NHS has had to recruit and retain enough workforce to deliver its commitments. Clearly, those are being compounded by the pandemic. We touched on some of the fatigue and burnout that NHS and social care workers have experienced over the course of the past two years. Connect that to the extent of the forward plans to recruit many more additional staff to deliver the plans to tackle the backlog of patients. The workforce strategy is ambitious to deliver the backlog. We welcome the plans to have transparency around that so that the public, the committee and the Parliament can track progress in a transparent way. We will continue to be involved in the audit work. It is very clear my expectation that, through our report on the NHS in 2022, we will comment and audit and track progress against the delivery of the workforce plan. It is probably difficult to see much more at this stage, noting that the strategy will need to be accompanied by more detail, more evidence of progress alongside both the workforce and the other significant components of that, such as the national treatment centres and other factors. I am sure that the committee will want to explore that, but it is worth pointing out that one of the other key plans is that high-quality and complete data needs to be accompanied alongside that, so that it is possible to track progress in a workforce context and in the delivery of services. That was something that I wanted to come on to. It is very difficult to know what you need and it is very difficult to know what to do, if not impossible, if there is a lack of data when it comes to that. Do you think that we are seeing progress or a lack of progress on data collection analysis? What gaps are there and how do we fill those gaps? I will bring Lee in a moment to say a bit more about some of the gaps. It is difficult to give you the assurance, Dr Gohani, if we are seeing sufficient progress in respect of high-quality data. We note in the report gaps in workforce, primary care, community, social care settings and on health inequalities. All of those need to be tackled so that there is a complete transparent picture that applies across all aspects of public services, so that you can be clear on what impact outcomes are being achieved from public spending. At the moment, the data gaps are a real barrier to doing so. Regrettably, there are many reports that I produce, that Audit Scotland produces, that comments on data gaps as being one of the barriers to being able to track outcomes and knowing how well public spending is being delivered and what it is actually achieving. To give appropriate balance, we recognise the data strategy that is pending and the Government's understanding of the issues in respect of its response to this report. We look forward to seeing progress so that those data gaps can be filled and there is clear transparency in the delivery in the context of health and social care services. We have some more questions on wider data than just workforce planning, led by Gillian Mackay. Good morning, convener and welcome panel. Audit Scotland has previously recommended that data on waiting times based on the categories in the clinical prioritisation framework should be published, but that has not yet happened. To what extent is there transparency regarding how long patients will be expected to wait and how they are prioritised? We sometimes hear from constituents, for example, that they are placed on a list and they hear nothing more about when they will be seen or how they will be prioritised. That obviously impacts patient experience of the system as a whole. Good morning, Ms Mackay. I will certainly remember to bring my colleague Lee Johnson to support my response. The clinical prioritisation framework itself is an important statement of transparency. What we have not yet seen is a company that is managing patients' expectations about how long they will be required to wait for the receipt of the services or treatment that they are waiting for. It is a point that we made in our overview report in 2020 and have repeated again this year that it is a key component of public involvement, public understanding and managing patients' expectations of what they can receive from the NHS. If I may, I will turn to Lee Johnson to say a bit more about what we understand of the Government's plans in this area. We have made that recommendation last year and, as I have said, until we see the data attached to that clinical prioritisation framework, it is very difficult for us to make any analysis of the progress that is being made towards dealing with the backlog. Through our conversations with Public Health Scotland, they have assured us that that data will be available later this year. There have been issues that they are trying to work through with any data at this level around reliability and robustness of that data. Once they have sorted those issues out, they will make it publicly available. Until we have that data, it is very difficult for us to make any analysis of what progress is being made. I think that the clinical prioritisation framework is really quite clear about how patients will be dealt with and about the way that patients should be followed up to check that they are still at the right level of prioritisation. However, whether or not that is happening in practice, we have not looked at that in detail. Once we have that data around the framework, it will enable us to do a bit more analysis of the progress that is being made. The report notes that data on primary care needs to be improved. For example, data on the number of GP appointments carried out is not currently available. How important is it that the data is collected and what impact would that have on how services are planned? You are right. It feels like a surprising omission. I think that it is probably one that patients are hearing out, recognising that, for many patients, their journey starts at the GP and then elsewhere as required. We make that as part of the finding recommendations from the report that there needs to be a complete suite of data, including GP appointments, to support planning. I think that, especially as part of the wider thinking of the care and wellbeing portfolio, the reform of the NHS, we are moving to a more preventative model, shifting the balance of care that we have talked about for so many years. Having a complete suite of data will be central to that, including the number of GP appointments and elsewhere to support some of those reform thinking. We turn and look to the data strategy as being part of that thinking and seeing what comes of that. We look to review that. If the committee wishes to pursue it, it may be that it is with Public Health Scotland or the Government in the meantime. I have some more questions around data. Thank you, convener. It might be best that Steven and maybe Leigh answer us. I am not sure, because it is back on that clinical prioritisation framework. You mentioned Leigh. You were not very sure if you were getting a sense that patients were in that right prioritisation, and indeed we will