Chamber and committees

That is exactly why the strategic network is so important—it has those dedicated workstreams and brings them all together at the national level. Where we are trying to improve services for adults and children, we make sure that there are no gaps between services for young people who are in that transitionary phase. As you would imagine, that issue presents itself in many other parts of the health and social care system, but it has not been raised with me specifically in relation to long Covid. However, I am happy to take that issue up with Long Covid Scotland and Long Covid Kids.

That is such a good question. I have been engaging with the British Medical Association and the RCGP on that issue for quite some time. As Brian Whittle will know, before the pandemic, many GP practices would traditionally close on Friday afternoons and would have an agreement with NHS 24 that it would pick up any calls or inquiries that came in after that. That approach gave practices the flexibility to do CPD and it meant that their patients had the confidence of knowing that their calls would be picked up by someone else.

In the course of the pandemic, practices were not able to do that. I suspect that I do not need to tell Mr Whittle how much pressure NHS 24 is still under, so we have to find another model. We are working on that with the BMA and the RCGP. For me, practitioners having protected learning time for CPD is absolutely pivotal. It is important for all of them, but it is especially important in giving our trainee doctors the confidence to progress in their roles as general practitioners. We are working on that.

At the moment, because of the pressure that NHS 24 is under, practices are approaching matters in a way that suits them, as opposed to using the previous model, which involved NHS 24. For example, in a practice that I visited, which is not far from the Parliament, GPs are having to use half an hour in the morning to go through their educational or CPD material, which is not ideal. I give my commitment to the RCGP and the BMA to see what more we can do to support them in that regard.

That is a really good question. We have learned a lot from the vaccine programme; we have had to really understand where uptake has been lower and what we can do to respond to that—for example, by putting mobile clinics in areas of higher deprivation, and in mosques, gurdwaras and temples. We have to take the learning from the vaccine programme and make sure that it goes right across the various parts of health and social care. The UK-level survey data indicated that what John Mason said is absolutely right, which is that prevalence of self-reported long Covid is greatest among people who are aged 35 to 69 years, who are female, who live in more deprived areas and who work in social care. That goes back to Jackie Baillie’s point, as well.

We know that the data exists, and I guarantee to John Mason that what we are doing in health and social care is often focused on areas where there are issues of accessibility and lower take-up. That is something that we have learned very well from the vaccination programme, so we are making sure that it is embedded right across our health and social care approaches.

We have to do our best to use the data that we have. For example, the World Health Organization commissioned a study—which a certain John Mason will know about—that showed that the vaccination programme saved well over 20,000 lives in Scotland. Given the recent autumn and winter booster vaccination programme, I am certain that that number has gone up. We need to rely on data and evidence and try to counter some of the misinformation. I am afraid that there are some people whom we will almost never be able to convince, but we can convince the vast majority, and that work will continue to rely on the strong evidence base for the vaccination programme.

We should also use as many different people as possible in society to get the message out. People might not trust politicians—shock, horror!—but we should make sure that we empower clinicians, as well as the people who have benefited from the vaccine, to speak about the benefits. Of course, all of us should make sure that we speak about the benefits of the vaccine and vaccination programme, as well.

We should be able to get those figures to you. Forgive me—I do not have them at my fingertips, right now. If I am able to give them, I will be happy to share them with you, convener, for sharing with the rest of the committee. I think that that should be possible but, if you do not mind, I will take that off the table and see what we can provide.

We have looked at other long Covid clinic models around the UK, such as the Hertfordshire model, which Dr Sandesh Gulhane has mentioned previously. I go back to the Scottish intercollegiate guidelines network and NICE guidelines on long Covid, which say that one model would not fit all areas. I think that we all accept that.

I agree strongly with the RCGP’s written evidence to the committee on that. I will quote it directly. It says that long Covid

“often requires generalists skills to treat, but most can be fully managed in primary care, and the GP is best placed to provide this holistic approach.”

It goes on to say:

“there is an increased risk that patients presenting with Long Covid symptoms may have instead another cardiac or respiratory condition which may have similar or even identical symptoms. Patients need a GP assessment and investigation”—

this is the important part—

“rather than being funnelled inappropriately into a clinic that is designed for one condition, and then require further investigation and alternative management.”

