 Welcome everyone to the 12th meeting of the Health, Social Care and Sport Committee in 2022. I've received no apologies for today's meeting from any member. The first item on our agenda is to decide whether to take item 4 in private, and members agreed. Our second item today is two evidence sessions as part of our inquiry into alternative pathways to primary care. Our first panel will focus on social prescribing, the link worker programme and the role of the third sector, and I'm delighted to welcome our panelists this morning. We've got Claire Cooke, the regional manager and co-chair of the Scottish social prescribing network. We've got Alison Leitch, community link worker area lead and co-chair of the Scottish social prescribing network. Rizan Logan, the links programme manager for the health and social care alliance. And Kristiana Mellum, the chief executive officer for the National Association of Link Workers. Welcome to you all. I'll go around you, do all really, to start off, in terms of the, if you think there's a wider, there's a potential for wider use of social prescribing in Scotland than there is now, and how we can find a better balance between the medical and the social approaches to health care more generally. So, if I just go around you in the order in which I introduced you, I'll take Claire first. Morning, everyone. So, yes, absolutely. I think there is a place for social prescribing in Scotland. I'll just tell you very briefly about spring social prescribing because that will influence the demands that are going forward. So, spring social prescribing is funded by the national law to the community fund, and we help addressed adults, supporting them with their social, emotional and practical needs, improve their health and wellbeing, and we do that by connecting them to community support. We are based in eight community-led health organisations in Scotland. So, it is a different model to the community link worker programme. So, but we work very well with the community link worker programme. So, what I would say is that not one size fits all. So, I would say to recognise that there are lots of different models in Scotland and lots of experience and professional organisations that run them throughout the country. Thanks, and can I come to Alison Leitch? Hi, thank you. As Claire said, I absolutely believe that social prescribing should be used on a wider basis. The Edinburgh link worker programme is part of the Scottish Government-funded programme that was the 2016 election manifesto. So, the setup that we have in Edinburgh is that the link workers are employed in third sector organisations in their localities, four localities across Edinburgh, but at the moment we have 21 link workers covering 43 GP practices and they are employed by 11 different third sector organisations across the city. We have 21 GP practices as part of the national programme focusing on health inequalities. Those practices have at least 20 per cent of their patient population class as deprived. We have 22 practices that are covered by primary care improvement plan money. That is where we see our growth. Those GP's see the benefits of those practices and the health inequalities. Funded programmes, they see the benefits that they bring, so it is really great to see that other practices are coming on board with the link worker programme and seeing the link worker as part of their multidisciplinary team. I think that Claire hit the nail on the head. There are so many different models across Scotland and as part of our social prescribing network that is what we are trying to map and have an overall structure to that. I am part of the working group on the Scottish community link worker network that has recently been set up. That is trying to gather the information of the different programmes, not one size fits all at all, but to try and have some overarching picture of what link worker and social prescribing looks with in Scotland. Alison, I will pick up on something that you said, which I am interested in. You said that GP's are already seeing the benefits of that. Can you expand on that? What are they saying as a benefit? A lot of the GP's are realising that they are not always the best person to service the needs of that patient. We are all very well aware of the pressures on primary care at the moment. When you have only got a five, seven or ten minute appointment, you are not going to get to the root of the social problems that the patients are bringing. When a link worker can spend an hour with somebody, he can address housing issues, benefit issues and employment issues. Those are the things that the GP's cannot deal with. If they have got a link worker dealing with that, even if the patient still continues to attend the practice, the GP is getting better use of their time because all those social issues are taken out of the consulting time and they can address the health issues directly. That is helpful. Can I come to Roseanne next? Good morning. Hi, I am Roseanne and I am the programme manager with the Alliance. I agree with both my colleagues that have been on already around the wider use of social prescribing. With the Alliance, we ran a pilot programme in 2014 in Glasgow, which was in collaboration with Dpenn GP's. That started out with seven Dpenn GP's. We are now sitting in Glasgow in 53 GP practices, which are all Dpenned. We also have a model in Western Bartonshire, which is going to be quite different. As Claire has alluded to, different models are really important across Scotland because we have different dynamics across this country, so we need to be able to embrace that. As well, getting the balance of the medical model and social model is really important. Alison Hill was alluding to that. For GPs and for other healthcare professionals, they are limited in the time and the scope that they have with patients. They do not tend to know a lot what is going on within their communities, and that is where links workers, especially are really valuable, coming from third sector, voluntary sector backgrounds. They know their communities, they link in with their communities, they know what is available, they know the importance of building relationships within their communities, so they are best placed to support patients with aspects of social issues that are impacting on their lives. It is really important that, as we move forward, we have the SSPN, the NALW, because we need to be looking at our workforce very varied across the country, but we need to be having the opportunity to bring them together, to collaborate and to be looking at sharing learning as well. You have hit upon something about the patchiness of provision across the country. You are alluding to the fact that maybe that best practice is not really being shared at the moment. Would that be fair to say that there is potential for more knowledge sharing on the benefits of it? Yes, definitely. That is why it is really great that we have the SSPN. I sit on the steering group with the SSPN, and I also sit on the advisory panel with the NALW, because I see that there is real value for us to be sharing the knowledge, to be looking to see what there is across the country. Both those organisations and set-ups have the opportunity to do that, to bring together people from not just that sector, but also some KHSCPs and some health boards are employing links workers. We want to bring those different models together to be sharing the best practice. Ultimately, that is what we want. It is the people of Scotland that we want to ensure that we have been able to deliver the right service for those individuals in their communities. It is lovely to be here, given evidence with colleagues. NALW, like Roseanne, is alluding to more focus on the workforce. We are a professional body of social prescribing workers in the UK. I am going to be sharing experience and learning from our members in Scotland and some of them are all members of the panel as well. They are round-table discussions that we had to inform what I would say at this meeting. First of all, can I pay tribute to the social prescribing programmes in Scotland that have won lots of awards. We do run annual awards, and we have a representative of those award winners in this panel. The first social prescribing link worker of the year was won by Sean, who is part of GLEAS Spring's social prescribing programme. We have the community group of the year award that was won by EAP, which is a community project run by the Alliance. We have Roseanne, who has been the highly-commended manager of the year for social prescribing. We have also had North Asia community link worker programme, the Edinburgh Health and Social Care Partnership, all have been finalists and have been highly-commended for the social prescribing effort. There is lots of experience and knowledge to really share. At NALW, we think that it is time to mainstream social prescribing because general practice is at risk of becoming a crisis service. Everybody is chasing the symptoms or treating the symptoms. If we are not going to intervene in the vulnerabilities and get to the root cause, then we have a healthcare system that is all about illness. Yes, we know about the impact of the social and economic and environmental actors that affect our health. Therefore, it does not make sense to separate votes or the challenge has been with no mechanism by which we can mainstream this in the NHS until the introduction of social prescribing. What we have been able to do particularly in general practice is about that whole-person medicine. What is the difference between general practice and special services is because of the whole person, is because of the continuity of care, is because of the prevention, is because we are asking people, how are they? With the pandemic, lots of people are now asking people, how are you? This is a very big problem because people need to be listened to. Listening itself is a treatment. As one of the patients that have been supported by social prescribing says, a listening ear is what a million dollars. It is very important that we have a mechanism by which people feel listened to. We have a mechanism by which we are actually empowering people. This is definitely about social justice and it is about inequalities. It is about recognising that the way people feel within their community, the way they feel, whether they are integrated within their community has an impact because if they do not have anywhere to go to, they know that the NHS will not be on their back. It is not about preventing people from coming. It is about when they appear, when they are at your door, what support do you have available for them? Do you have the social prescribing opportunities for them? Are you supporting the link workers? How are you also encouraging social mobility? The people that become social prescribing link workers themselves have to leave their spirits. People want to help. There is a lot of opportunity for people to help them. Social prescribing is the bridge between the community and the NHS, which means that they have a lot of information and knowledge to share to policy makers to actually say what is going on for people because they have the time to spend longer with them and build up that trusting relationship, which then is transformational. There are lots of people for 20, 30 years, if not had anyone listened to them with the depth that the social prescribing link workers have got and with no agenda. In itself, it is transformational. You then see communities that are thriving, that are transforming, that are wanting to help. This is the way we reduce pressure on the NHS. It is about the impact infrastructure that is around the person. What is the incentive for the person to look after their health? What is the incentive to go for the war? If they are not able to go for the war, who is removing those barriers? Somebody has to take responsibility to enable and empower people to take control of their narrative. Thank you, Christiana. I really like what you said there about the whole person approach. It strikes me when I am listening to you. One of the things that us as elected representatives, as somebody who has people coming to us in crisis, is that I often worry about the people who do not come and see me, but everybody goes to their GP surgery and bring services to where people are. Do you agree that that is important? It is hard to reach people who will need help. It is important that we move services to be where they are. Yes, absolutely. That is what we have said. Social prescribing is one size fits all. We say that any place where there are human beings and you want to reduce health inequalities and social injustice, you need to consider social prescribing. It is not just health, it is something that is cross-cotting as well. General practice in itself by being a community asset is the glue that connects to other services and professionals, rather than being seen as the focal point on which the patient is dependent on the particular GP. There are community-based social prescribing programmes as well. This community-based social prescribing project as well means that people who do not assess the GP practice or communities that are marginalised can also get support. The interest for us is how do we get that integration where community-based social prescribing services that are not based within the GP practice, those that are based within the GP practice, what is that interface? Surely social prescribing link workers can be that glue between those as well. It is more of how do we integrate, have an integrated approach that enables continuity of care, that means that the person is not repeating themselves, that then empowers clinician with a full picture of what is going on if the person is supported in the community or general practice. Then the medical diagnosis or the whole picture perspective is really clear and also helps to inform treatment. Thank you so much. Thank you to all. I know that Claire and Alison want to come back in and I will bring you back in, but I do have a supplementary question from Sandesh Gohani. Thank you, convener, and this is Christina. I would like to just suggest something that you said there about when anywhere there's a human paraphrasing, anywhere there's a human being, we need that listening in here, we need the help, we need to be holistic. What are we doing in terms of helping people who might be coming across from Ukraine as far as link working is concerned because I think the social prescribing aspect is going to be key here? The social prescribing programme is obviously a state law model, isn't it? It's funding mechanisms and who their services might be for, so some have got that level of flexibility based on the model. There are also social prescribing link workers in Scotland that are specialist and focus on refugee and asylum seekers. We've got migrants groups as well, so what the social prescribing movement has identified is where there are specific cohorts that need proactive intervention and support. You can actually have social prescribing link workers that are focusing on those, then you also have some that are in general practice where it depends on the culture, and if the general practice is focused on those that are just on your list, then the social prescribing link worker will be focused on those that are on the list. If it's a community-based social prescribing programme or it is a social prescribing service in the GP surgery that is open to those sort of intervention, there's about the community and opens up its doors to the community, then the social prescribing link workers can support them. So there is no, in some programmes, there is no closed list, they support everybody that needs to have support. The challenge is then that the social prescribing link worker is only as good as what we've got in the community, and they also have information on some of the social and structural inequalities that is driving those. They can only help the person to reduce or remove some of those barriers and inequalities based on the services that are available, but then when they identify these blocks, how do they feed that back to systems, to policy makers, to understand what is actually getting in the way? It's one of the aspects of the social prescribing link workers role that has not been tapped into is the information that we've got to actually shape policy. I just wanted to touch upon the hardest-to-reach people in our community. The benefit for spring social prescribing and Alison's programme is the same as that our social prescribers are hosted by community-led health organisations. They know the community really well, and they know where the hardest-to-reach people are. Those are people that traditionally might not approach the GP for certain different things. For us, meeting with a social prescriber in the community, it almost normalises that engagement and encourages participation as well. I wanted to say quickly about support for Ukraine. That's something that we would definitely be doing. I know that we're going to be discussing opening up referral routes, but post-pandemic, we changed our referral routes. Previous to that, we were accepting referrals from GPs in primary care only. However, as people weren't attending, we were different professionals for the right reasons, and we had to change our referral routes. We now open to a whole range of different places and organisations, such as pharmacists, the community link worker programme refers to us, housing associations, carers centres. I would imagine that anyone from Ukraine would get that support. They don't need to be part of a GP practice. They would get support with a new community-led health organisations. Our statistics show that GPs see 70 per cent of the population over the period of a year, so they're the ideal place for people to have the knowledge of what happens in the community and the third sector. As Claire said, our link workers are embedded across the four localities, employed by localities-led third sector organisations that know their communities, and they know the needs that the public face. They bring that knowledge. We have GP leads sitting on our programme as experts, so they are fully aware of what is happening in the third sector. Building bridges between primary care and the third sector is essential, whether it is getting GPs involved in funding decisions or we have a trust fund in Edinburgh, where primary care and third sector organisations are. We have had a few successful grant applications for that. We have had third sector organisations host PLTs. It is getting that knowledge shared so that, when somebody comes to the reception or answers the phone, everybody knows that their organisations are on their doorstep. To follow up on the UK, Edinburgh does not have a huge amount of asylum seekers, but we have anybody registered to a GP practice that holds that status. We work with them. We have a unique link worker that works with the homeless practice. That is only one in Scotland. The pandemic has shown that we completely changed the way that we worked when that hit two years ago. We became very responsive because the third sector has that flexibility to change immediately overnight. We changed from delivering food parcels to prescriptions. We opened up the whole service to every practice in Edinburgh. We helped with the Government's signpost and helpline, the local Edinburgh Council one as well. We