know themselves that, while they are waiting sometimes for up to two years, their symptoms can get significantly worse. Are they progressing to that higher priority level? Do you get a sense that, when people lose absolute hope that they might ever get seen, that they are taking themselves off the NHS list and are we measuring those that are going off to any private providers to have the treatments that way as well? We do not have that data either. It is not something that we looked at in much detail. We presented the findings of our reports to the Public Audit Committee, and they have recently written to the Scottish Government. It is one of the questions that they have posed in the letter that they have sent to them, asking for further data and evidence. It will be interesting to keep an eye on that and to see what the Scottish Government's response is on how many people have gone to the independent sector to meet their health needs. Good morning. It is just a quick question about data. We need the data to show a transparency of information to make sure that we are following the pathways for care and everything like that. Is the data part of a whole data supply chain in that it comes from health boards, IGBs or local authorities? Who procures the data? Is it the Government that is providing it for you? I get feedback that everybody is so busy churning out data that they can not even get on with their job. The same clinicians or co-ordinators of care are being asked to provide data when they really want to get people on to waiting lists, get them into appointments and get them moving forward so that they are not just waiting to be told when their hip operation is, because there are other parts of this data processes about people, I suppose, engaging in a pathway of care. Good morning, Ms Harper. You are right that there needs to be a balance to be struck between collecting data and delivering patient care. We do not want to create more bureaucracy than is necessary. However, at the same time, what we look to set out in the report is that the gaps that exist at the moment are barriers to understanding how well health and social care services are being delivered. We also look to the future barriers to delivering some of the reforms that are needed for the delivery of health and social care services. There is a transparency point and a planning point. However, there is also a leadership requirement around that. Probably the only one that the Scottish Government can provide, given the reach into different parts of public service delivery. Yes, that applies to primary care settings, to health boards, to IGBs and particularly to some of the reforms in the national care service. That also starts off with the right footing of high-quality data involving the Government and its local authority partners. I agree that there is a need for balance that is not seen as interrupting patient care in the here and now, but it also gives the right platform for some of the reforms and future aspirations. What Audit Scotland needs from the Scottish Government is different types of data or what data is missing, for instance, so that the Government provides you with the data that you can analyse. Our needs are only one answer to a pretty small part of that in terms of our assessment. What we are looking to point out in the report is that the Government does not have the complete suite of data that we think that it should have in order to make some of the decisions about the delivery of health and social care services and some of the thinking for reform. Our requirements will be used to report publicly as we do through our audit work on how well public money is being used and what outcomes have been delivered by public services. However, it is not just us. Clearly, both the Government and patients have touched on the transparency point already, but I think that, especially the reform, all of that needs a complete data set and addressing some of the gaps that we currently have. If you would like to continue on to your theme about prevention and early intervention. I am interested in prevention and early intervention, and Public Health Scotland became fully functional in April 2020. I am interested in looking at the prevention aspects. What needs to be done more in looking at up-front tackling of preventative actions, for instance, in order to support better public health across Scotland? We would reasonably recognise that the aspirations of Public Health Scotland that, as it was originally conceived, have not been delivered upon, given its role during the course of the pandemic that it continues to deliver. Public Health Scotland, as the committee will be familiar with, was established as a joint programme between Scottish Government and COSLA as a way of focusing on prevention and health inequalities. However, by virtue of the pandemic, much of that progress has been interrupted as it has supported the delivery of Covid-related services. As it emerges from the pandemic, that thinking is vital in a public health context, but looking to address some of the inequalities in health outcomes that were very clear in Scotland and remain the case. Even just in some of the statistics that we touch on in today's report about the challenges in life expectancy and healthy life expectancy, I have stalled over the course of the past decade. It is a clear role for that organisation to enter into this space and through its work in partnership with local authorities and the third sector to make progress in this area. Lee, if I may, can bring her in and say a bit more about what we know in respect of Public Health Scotland's plans. As the Auditor General has already said, Public Health Scotland has been very focused on the response to the pandemic. That has been its main focus for the past couple of years. It is starting to look at its future plans and early intervention prevention, and that whole-system approach will be very much at the centre of its plans. I think that we have commented for a number of years how important early intervention and prevention is for the sustainability of the health service going forward, and not only the health service for social care, too. I think that, going back to our health and social care integration report, we say very clearly that there is a real challenge about how you move investment from the service delivery to early intervention prevention, and that is the struggle that we always see within services. What I would note is that we also talk in our NHS Scotland report about the care and wellbeing portfolio that the Scottish Government is currently developing. The intention is that that will be the vision and strategy for the NHS going forward. One of the key components of that is preventative and proactive care, to proactively keep people well independent and in the most appropriate care setting for their needs. The development of that portfolio is at an early stage, but we will keep a close eye on that. Its intentions are good, but we need to see how it progresses and how it is implemented to see whether more progress