Official Report 1069KB pdf
Good morning. The first item of business is general questions.
Health and Social Care Reform
To ask the Scottish Government how reform across health and social care will progress, following the decision not to proceed with part 1 of the National Care Service (Scotland) Bill. (S6O-04298)
Last week, the First Minister announced plans to drive down waiting times and reduce pressure on front-line services, and our draft budget sets out almost £2.2 billion of investment in social care and integration.
We have revised our approach to the national care service. Parts 2 and 3 of the bill will go ahead, reforming information records and standards and introducing Anne’s law and the right to a break for unpaid carers. We will establish a non-statutory advisory board to drive improvement and ensure that services are consistent, fair and of high quality across Scotland.
The Edinburgh integration joint board is facing another budget gap in the financial year ahead, requiring gross savings of £51 million. The previous chief officer indicated that integration has not been functioning properly in Edinburgh, with issues dating back to when the Scottish Government established the Edinburgh IJB in 2015. In November 2023, the City of Edinburgh Council unanimously agreed a cross-party motion to review the integration scheme, but more than a year later, it has been alleged that NHS Lothian is pushing back against that review as the current scheme sees the council being required to continually bail out the IJB in Edinburgh. What is the Scottish Government doing to ensure that the integration scheme is working fairly for the city of Edinburgh and NHS Lothian?
As the member will be aware, decisions on funding the integration joint board when it was set up and annual decisions on funding, which comes from both the local authority and NHS Lothian, were and are for local leaders, and those leaders are democratically accountable to the local population. I am more than happy to look at how the integration scheme works; whether it is delivering for NHS Lothian; and, as the member has asked me to, whether it is working well for others. Efforts to look at that are in our programme for work, and I would be happy to pick that up.
Change in social care is needed, and we must all work to secure improvement. I understand from the minister’s statement that was delivered earlier this month that a new non-statutory advisory board will be established to drive improvement in the sector. Will the minister advise when that board is expected to meet and how quickly it will be able to deliver vital reform?
We are moving quickly to establish a non-statutory advisory board that has lived experience at its heart. We expect the board to meet for the first time in March 2025, and it will be critical to the national care service’s efforts to drive improvement and ensure that services are consistent, fair and of high quality.
Strengthening national support and oversight of the system remains our core intention. Membership of the advisory board will include people with lived experience of accessing care services, unpaid carers, members of the workforce, care providers, trade unions, the national health service and local government. As I have set out a path forward that I believe that everybody is able to get behind, I expect the board to have an impact rapidly.
Question 2 was not lodged.
National Health Service (Dumfries and Galloway)
To ask the Scottish Government what action it is taking to improve NHS services in Dumfries and Galloway. (S6O-04300)
It is for health boards and their planning partners to plan and provide services that best meet the needs of local people, including those in rural areas, in a way that is consistent with clinical best practice, national policies and frameworks. One example that Oliver Mundell might be interested in is that NHS Dumfries and Galloway was one of two boards to implement the new digital dermatology pathway last year, allowing patients to benefit from faster diagnostics and assessment of skin conditions. Once fully rolled out, the programme will impact 400,000 patients in Scotland over three years and reduce waiting lists by 36,000 hours.
It is always good to hear positive examples but, clearly, services are under pressure, with a crisis in dental provision, challenges in the provision of primary care and worrying delays to hospital discharge. One patient in Dumfries and Galloway has been stuck in hospital for 916 days.
Although I accept that such cases can be complicated, surely the cabinet secretary agrees that that is unacceptable and that it drives growing fears among elderly constituents that if they go into hospital, they might not get back out again. What is the Scottish Government doing to investigate such cases, which are prevalent across Scotland? What is it doing to address the growing challenges around delayed discharge?
I do not know the detail of the case that the member raises, but on the face of it, I agree that it is unacceptable. With longer-term cases, such as the one that he has referenced, there is often complexity, but I am very clear that the current level of delayed discharge, particularly the considerable variation across different areas, is not acceptable.
As a result, the Government has been working with local health and social care partnerships and the Convention of Scottish Local Authorities to identify key challenges and barriers to hospital discharge, as well as identifying shared good practice to support improvements. The work includes the provision of more direct whole-system support to areas such as the Highlands and Dumfries and Galloway, which face the biggest challenges with delays.
I am confident that our collaborative work in that space will deliver improvement, but I know that more needs to be done to support it. That is why the 2025-26 budget includes a commitment of an additional £100 million in funding to tackle delayed discharge by, for example, further expanding the hospital at home service. If approved by the Parliament, that funding will support our ambition to grow the hospital at home service to 2,000 beds by December 2026. That would make it the biggest hospital in the country, and would help address hospital occupancy and delayed discharge issues.
