The next item of business is an urgent question.
“NHS in Scotland 2024: Finance and performance”
To ask the Scottish Government what its response is to the findings of Audit Scotland’s report, “NHS in Scotland 2024: Finance and performance”, that the Scottish Government has no clear plan to deliver its NHS vision.
I thank Audit Scotland for its “NHS in Scotland 2024: Finance and performance” report. I agree that reform is essential—I already acknowledged such in my vision for reform, which I set out to Parliament in June. I stated then that, given the scale of the growing demand that our health and social care services face, major reform is required to ensure sustainable health and care services.
We are already developing and making good progress on new models of care and exploring how we can further improve productivity through innovation, technological advancements and workforce models that will respond directly to the challenges in our system.
This year, we are providing more than £19.5 billion for health and social care, but we are determined to continue to improve our health service. The budget that we set out tomorrow will throw the weight of the Government behind performance improvement and ensure that we can tackle the challenges in our health service.
This is the second time in nine months that Audit Scotland has warned the Scottish Government that Scotland’s NHS is failing on its watch, with no clear long-term plan and unsustainable spending. We have the worst record on accident and emergency waiting times, one in six Scots is on an NHS waiting list, we have the lowest life expectancy in western Europe and we have record drug and alcohol deaths.
We were promised action on the mental health crisis, but this Government has slashed £20 million from the budget, and we were promised an end to delayed discharge, but it is at record levels. The list goes on and on. Limitless promises bring little change. There is ever-greater spending, but ever-poorer outcomes. There are endless directives, but no direction. Change has got to come, and the first step in making that change is recognition that it is needed. Will the cabinet secretary accept that his Government’s attempts to fix the NHS are not working?
I thank Brian Whittle for his question.
I have already said that I accept and agree with Audit Scotland that reform and improvement are needed. I am not just saying that today—I said that in June, and when I first took office in February. We have not been waiting to see improvements and reform take place; rather, we are in a national conversation with our clinicians, staff, trade unions and patient organisations to inform how we will shift the balance of care.
I think that we are all clear—I am certainly clear—on the direction of travel that we need to go in. As I set out in response to a topical question earlier, it is about shifting the balance of care from the acute sector into primary and community care services and moving where we deliver care closer to people’s homes, for the reasons that Mr Ross set out in his question. We are all in agreement on that, so we now need to make sure that we get on and deliver it.
I have heard that answer every single year that I have been in this Parliament. If I sound angry, it is because I am, and because the public are, too. They are tired of hearing about record investment or by what metric Scotland is doing better than England this week. They want an end to 8 am queues on the general practice surgery phone line; they want to know that the waiting time for treatment will not be measured in months or years; and they want to be confident that they have a Government with a credible, focused and achievable plan to give them back a sustainable NHS.
Scotland needs a long-term strategy or, at least, a clear strategy. The solutions are not a mystery, and we have been talking about them in the chamber for as long as I have been here. They are reduction in preventable illness, investment in technology to speed up treatment, and reform to get rid of unnecessary bureaucracy and wasteful spending.
Does the cabinet secretary agree with the Scottish Conservatives that it is time for his Government to focus on and deliver the meaningful reform and strategy that are needed to improve outcomes for patients and healthcare professionals, and to give Scotland back the national health service that it needs and deserves?
I say, with respect, that we are doing just that. We have set out £30 million of investment this year, which is generating tens of thousands of new appointments to get waiting times down. Last week, I announced further investment for general medical services, recognising the investment that is required to shift the balance of care that I am talking about and for the work on adopting greater innovation. That is already happening with the likes of the ANIA—accelerated national innovation adoption—programme and the work in Government of the chief scientific officer. There are examples of good work happening across Government and our health service to deliver the aims that I have already set out, and tomorrow’s budget will include even greater investment to ensure that we can continue to deliver them.
Before we move to supplementary questions, I note that there are many requests. I would be grateful if we could keep questions and responses concise, such is the level of interest.
Audit Scotland said last year that the Scottish National Party had “no vision” for the NHS and was not delivering, and this year it is forced to repeat itself. Not only does the SNP have no clear vision for the NHS, it has no plan. After 17 years, the SNP has weakened the NHS—there has been no effective reform. John Swinney has been at the helm of the Government either as finance secretary or as Deputy First Minister. He is not an innocent bystander. This is a crisis of the SNP’s making.
Record resources are now available, but they need to be accompanied by reform and political leadership. Talk is cheap, and action from the SNP is missing. Is it any wonder that the people of Scotland have lost trust in this Government to deliver for staff and patients in our NHS?
As I said in response to Brian Whittle, we have already started investments to drive down waiting times and to shift the balance of care into primary care. I set out our vision for a health service very clearly to Parliament in June, and we are now in a process of conversation with patient groups, medical professionals, clinicians and others about how we will ensure that we deliver on that.
Tomorrow’s budget will set out a clear direction of travel for how we will invest in the NHS in Scotland. The challenge for Labour members is whether the resources to go into the health service will be supported, or stopped because they vote down the budget.