can be made in that area. Looking at Public Health Scotland's website, it has loads of virtual learning opportunities for clinicians, for anybody in healthcare or social care. It has modules on health inequalities and human rights, health and wellbeing, tackling poverty, mental health, health at work and public health workforce. There are loads of learning opportunities for people to log into and look at that. That is something that is out there and that is available. I am interested to know if it is something that Audit Scotland would look at as far as uptake of virtual learning experiences and whether who is involved in taking that on. Should this Government be doing more to help to support Public Health Scotland's work to ensure that those kind of learning environments are taken up by health boards, local authorities, IGBs and all that? We have not set out any plans to do work in that area to analyse the success and outcomes that are achieved from the public health Scotland's learning environment that it offers to health professionals. That is something that we can take away and have a think about. What I would expect is that Public Health Scotland would have a clear idea of the outcomes that are being delivered from the offer that it is making through its learning channels to health professionals. We can see if we have any information on that and share it with the committee. If we do not, it may be a line of inquiry that the committee might wish to pursue directly with Public Health Scotland. How can we monitor the progress on the roll-out and the delivery of that preventive agenda and the healthcare and the process that it is putting in place? Is there data there to support—it goes back to the data again—to monitor the progress? When it comes down to the outcomes, it is just a challenge, is it not? We hear a lot about it, but how do we monitor the progress? That is the key challenge. Over past years, it has not been successfully met to track and monitor what outcomes are changing for the people of Scotland and what is being achieved from public spending. If we see the reform of health and social care services as envisaged, that will require a considerable amount of public investment. The delivery of tackling the backlog will similarly require that public and the Parliament will want to be satisfied about what outcomes are being achieved. Is the patient experience improving? Are taxpayers getting good value for that investment? Audit Scotland has a clear role in some of that, but more directly, the Government and health boards will want to set out very clearly. As I mentioned once or twice, the annual report on tackling the backlog, together with the work of the care and wellbeing portfolio, will be the strategic centre of how Scotland will shift the balance of care to set out that very clearly as what matters, so that there is transparency about what comes next. The second question was back to sort of drawing the parallels with that clinical prioritisation framework that is something that I have certainly been aware of. While the Scottish Government is piloting the pre-habilitation for cancer patients, what value would you attach to rolling out the scheme more broadly across the NHS for those that are particularly on those various points in that prioritisation framework and to make sure that people are in good shape when they eventually get to the time to have their treatment rather than being in worse shape? I will perhaps turn to colleagues to see if they are more familiar with the detail around that than I am. Before doing so, I would reiterate the point that has been made a couple of times. Everybody who is waiting for services needs to have a clear expectation as to when they will receive those services, whether it is cancer or other treatments on the clinical prioritisation. We are very clear in our recommendation that there is a key missing part of transparency in doing so. We welcome, as Leigh's mentioned already, that Public Health Scotland is committed to doing so later this year. We look forward to seeing that coming to fruition. I will turn to Leigh or indeed Derek if he can say a bit more about that. I do not have anything specific to say other than, obviously, what we are seeing is where treatment has been delayed or diagnosis has been delayed. We are now finding, for example—I know that the committee has mentioned the pressure on A&E—that people are presenting more unwell than they previously were. I think that any initiatives and ways of delivering services that we can implement are shown to be a good practice that is evaluated and worked well. If we can roll them out across Scotland, there has to be benefits in that going forward. I know that we talked about prevention earlier. The Government provided financial support for deep-end practices to monitor engagement in governing Glasgow, for instance. Part of that was to look at supporting link workers, supporting anti-poverty work, supporting people getting welfare advice. That is the kind of data that we have now to show that we are engaging and supporting deep-end practice work. That is something that we can look at and see the value of investing in that particular project. Is that something that we can audit right now? I am not familiar with the example, but I would recognise that from many practices that exist. Shifting the balance of care preventative won't just be delivered from NHS spending, the connected nature through social care, some of the education spending, pupil equity funding that we have seen will all play a contribution to shifting the balance of care, reducing health inequalities. One of the features of our reporting over many years, particularly on the integration of health and social care, has been what it has felt like at times anecdotal examples of progress, and not really the system-wide changes that will deliver some of what we would hope to do with some dramatic improvements. Looking for examples of good practice to be harnessed, shared more widely and benefit all of Scotland, and building on some of the great examples of whether it is in Glasgow and others that we hear about across the country. It is really gathering all of those and applying them in the right setting. Public health Scotland and the Government will have a very clear role along with whatever changes that will happen through the national care service to make that happen. We are going to move on to talk about health inequalities. That led to the first question, if I may, particularly of interest to us. We are about to do our own health inequalities inquiry. Your report suggests that you have an overarching strategy to tackle health inequalities. It is not just simply in the public health portfolio or the health portfolio, but across all the Government portfolios. In terms of your work, monitoring that kind of strategy, which I think is agreed by most people who come in front of us, is the way to look at health inequality, not just siloed into what happens in our hospitals, what happens in our GP surgeries, but actually what happens in society more