have the ability, when there is a need in the wider general public, to link workers in third sector organisations and to shift with that need. It also highlights—Claire and I have had this conversation with Niall Taylor, who sits under my retorts team, and we have had it through the Scottish Community Link Worker Network. Where Scotland falls down, sadly, is that there is nobody taking charge of social prescribing in Scotland. In England, we have a head of social prescribing within the NHS in Wales through public health. Niall Taylor, Katie and his team have been having discussions with England and Wales, and they have the joint network, the All Ireland network as well, because they are aware, because they follow two of the minister's portfolios. We know what happens at the grassroots, and we know that the Scottish Government has it within its strategies and policies. There is a gap of knowledge and of feeding back. We all want those strategies and policies to work, but we also want our programmes to work. We need the evaluation to come back up, because we know that there will be increase in pressure on state money. We need to prove that we can show you the good work that we can do, and we can show the difference evidence and everything, so that if there are GPs that are maybe a wee bit doubtful, we have that evidence base that gets fed back up into the Government and that is shared. As we touched on earlier, sharing the best practice, there are new link worker programmes coming on board on new social prescribing. Let us not reinvent the wheel. We have all been cutting our teeth on that for a few years now. There are different things coming on board. The Heads on the Health and Social Care partnership has just made a huge investment into taking on board Elemental, which is a social prescribing management tool that talks to the GP vision systems. The evaluation and opportunities that that gives us is huge. Westlodean is also on board with it and Highlander is taking it on. Possibly that might be something that we could look at more on a national scale, so that we are all getting the evaluation that is proof that what we do is worthwhile and meaningful and then is worth future investment. Thank you, Alison. That was very helpful information. I can see a lot of people making notes about questions that we might want to put to the Government on this. I think that Roseanne wants to come back in and then I am going to move on to questions about public perception from Emma Harper. Roseanne? Yes, thank you. Just going back to linking primary care with third sector, I think that it is really important. A lot of GPs do not know a lot of what is going on within their local communities, so one of the initiatives that we had been carrying out before the pandemic, especially in health centres across Glasgow, was about bringing the community to you. What we would do is link in with third sector and statutory sector services such as smoking cessation, Macmillan transforming cancer journey and invite them into the health centres or the GP practices once a week. They would set up their stall, so they would get to meet the patients that were coming through the practice, but the links workers would also encourage the GPs and the practice nurses to come out at their tea breaks and come and meet those services, so they know exactly who is in the communities. I think that it is really important that we continue to forge those relationships between our primary care and community services. One of the other big issues that we have found, and I am sure that that will be no surprise, is around space within primary care. It is at a premium. We are having new health centres being built, but still there is lack of space, especially when we move forward with our multidisciplinary teams. We are bringing in pharmacy into primary care, MSK physios, welfare rights officers and links workers. Where are we housing all those individuals? Where are they going to be? We need to be looking at community space. It is important for a links worker that they are visible within their practice so that they are not forgotten about for receiving referrals. However, for them to see people, a lot of times it is important for them to make links out in their community. That can be with the local house association and asking to use one of their community rooms. It can be looking at other community venues and other libraries. I think that it is clear that it is important that we look at where there are other spaces in our communities and look at utilising them, because for some individuals that will be comfortable for them. It is a person-centered approach, and for some people coming into the GP practice, there is that place of trust for individuals. For some people, meeting out in the community could be a really valuable resource that we have. For the last point that was made about Ukraine and the situation there, we are already within Glasgow, especially. Again, no surprise, there is a large percentage of asylum seeker refugees across the city. We are based in Government Hill in Glasgow in three practices where we have the largest Roma community for the whole of Scotland. We are used to working with local community groups and networks and really building relationships with those organisations and looking at how we can link in interpreter services. That, again, can be a challenge. We need to ensure that that is a nation that we are equipped then if we are going to be taking an abundance of individuals coming from Ukraine, that we have interpreter services to ensure that we can work closely with individuals where English may not be their first language. We need to ensure, as we did during the pandemic, that resources are made available in languages so that they are easily read for individuals so that they know how they access their GP practice. For a lot of people just now contacting the GP practice when they phone up, the response that they receive is in English. If English is not your first language, how are you going to get through that initial barrier or even contacting your GP practice? We need to be mindful of those things as we move forward, just around how we can remove all barriers and access for everyone who is going to be living or coming to Scotland. I'm interested in what the public know about social prescribing, because there are a few papers out there that say that it's been around for years, but then we've started having more dialogue about it. We know the value of social prescribing, especially during the initial lockdown in the pandemic. For mental health and social isolation and befriending, there are two particular projects that I know of locally in Dumfries and Galloway. One is called listening ear in Stranraer and the other one is by the GNG third sector. I'm interested in what your understanding is of the public's knowledge of social prescribing as a pathway for treatment, not just for men's sheds or mental health. What do the public understand about it? Our programme, We Don't Take Self-Referos, has to come from Sunday within the practice team, and that decision was made because of risk. Sunday in the practice team has to be aware of the risk, because we've had a couple of near misses with patients being in our own Linkwickers that shouldn't be. We also have an obligation to assess and risk when we refer people on to community organisations. We don't have posters or leaflets in practices, but we rely on the GPs. It's all about that trust in relationship. It was touched on earlier that people will come to their MSPs about issues, but almost GPs are put on such a pedestal that people trust them so much. It's around GPs educating their patients into the other services, the alternative pathways that are available within the practice. Whether that's a physio, a pharmacist or a Linkwicker, what I found especially when I had a case load in the practice is that when the GPs have the discussion around, let's look at alternatives, because I'm not the best person to help you, but I have a Linkwicker here. The person trusts the GPs that they agree to then come and see the Linkwicker. Again, we have a handbook guide for our Linkwickers that we say that we should work with a person for between four to six sessions. That's not set in stone, but it's to set expectations out at the beginning that we are not support workers and that is not an endless service, but there are boundaries around that. You're setting the expectations up quite early. Because you get to spend that time, if you've got an hour to spend and get to know somebody in that first initial appointment, then you start building trust from there. When you come to the second or third appointment and you start suggesting support services or group activities, you've got that buy-in from the patient. It's maybe not about the public awareness, but once they are in that consultation room with the GP that the trusting educational process begins, a GP is not always the best person. That varies through generations. We practice a lot of training doctors, and those doctors just get it right away. When they start suggesting things to their patients, it just seems to work. You see that trust in relation moved from the GP to the Linkwicker to the community organisation, and that's the best outcomes that you can hope for. I should probably have mentioned it to other panellists. If you want to come in in anything, use the chat box. Let me know if you want to come in. Christiana does. Thank you, Christiana. Over to you. Thank you. I think that that's a great question. The thing is that with social prescribing, it's about social change. It's not something that we can rush, so there needs to be a national campaign. The challenge with that in Scotland is that access is not universal. Some areas, there is no social prescribing link in the first place. I wonder if that is what when you're introducing change, you need to make sure that you have a mechanism to also communicate that. That is something that is lacking where it's just left to the individual social prescribing programme to do that. You need education across the board because you're introducing a social change. Some of the GP colleagues will say that this is the biggest cultural shift in healthcare and medicine. It's quite a huge change where even the training for clinicians and the way they see things needs to change. VCSC organisations that might have been doing some elements of social prescribing, and it depends on the social prescribing activities, well, they now need to understand the philosophy of this and that if it's mainstream, there is an expectation from the patient there is a level of expectation if they feel it's actually something that is mainstream. That's one of the things that we are concerned with, as well as social prescribing is based on local needs and local tailoring. We still need to have some level of consistency. We don't want somebody meeting a link worker in a particular area, and then there is a risk there. If you see a GP, you see a GP. If you see a clinician, and I did read some of the views from the survey, and you can see, so how do we give people the trust that they need? This is what NLW is trying to do. We've got a code of practice, which is all voluntary. We've got a CPT framework, and we are beginning to have conversations with NHS education for Scotland, but it is something that the panel helps to encourage them to take ownership, because across other nations, it is their education as AMSLEM body statutory that is overseeing that. The training and education needs of this link worker is not being catered for enough. We need to have a comprehensive framework for Scotland. We've got Wales there, designing theirs, England has just done theirs as well. It's very important that we make sure that there is no postcode lottery, that there is a baseline of what you expect. We did our survey last year. What it highlighted was the biggest challenges that our members face is the lack of understanding of their role and role boundary. It's QK-wide, and this is a problem. It is something that we need to address, and we need to specify and get some standards and basic understanding of what this person does. Interestingly, we are doing an engagement work with the National Association for Patient Participation. I did love what one of the chairs from one of the PPGs actually said, so we are trying to explore their understanding. The report is published before May, and I am happy to share that. It's quite really surprising in terms of how the patients we are describing are so superscribing. Some of them said, well, I used to pile up a compile list of all their singing groups, all the walking groups in my area, even before we now have a link worker in our area. There is an understanding in terms of the activities of what those people are doing, and some of them were actually describing what they felt they meant. We were saying, oh, maybe that should be the new description which she used. Don't underestimate the fact that some of the patients they quite really understand and appreciate it because they feel that's what they've been doing. Patient participation group is a community group. That is one of the groups that you would connect somebody to. They have been listening to and supporting their members. The concern that we have is how are we sustaining these groups? How are we sustaining these groups, these groups that are reliant mostly on volunteers? How are we helping them to be sustainable? If the social prescribing link workers work is very narrow forecast and a big medical life, we forget that this is about community asset. This is about what are the gaps? We're setting up new groups, community integration. It means that if you're feeling lonely or you're feeling a little bit down or you just need to get somewhere, you're just kind of like neighborhood. Everyone knows everybody because it's about the social prescribing workforce. It's not just the link workers. It is also the community and all the assets around them. There's a lot of goodwill there and it's not just patients asking for appointments. They are also part of the social prescribing workforce and wanting to help. Some of the PPGs are no longer in existence now. Some of the community groups no longer in existence because we've had COVID and people are fearful. What is the remobilisation plan that we have to rebuild communities? What is the remobilisation plan that we have for PPGs? In terms of raising awareness, it's something that we all have to collectively do. It is the social responsibility that we have. This is about social justice and reversing the inverse care law. It's not just us in this group. It's something that the Scottish Government can do to make sure that, as an encore organisation, it helps to stream that. It's something that everybody needs to raise awareness from patients to clinicians, to a VCSE, to businesses and everybody that is interested in reducing inequalities and social injustice. I want to bring in Claire, Roseanne and Alison again. I know that you want to come back in, but I'm going to go back to Emma because she has a supplementary question to throw into the mix. If I go back to Emma first, we'll go to Claire first of all. Okay. On the basis of what Alison and Christiana said, I'm interested in what the barriers are for people to pick up a social prescribing pathway. Alison talked about people seeing the GP first and then they've got one or two or three further visits in order to get them enticed into joining a walking group or visiting a men's shed or participating in listening ear, for instance. I know that we've seen with the community empowerment legislation that community hubs are being created, community asset transfer has enabled communities to get together and create community hubs and community centres and feel empowered. That's also been helping. What are the barriers to somebody saying, okay, I will do this instead of seeing the GP again or again or again? What is that particular thing that stops people progressing? I'll just touch on the public's perception of social prescribing. I don't think that social prescribing is widely used in public. I don't think that it's the language. I would agree that a lot of the organisations that I support have been doing this for a long time, so it's almost about the terminology that's new. Like Alison's programme and the Alliance, we need to take referrals, and it is to mitigate that risk from self-referos. However, in terms of the barrier for the organisations that I support, spring social prescribing is only one element to what they do, so I know that because those organisations are based in their local communities, anyone can walk in off that street and go to that organisation and say, I need a bit of support. It might not be through spring social prescribing that they can get that support, but it might be through some of the other programmes that are held within those organisations. There are barriers, but there are certainly ways to get around about those barriers where people can pick up the phone or access first sector organisations. However, those organisations are only as best as the funding that they have. I think that that's obviously a big barrier. It's about funding for those organisations that are in existence. I think that it's really variable. If a GP practice has a links worker, maybe not all of the practice population will know that there's a links worker based in that practice. Our Glasgow programme takes self-referos, and that was something early on in discussion with our GP partners. We've found that there's an increase in self-referos now. People will talk about the service that they've received and tell their friends, tell their colleagues, so people will come and self-refer. We also have leaflets of information about a links worker and what it is that they do. It talks about some of the social areas that they can support people with, whether it be around housing, bereavement, benefits, etc. What's really important is the use of medical records, because our links workers can access medical records. Just like anyone else in the practice team, they'll see if there's any alert for any patients. If someone's making a self-refero, they'll do that through the receptionist. The receptionist will be able to see if there's an alert. If that's the case, they'll assess the risk and look at having a joint visit in the practice for an individual, just the same way that the practice nurse would. With our programme, there's no exclusion criteria. Similar to the GP practice, there's no exclusion criteria. Anyone on the practice list can come along and see any of the health professionals in there. We're talking about barriers for individuals' access and services for many people, especially with our Glasgow programme, which is based within GP practices, so some of the areas that we are working within. People aren't ready to engage, and that was even before the pandemic. People weren't ready to engage. The links worker has the opportunity to build that trust, to have that conversation with someone. We're not time limited either. Although we capture how many sessions people will have, it can vary from one session to people working with a links worker for months, because it may be that they're trying to access or navigate either a statutory mental health or social care service. One of the other things is just around individuals' lack of confidence and self-worth. We've got anecdotal evidence