I refer members to my entry in the register of members’ interests. I am employed as a bank nurse by NHS Greater Glasgow and Clyde.
We can all agree that reform is crucial to ensuring that our NHS thrives. What steps is the Scottish Government taking to progress reform and improvements, and what engagement is under way with key stakeholders?
I have set out that we are in a conversation with clinicians, trade unions, patient groups and academics on how we can make sure that we deliver on the vision that we have set out, which seeks to shift further the balance of care from hospital-based services into the community. We are not waiting for the outcome of that conversation. As I have already set out, we are investing in relieving the blockage on waiting times that built up during the pandemic. We have started to make that investment, and further investment will come in the budget.
We are investing more in primary care services, as was evidenced by the money that I was able to allocate to general medical services last week.
We will continue to work with local partnerships on relieving the pressure that has been built up in social care and which is delivering higher rates of delayed discharge, which is unacceptable. We need to see further reform in social care and there is a conversation to be had across the Parliament about how we will realise the ambition and expectations that service users have of us in delivering national standards for those who are in social care. That will come through the National Care Service (Scotland) Bill.
The brutally honest Audit Scotland report shows the ineptitude of the Scottish Government when it comes to our health service. Given that NHS Highland has to borrow £50 million a year to keep afloat, will the Government ensure that it continues to get that money, or will it just accept that elective surgery will have to be binned until the board has enough money to do the job?
In this year’s budget, we have allocated a real-terms 3 per cent increase to health boards to deliver local services. I recognise that, even with that, pressures are being felt across the country: NHS Highland is one example of where there are resource pressures that need to be contended with.
In the budget that will be announced tomorrow, we plan to continue our record of investment in our health service and ensure that our health boards are resourced to meet the needs of the people whom they serve.
We note from the report, and others like it, that our NHS staff are overwhelmed. They are on their knees and hospital activity levels have not recovered. Today, we learned that more people are stuck in hospital than ever before because the care system is broken. There are more than 2,000 beds that cannot receive elective surgical patients and admissions from accident and emergency departments. That is why our ambulances are stacking up outside our hospitals. With the health and social care system going backwards by any metric of the Government, will the cabinet secretary admit that the three-year-old NHS recovery plan needs to be completely rewritten?
I accept that we need reform and improvement in our national health service. We have set that out in response to Audit Scotland’s report today, and we have clear areas of investment and prioritisation that will ensure that we will continue to see waiting times come down, an improvement in accident and emergency waiting times and an improvement in delayed discharge rates.
We also need to see reform of our social care system, which is why we made our proposals in a national care service bill. Those who stand in the way of social care reform need to answer to service users who are demanding that reform and to say, if not that reform, what it will be.
Scotland’s health service has a high rate of sickness absence. For example, 10,000 days of work have been lost at NHS Borders since 2020, and that is just for mental health reasons. Staff absences are putting pressure on other staff and wider services. Why is your Government failing those staff and the NHS?
Always speak through the chair, please.
I, of course, recognise the pressures that many staff in the NHS and across public service delivery face. I recognise the great demands on them, which is why we have sought to bring forward pay deals that support them and reforms to their contracts, including a reduced working week, to which I remain committed, so that they have better support in the workplace.
The best way of improving the situation for our staff, however, is to have better performance. The current situation with regard to accident and emergency waiting times and the blockages in our hospitals because of delayed discharge and social care provision are putting pressure on our staff. That is why the investments that we will make through the budget tomorrow are designed to support better performance and why it is important that Parliament supports the measures that we will take forward.
It is crucial that, when we discuss the current state of Scotland’s NHS, we acknowledge the significant increase in demand in the aftermath of Covid, which is still having an impact. What action is the Scottish Government taking to tackle pandemic backlogs and to reduce waiting times for folk across the country?
I recognise the incredible work that staff up and down the country have done to respond to the pressures that we face, and I am incredibly grateful to them for that. I recognise the challenges that staff face, whether we are talking about staff in NHS Grampian responding to a critical incident or, in Ms Roddick’s constituency, about their delivery of services in rural and island communities.
To answer directly Ms Roddick’s question on the investment that we are making, we have provided £30 million this year to address Covid-related elective surgery and diagnostic procedure backlogs. We will continue to invest in areas where we can see a reduction in waiting times and an increased amount of activity so that the backlogs reduce.
Healthcare accounts for 40 per cent of the Scottish budget, yet many health board areas, including my own in Ayrshire and Arran, often feel short-changed by the NHS funding formula. Does the cabinet secretary have any intention of reviewing the NHS Scotland resource allocation committee—NRAC—funding formula to ensure that resources are distributed fairly?
Cabinet secretary, please respond with regard to where the question might refer to the report that is under discussion.
Funding is directly relevant to ensuring that we overcome the pressures that Audit Scotland has referred to, but I am conscious of the need to ensure that the spend that we make is effective in dealing with the issues with which we are presented. The Cabinet Secretary for Finance and Local Government will set out in greater detail tomorrow how we intend to do that through the budget.
That concludes the urgent question.
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Topical Question TimeAir adhart
Point of Order