general. What kind of data will Scotland be looking to have in order to audit that overarching strategy? There is no straightforward answer to that, convener. We have already touched on addressing some of the data gaps. Having a clear plan to do so, we understand that that is the Government's intention through the data strategy that will tackle that problem first. I perhaps restrict myself to talking in overarching terms about the need for a system-wide data to analyse what outcomes are being achieved from public spending. Too often, in our reporting, we talk about both data gaps and data sharing arrangements between public bodies. That might be a potential area of the committee's interest about giving the system-wide requirements to tackle health and inequalities. It does not exist within the NHS, which is clearly a role for local government, third sector integration authorities and education provision, all of which will have a key role to play. However, the provision and sharing of data across different partners is not as clear as it needs to be. We would be looking for a clear strategy leadership that sets out very clearly what impact public spending is having on tackling health and inequalities. I do not wish to be blasie about that, so I suggest that that is a straightforward thing. However, it really ought not to be a surmountable problem for us that we can have a clear vision strategy reviewed, commented on, reported annually, a transparent plan to track progress. There are many other planks to that as well. For the committee's interest, we will be publishing a report on the roll-out of social security in the next month or so that will comment upon progress. In that respect, we will also have a very anticipated impact on the longer term on tackling further health and inequalities. In your work, for example, if you were to do something around housing strategy or tackling fuel poverty, for example, you would factor in the potential health benefits of any spend in that area? That is right. One of the key priorities that I have, and shared by my colleagues in the Accountants Commission who oversee local government spending, is stepping back and thinking about the wider impact of the spending on inequalities. That cannot be done on a siloed or single system basis, so, across our audit work, we look to weave that into our reporting to see the impact that multiple strands of public spending are having upon tackling inequalities and then, perhaps, broadening it into other themes as well. Climate change will be one of those, too, so yes, it is very clearly part of our work, convener. I will bring in some of my colleagues who have some questions on this. Sue, you have some questions on health and inequalities. Thank you, convener. Just the one question. In your report, you noted that there was no overarching strategy for tackling health and inequalities in Scotland, despite the endemic nature of the persistent and acute inequalities that exist. We have heard some of the activities that you are doing there about weaving the strands of spending across different portfolios, but what conversations have you had with the Scottish Government on the need to urgently establish an overarching strategy on health and inequalities, which would almost act then as the linchpin as we recover from the pandemic? I will bring in Leigh Ann just to look into the future. We have regular engagement with the Scottish Government, NHS officials and note. Both the anticipated work of Public Health Scotland and the Government's creation of a health and inequalities unit within the Scottish Government health and social care directorate and tracking what progress those changes will make. It is probably too early for us to pass any judgment on what that will make, but we do know and share the ambition that there is a clear strategy for tackling health and inequalities. As we touch on in the report, some of the outcomes for people of Scotland will have been impacted very clearly from the pandemic and noting some of the other challenges that are affecting healthy lives. We continue to review this area and remain one of our priorities. I am just going to check in. Carol, do you have any questions on this theme? Thanks, convener. As a quite new member to the committee, all this information takes out a wild process. The thing that I am quite interested in is particularly around health and inequalities life expectancy. We have known this for quite some time. I am wondering how often in the past have we tried to get that kind of data pulled together? Have we tried to do that before? What have been the barriers to that if we have tried to do that? I will do my best to set that out, but I think that I would probably refer back to some of the earlier discussion this morning about data gaps as a clear barrier, some of the data sharing arrangements that exist between public bodies. Some of the way that we set budgets to deliver public services, we have commented in some of our recent reporting in respect of the pandemic, but it applies before the pandemic as well. We set budgets generally on quite a silo basis of how services are delivered, so there is allocation of a local government budget, an NHS budget and more recent years as an integration budget. However, as the convener suggests, health inequalities will touch on many different aspects of public spending. To be able to be clear about which part of public spending is having the biggest impact on reducing health inequalities is not as straightforward. There are a number of steps that need to be taken in respect of high-quality data and evaluation of what amount of public spending is having the intended outcome before we are going to have a complete suite of the necessary information to make those assessments. There are a number of steps to take place, Ms Morgan. Can I just ask in terms of making that transition? We have talked about who's responsibility in the health service and social care. Is there some kind of leadership at government level that needs to really push to get this to happen? Do you think? We know that there are plans to involve a data strategy to set out how the Government plans to tackle the data gaps and then measure the impact. We will look to track that through our work and I am sure that that will be of interest to the committee. We are now going to look at NHS Finance. You made some very positive comments in your opening statement about how change can happen quickly and effectively as seen during the pandemic. You noted that the NHS was not financially valuable pre-pandemic and Covid has obviously exacerbated that. You noted the Scottish Government's ambitious plans, but do you feel positive about the Scottish Government's plans? Is the Scottish Government moving towards achieving real sustainability for the NHS? I think that it is too early to tell as to whether the ambitious plans for recovery will be met. I think that we have touched on in the report and through discussion this morning that the success of delivering the recovery and tackling the backlog is reliant upon recruiting, retaining