of individuals being spoken and told about services within the community. One is a young mum who had a young family and was socially isolated. She didn't know anyone else in the area. The links worker spoke about a bouncing rhyme class that was going on in the local library. That young mum didn't feel that that was for her because she said that she would feel out of place, because, as she put it, that's the yummy mummies. That's mums that are on maternity leave. I'm not. I wouldn't have any conversation. I wouldn't know how to speak to them. That barrier was overcome by the links worker saying, do you want me to come with you? Would that help if I came along to that class with you? The links worker supported that young mum to access that service with her baby. She went twice until that young mum realised that her perception of what that group was was very different from how she'd seen it previously, but she was able to then access that. I think that that's really important because it's not just around signposting or referring people to services, but it's been able to walk alongside someone to look at it in an individual, a person-centred way and ask the person what matters to you, what is going to be the difficulty of the barrier, is it walking through the door of that woman's centre, is it walking through the door of the men's shed, then I'll come with you if that would help. I will walk alongside you with that journey, and I think that's really important that that's captured as well. There's much more to social prescribing, and that's where we need to look at all the different models that we have across the country. It's just to go back to the public awareness. There's a Scottish Government advert that's out just now about the receptionist. When somebody phones the receptionist and she can redirect you to whether it's an optician or whether you need to go to pharmacy, I don't think that social prescribing is part of that advert, but it's engaging the whole practice team so that if somebody happens to mention, and I know that some people still have receptionists, my old practice is primary care, we've got care navigators or primary care advisory, so again it's about changing that shift of language, so that if somebody mentions to the receptionist, oh, Mamam's lonely, Mamam's nob, but she doesn't speak to anybody or she's struggling with her food, then that person can say, well, we've got a link worker, so that it's just that whole education around alternatives to a GP, and I think that advert's a really good place to start because we all know people say, oh, that receptionists are too nosy, they ask too much, but it's not as about, so they can find you the right place for you to go, so I think that that's something a few of my link workers do the social media pages for their practice, and I know my old practice, we did a big publicity push, the pandemic, so this was advertised on the television in the waiting room, it was also published on the bottom of prescriptions, follow us on Facebook, follow us on Twitter, and we were advertised in the local groups there, we could tell them food pantries, the over 60 social clubs, what was happening in the local library, so even if people aren't seen that link worker, and our model is that anybody in the practice team can refer into them, it doesn't have to be a GP, but by building that awareness, it might be the worried well that see their doctor, that they don't need that appointment by following on social media, they can see what's happening in their community, and they might be the ones that can just pick up the phone and take themselves along happily, but the ones that the link workers do, as Roseanne she hit the nail on the head, it's about that, those are the people that are so entrenched in their illness or their social issues that they are never going to pick up the phone and they're certainly never going to be the new person that walks through the door at a community centre to join a group, but the link worker has that, well I know it's Mary that runs that group, there's about 40 people go or it's half women, it's half men, the age group is over 50s, whatever, so every time they're, every bit of knowledge they've got about that group, they're reducing the barriers, so you're setting the scene that patient builds the picture of what this group then looks like, and it's like, well, if Alison says it's all right and Mary's nice and she's been four or five times, I'll give it a shot, and Alison's even going to come on link, but so when they open the door and everybody turns round, there's somebody else that they're looking at with me, and that's where you get the buy-in, having that chum, yeah, I'm all, I'm all from a link workers chumming people on, because that's how you'll get that buy-in, and as Roseanne says, if it takes two times to go along to get somebody settled, then that's what it takes, and then you see that patient go off, and it's almost like, well, I don't need you anymore, and that's the best result you can get. Thanks, Emma. Just a final question, and I will be short, and I'll aim it for Christiana. How can we raise awareness that link workers exist? Thank you, and I think so on the last point, I was going to say that there are not no refined sign posters, so there is a need to educate the public and to be aware of what support and services that's available. This is where some form of directory, but the challenge has been who is keeping that up to date and things like that, because there's a tendency where public health interventions sometimes may well increase inequalities if we're only catering for some, so the social pressure travelling workers for those that has got complex needs and those that cannot make those connections, so there is a need for sign posting so that we don't overwhelm the social pressure travelling link workers, which then means that those that need support don't get the support that they need. In terms of how we raise that awareness, so I think firstly we need to get political buying to raise that awareness. We need to have a national campaign that is there to help to raise that buying. We need to also have campaigns that embed and embraces social pressure travelling link workers role as part of the team, so we're not longer saying we're saying team GB, team general practice, it's not just about the general practitioner anymore, so it's the language that we're using about how we normalise things and what education package do we have for both clinicians, do we have champions, I mean in some areas they've got clinical champions for social prescribing, we need to have more clinicians that are actually championing this because the GP is a place where you go to be connected to other professionals as well as services, it's not the focal point where you're reliant on just one person alone, so yes at a national level we need intervention from the government to help with that. We also need other professional bodies, certainly the Royal College of GP Scotland needs to do more to raise the profile of social prescribing amongst their members. We've been doing some work with some professional bodies, doing podcasts because there is training that is needed and awareness amongst all the professionals and then working with existing patient groups for example the National Association for Patient Participation, helping them to be helping to raise that awareness as well as the DCSE infrastructure organisations who have a role to help to raise their awareness as well. Thank you, I'm aware that we have a lot of members wanting to ask questions, I want to move it on to talking about health practitioners uses of social prescribing, so if there's any points that our panellists wanted to make off the back of Emma's question, build them in by all means to further questions, I'm just really worried that we're not going to run out of time, but it's incredible to hear the enthusiasm that you all have for your area of expertise. Thanks, convener. I've got a couple of questions, I'll give them individually. In 2019, the committee acted in an inquiry and highlighted a number of the barriers health practitioners and their use of social prescribing in primary care. Such barriers included a lack of strong evidence for its long-term effectiveness, time constraints, awareness and quality assurance. I was wondering maybe Alison can start as has any progress been made in tackling those barriers over the past three years? I missed a bit of that at the beginning. I was asking about, in 2019, this committee, when we were taking evidence—it wasn't me—they heard a number of barriers that healthcare practitioners faced in terms of their use of social prescribing. Those barriers included the lack of strong evidence for its long-term effectiveness, time constraints and awareness and quality assurance in terms of how they can be assured that there's that consistency of quality. There's also, if you link into that, that continuous monitoring that those services are still there in the community, because we know how transient some of those organisations may or may not be due to funding. Has any progress been made in tackling those barriers in the past three years? I know that our programme network manager, Ann Crandles, was involved in previous committees, given evidence. There were to be more meetings with the Scottish Government at that time, and then the pandemic came along. When you talk about evidence, all the Scottish Government asks from link worker programmes for information on minimum code data, which is dates of birth, genders, postcodes, ethnicity and the reasons for referral. There's a few more. Our programme, every year since 2017, we've produced an annual review, given statistics of the number of referrals, the number of people that engage, the gender split, the age split, especially the postcode splits, because that fits in with the health inequalities work. That gets broken down into practice. We send out stats every month on engagements, referrals, how many DNA rates, any funding applications, and we give them informational caseloads. That goes right across our network. I touched on earlier that we've got two GP advisors on our programme, and one previously did a bit of work on looking at a patient cohort group. There are attendance rates the year before they were referred to a link worker, and there are attendance rates the year after they had seen a link worker. There was a 30 per cent drop in attendance. We've also seen by link workers being involved in doing a bit of sign posting training for receptionists that they were able to redirect 6 per cent of requests to a GP to other places. That is what we are doing. Professor Stuart Mercer of Edinburgh University, I'm sure he is, is involved in looking at doing some more work. The fact that we've got this elemental programme coming on board should be able to give us more data that we can delve into. We need to start showing our evidence, but we all know that the best evidence that they can get is when they hear a patient, or the best thing that they can hear is when a doctor says, I haven't seen Mr Smith in four months. Where is he? Well, he's at a men's shed, or he's volunteering, or he's at the walking football. Claire and I hosted a session for the Scottish Government in September, and we had a patient speak about their own experience, and that's the best evidence that they can get is when they hear it from somebody that's living it. I suppose that you've alluded a little bit to that as well. I think that workers have quoted that there is that lack of understanding of their role among, I think, nationally on that one, which does impede also the progress on social prescribing, and you've mentioned some of that. So what progress has been made to raise awareness of their roles and make it a much more viable route for care and support? I'm also looking to ask around that point of contact, and I'm going to still say it's through the GP. It's through the GP practice, and a lot of the frustrations that we hear are from people who are struggling to get past the receptionist. Everyone is still having to come in to that GP practice to get that referral. I was interested when I heard from Claire earlier when she was speaking about some of the self-adveril pathways. What are we doing to increase the lack of understanding among the role that she needs? I think that there has been a change over the past few years, certainly in the evidence that we've been gathering. For spring, we were the first to use the elemental software, so we've been using that for three years, and it's been really beneficial in capturing our evidence. We measure the impact for people, communities, healthcare and government, and I do have an external evaluation, which I'm more than happy to share around because there is a lot of evidence that we capture within that. It's not just about the improvements for people, although that is incredibly important. It's about what difference are we making to NHS GPs? Are we reducing the pressures? That's why we were shut up, and we have found evidence to say that we are doing that. I can share that around so that you can have a look at that, and if there are any questions, please come back to me. I also want to say about the work of the Scottish social prescribing network. It is our ambitious aim, but could we not look at evaluation tools across the country? Could we not be capturing that evidence so that we prove social prescribing work? We know what works within our individual services from the four members that are here today, given the evidence, but how can we capture that across the country? That's the step when I'm ambitious, saying that we have as part of the network. What was the second question there, Shonnie? Just about referral routes. Did you mention earlier, Claire, about some self-referral stuff that's been going on rather than everyone having to phone in to the chief perceptions? I think that I've touched on that before. The GPS is a good place to go, but it's also a barrier for some people. Some people can't get an appointment for various different reasons, and some people are really scared to go into these healthcare settings. That's why we changed our model. It's to make it more accessible to people in the community. We're doing that. We're able to do that, Alison. I've touched on that before. The third sector is really proactive and able to adapt quickly. We're ever changing a programme to suit the needs of the community. We're opening to different suggestions of different referral routes that we can take so that everyone gets the appropriate support going forward. I just wanted to touch briefly on the progress in terms of evidence. At the moment, the National Institute for Health Research has funded a national evaluation that the University of Manchester is carrying out that is going to look at some programmes in Scotland as well as programmes around, but that would be helpful in terms of helping with the evidence base. That's going to be a three-year study or something like that, but it's just echoing what the colleagues have said, where we have a problem with people understanding what we're doing in the first place. Therefore, this is a role that is about the glue in the community and the NHS. I worry that the evidence might be measuring the wrong things. This is about relationships. This is about integrating care and social prescribing. The patient makes them happy, so how can you quantify that? It's just being very careful that we can't do a randomized control trial because there are various variables to be able to control, so that's not applicable for social prescribing research. It's going to rely on that social care research. Before coming on here, when we had around table some of our members, they just felt, why do I constantly need evidence that I'm doing great work? Some of the professionals don't have to do this as well. Are we measuring the right things in the first place and more of some of the services and activities that we refer people on to? They are already evidence-based. We know the value that physical activity or eating well will be connected to your communities and all of that, the impact that it has. The social prescribing link workers are doing is being the person with the link to those and removing the barriers that people face as well. Another challenge that we are getting is in terms of capacity. We need to increase capacity. Some of the social prescribing link workers are actually at capacity. Covid has highlighted the need that people have or things that they put, that they're not seeking health interventions or support. It also has highlighted some clinicians in terms of the value that they bring to their communities. We need to get ambitious. If this is something that we're going to mainstream, we need to get ambitious with the numbers. We definitely need to increase capacity. We need to protect this workforce. We can't have a cycle where we keep overrunning new things, come on, and then we don't have plans to expand it, and then the workers get burnt out. Nobody is looking at their career progression, educational needs and all of that, and then it becomes unattractive as well. It's something that we need to think about how are we increasing capacity as well, and the pandemic has not actually helped in terms of progress, in terms of evaluation and stuff, because the role has changed for some social prescribing link workers. Everybody has had to adapt as well, but now what is the remobilisation plan for social prescribing in Scotland? How are we going to recharge communities? It's now the community groups and what they're able to provide is limited. How are we going to make sure that we have an increased number of people that are going to be listening to the patients and asking them what man asks them and saying how are you? At the moment, when people don't feel listened to or get heard, that's a very big problem. Yes, they need to get heard first before saying that there is no appointment available. So how do we do that, and how do we increase resource? That means that they don't actually have to ring through the GP in the first place. We can't manufacture any more GPs, so it takes a long time to train other members of clinicians. What we've got at the moment is community. It is in non-clinical roles and community assets that can help us, and I think that we can deploy that immediately. You've led very nicely on to our next theme on community organisations, Evelyn Tweed. To what extent does the third sector have capacity to deliver more socially prescribed activities? I'd maybe like to direct that to Alison first, and if anyone else wants to come in. I think that the third sector has been massively impacted by the pandemic. Everything is shut down right away, and they're only slowly coming back out of that now. I think that we've touched on a couple of issues already. The third sector has the ability to be very responsive to needs and can respond to almost anything that's asked of them, but they need properly resourced. As somebody mentioned earlier, social prescribing is only as good as the resources that you can prescribe to. That's the biggest challenge that we face. We've concerned that our network really set up in 2017. We've said that part of the link worker's role is to highlight gaps in services and highlight the ones that work very well. We've had a couple of success stories of joint funds and applications for self-management courses, so