I have never been opposed in principle to long Covid clinics—I have said that from day 1. That is why I have asked my team to look at the Hertfordshire model, for example. In effect, they try to cut out the middle person. We have GPs and, if they have the appropriate referral pathways through the implementation support note that take people directly to a Covid rehabilitation service in, for example, Lanarkshire—that is the example that I keep using—that is a better model than a GP having to refer someone to a long Covid clinic that would then have to refer them on to another pathway. I am not opposed to long Covid clinics in principle; I am trying to allow local health boards to design services to meet their local need.

It will be reprofiled over the next few years.

Thank you very much, convener, and good morning to you and to committee members.

I want to start exactly as you did, convener, and offer my condolences to people who lost loved ones over the course of the pandemic and who are continuing to do so. I would also reflect, as we will in the course of this conversation, that many who first contracted Covid suffer to this day from its long-term debilitating effects.

I am grateful for the opportunity to appear before the committee to discuss the impacts of long Covid and to provide information on the steps that we are taking to support the health and wellbeing of people with the condition. As committee members know, long Covid is a term that encapsulates a wide range of more than 200 different symptoms, which vary highly between people.

At present, the underlying causes are poorly understood. What is well understood, however, is that for the adults, children and young people most severely affected, the symptoms are having a significant impact on everything from their physical and mental health through to their education and employment. Indeed, I have heard as much myself in my meetings with people with long Covid and from those in our national health service who support them. For those who are severely affected, life can be extremely challenging.

Around the world, science has begun the work of trying to find not just an explanation but treatments for long Covid. That science is still in its early stages, and proven, safe, evidence-based treatments are still in their infancy. Scotland is contributing to that worldwide research effort and, in the meantime, we are taking steps to test new ways to support people. We know that, as we evolve our understanding of the disease, the current lack of effective treatments can, understandably, contribute to distress, and we understand the need for supportive care that recognises the challenges faced by people who are living with those symptoms.

At the moment, the clinical guidance recommends the provision of treatment for people’s specific symptoms, where possible, or a rehabilitative approach to help people manage the impacts of their symptoms on their day-to-day lives. That care and that support are being provided through the full range of services delivered across our NHS. People can access general practitioner assessment in a setting close to their home, and GPs can then make referrals to community rehabilitation services or secondary care pathways such as respiratory care or cardiology, where appropriate. Those individual services are best placed to investigate and support people who have as a result of long Covid symptoms that might require support.

That said, I know that people’s experiences of accessing and navigating support can be challenging. There is certainly room for improvement—there will be no challenge to that premise from me. That is why we are committed to investing £10 million in a long Covid support fund and have made an initial £3 million available from the fund this year. Rather than mandate one specific model, we are supporting NHS boards to innovate and plan based on local needs and infrastructure. The long Covid support fund is targeted additional resource for NHS boards to increase the capacity of existing services, to develop them into more clearly defined pathways and to provide a more co-ordinated experience for those accessing support. We have heard time and again from long Covid sufferers that that is what is needed. The approaches being tested include looking at ways of achieving those outcomes through having a single point of access for assessment and co-ordinated support from services, including physiotherapy and occupational therapy.

Along with our support for the initiatives that are under way in boards, the Scottish Government has delivered a clinical guideline implementation support note to help GPs effectively assess and refer people with long Covid. We have a dedicated microsite on NHS Inform that contains key information and sources of support for people with long Covid; we have launched a marketing campaign to increase awareness of the condition; and we have allocated funding of £2.5 million for nine Scottish-led research projects to better understand it. As the committee knows, we have also established a national strategic network, which brings together people with lived experience, clinical experts and those working on local service responses.

Long Covid is undoubtedly a considerable challenge. There is still much to do and learn, and there are improvements to be made, but we have an opportunity for our healthcare system to adapt and learn based on the best evidence available.

I very much welcome the committee’s inquiry on the issue and the opportunity to discuss it and to take questions from members.

That is a fair question to ask. Of course I would look to see where we can provide even more support. I make the point, which I know is well understood by colleagues around the table, that the long Covid fund is on top of the £18 billion in this financial year and £19 billion in the next financial year that we are giving to the NHS and social care, a chunk of which is given to our health boards. It is worth saying that our front-line spend per head is higher in Scotland than it is in other parts of the UK. It is £323 per person higher than it is in England, for example.

I keep going back to the Lanarkshire model because I have seen it first hand, and I have spoken to some people who have benefited from that service. When that rehabilitation service was up and running, people did not wait for the allocation from the £10 million long Covid fund; they used their health board allocation to create that team—to recruit and hire those multidisciplinary team members who are providing that support to long Covid sufferers. I hope that that gives you some reassurance.

Agreed.