and nurturing NHS staff. Although the past is entirely predictive of the future, we point out historically that there have been challenges to be met. Again, we welcome the Government's commitment to be clear, transparent and publish an annual report on its progress and we will factor that into our forward work. The sustainability of the NHS is right. We have said previously and we repeat in this report that the model of health and social care was not sustainable in Scotland for a variety of factors, and to use that opportunity for reform will be built into the plans around the national care service and the future delivery of NHS-based services to shifting that balance of care, focusing more on prevention, tackling health inequalities, all of which require multiple strands of work and weaving those together in a clear, measurable strategy. Obviously, during the pandemic, the Scottish Government has put a lot of money into the NHS. Do you feel that you can comment on how effectively those resources have been spent? We have done some of that work already. For example, we have produced briefings on both vaccination programmes and the use of personal protective equipment. Through this report, we set out the scale of change of NHS spending and the additional £2.9 billion of funding in the delivery of NHS services. Again, I have not said it enough, recognising that that was during the course of a pandemic and the emergency footing that the NHS remained on. All that is clear and accounted for. We have audited the finances through the audit of the Scottish Government consolidated accounts and that is set out in that report. What will happen in the future is clearly about what outcomes are being achieved in the longer term, and that is clearly part of our forward programme. I will pick up a bit further on Evelyn's questions about how NHS Scotland was not financially sustainable before the pandemic. Two questions. What steps do you think we could do to make the health service more efficient? What work have you done or seen when it comes to things such as silos and pots of money? An example would be a department having a pot of money to employ locums and a pot of money for its current staff, and those that money cannot cross. Current staff are not paid what locums are paid, and thus do not do the internal locums. To take those questions in reverse, if I may, Scotland has 14 territorial health boards. It has a range of national health boards as well, all providing services in support of or delivery of patient care. Responsibility for the delivery of various strands of that will reside on a national basis, and some will be for the individual health boards. Locums, for example, is a really interesting example. Last year or perhaps two years ago, we reported on NHS Highland and some of the challenges in a remote and rural setting that that board was having to recruit for some GP services, and some of the very significant additionality that it was having to pay for the delivery of those services. Reflections have taken place, and we know that some of those costs have been reduced due to some of the work of the board. I think that it speaks to some of the earlier conversation today about opportunities to share that learning across Scotland and for all of our health boards to benefit from some of the thinking to deliver efficiencies. It is really important that that work continues. We know that it happens in places, but it is also a point if I am able to broaden it out about how we set budgets and how we use budgets for services, that accountability follows budgets, and accountability for the delivery of services typically rests on an individual board basis. However, the delivery of longer-term outcomes requires multiple accountabilities. That was one of the conclusions that, when we thought about Christie, was that individual accountable officers across Scotland will be measured upon the delivery of performance for their own organisation, as opposed to the delivery of wider outcomes. Thinking about the opportunity for reform of accountabilities might be part of one of the ways to unlock some of the more joined-up collaborative working that will be required to deliver changes in services and to shift that balance of care. That is one of the barriers that we are seeing at the moment. There is opportunity and a route through that, but it will require some significant thinking and changes to the arrangements that we currently have. I think that this morning, what has been key to many of our questions and considerations is that scrutiny and that on-going assessment of the work that has been done in order to deliver change. I suppose that, as an opener, what future work on health and social care is of Scotland that we are currently planning to undertake? You are right that, in terms of our forward work programme, mirrors, as we hope, some of the key challenges that the public services in Scotland are facing. We will continue to produce an annual NHS overview of the NHS in Scotland. We will think carefully about the themes for that this year. One of the observations that I would make about this report is that, of course, Covid-19 has dominated. Previous iterations of the report have probably been more focused on finance. Finance is, of course, always particularly important and relevant to the work of Audit Scotland, and we expect that that theme will increase in future years. However, I would anticipate—as I mentioned already this morning—that the recovery of the NHS will be very clearly part of the report next year and beyond. We will also be auditing and reporting on progress toward the reform of the NHS, as well as through the work of the care and wellbeing portfolio. I will bring colleagues in a moment to be able to say a bit more, but we plan to undertake some further work on mental health services in Scotland. Together with my colleagues in the Accounts Commission, we will be preparing a programme of work as Scotland progresses to national care service and how that will look. I think that there is probably an appropriate analogy to some of the work that we did on health and social care integration and continuing that theme, all of those themes. As the convener mentioned, we will be weaving in inequalities across all of our work and building those themes. The last point that I would mention is climate change. We will look briefly at the commitment towards the 2040 target, the 2030 interim targets, and we will look at the scale of the estate of the NHS in Scotland, what changes will be made around that and what will require some real long-term thinking, all of that is part of our forward programme. In case I have missed anything, I will turn to Lee and Derek if there is anything that they want to add. I think that that has covered everything. We have plans this year to have a real focus on the recovery plan and progress with the recovery plan, taking a closer look at workforce planning and the new strategy that came out following the publication of our recent report, so we will take a closer look at that and make some assessment