they've not had to rely on waiting for funding to come down the statutory routes, but those are few and far between, and they're all those short-lived. That's what we don't want. Things have to be sustainable for the future. Although the link workers do a great job, they create extra demand on the third sector, so there really has to be the investment into that. As I mentioned earlier, what would be ideal is getting primary care involved in those funding decisions so that it really does firm up that collaborative work and acknowledges the good work that the third sector can do by supporting state services. I think that, similar to Alice in saying there around, especially with the pandemic, a lot of third sector organisations, they changed and adapted to what they could deliver. Speaking for within Glasgow, a lot of local organisations, small local organisations, really stepped up where other services weren't available and really took hold and supported communities. I think that it's quite sad as we move forward that a lot of those organisations now aren't being funded, so we're going to be losing them. That really saddens me that a lot of our links workers then won't have these valuable resources to be linking in with. We're really fortunate again that we've been able to do some collaborative work with other third sector organisations looking at funding bids, supporting funding streams, but also for some organisations we've looked at getting spaces within some of the health centres, so maybe more national organisations that are further afield. We've supported them to come in and offer services within health centres so that individuals don't have to travel to other parts of not just even the city, but I think of one organisation, the Moira Anderson Foundation, that we've linked in with because we have had a number of individuals with childhood sexual abuse and requiring support and services to travel to Airdrie for a lot of people who were really out with their comfort zone, out with their financial capability, so for us to be able to support those services to now be able to offer on the doorstep within Glasgow have been invaluable. I think that there was a piece of research done and it is going back quite a bit. I think that it was 2015 and it was Catherine Skivington at Glasgow University. She did a piece of research around the impact on third sector and that was primarily around when the Glasgow service was a pilot and she looked at what impact that was having on third sector by having those links workers now referring in. One of the things that they did find was that there was an increase in referrals coming from links workers but also it was the appropriateness of the referrals so in the long term it took them less time because previously they would have had referrals that would have been inappropriate and they would have had to have worked through that process and realised that at that point that referral wasn't appropriate whereas now although they were getting more referrals they were actually appropriate referrals so there was time being more ably spent with actual individuals rather than having to re-refer someone back or trying to link them in with another service. We really need to look at moving forward we need to be looking at funding streams for our third sector and maybe not calling them third sector because they're not just as important as any of the other statutory sectors so we need to be giving them that same place at the table. I know that Claire wants to come in and then Evelyn if you have a supplementary question if you can direct it to someone I'm just I'm looking at the clock I've still got some members want to come in on other themes. Claire can I come to you? Just quickly so I'm not going to cover all ground from what Alison Rosan said but absolutely agree with both their comments. As part of spring to China levy the capacity that these organisations face we built in a capacity fund so that if there's lots of people being referred for different services that they would have that fund to cushion that role so they could put on more activities and groups and the other thing I wanted to comment on is about a solution that the organisation I work for got to stream it for health and wellbeing you've written a blueprint for a healthier Scotland and that talks about the capacity and it also offers a solution for this issue that we have but I don't have enough time to go into that today but I will send it around the group so that you can comment on that and maybe get back to me and it's definitely a solution that's there for Scottish Government. Thanks, convener. To what extent is a lack of reliable up-to-date local information about services hampering the ability of health practitioners to use social prescribing and I'll maybe direct that to Rosan. Thank you. Yeah, I think that that's something that's really important. Links practitioners, links workers, navigators, community connectors, they all need to know what's going on within their areas. What we did within Glasgow at the start of the pandemic was within each of our clusters that we were based. We didn't have links workers in every GP practice within that cluster but we realised that we could have a resource and support all of those practices and what we did was we allocated a particular links worker for each cluster to the start of the pandemic when we went into lockdown. They, every week, would look at what the resource is and they would take time out of their working week to look at and link in with those organisations and ensure that information was up-to-date. That is a real time constraint for links workers who are based in practice, have benchmarks of referrals that they need to achieve so we really need to look at how we can have much more robust links with what services are available and some of that responsibility then also goes to those organisations to be ensuring that they keep up-to-date. I know that within the Alliance we have the ALIS programme and I know that the next session that one of my colleagues is going to be speaking at that and across the country there are different directories but they all take time and if it is a digital directory that may be great for some individuals but again there is a completely different theme around digital exclusion. We have not even touched on that yet but we want to be making sure that resources are available for everyone to be able to access so it is about how we get that message across and keep on keep on board of what changes there are taking place with services and service delivery. I think that the digital exclusion aspect might be touched on by my colleague Paul O'Kane later on in the session. Can I have a quite supplementary question from Stephanie Callaghan? I am aware that Christiana wants to come in on that theme but in the interest of time I am going to get Stephanie's question into the mix as well before I come to you Christiana. Thank you very much convener and it is actually just picking up on some of what was said there by Rosan to and I was going to direct it Christiana. I think both might want to comment there just around the ALIS database I'm wondering how widely is it actually being used and is it the right system? Should we be really investing in it and ramping that up or should we be looking at it to something local work a bit better? Thank you. Thank you. I think when we were preparing for sort of like this evidence session and met with some of our members in Scotland and you know a few of them were not using ALIS and they said it didn't fit within their locality because the needs are kind of like different and what is available so they did still have their own local sort of like a directory that they use but I think there is a role for a national directory where people can go and find information but it won't take away the the need to still have your own information database because some of the groups that the link workers might find might be quite really small community groups so that are not kind of like very formal or you know nobody just knows about it just a few people that know about them so they they still have that. The challenge is that we need to recognise that this is about social change. We need to find the whole social prescribing service so in some social prescribing services that are robust they would have a project management office that they would have somebody who is looking after their own internal directory of services because this has been the same challenges that the GPs have always had where who is keeping the directory of the signposting options as available. What we cannot then have is having the social prescribing link worker just taking responsibility for that because again we need to meet people's needs. Some people need information, signposting, some actually need somebody they haven't identified what they wanted to in the first place and then that's where they need the social prescribing link worker or the need barrier so there is a need to empower people where they go to reliable information up to date but then the social prescribing programme still have their own database but then also going back to my point about this has been about reducing inequalities and social justice. Well part of the role of the social prescribing link worker and how they do that is by identifying gaps. They are actually identifying modernised communities or communities that are at risk of marginalisation and saying that there isn't services that are available for these people and the challenge has been who is taking responsibility for that. That's not something you bring up at the MGT needs to be, the MGTs for customer differently and this is then how we begin to truly reduce policies where we're having some groups that is actually nothing for them. If you feed that to the infrastructure VTSC organisations are they taking that on board? Also the short term funding it kind of becomes a problem. Give an example I've got a walking group that I actually attend this for women of colour and now because it's volunteer led they're not sustainable they're not putting in they're not putting up a lot of walks and you know and I'm feeling like okay there isn't so this is a group that is a good case study that an infrastructure organisation should be able to support to help them to be sustainable and then that way we are actually doing that. So what is the role of the VTSC within this is their funding mechanism a hindrance and means that they are not very outward looking are not you know able to capture those intelligence from the social prescribing workers or there is no mechanism to feed that back because I think this is about creative disruption so everybody needs to wake up to the times that we are in if your GP practice your VTSC if you know we all need to wake up to the times that we are in so that means there is a bit of a creative destructive thinking to make sure that we are proactively meeting needs and we are evidence informed and not just duplicating the same service over and over again. Alison, what's to come in on this and then we must move on to questions from Sandesh Alison. Just very briefly, the Scottish Community Light Worker Network that's being set up that's a discussion that we've been having about the sources of information not a huge amount of authorities use Alice and there is the then spend money on setting up their own online resource so in Edinburgh we have the red book we're having that linked up to the elemental system but I already know from my link workers that there's an I thrive directory there's also a long term conditions directory but even within Edinburgh there's four different directories that my link workers check buster local knowledge plus social media so that is an issue and it is always a challenge to keep them up to date I'm constantly asking my link workers to let us know about changes to the red book but also as Roseanne touched on there there should be some responsibility on the local group to keep that up to date as well because these online resources they're not just for the health inequalities it's for anybody we know through the increase of the link workers and PCIP surgeries that you know loneliness can affect anybody so these resources need to be accessible for everybody and we have touched on the digital exclusion which was really highlighted at the start of the pandemic but I know that that's going to be discussed on so I'll leave that there thanks. Thank you Alison can I come to Sandesh go honey. Thank you convener I just want to pick up on something that Alison Leitch said right at the beginning of the session as to how much GPs like having link workers as a working GP I can tell you I love my link worker because they take a lot of work away from me social issues navigating benefits these are things I simply can't do I don't have time to do so I absolutely love the link worker. I've got two questions one's about recruitment the other is about retention so my first question is that we were looking the Scottish Government was looking to recruit 250 community link workers in GP surgeries by 2021 but there are areas like Aberdeenshire, Fourth Valley, Midlothian, Highlands and Western Isles without any link workers so what assessment have you made of the efforts that have been made and how can we stop areas from falling further behind will we go back to Alison on that and this is what this is one of the challenges that the Scottish community link worker have been tasked with and the Scottish Government have funded voluntary health Scotland to run this so there is a map and exercise just now on tracking where these 250 link workers are I think there was an article that said that there was 210 so voluntary health Scotland are working on it there's a stealing group with different different representations on that and I am on the working group we're also looking at the training of link workers and there's been two peer support sessions this month and last month to ask link workers what they would like for that sorry I've forgotten what the second part of that question was so what can we do to stop other areas falling behind well we need to map the existence that what link workers are actually out there and we plan to get information on what their programme is at health inequalities programme is it a general one and what's their evaluation so we really need a map and exercise of what that link worker programme looks like in Scotland so then we can build on you know there's the commitment for a thousand mental health link workers there's the call the royal college of gps put out their manifesto pledge last year looking for link workers to be placed in every surgery but concentrating on those ones in areas of deprivation first of all so we really need to see exactly what the scene is like in Scotland first of all and then that would be complimented by the Scottish social prescribing network it would map all the social prescribing programmes that are not funded through Scottish government but out there such as Claire's programme and to see what the overall social prescribing picture looks like in Scotland and that would be our starting point thank you but my second question is around retention and i'm a bit concerned because there's a report in 2020 which suggested one in three link workers plan to resign within a year due to a lack of support and supervision so my question is to what extent do you think these problems are undermining the shift to social prescribing and what we can do to reverse that if that's the national association of link workers report the response from Scotland was minimal to that report but what has been highlighted through the establishment of the Scottish community link worker network is the huge differences in the programmes that are set up we had a team leads and managers meeting just the other week and for example Edinburgh we're quite adamant that link workers should be paid a salary equivalent to a band five within the NHS and every time our service level agreements are up for renewal that gets tightened because we know as soon as if somebody pays the lowest as soon as a vacancy comes up somebody will just jump the next where the highest pay is but the increasing gallery have told us that their link workers are only paid a band three and that's constantly getting squeezed so their recruitment is they find that really really hard whereas in Edinburgh we have hardly lost anybody other than moving they've either moved away or they've gone back to studying or taking a career break so we do not have a lot of turnover because we are really passionate that they are seen on a level with the multidisciplinary teams within practices the way that are then looking at the additional things that we can do through training through cpd what are the things that we can help professionalised and that's why we've really encouraged our link workers to take part in the scotches network in peer support stations so that collaboratively all these link workers across the country have a voice that can then influence the government level Can I bring in Christiana before I come to Julian Mackay? I've got a question on this. Christiana Yes so I think that without a doubt there is a problem around quality, safety and retention we also did a survey when we were trying to explore the prospects of a professional register this was led by England but we used that opportunity to consult with our members across the UK and over 70% called for register and the reason why they wanted to be regulated was because of the challenges that they were having in terms of not seeing as professionals and the pay issues that they were getting, lack of training, lack of educational opportunities and also sustainability of the role as well and then we also did an animal survey as well and we had examples from Scotland where they said they are resigning because they felt like the other colleagues in the same area they are working on another pay band so there's something around inequality here amongst the social prescribing link worker workforce. How can we be expected to be helping reducing inequalities and social injustice when you're feeling that in the first place and I don't think that this is anything that is just specific to social prescribing link workers all the professions face this so when you've got a profession that is only setting up ease identity so of course it's at risk of all of these things. We are developing an education standards which we're going to launch in May so again we have been conversations with Wales after the school as well as with Education Scotland and things like that. You need to have something that says this is what these people do and these are the level of requirements or experience and knowledge you need to have so yes you can come in as an expert expertise is not professionalism professionalism is the way you carry out the role and that is the concern that we have it's where you're rolling out something that's skilled and you're using taxpayers money to do that even though you but leave the experience of doing this you need to be protected and do this as a professional role and not just a hobby what that means if that means that we are not get away from the postcode lottery so there is a big challenge where we need to standardise the pay we need to make sure they're getting the correct education that they needed and the training this is a it's a it's a national issues a global issue there is a