of it. We are just in the middle of scoping our mental health audit. Obviously, we produced a report on children and young people's mental health services back in 2018, and the plan this year is to look at adult mental health services, but we are just in the process of scoping that audit. As the Auditor General said, we had also made a commitment to do a third performance audit on health and social care integration. Again, that will be a joint report between the Auditor General and the Accounts Commission. We will need to consider what the scope of that is going forward, obviously, in the context of the national care service and how we might want to look at it. Emma, you had a question. Paul had not finished, so I will come to him after. I am very tempted to go into a shopping list of things that I would like Audit Scotland to look at, but I am going to resist that. On two areas, if I can briefly, given the pressures that exist in emergency medicine and quite a lot of what we have at this committee, and I think more broadly in terms of A&E attendance and ambulance services, is there any particular focus that is going to be taken on emergency medicine? Secondly, this committee has done an inquiry into pathways into care and looking at GP services, pharmacy and the different levels of services that can be offered. Is there any forthcoming work from Audit Scotland that might help to supplement and support that work? We do not have any definitive plans on emergency medicine, but we would acknowledge the challenges facing A&E departments, and some of that has clearly been exacerbated by the pandemic. Similarly, in terms of pathways and some of the innovations, we refer to some of the plans that are happening around that area in the overview report. I suspect that that will be the best place for us to comment on that in the short term. As ever, none of our plans are fixed into the medium or longer term. We have, perhaps one of the committee's awareness, changed how we do our forward planning for our audit work in light of the pandemic. Typically beforehand, we would set our plans a year in advance, given years 2, 3 and 4 as fairly indicative programmes. We needed to be more flexible than that, to allow us to report more regularly. We mentioned some of the briefing papers that we have done. We will continue with them, and that gives us the flexibility to respond to some of the live challenges that are facing public services. We will keep those two areas under review if they are not included in the overview report. I won't give your shop unless either of things to look at, but it is interesting that I asked NHS Highland when we had the men about emissions reduction equivalent of mileage that has not been travelled, because folk are now doing teams meetings or near me. Is that something that you would be planning for, especially for remote and rural working? How does that support net zero ambitions then? Very clearly, we are planning a programme of work that is a bit like health and social care integration, similar to the national care service on climate change, of how Scotland's public services intend to move towards net zero. So many public bodies have made this commitment. What matters now is that they themselves have a clear plan as to how they are going to deliver upon their net zero interim and long-term targets. You are right that reduction in mileage will be one of the factors, and I think that it has also touched on already about the state in which public bodies operate and how their buildings can be made more efficient to support net zero ambitions, too. If we do not undertake a standalone piece of work, and I suspect that it will not be, but probably more across all our activity commenting on climate change, then public bodies' reporting should set out themselves how they have been planning to move towards net zero. We will be auditing that through our annual audit processes. We are seeing that people are more keen to live in remote or rural areas because they can work from home two or three days a week and then maybe only travel one or two days, whether it is outside of Dumfries and Galloway to the central belt or instead of having to drive to Dumfries every day. That is where I was thinking about, as far as emissions reduction linked to mileage or the unnecessary travel, whether it is clinicians or staff that are supporting clinicians' work. That is understood. I will very—as well as our own work in climate change, but I suppose that the sustainability of services is well that if there is not a dominance of attending or living in the central belt—perhaps a reference to NHS Highland—there may be a positive knock-on effect about making Scotland's remote and rural communities more accessible and more attractive places for people to live and work. We will think carefully about how we can factor that into our own work, not just the climate change reduction but sustainability points. I want to follow up on some of what my colleagues have been asking and to follow on from some of the data stuff from earlier on. I have been speaking to a couple of stakeholders, particularly in terms of the climate impact of medicines. Do we currently have, in your opinion, sufficient data to be able to assess any climate impacts of the way we—of any changes in the types of medication or the ways that we prescribe medication? In particular, I am thinking about the likes of Asmanhalers. The powder ones are infinitely better for the planet than the more traditional ones are. Do we currently have the level of data that we would need to assess the impacts of changing away from, for example, the more harmful types of Asmanhalers? I am not sure that we have that data, Ms MacKaz. It is not something that we have looked at through our work. Before turning to colleagues to see if they can add anything, I think that it is again the type of thing that we would expect the NHS to be tracking and monitoring the totality of their carbon emissions, not just how they deliver services themselves, but how they are bringing them in from elsewhere. I am interested in the issues around inhalers, because it is not just about one measurement of hydrofluorocarbons as the delivery mechanism for selbutamol, for instance. It is about the whole measurement of that bunch of plastic in a dry powder that can be recycled as easily as some of the components. We really need to be careful in how we are just saying that we are not going to give people certain inhalers and only give them dry powder, because it is a whole bigger issue than just looking at propellants for those inhalers. We are really interested in your future work, climate change. As a former convener of the Climate Change Committee, we asked the NHS about that when we put in the climate change bill. I am going to bring in the final question, Sandesh, before we let you go. I am not as disciplined as Paul and Emma. I am very keen for long Covid to form a cornerstone of future work. The reason for that is because of how little we do know about it right now, but understanding is definitely gaining. The number of people that are affected and the devastating impact that long Covid is having, so I would be very keen on wondering what your thoughts are, whether that would be something that you would be able to do. Not looking at what is going on, how it is going on, what the planning is, how the money is being spent and, actually, are the patients getting what they should be getting? I am very happy to take that away and to factor that into our thinking. As you have seen in today's report, we referenced it and, as Lee rightly added, the Government's plans are generally at health board level to support patients with long Covid. We would expect that that will be reported clearly on the progress and impact of the funding that has been allocated there. For ourselves, again, as well as clear data on it, definitions will think carefully about how we can contribute to public scrutiny and understanding of that and factor that into our thinking of our plans, too. I want to thank you very much, Mr Boyle, for your time this morning. To Derek Hoy and Lee Johnson for the support this morning, we are going to take a break into our next part of our agenda. Thank you. The third item today is an evidence session on a further supplementary legislative consent memorandum relating to the UK Health and Care Bill. This is a supplementary legislative consent memorandum health and care bill S6-5C, lodged on 12 April 2022. I welcome to the committee, Humza Yousaf, Cabinet Secretary for Health and Social Care. Accompanying the cabinet secretary, we have Scottish Government officials Sam Baker, acting head of unit of infected blood and abortion services. Robert Henderson, team leader for Intergovernmental and International Relations Unit. Lucy Orrin, slister for food, health and social care division. Thank you for all of you to rejoin today. Cabinet secretary, I believe that you have an opening statement to make. Good morning, convener and committee members. I hope you are keeping well and keeping safe. Yes, thanks, convener. I have very brief opening remarks that I was wishing to make. I thank you again for inviting me to discuss the amendment to the health and care bill regarding the extension of the Offences in the Human Tissue Act 2004 and the Human Tissue Scotland Act 2006 to cover the supply of human organs outside the UK. That is the third supplementary LCM that I will have placed before the Scottish Parliament for the health and care bill. I have written to UK minister Mr Argar expressing my concern about having to make several requests for a very valuable parliamentary time to be spent in considering the legislation due to the piecemeal way in which the bill and the UK Government's engagement with the Scottish Government has been handled. The amendment includes provisions for additional criminal offences with a person who is habitually resident in Scotland or who is a UK national travels outside the UK to either buy or in any way arrange a form of reward for an organ. In my LCM, I have recommended that the Parliament should grant legislative consent to the UK Government's amendment. Although we do not have any evidence to suggest that the small number of people living in Scotland who have organ transplants abroad are paying for their organs, the Scottish Government is committed to tackling unethical organ donation practices. That amendment would help to tear anyone who may in future want to consider travelling abroad and being for an organ and would also allow progress towards the implementation of the Council of Europe convention against trafficking in human organs. I am happy to hand back to you and take any questions that you may have. Thank you, cabinet secretary. I know that you are in agreement with the substance of the amendment, but you mentioned the piecemeal approach. I want to ask one of the things that we always keep an eye on is the consultation process with regard to any of the LCMs or any kind of statutory instruments that come our way as a result of changes in legislation in the UK Government. Has there been enough consultation on that process between the two Governments? It is an important point to make because of the way that the LCM has been brought forward. I should say that the UK Government amendment has been brought forward, and the requirement for an LCM has been a very limited amount of consultation. That is the source of our frustration, frankly. It also very much limits the consultation that we can have. We have had consultation with our clinical advisers on our condemnation. There is a Scottish national group on our condemnation, which we have managed to take a view on. There are no concerns that have come forward. In principle, we are in agreement because of what the amendment is trying to do, but clearly, if we had more time, if that was done on a more structured as opposed to an ad hoc way, we would be able to have more meaningful and deeper consultation with a variety of stakeholders. A couple of my colleagues want to ask some questions at Emma Harper. My first question is that the Human Tissues Scotland Act 2006 is what we have in Scotland. Does that mean that we will need further amendments to our own legislation in Scotland? The fact that we now have this legislative consent memorandum about illegal organ donation procurement and so on? No, it should not require anything further. As the amendment lays out, the UK-wide legislation, although it does not include Northern Ireland—I should have said that in my opening remarks, due to the fact that the Parliament is not sitting and having elections—would not require anything further from us is my understanding. However, I am happy if officials wish to come in. If the Parliament agrees to this, it should not require anything further from us in terms of legislative amendments, but I do not know if any of my officials wish to come in to elaborate on that. Just to confirm that that is correct, there is no need for any further amendments. The UK bill would amend the Human Tissues Scotland Act 2006 so no further changes will be required. Thank you for that. Emma Harper I have another quick question. Does it mean that if somebody that we thought was on a transplant list for a kidney, for instance, showed up needing anti-rejection medication and seemed to be doing well? We would assume that they have had an organ somewhere else. Does that support the ability to have better traceability of organ surgery, procurement and all that? If somebody did have an organ outside of Scotland, then anti-rejection medication is part of that treatment following the transplant. Would that be a trigger for pursuing criminality? We know that there have been small instances of where individuals have gone abroad for an organ transplant. It has mainly been for a kidney transplant. In fact, I have a constituent who has been abroad in the years gone by. There is nothing to suggest, as far as we know, that that was done in any way unethically. Our protocols and processes are in place for anybody to ensure that we are informed here in Scotland if they go abroad to get an organ transplant. You