global social prescribing alliance as well so it's very important that we are paying paying attention to the ethics of the role we're paying attention to the professional standards so yes it's not regulated but we need to have some baseline yes you've got a link worker in this area and a link worker in that area and everyone has got different levels of experience and expertise well the patients just know that they saw a link worker so you need to start out whether this person has got the right level as well but this is the reason why we've got the national decision of link workers and whilst we are working with bodies that are concerned with the education and workforce development so that we have a workforce strategy what we would like to see is what is the workforce strategy for social prescribing link workers in Scotland that strategy should take into account how we grow the workforce because at the moment because we don't have the standards people want to become social prescribing link work how do you become a link worker it then means we are indirectly excluding people we're not having apprenticeships we're not having traineeships and we're not maximising the opportunity that it brings whilst people are there within the role they're not then clear in terms of where are they moving on to which by having those standards and mechanisms it means that people can move on to older clinical and non-clinical role around the system so we have created a profession but then we it doesn't have everything that it needs and particularly in Scotland is really really lacking all the other nations are stepping up to the mark and having the support offer for their social prescribing link workers and at the moment it's lacking thank you jillian thank you convener and good morning panel social prescribing covers a wide range of activities and organizations as we've heard from all of you this morning do community link workers have time and capacity to engage with all aspects of social prescribing is there a risk that they're being asked to help people with an ever expanding range of issues from mental ill health to financial concerns and many of the other things that you've all detailed staff this morning without any increased capacity and support and could I maybe go to Claire first thank you Claire yeah i think they do have capacity certainly with my social prescribers they wouldn't do all of that so say for example if it's money worries or financial issues they would support the person to engage in services that do that professionally so for example citizen advice funeral money matters so they would physically support that person to get to the right access so it's not it's not about the social prescriber doing everything it's about making sure that they get the right professional support that they require is there anyone else let's come in on that are we content to move on Alison yeah i would just say um if anything right now my link workers are are seeing huge demand on welfare rights so it's about those the services that are around to support the link workers to do their job effectively just because of the increase in demand the health and wellbeing fund the money that came out link workers have had a say in that and we're hoping that that is directed into the areas that will help support the link workers refer people on to and i think just about their capacity link workers just have an ability to be incredibly flexible meet the needs but also to enforce their boundaries and know where they can be effective and when when they can't or we do more hand to the patient or to themselves because we do have we do have to look after our link workers as well and can they bring in Rosanna thanks very much i think that there has been you know that capacity building for links workers but and especially over Covid within mental health services and we've seen a lot more links workers having to hold patients if you like because the services aren't there statutory services or long waiting lists and people are coming back to their GP practices because the referrals are being made and but they're being told six nine months waiting lists for some trauma services for one individual in Glasgow was 27 months from the initial referral before a service was actually put in place for someone now these individuals have to have somewhere to go and they do come back to their GP practice GPs do look at their links workers at being able to support these individuals we're looking at other creative ways on how we can do that and with that could be some locality approaches where you know a few links workers will come together and maybe look at setting up a conversation cafe where not all of them have to be available there but we can take it on a rota basis and so the individuals that are waiting for services to become available for them they have somewhere where they can go so that they still feel listen to the still feel that we're being supported and i think that's really important especially as we start to come out of this pandemic there's just going to be even more of a tsunami regarding mental health and wellbeing services and individuals needing support thank you thank you so we've extended their session by about 10 minutes because we do want to give a good hearing to inequalities aspect the questions led by paul okay and paul thank you convener and good morning to the panel um yeah i mean i think a lot of our answers this morning and our discussion has been peppered i think by some of the barriers that exist in terms of accessing the sorts of um you know pathways that i think are there and the sorts of interventions i suppose i'm interested in the views about the potential for the exacerbation of inequality so something rizan was talking about in terms of that the need for support you know for someone to perhaps be accompanied to certain activities and to have that intervention there but also the aligns in their written evidence had spoken about some of the challenges with for example passes for sports and leisure activities so i suppose what i'm interested in is you know if someone has never had the support to learn to swim for example and are then given a six week leisure pass that ends after six weeks you know is that actually increasing the barriers because that person then feels like well you know that didn't actually help me in a way and i suppose related to that after that six week period is that the financial barrier too high in terms of being able to continue with some of these activities so sorry i appreciate that was quite a lot but i don't know if rizan maybe wants to start because it was some of the alliance's evidence that i had drawn some of that from yeah definitely thanks very much for that and i think that that is one of the the big barriers that that we face when we are linking into other resources as we have to look whether there will be financial exclusion for individuals and we do try as much as we can to ensure that services we're accessing will either have a set fee or they'll look at an individual's financial status around accessing especially around some particular counselling services i'm thinking for example around anger management i know that there's a service that we would link into within Glasgow who will have a flat fee but through discussions with our programme and talking about those referral pathways they now have an opportunity for people to pay what they can afford as well so it's about looking at where we can where services are able to accommodate that the the Glasgow access for leisure facilities you know that's great that gps and links workers can access for six weeks for a patient to get access to all these services but as you say at the end of that six weeks £15 a month is a lot of money for someone do they do they not have food for that week or do they go and take on this gym membership and that's even before then we're looking at individuals that wouldn't have recourse to public funds where can we highlight for individuals so what we what we will look at is we'll look at a lot of organisations or assets within our communities that are going to be free and that's what we try to that's what we try and link in with because we are very mindful that even something you know some people might think 15 pounds isn't a lot of money but for a lot of individuals that we're working with 15 pounds is you know a lot to do with and we need to be mindful of that there's a lot of great resources in the communities within which we work and that opportunity for people to link in with is really important. In Glasgow we've also the HSCP have for practices some practice development money and what some of our GP practices have also done with some of that practice development is use some of that funding to buy pantry vouchers because again for individuals accessing food banks there can be stigma for some people that they don't want to access the food bank being able to go to a food pantry where they have more choice and we can highlight and be able to give over that voucher so they don't even need to have that £2.50 that's really increasing we've noticed anecdotally increasing people's self-worth and you know and you can't put a price on that and all that was was a £2.50 voucher to go to a food pantry so I think we really need to we really need to look at our community assets we really need to look at how we're funding our community assets and we need to make sure resources are available in these localities and neighbourhoods that really do need it. Thank you. Alison and Christiana, what's coming in? Can I take Alison first? Thank you. I think that that example of swimming is a very good one. We have a healthy act of minds programme in Edinburgh that people get they go on a programme and then they get access to leisure for a pound of time but that's only for a year and then you can't be really referred to that so all the good that you can do by having somebody access sports facilities then disappears after a year and we don't know what their own situations are whether they could get into work so that that would be sustainable. This is where I would like to see an overarching social prescription framework so that all this can be fed back in so that it can influence the bigger strategies such as public health. You know at the beginning of the pandemic the UK Government launched an obesity strategy because of the people who were ending up in intensive care. There was initiatives there about get your bike fixed, get out, get moving but all this could be hidden in the sports strategy so if you have a collective voice through social prescribing that feeds back those challenges to keep people well that obviously impacts the wider population then by having that overarching social prescribing structure within the Scottish Government I would like to see the link workers and social prescribers be able to influence change at government level so that we didn't find these people falling off a cliff after so long because then you just send them back to the issues that they came to you with in the first place. I think we would like to see who is benefiting from social prescribing so break that down by various demographic data because what is beginning to highlight is that we actually need more diversity in terms of the social prescribing workforce itself so it's very important that we are looking at who is benefiting from social prescribing in the first place and I also think that as a society if this is about social injustice and inequalities well we need to be prepared to actually fund to help people because some of the people that will be vulnerable and benefiting from social prescribing may not initially have the means to do that whereas there are some that with support they actually are able to you know find find find the means so let's just be very careful about what social injustice can do it's kind of stereotype people and by default the silence is the voices so it's about those that need help they should be able to get help and it should be free those that are actually able to then move on they should be able to be able to do that and not being put into one category oh this is the asylum person or oh this is the BME or this is the disabled person they can also get work they can also have a stack of businesses they can also set up social enterprises people have got aspirations and I'll really see us how are we supporting people's aspirations and those that are not capable are not able to in society how do we actually help them thank you Paul thank you thank you and thank you for those very helpful responses i think something that i think i picked up there is we do want to try and avoid i think any sense that this would appear paternalistic or that there would be a sense that things have been done to people i think it's very much from what you said this morning about that you know collaboration essentially between link worker and patient i wonder if i can just come back to Rosanne briefly just on that point about we talked about the pathway if you like into sport i mean is there any kind of work being done to look at how you know people perhaps have an initial block of training or support to to access sport for example and then are encouraged or supported to actually join a local club that is free and because i'm thinking a lot of the barriers very often are about you know having the confidence to join a club that's free and get involved in things and i wonder if there's a sense of being able to kind of train someone and support someone to do that and then to access the free clubs that already exist in our communities and so just keen to understand how common that is i think again it varies you know across across areas i know of where there's been football sessions and so we've linked in and that's been around accessing the football fans and training or you know looking at walking football for specific individuals we've also been involved with some pieces of work around some sports that people may see as being elitists such as tennis and a great initiative within the drum chapel area of Glasgow where we've worked with individuals and encouraged them to become involved and they've started by having some free lessons but then also they have a they can join the club within that neighbourhood and it is free to come along the equipment that they require is then made available as well but i think it is quite few and far between you know a lot of the groups that we'll link in with are things that you don't need equipment for really so like a lot of walking groups will take place and they can be things that are free and taking people about we were really fortunate we got some funding from paths for all so we're able to then bring walking groups together and do celebration events every year and take people to different areas you know such as the kelps one year so it's about opening up opportunities for individuals but i think there is still a lot of work to be done especially within the sports sector around tackling inequalities because a lot of sports just aren't available or inclusive for a lot of the individuals that we would work alongside and i'll give the last word to allison and i'll need to round off the session allison just very quickly we have quite a lot of activities here that are free and accessible walking groups walking football street soccer different things but sadly one of the things link workers reports is that people don't have the equipment whether it's a pair of decent walking shoes or a waterproof jacket so the link workers then have to find funds to get these basics and even for the few asylum seekers that i can think of that have no recourse to public funds they would really struggle to engage in any kind of sports activities just because of the minimal income that they have so that's something that the link workers are very conscious of thank you i want to thank the four of you for your evidence this morning it has been very very interesting and very helpful to us and we are going to have to round this session off we're going to have a 10 minute break and we'll come back with our second panel thank you we move on to our next panel our second panel witnesses given evidence this morning is part of our inquiry into alternative pathways to primary care and this panel will examine their role of technology in alternative pathways to primary care now welcome to the committee we've got four panellists this morning scott henderson the head of programme for digital front door of technology enabled care chris mackey digital hub and alice programme manager for the health and social care alliance dr paul perry the associate medical director of nhs 24 and adam satura the head of policy and communications for age scotland so welcome to you all and your ears will have been burning throughout all of our our sessions because this has come up throughout throughout all of our sessions in our inquiry and i guess i want to ask you all first of all go around you all about patience and public awareness of the digital services that are out there in terms of whether you think people find them useful people understand what's out there and whether you think that maybe gives the patients people people of scotland increased capacity over managing their own healthcare i think it will depend on the demographic obviously i don't want to preempt what you're going to say but i'm really interested to know your your thoughts and can i come to scott henderson first of all good morning and thank you for inviting me to give evidence today to your questions i think that in general i think that there is good awareness about some services and not so much awareness about others i think that reflects the nature of the development of services we have things things that are more mature than others in terms of understanding those services again i think that for simple services there's good understanding for more complex services then more support is required and being able to give greater capacity over managing one's own healthcare i think that there is some evidence that suggests that this is helpful and i think that it's quite encouraging some of the evidence that we have seen over the years as this is an area that has been in development i guess for quite some time and is now starting to show maturity thank you and can i come to chris mackie yes good morning and i think that what we're seeing is that the development of digital health and social care technologies is really benefiting some people but we do risk widening the inequalities in in scotland because there is a real risk and i think we're seeing that people some people are being left behind and i think that one of the things that i would urge is that we consider human rights principles when we're developing such innovations that innovation is good and progress is good there's no question of that but it's a question of not leaving people behind we've at the alliance we've worked with scotland care and vox scotland on some human rights principles for digital health and social care and we're keen to see these embedded within scotland approaches to to digital health and care which will promote of course alternative pathways so just quickly i'm going to i'm going to run through those human rights principles people at the centre so in other words we don't put technology at the centre we put people at the centre digital where it's best suited and and that means that that sometimes digital isn't the best