are right in the aftercare that an individual would require after an organ transplant in that aftercare here in Scotland. There may be things that come out thereafter in that conversation. Therefore, a judgment would have to be made about whether, for example, a clinician thought that anything would have to be reported or not because it was a breach of the law or an offence was committed. It does not put an onus on clinicians to have to do that. I suspect that clinicians in their everyday lives have to make those really difficult judgments. I need to tell Harper that. Of course, she understands that well, given her background. In some respects, that may well be anginal, but we would have to ensure that those who are working on donations, organ transplants and the aftercare are aware of that change in the law. We know in Scotland that we have an opt-out approach to organ donation, but what other work has been done by the Scottish Government to increase the number of organ donors in Scotland that would help to limit the risk of the commercial dealings for organ transplantation? That is an excellent question. Ultimately, we do not want anybody to have any reason to want to have to go abroad. There is a lot of work being done, and I am happy to give more detail to that. Essentially, if you look through our donation and transplantation plan for Scotland 2021 to 2026, its core theme is to try to increase the availability of transplants. I suppose that what is important for that particular aspect is one that looks to try to increase the number of living kidney donors. As I mentioned in a previous answer, the instances that we are aware of of people going abroad for transplants have almost entirely been for kidney transplants, or the vast overall majority have been for kidney transplants. The other thing that is quite key in the work that we are doing is to ensure that we are encouraging people from as many diverse backgrounds as possible to come forward for organ donation, because we know in many instances that the people of similar ethnic backgrounds will be a better mix and match for an organ donation and transplant to take place. If we get more people from as diverse backgrounds to mitigate against the need for somebody or the perception that somebody has, they feel that they need to go to another country where there are more donors of that ethnic background in order to get a possible match. A lot of good work is going on in that, but I would commend the national transplant plan 2021-2026 to the member if she has not had the chance to see it yet. Thank you, cabinet secretary, and thank you also to your officials for answering our questions. We will now move on to the next item in our agenda. The fourth item in our agenda is consideration of three negative instruments. The first instrument is the sports grounds and sporting events designation Scotland amendment order 2022. The instrument updates the sports grounds and sporting events designation Scotland order 2014, which is also known as the 2014 order, to properly reflect the current list of grounds and events to which the act should apply. The 2014 order also needs to be updated to include football matches in the competition for UEFA Europa conference league, and the order will achieve that. The Delegated Powers and Law Reform Committee considered the instruments and made no recommendations and no motions to them have been received in relation to the instruments. Can I ask members if they have any comments in relation to this instrument? No, nobody has any comments, so I propose that the committee does not make any recommendations in relation to this negative instrument. Does any member disagree with this? No, we are all in agreement. The second negative instrument is the national health service pension schemes Scotland amendment regulations 2022. Those regulations implement reform to the national health service pension schemes for pensions for NHS workers in Scotland. The purpose of this instrument is to close the legacy scheme at 31 March 2022, moving all active members to the 2015 scheme on 1 April 2022 to ensure rules around additional pension elections and transfers into the existing scheme for transitional members are applied consistently to those previously classed as full protection members. The Delegated Powers and Law Reform Committee considered the instrument and made no recommendation and no motions to them have been received in relation to this instrument. Do any members have any comments in relation to this instrument? I note the work that we are doing here and the reasons that we are doing it, but I feel that we are not really doing enough when it comes to pensions and the current NHS pension scheme is hindering NHS consultants from doing extra work because they are essentially having to pay to go to work. I think that what we also need to do, and I love it to have been in here, but we need to do an employer's contribution recycling scheme, the same as what we have in Wales, to enable consultants to do more work. I would like to see more work on that, and if we could write to Cabinet Secretary about it, please. Occupational pensions are reserved to the UK Government, however, and it does not refer to the instrument, but your comments are on the record. I propose that the committee does not make any recommendations in relation to this negative instrument. Does any member disagree with that? The third and final negative instrument for consideration is national health service charges to overseas visitors Scotland amendment regulations 2022. The instrument ensures overseas visitors from Ukraine who have been displaced as a result of the on-going conflict can receive relevant healthcare services provided by NHS Scotland at no charge. The Delegated Powers on Law Reform Committee considered that instruments have made no recommendations and no motions to annul have been received in relation to this instrument. Do any members have any comments that they wish to make to Sandesh? Thank you, convener. Of note here, I see that people coming from Ukraine will be granted about £10,000 to councils to look after the health needs. Is that money being used here in this instrument, and is that money ring-fenced to help people from Ukraine to achieve the healthcare needs that they have? That is something that we will need to write to the Government about so that we can take that forward. Does anyone else get any comments that they want to make? I think that it is very pertinent. I would welcome this. I think that it is the right thing to do for those people who are probably going to suffer a great degree of trauma as a result of their experiences in their home country. I therefore propose that the committee does not make any recommendations in relation to the instrument. Does any member disagree with that? No, we are all in agreement. Our next meeting on 26 April will consider its approach to inquiry into health inequalities and a draft report on its inquiry into the health and wellbeing of children and young people, but that concludes the public part of our meeting today.