solution and digital is an on-going choice so so people can choose and should be able to choose not to use digital solutions and but they can also opt into them and that that should be a meaningful choice in other words that that comes on to the fourth principle which is around digital inclusion which is about ensuring that people have the skills confidence to use digital solutions and also promoting workforce development and ensuring that that workforce is equipped to use those tools and finally access and control of digital data which is which is something that we're we're seeing and we're talking about in terms of the Scottish Government's approaches to the consultation around the data strategy present so i think that you know what we're seeing is that their digital approaches are good but they're not for everyone and they shouldn't be applicable to every scenario so it's important to consider inequalities it's important to consider human rights principles when when developing such solutions thank you chris can i come to paul peri thank you convener yes so i'm just to introduce myself to start with i'm the associate medical director here NHS 24 should also disclose like i'm also a GP that works in the out of our service in NHS Lothian but for the for the remit today i'll be giving evidence on behalf of NHS 24 NHS 24 is Scotland's national provider of telephone and digital services and we work with partners and stakeholders to provide information access to urgent in-hours and out-of-hours care for the people in Scotland i think coming to your question about awareness NHS 24 you know currently provides alternative pathways to primary care particularly with that digital angle to it we commissioned a progressive piece of market research back in 2016 that looked at i suppose public's awareness of this trust and the NHS 24 brand this was updated again back during the pandemic in 2020 and essentially showed that it was a very high awareness of the help and advice provided by NHS 24 through those digital channels and of those participants 88 percent showed that there was a great benefit both in the in-hours and out-of-hours period through through those services and overall there was an increased understanding of those NHS 24 digital services particularly NHS inform NHS 24 you know we do provide those digital services good examples of those are the implementation of Scottish dental emergency service and we specifically used near meat technologies to design development implement that pathway during the pandemic another example is the use of social media and we provide annual winter campaigns as well which we have just done and over the festive period recently we also use social media as well and technologies to increase awareness of health related topics such as the menopause as to what we've recently done as well so I think in summary I think NHS 24 very mindful it is there's still a lot of work to do in this area and there needs to be further awareness of these alternative pathways particularly the technology enabled care to tap into those aspects of primary care thank you community and dr perry just picking up on that I mean awareness is one thing but also having choice is not for everyone and that we do hear people and when we hear that off our email inbox is people I've been fobbed off I don't want to do this I want to see someone face to face cognisant of that yes thank you convener very cognisant of that it's it's around offering choices for the public and patients and not removing those choices and NHS 24 we're very much patient centred we have a user centred experience team that looks at user centred design when we're designing implementing services we particularly sit centre in technology particular on that service development delivery angle when we look at NHS inform in that platform we've realised over the years that we need to design that platform that's used in different languages another example is the NHS 24 telephony one-on-one service which we use language line on as well for people whose English is not the first language so NHS 24 we're very mindful of reducing these inequalities thank you thank you and can I come to Adam Stature? Thank you very much convener and to the committee there's absolutely no doubt that over the last two years people have been far more aware of the digital services and digital access to these medical services than ever before and largely because for many it was the only way to access them and I think for many many people it has been very good and for a great number of people it perhaps hasn't been because they haven't had the access to a device the internet to be able to navigate a whole new system so I think they've been considerable challenges for people there and if we're looking on age Scotland's behalf you know not bloodhight in any way but for older people where you know about half a million over 60s in Scotland don't use the internet 600,000 over 60s don't have internet on a smartphone there's a huge number of people here who sort of will miss out and that can involve many people the first port of call may be their G practice website but it's a bit of a mixback in terms of how these things look in their accessibility and how to navigate through them so look challenges eglore for people but we do know that there have been very good strides made in terms of how to access services digitally and a lot of people have found them very very helpful indeed. Thank you. I want to pick up on something that Chris Mackie said particularly around human rights. We heard last week from Jess Sussman who's policy leader of the Royal College of Psychiatrists in Scotland and she pointed to the fact that a lot of the patients that her members see have very acute mental ill health conditions and for a lot of them that doing things digitally was just effectively cancelling out their access to healthcare because most of them would not do that so I mean where do we stand in terms of just making sure that there is a spread of availability of services that is right for for the individual? Yes I think that what we need to be doing is as has just been said we don't need to be closing any doors we shouldn't be closing any doors what we need to be doing is opening up complementary approaches to ensure that those that don't have devices, don't have data, don't have the skills and confidence can still access health and social care services but at the same time we need to take advantage of the innovations and the advances that we have you know we've seen great benefits from the near me platform and what we need to be doing is offering that as a complementary approach so that people don't feel that they've been phobbed off and that people still have the ability to access services in the way that they feel comfortable so I think that it's about not throwing the baby out of the bathwater really that we should make progress and we should exploit the technological advances but equally bearing in mind that we have a diverse population we have an aging population and we have lots of factors that will key in to whether people can use digital options and lots of people won't or can't use those digital options so let's not close down those avenues. Thank you. I'm going to move on some questions from Gillian Mackay. Thank you convener and good morning to the panel. In their submission to the committee NHS 24 highlighted that in stressful moments when people are feeling unwell or in pain figuring out what is available can be a new pressure which often results in them reverting to using traditional access points such as general practice or A and E. This suggests we need proactive communication so people are already aware of what's there before it reaches that stressful point. How successful has proactive messaging been and what more needs to be done to ensure people are fully aware of where they should go when they need unscheduled care and could I maybe go to Dr Perry first please? Yes thank you convener in terms of that proactive messaging NHS 24 does undergo national communications campaigns. A good example of that would be the redesign of urgent care pathway that was implemented back in December 2020 and the dental pathway as well that we set up during the pandemic as well. We are very active on social media in terms of signposting the public and patients to the right care in the right place at the right time and are very mindful of doing that in the best way that we can. Thank you convener. As we've picked up on earlier not everyone has access to the internet and electronic devices that will allow them to quickly visit NHS inform for example and over the course of the pandemic we've seen some reactive and quick changes to capacity and where people should receive care. How do we communicate changes to care to how care should be accessed to people experiencing a digital exclusion and could I maybe go to Scott Henderson please? Scott over to you. Could you repeat that question please I'm not sure I fully heard it. Of course as we've picked up on already not everyone has access to the internet or to electronic devices that allow them to quickly access NHS inform and as we've seen over the pandemic places where people receive care have had to change quickly and at short notice how do we communicate changes to people who maybe are digitally excluded and how to how their care should be accessed? That's a really good question. We've been relying through the pandemic on the Connecting Scotland programme to facilitate access to devices and upscaling where that's required as well. There's still a significant programme of work to be done through Connecting Scotland and certainly any programmes that I've been involved with seek to work alongside Connecting Scotland to ensure that that access is made available. I don't think that I can speak for NHS inform on this one. Can we go to Dr Perry again on that? Yes thank you convener. In terms of communicating the care to the public and to patients we are at NHS 24 very mindful of particularly those digital inequalities and public health inequalities and reducing those barriers as best that we can as a nation. I suppose alongside the digital channels and services that we provide we also offer that telephony 111 line as well which would be which we go some way to offering a reduction in that barrier to patients that don't have access to those digital channels and services that we provide. Our user centred experience team are very well equipped in terms of looking at service development and delivery of those services with the patient at mind particularly those ones that don't have access to those digital services and channels apps and mobile devices and wi-fi and broadband as well. So we're very mindful in terms of the public that don't have access to these digital ways of accessing care and that forms very much a part of the service development and delivery of those services. Thank you convener. And from the Age Scotland perspective Adam over to you. It's a very good question and I think the answer to this is well you sort of go where the people are then you know we've had leaflet drops nationwide looking at this itself. The hope then would be people will keep these booklets in their own homes understand how a pharmacy or community pharmacy can help them more than they've ever imagined and perhaps wider GP might not be the first place to go. So we're looking at leaflet drops in a regular base that people keep because also people move and they lose things. Edeadverts, radioadverts, these types of things but also in you know in medical settings that you know once people have been there that they are able to you know take material away to have as that good good and quick a quick reference. But I think one of the challenges here is also that across Scotland depending on where you live you might have fewer options with regard to where you go for this. You know your GP or your or hospital might be the only place that you can go with a reasonable distance to access medical treatment or if you're on well anyway so there might not be these other pathways that exist in rural remote Thailand Scotland anyway. That's great thanks. Paul, can I come to your digital exclusion in particular? Thank you convener and good morning to the panel. I wonder if I can perhaps follow on from the kind of path that colleagues were going down there around digital exclusion. We've heard some evidence from patient groups particularly the Riverside participation group from Musselbrough who noted that approximately 10 per cent of the population doesn't have access to or indeed have the skill required to use new forms of technology and very often those patients are most likely to have the greatest health needs. So what else can we do in terms of protecting their rights if you like to access primary health care? I don't know who wants to take that first Chris possibly. Yes thanks for that it's a very good question. I think that yes that you know I spoke about human rights earlier and I think that that you know we know that some people don't have access to technology, they don't have devices, they don't have data, they don't have the skills or confidence and so in some cases as I said it's about keeping options open for for those for those people in some cases it's about providing the devices of the data and connecting Scotland has made great strides in that but it's also perhaps about thinking about well who can who can help you know we've seen through connecting Scotland the digital champions have come to the fore as well and I think it might also be about the consideration of maybe something like a digital advocate a person who can use those digital tools on behalf of another person and that could be a family care or it could be somebody you know a social contact but I think that there are such benefits available and and now coming on straight through the use of digital health and social care that there are ways that people could use those and make and have benefit from them without actually having to use them in person so I think that it's about considering other options whether it's a support worker whether it's you know somebody who's known and trusted by the individual to to use those avenues that even if they don't have the device even if they don't have the skills and confidence that they can still benefit because there are there are significant benefits that we can see through the use of these digital technologies thanks and Scott Henderson wants to come in on this thank you yes I guess from a Scottish Government policy perspective digital services are very much being seen as additional to rather than instead off traditional services and it's about providing an opportunity for those that are willing enable to access services in a different way to support them to do so within that as Chris has quite really referred to the connecting Scotland programme it does support those who want to access in that way but don't have either the means or the skills to do so to acquire those so that they can access in that way and I guess there's you know there's some pretty good evidence to suggest that that's a really worthwhile investment to make because studies that have been done it certainly shows that there's been a reduction in people just turning up at services because they don't have any other option and I think we need to be very mindful that everything that we design and everything that we bring into service from this point forward needs to be mindful that it's not replacing something it's there to supplement or to complement something thank you Paul Thank you perhaps just to explore some of that further I think Chris's point was interesting around who can support and advise you know I'm very keen on what we can do in our libraries for example in Scotland and I had raised this point with Citizen Advice Scotland they talked about some of their services although I'm not sure that there is fully universal coverage on those services so you know I think there is opportunity to do more there and I don't know if the panel has reflections on that I don't know if certainly if Adam you know people that you interact with through Age UK are interacting in terms of kind of library services so look we know how important library services and community centres are and you know last two years demonstrated innocent or things the doors have been closed and as they reopen and need to reopen these can become very valuable places for services to be hosted number one but also for people to get the information that they require but there's also look there's also a whole bunch of phone services that exist as well you might not always want to interact with and the NHS or all that but you know Age Scotland's national health plan our advisors can help you know direct refer signpost people to the how to to get access to the services that they might need as well often we hear from people who just haven't been able to get to them in the first place I think going back slightly early to one of your points Paul in about what more you can kind of do is I think the kind of those services for your interacting with that the starting position from them is that there may be people and maybe quite a lot of people who just won't be able to go online or do it over the telephone and how do you make sure that our doors are doors are just open in general we can direct people to a digital service if that's appropriate but you know I think this has been a big challenge as doors have been closed and trying to especially our NHS settings over the last two years is kind of almost keep as many people as we can who don't need to be in this but need to be in a way and I think that's certainly come through very loud and clear despite not obviously GP's and health professionals want to see anyone who's presented himself but there has been that under underlying protect the NHS so we'll stay away and when we surveyed in two and a half thousand over 50s at this point last year there was certainly a core theme through that people didn't think that they were able to go and access their services yet now challenge here is the longer people are going without the medical treatment that they require or think they need sort of the sort of further poorer health that they may experience and the sort of the challenge becomes further exacerbated and can I bring in Paul Penny thank you convener I suppose I just wanted to build on those points really you know reducing those barriers and inequalities around digital and health inequalities it is really around offering choice more than removing those choices NHS 24 was commissioned to do a piece of market user research there at the beginning of last year around particularly digital access and the learning points that were gained from that was particularly around the health access piece the public essential wanted more information which was tailored to their condition and and as a clinician myself I know that each patient that I see is different to the next patient that I would see in my waiting room each public member also wanted a different journey which again was tailored to their to their own condition and patient journeys are often I suppose multi factorial and multi touch points you know they might start off as a face-to-face consultation but they also might have a digital element to it and other elements in factored in as well and the main thing that is factored in to a supposed design of healthcare like this are factors like experience, age, comorbidities and accessibility which is very important as well thank you convener thank you and chris wanted to come back in yes thanks for that it was just to come back about libraries and just what a fantastic resource that they are in scotland and I think we need to do more to build on that and there's a recent report an action plan which is entitled a collective force for health and wellbeing and it recognises the role of libraries within communities and I think we are at a you know at a junction point with libraries that yes there are a place for books but there's also so much more going on within libraries and we need to talk about it and we need to promote it and and also the fact that that within libraries there are there are staff who are who are skilled in using digital tools who can signpost to you know the resources that are out there for digital health and social care so so whether it's libraries or community centres or whether we look at more mobile options where where geography is challenging then I think that we need to be looking at these kind of community-based type resources and options for support for people to access health and social care through alternative means and and I think as I say I think we're at a crossroads with with libraries and I really hope that we can see them as as the absolutely excellent resource that they are and because the alternative is you know use them or lose them and we're seeing that in some communities where where there's stress of closure so you know really would be for me to endorse libraries and resources like that as being as being highly valuable within communities thank you and Scott Hedgeson wants to come back in thank you yes I agree with my fellow panel members that community-based resources like libraries are very important and and do you need to be considered continually as to their role they're not necessarily a panacea though for example you may not want to do your video consultation in the library maybe because you wouldn't necessarily get the privacy to do that but there are other services that would be more appropriate to access through that route I guess my main point here is that we need to be understanding the access problems and inclusivity problems almost on a service by service basis and to make sure that we're building in whatever measures that we can at that level to make sure that all those who wish to can access services thank you Pauli, you have a final question and I'll bring in Emma Hart. Thank you just specifically I think on NHS 24 in terms of telephony service and I've raised this committee before but I think we have seen an exacerbated demand for that service because people want to have that contact via the phone that has led obviously to the pressure meaning that sometimes calls are unanswered which is obviously none of us would want to see that and I suppose my question is what more do we need to do to kind of bolster and support the service I don't know if Dr Perry feels that's about capacity in terms of staffing both call handling and clinical or what else needs to be done there? Yes thank you convener so the question was on the telephony service in terms of how we can bolster up the service and meet the needs of the patients is that what I heard? Yes sorry I was just I was referring Dr Perry to some of the challenges I think have existed over the winter period with perhaps calls going on answered and I think the importance of how do we ensure that that doesn't happen and that we have solutions in place to deal with the pressures? Yes thank you but I suppose the answer to that question is around us increasing capacity within a workforce which is what we've done. We've recently opened the Dundee Contact Centre in December last year which will increase the capacity within a workforce to be able to deal with that volume of calls. Last year we dealt with 1.6 million calls to left any line which was I think roughly 10 to 15 percent higher than the previous year so we've definitely seen it increase demand over that time. We are coming out of a Covid-19 pandemic which again has increased demand not just on the NHS 24 services but I think whole system wide but we are very mindful to be able to increase that capacity within our own workforce but I think we need to take a stand back from this and actually see it systems wide so it's not just NHS 24 but how the whole system deals with the demand going forward I think particularly from an hours and out of hours primary care perspective, secondary care perspective and then you know how we can work with partners and stakeholders in the third sector and voluntary sector as well. Thank you. Emma, you have a question on this. Yes, thanks, convener. Just a wee quick sup. I know that when we're talking about library services and Chris Mackie said use them or lose them, Perth introduced dog friendly Fridays in their libraries and that was in 2018 and Edinburgh introduced dog friendly Thursdays October 2019 to tackle isolation and loneliness and so that folk didn't have to tie their dog up outside the library or leave their dog in the car and is that something that you're aware of and if so, is it something that we're tracking to see if dog friendly Fridays in libraries is a good thing? This is Emma's attempt to get dog friendly Tuesdays in the committee which I'm fully supportive of. I saw a few of our panelist nodding. I saw Scott Henderson nodding along. I am muted, okay. I have no awareness of any plans around tracking or monitoring these sorts of services for libraries. It sounds intriguing and I would be very interested to learn more. Emma, I think you've made your case. We'll move on to talk about health literacy with Sue Webber. Yes, thanks, convener, and hopefully you can see me this time. The signal is a bit more stable. The Royal College of Nursing has really pointed out that those who are health literacy are less able to identify or label what's wrong with them and are therefore less able to identify and self-refer the various alternative pathways that we hear so much about. What is your assessment of the risk that an increase in the use of digital pathways could increase the actual health and equalities that we faced or many faces? I know that, Adam, you've mentioned earlier on the scale of the issue in terms of even the number of over 60s not having a device. Chris, you mentioned that digital should always get an ongoing and meaningful choice, so maybe either one of you might be interested in responding to that. Thanks for the question. It's a very good one. It's something that we hear of quite a lot through our helpline. When people are trying to articulate or have been the last two years what is wrong with them, they're not really sure. However, if you consider the fact that people over the age of 70, on average, are living with three chronic health conditions, and there are lots of different things that you could be living with, you're sometimes not really sure what the issue is and where you go. You might just want to go to your GP whether that's that traditional view or something that you would do, but other things that can be picked up on whether it's malnutrition, which we know is a real difficulty among older people. People are being malnourished, though in this isolation that could be an underlying cause for ill health, the mental health challenges with older people who often don't identify that these are things that they may have. I think that it's very difficult that people just won't know where to go for each of those things. If it's just one thing, it might be more straightforward, but trying to articulate that, particularly if English isn't your first language or you just don't know what's causing the ill health that you're having, but trying to find out and navigate the web to do so. If you're living with some of those conditions, getting access and using digital devices could be pretty hard if you're arthritic, if you have Parkinson's, if you've got sight loss. You're probably not wanting to ask somebody else to go and help you do all those things because it's your own medical conditions that you might not want to disclose to other people and just ask for help from friends or family. I don't think that that really works in this sense, if we're going to be—a lot of people are quite private about this and not want to disclose just the extent upon which they might not be well. I certainly know that from older people in my life too, but that's not something that they're really wanting to tell you the full story and quite rightly, because it's a personal thing. I think that it was Chris that so identified us. Yes, that's me, Chris. Yes, absolutely. We need to tackle health literacy, and I know that the committee in this morning has heard about link workers and social prescribers, and I think that that's a really good way that we can address such issues, but we need to expand those programmes. We need to deem work, link workers, more social prescribers who can help people to articulate what is going on with them. I think that it's about normalising those kinds of approaches and expanding them into different settings so that people don't feel that they're getting a special service or one that's—we've seen in Glasgow the Alliance's link worker programme initially targeted deep-end GP practices, and I think that that was the right approach. But it's important that those types of offerings are made more normal with quotes around the word normal, of course, so that people feel that this is just something that you can access so that they're not feeling like they've got something that's special or cost-driven or is in some way some kind of second-rate service. I think that the evidence committee heard this morning would underline the value of those types of approaches, but we need to expand them into different settings to ensure that they can help people with their health literacy. In 2017, the Scottish Government published a health literacy action plan that was five years ago now, and that was from 2017-2025. In those five years, what progress has really been made in improving health literacy? What sense do you get that there has been that improvement? Do you think that the plan is contributing to the progress? Again, I'm not sure if maybe Chris is able to see the man at all. Sorry, I'm not familiar with that report. I think that what we need to be doing is—perhaps the report does this—but what we need to do is drill down into the different communities and sections of the population who are experiencing the biggest inequalities and drill down into those and make sure that those communities are able to access the sorts of supports that can improve their health literacy. We look at that across the board in terms of the intersections of different inequalities, including poverty, unpaid carers and those that are traditionally not recognised when we look at inequalities. Are we able to move on to the next theme? It looks like there are a couple of people who might want to be able to respond to that. I'll bring in Scott. Sorry, we lost our connection to the chat here. We're having some difficulties, so I'll bring in Scott. Thank you. On the first point about perhaps making worse the health literacy or at least the inequalities expanding the gap by using digital services, I think that there is a valid point in that what we have seen is that those who engage with digital health and care services do increase their health literacy. My definition is that those who are not accessing can be at a disadvantage. I don't think that the answer to that is necessarily finding more digital ways to increase health literacy. I think that it's about finding other ways that are more direct to help improve health literacy. You made reference to the action plan on that. I'm not familiar with that work specifically, but I think that the suggestions around using link workers and key workers and others in the community to be able to support that in a focused way would be more likely to be an effective means of addressing that gap. Thank you. I'll just check. Paul, did you have something you wanted to say on that? Yes, thank you, convener. There's a very famous piece of medical research and evidence that dates back 50 years, published by Julian Tudorhart, which essentially looked at the health inequalities and essentially looked at and described those that needed health care the most, were least likely to receive it. There's things that we can do to improve that and to narrow that gap. Such things have reduced variation within health care service provision and improved the quality of those services as well, particularly around tackling the need for the patients, increasing the supply and improving that quality. I think that this conversation that we're having today is around technology, digital, but specifically data. We can look at data to really help drill down and do a deeper dive and understanding to which groups within the population are either over or underrepresented in different parts of the NHS service that we can help the most. Thank you. Can I move on to questions around digital health and care information from Emma Harper? Emma. Thanks, convener. I am interested in how we are communicating what services are out there. I have raised questions around the ALIS system in previous evidence sessions, and we've heard this morning about an Edinburgh equivalent called Red Book, and there's one in Dumfries and Galloway called DG Locator. There's a mental health one called Spring in the Borders, so I'm interested in how are we communicating to wider people that can direct care? How are we helping people to understand that there is a system called ALIS? That's pretty much my first question. We should probably go to Chris first on this, since we've mentioned ALIS. Yes, it's in my job title, so I should be able to answer this one. I joined the Alliance about a year ago managing the ALIS programme. What struck me was that there were so many great things about ALIS, but in a lot of cases, communication wasn't quite there in promoting ALIS as a resource for people to find information about health and wellbeing, because it is a national resource that maps community assets right across the country, and it brings people many routes into improving their health and wellbeing. It's a crowdsourced information resource that brings with it a number of challenges, but, in my view, that's the way to do that kind of work. I've had conversations with Scottish Government and with a variety of stakeholders. People say that if we didn't have ALIS, we'd have to invent it. One of the things that we're seeing with ALIS is that it's been around for 12 years, and it's gone through a number of incarnations. We're at the Alliance, and we're seeking to continually improve that. However, one of the challenges is that everyone's got a directory. Even if it's just like a spreadsheet on your desktop, you've got contacts that you know and trust. It's about encouraging people to invest in ALIS as a national resource. I heard this morning about EVOC in Edinburgh and their Red Book resource. We also heard about a number of other different resources that are out there. One of the pieces of work that I'm keen to do at this point in time with ALIS is to form partnerships with those who have these local directories and to look at aggregating their data into ALIS. As a national resource, there are a number of benefits from a public health from a policy perspective. We can see what resources are out there, but we can also empower citizens a bit better locally. A good example of that would be the fact that I live in Bishop Riggs, which is in Easton-Bartonshire, but I'm on the border of Glasgow. With ALIS, I can see community assets that are just nearby, regardless of whether they're in the Glasgow area or the Easton-Bartonshire area. There will be countless examples like that. We can work together with the different local information providers to aggregate in to ALIS and to improve the resource that we have there. As much as that is about looking at the technology side of things, and with that it requires investment, so capital investment is required into ALIS. However, it is also about the people aspect of it and promoting the resource that we have. Today, we say, let's work in partnership, let's say that we have a national resource, let's improve that as best we can, but let's also respect the work that has been done locally with those local directories so that we can have an improvement on ALIS and the offering that is given there. However, it doesn't discredit or take away anything from what has been done locally. As I say, the ALIS system requires investment from a financial perspective, but it also requires investment from a political side of things. I would urge from committee's perspective to push the Scottish Government into saying, let's promote that, because the awareness isn't what it should be, the communication hasn't been, and the Government has funded ALIS for the past 12 years. I think that it's about saying, well, let's capitalise on that because we have a fantastic resource of community assets, and the approaches that it takes are all the right ones, in my view. Emma. I'm not saying that because it's in my job title. Thank you. Okay. Thanks, Chris. Just to come back at you then, did the use of ALIS increase during the pandemic when we were going through the first lockdown phase where people were using it more? Alliance has shown that ALIS usage has increased and in 2021 it showed that, so I wonder if Covid had an impact on the use of ALIS. Also, who's using it? Are we tracking whether it's link workers or whether it's other people? Last week, Optometry Scotland and Community Pharmacy Scotland hadn't heard of ALIS, but they also spend a lot of time with patients, sometimes up to half an hour if they're doing somebody's eye examination, so who's using it? Oh, yeah. Thank you. Just to come back regarding the numbers, I think you've seen in our submission that increase in 2021. I think what we saw in 2020 was that there was expectations were lowered with lockdown. We were in a full lockdown for a good period then and went back in again towards the age of 2020 and into 2021. When things opened up we saw more usage of ALIS. Hopefully, we could build on that. One of the other things that I'm looking at at the moment is increasing the number of access points, not just alis.org, but partnerships such as the one that we have with NHS 24, where we have ALIS data surfaced on NHS Inform, but we've also seen a new partnership with, for example, the Glasgow Alliance to End Homelessness. They have a get help Glasgow resource on their website and they bring ALIS data into that. One of my tasks is to forge new partnerships like that. We're talking to people in a variety of aspects, including the social prescribing technologies, to bring ALIS data in there. Specifically, to answer the question about who's using ALIS, we can see that we have a sizable proportion of people coming through Google searches or other search engines, which are out there, of course, but we're also seeing usage directly from alis.org. We can surmise that citizens are using ALIS, but there's maybe about half of their usage, I would say, estimating that they are either professionals or they're searching on behalf of others. It's important that we make the ALIS resource fit for purpose across a range of devices—mobiles, tablets of course, desktops—would traditionally be more professional users. We've done quite a big piece of work around accessibility to ensure that people are affected by sensory loss. First of all, we can access ALIS and we'll be able to use it as best as we can make it. We're finding on a number of fronts to ensure that ALIS is fit for every citizen. That's the aspiration. It's not just for some people, it's for everyone. Can I bring in Sandesh Gullhoney? You said that ALIS has been around for 12 years and you also went on to say that the communication is not what it should be. As a GP, I'd never heard of ALIS. No GP I know has ever heard of ALIS. Organisations giving evidence to us have not heard of ALIS. It's not that the comms aren't what they should be. The comms are non-existent. After 12 years, I would expect a very good data source to be something that people use and know about. My question to you is, is this actually value for money or should we be looking to maybe use this money for something else? What we're looking at is that communications need to be made on a number of fronts. From an alliance perspective, the resource that we have is spread quite thinly and we have a small team working on ALIS. As I've said, some of that responsibility comes to the Scottish Government and partners in the NHS and others to say that the resource exists. The ethos of ALIS is the correct one. I would say that the technology that sits behind it is the correct one. However, it needs investment. If you're saying that communications have been non-existent, then what we need to do is invest in those communications. That's the issue that I would say. Thank you, convener. It's just a quick question. In one of my local areas, the manager, who is one of the manager, leads of all the GP practices. He knows about ALIS, so his GP practices are known about ALIS, but they said that it might not be as up-to-date. It's where it should be. I'm aware of some general practitioners that know about ALIS, but I think that Dr Gilhane's point about not knowing any GPs that don't have access is probably quite important. That's a point about raising awareness and linking to make it work better. A DG locator, which is a third sector D&G run, is working on collaborating with the GP practices to direct more to ALIS and other services. What do we need in order to make ALIS work better, apart from just money? I'll come back to Chris. Our inquiry throws up those points that are all well-made. Of course, we put them to the Scottish Government as well, so it's all very worthwhile. It is a constant issue that comes up with ALIS and any information resource of this nature, all those local directories that you spoke of will face the same in issues about keeping things up-to-date. One of the things that I said about the ethos of ALIS, is that it depends on people keeping things up-to-date. What I'm hoping to do, using the resource that we've got, is to alter focus slightly and to address that data quality issue specifically, because I know that people will go to ALIS and they will look at information and they'll say, all of that, I wasn't updated recently. What confidence can I have in it? I think that what we need to do is continue with the crowdsourcing approach, but also redirecting some of our attention into specifically addressing that data quality issue. We've got some plans for addressing that with staff time, but we've also got some plans around the technological aspect and giving people reminders to keep things up-to-date. That we can do through automatic means on the platform itself. Not a day goes by without that quality issue being raised. It's something that, from an ALIS perspective, we need to look at. If we're looking to local solutions to aggregate as well, we also need to be mindful that those directories need to be up-to-date. It's a constant battle. If anyone's done any work in this sort of area, then you'll know that as soon as you publish something, as soon as you write something like that, they go out of date, so the job is never finished. Can I bring in Scott Henderson before we move on, Scott? Thank you. I think that there's a couple of really interesting points in there. The dataset through ALIS is a really important one, and it's never ever going to be perfect because of the nature in which it's providing information on, because those groups change quite frequently often. I think that the other point about GP's awareness of it is an interesting one simply because I'm not sure that GP's have been a target audience for ALIS, certainly not 12 years ago. We're now in a situation where there's much greater interest in social prescribing, so there may well be a case to be made for having more promotion to GP practices of ALIS as a service. The other thing is that we need to be thinking about this as a service that needs to evolve, and we know that, post Covid, the world is a different place, and we need to think very carefully about which services the public are going to want and when they're going to want them and what format they're going to need them in, so I think those are just some additional points for the committee to consider. Thank you. Thank you, and Sandesh, you wanted to come in again. Yeah, thank you, Camila. Scott, you said that GP's were not a target for ALIS, with about up to 60 per cent of the things that GP's do being social, with link workers, with the new GP contract, and that was in 2018, so maybe not 12 years ago, but certainly from 2018 until now, I would say that ALIS would have been a wonderful resource for GP's to know about, so my question to you is why were GP's not a target, because that, to me, seems nonsensical. Scott? I would love to be able to answer that directly. I cannot because I've not been involved in the work to date. I think it's an interesting question and we can certainly take that back. My point earlier was that it maybe wasn't originally intended or marketed to GP's in that timescale, but I do see that there is definitely an opportunity for it to be more widely promoted now. Obviously, that could form part of our recommendations, and this is the value of committee scrutiny in action. Can we come on to questions from David Torrance? Thank you, convener, and good morning to everyone. From a health practitioner perspective, what are the advantages and disadvantages of remotely-delivered health and care services, and to what extent do remotely-delivered consultations and services ease pressure on GP's and GP's surgeries? I'll go to Dr Paul Perry first. Paul. Thank you, convener. The question on remote delivery of health care services and the advantages and disadvantages of those in NHS 24 has been very much up the middle of remote delivery of those services. The use of near me roll-out within our dental service last year was a good example of that. It allowed an increased number of consultations with patients who couldn't access dental care last year. With the design and development of any healthcare service, there are always advantages and disadvantages. We've touched a lot today on those inequalities, particularly on the public health inequality side and the digital inequality side. At NHS 24, we're very mindful of that, having the user-centred research team to interact with the public through public partnership forums to take their advice and guidance on those. Online triage systems, how could they be improved not only to give confidence to the patient but to the practitioner to use them? I'll go back to Dr Paul Perry, please. Thank you, convener. In terms of those online triage systems, you're right. Those things have definitely increased since the pandemic in the last two years. Again, online triage through the use of near me with our dental service was one of a few services that we rolled out over the past year. There is on-going work within NHS 24 to do a further scoping exercise to see what the possibility is of the use of online triage systems, particularly remote consultations and video consultations. We have phase 2 of the redesign of urgent care that is going forward, particularly focusing on musculoskeletal. We are working in with partners and stakeholders on that going forward. The use of video consultations is one example of many. We will take forward and look to see how we can design and develop that with partners, with the public and our stakeholders going forward. Scott, do you want to come in on this? Yes. I'm currently doing some work on online triage and GP practice through a programme called a GP DAX. The evidence that we've gathered around this gives a very mixed set of messages. There are some general practices that I absolutely love using triage tools and believe that they are reducing workload in their practice and making excess demand more manageable. On the one hand, there are others who find that they are generating a lot more work. There have even been reports of staff wellbeing being affected by the use of those products and not in a positive way. From a patient perspective, some of the advantages are that they can contact the practice side of ours and don't need to be joining that 8.30am telephone queue. The public engagement that we've done around this, which has been fairly limited, has shown that the public is generally quite positive, but it is conditional that they want to know more about who is looking at the request when it comes in. More generally around the remote delivery of services, there are other benefits. When we look at long-term condition management, there is a lot of work going on. In that area, I can give as an example the scale-up blood pressure monitoring programme, where that has been shown very much to positively have an effect, both on reducing the need for face-to-face appointments and improving convenience for patients. It also shortens the time to diagnosis for things like hypertension. It has been very mixed with the advantages and disadvantages of being able to describe all of these as the single things that are a bit dangerous, because each service has its own advantages and disadvantages. It depends quite a lot on how they are designed and delivered. I am aware that, during the pandemic, pulmonary rehab was starting to be delivered digitally, and the evidence says that that does work, especially because those folk are vulnerable and might not want to go to face-to-face appointments. I know that we do remote monitoring for chronic obstructive pulmonary disease, because I am the co-convener of the Lung Health Cross-Party Group, and we have done a lot of work around that. Do your thoughts on whether those remote monitoring ways and the pulmonary rehab delivery are something that we could be looking at doing more widely, for instance? Absolutly. It is interesting territory because we are changing the ways in which people are working. There is quite a lot of work to be done around how you design new pathways around each of those services. There is quite a bit of variation between services across Scotland in the way that they wish to deliver their services and how they would want those redesigned pathways to be delivered with digital supports. The Scale Up Bp programme is a good example of having perhaps two or three different approaches coming together and becoming much more of a national approach, and that is where we have seen the benefits start to really get realised at a national level. There is lots of work to be done to make sure that we design those things properly and to make sure that they are producing the benefits and that we are avoiding as many of the disbenefits as possible. Absolutly, we need to continue to invest in this area and to accelerate where we can. I want to talk about something that has come up an awful lot in our inquiry, and that is the concept of a single electronic patient record. Questions led by Sandesh Gawrhani. Yes, a single electronic patient record has certainly been coming up a lot. A lot of organisations that we spoke to spoke of the potential great benefits that they would be from creating this. I also have two questions. One would be to Dr Paul Perry, if you could maybe talk a little bit about how useful that would be from an out-of-hours NHS 24 point of view, and then my question would be what progress since December 2021 has been made towards creating this single electronic patient record? Yes, thank you very much. The first question was about that single patient record and the latter question was about the progress that NHS Scotland has made on that during the pandemic. To take your first question around the single patient record, yes, I think that this, as a clinician myself, frustrations at times in terms of being able to see the whole patient record and that whole patient journey, whether it's an out-of-hours GP or an out-of-hours GP. At the moment, the out-of-hours GP is able to produce something called a KISS summary, so key information summary, which allows that to be shared with some care providers in terms of giving a sample of the patients' medical conditions that have been diagnosed with. There's the ECS as well, which allows a care provider to be able to see the medications that patient may be on. Unfortunately, at this moment in time, we're not able to see that whole record in terms of the day-to-day consultations that the patient might have with their in-hours GP. At NHS 24, we use the SAP data system at the moment, and the out-of-hours services in territorial boards use ADASTRA. There is an element of data interoperability with that, so if I was a clinician working at NHS 24, I would be able to send down an electronic summary to the out-of-hours clinician in the territorial boards, and that would give a snapshot of that patient record at that moment in time. Unfortunately, at this moment in time, we're not able to share that whole patient record and to see that. There are lots of clinical assistants that are out there in the NHS, but to overcome that barrier, we need a central platform and a cloud-based platform. I am mindful and aware that there are conversations on going just now with an NHS Scotland at looking at those and doing a scoping exercise around those opportunities. In terms of that patient record, we need to overcome those barriers of the data interoperability, sharing that data so that we increase the continuity of care for patients, which is the heart of that, and reduce the need for patients to repeatedly tell their story to different clinicians and different care providers. Stephanie, you have some questions around that. Just to come back on that wee bit, Chris, you actually just reiterated a lot of the points that I had written down here as well, and it's really interesting to know that that work is actually going on already to look at a centralised cloud-based platform. Just for some clarity as well, at the last evidence session last week, we had pharmaceuticals. We're talking about the fact that we've been able to actually write up information on that and have access to information on it as well there. Is that something that's included in the pilots that are happening just now? No, come to Paul. I don't know if everyone heard me there. Again, some gremlins in the system. Paul. Yes, thank you, convener. Again, the question was around, I suppose, that cloud-based platform and data sharing. It is my understanding that there has been a data strategy engagement programme that has been set up, and there are various partners and stakeholders sitting around that table to look into that. There is other work on going at the moment with NSS and NHS Scotland around e-prescribing in terms of that pharmaceutical aspect. Getting away from having to write a paper prescription to a digital prescription, and this work is currently on going. I don't know in terms of what the timelines are on that in terms of it actually hitting the shop floor, but I do know that stakeholders and partners are working hard behind the scenes to get that up and running. Fantastic. Just to follow up on that as well, is it more about having a cloud-based system that all the different systems that have been used by different health professionals and beyond that as well until there are turns of pathways? Is it more about all those connecting into one cloud platform now, rather than having a system that runs right the way through and that is the same everywhere? Yes, thank you. I think that the best way of approaching this is probably to often take a stand back and to see it through the whole system lens in terms of what in hours and out of hours primary care needs are to meet the needs of the patients and the same with secondary care as well. In terms of options and opportunities, I think that that is probably one of many. I think that that is definitely one that is being discussed at this moment in time. Thank you. There is a data strategy for health and social care currently being developed. It will be publicly consulted quite widely and I think that the delivery date for that is late summer this year. I think that there are some important points coming out here around a single patient record. I think that we need to be also mindful that its health and social care record is probably the goal here so that we are able to have truly integrated services. I know that that is part of the work that is being considered through that strategy development and also through the work of the national digital platform. Thank you to all our panels this morning. You have raised some very interesting things for us to consider ahead of our session, particularly with the Cabinet Secretary next week, I believe. That is all for our second panel and I thank you very much. We will move on to our next item in the agenda. The third item on our agenda is consideration of three related negative instruments and they are national assistance, sums for personal requirements, Scotland regulations 2022, national assistance assessment of resources, amendment Scotland regulations 2022 and national assistance assessment of resources, amendment Scotland number two, regulations 2022. Those instruments refer to annual changes in rates to charges for residential accommodation. The first instrument increases the value of personal expenses allowance in line with average earnings, that is an increase of 5.8 per cent. The second instrument increases the value of savings credit disregard in line with average earnings, which is currently forecast at 5.8 per cent. It increases the lower capital limit from £18,000 to £18,500 and the upper capital limit from £28,750 to £29,750 in line with CPR forecast at 3.1 per cent. I hope that everyone will follow that. The third instrument is to disregard payments paid to individuals living in residential care from the Scottish Infected Blood Support scheme and equivalent schemes enacted in other parts of the United Kingdom. The Delegated Powers and Law Reform Committee considered the instruments and they made no recommendations to us and no motions to annul have been received in relation to those instruments. I ask members to forget any comments in relation to any of the three instruments. We do not, therefore, propose that the committee does not make any recommendations in relation to those negative instruments. Does any member disagree with that? No, we are in full agreement. At our next meeting on 23 March, the committee will hear from the Cabinet Secretary for Health and Social Care as part of our inquiry into the alternative pathways into primary care, and that concludes the public part of our meeting today. Thank you all.