Last week, the First Minister outlined that a greater proportion of new NHS funding will go towards primary and community care, and the cabinet secretary has just outlined greater collaboration and the hospital at home service as examples of that. Will the cabinet secretary say something more about how the 2025-26 budget will ensure that general practitioners and services in communities across D and G will have the resources that they need to play a greater role in our health system, including helping with delayed discharge?
Absolutely. Scottish Government officials are currently determining how best to allocate the additional funding for primary care to ensure that we realise the maximum benefit from that investment. The investment will be used for a range of initiatives, including to increase capacity in general practice and to make it more consistent across Scotland. It will deliver a new acute anterior eye condition service during 2025, which, with the community glaucoma service, will free up to 40,000 hospital appointments a year. We will also be expanding the pharmacy first service, so that more clinical conditions can be treated by pharmacists, and targeted investment in the dental workforce will improve capacity and patient access, with a review of existing incentives for rural practices.
The rate of patients being seen within four hours at accident and emergency departments in Dumfries and Galloway is the worst on record. Although we understand the immense pressure that NHS staff are under, lack of capacity has led to treatment taking place in areas that are unsafe, inappropriate and undignified. Last week, I asked the cabinet secretary whether the Government would commit to publishing regular data on the care that is taking place in inappropriate settings, but he failed to address the issue of data altogether. I ask him again: does the Government intend to publish regular data on corridor care?
I accept the situation that Carol Mochan has set out with regard to the four-hour standard. We have rehearsed and discussed some of the issues that are driving that, including the hospital occupancy and delayed discharge issues that Oliver Mundell and Emma Harper have referenced. This morning, I met Colin Pullman, the executive director of the Royal College of Nursing, to discuss the RCN’s report on corridor care, and I committed to exploring further how we can, consistently, have a greater sense of what the picture looks like and, therefore, how we can address it.
Budget 2025-26 (Hospice Care)
To ask the Scottish Government how it plans to invest in the hospice care sector, in light of the £4 million referred to in the draft budget 2025-26. (S6O-04301)
The draft budget for 2025-26 now includes £5 million of investment to support independent hospices to provide pay parity with national health service agenda for change levels. The aim of that is to support hospices to retain staff who deliver essential end-of-life and palliative care services. My officials are already undertaking work to explore the mechanisms for providing that funding, while respecting the roles of integration joint boards and local commissioning arrangements.
I thank the minister for putting on the record that the draft budget includes £5 million for that. I note that that increase came about during budget negotiations.
On a recent visit to Strathcarron hospice, which provides invaluable end-of-life care for almost 500 patients and families in central Scotland, I was fortunate to speak to staff and learn more about the quite incredible work that they do. However, the chief executive told me that one of the challenges that it faces is Labour’s employer national insurance increase. That will put additional pressure on its budget, which is largely funded by donations. Although the increased budget commitment is hugely welcome, what update can the Scottish Government provide on a new national funding framework for hospice care in Scotland to help mitigate the longer-term impacts of Labour’s damaging policy?
Like Michelle Thomson, I have had the privilege of seeing the incredible work that independent hospices do—both personally and as a minister. I also recognise that Labour’s decision to increase employer national insurance has created huge pressure across the whole of the public and third sectors, including Scottish hospices. If that is not fully funded by the United Kingdom Government, it will pose risks to service delivery.
We remain committed to working with the hospice sector and IJBs to develop a new national funding framework that will support IJBs and independent hospices to agree sustainable funding, planning and commissioning arrangements to meet their local populations’ needs. We will be creating a partnership group to drive that work.
The fact is that the hospice sector is facing a double whammy of national insurance increases and meeting the agenda for change. The £5 million announced in the budget is welcome, but the sector is calling for £15 million to stand still. We know that £350 million is available in contingency funds in the Scottish Government’s NHS budget for the current financial year. If the issue is not addressed, hospices across Scotland—which are setting their budgets now—will see the disparity increase even further. Is the Scottish Government looking to provide the £15 million that the sector needs, and not just the £5 million that is currently in the budget?
I thank Miles Briggs for his question and recognise the work that he does in supporting hospices in his region and across Scotland. As I referenced in my previous response, we have been working closely with hospices to address the situation that has arisen—the double whammy, as Miles Briggs called it. We are creating a partnership group to drive that work, and I meet hospices regularly.
I welcome the additional funding, which was secured through the budget partnership and negotiations with the Scottish Liberal Democrats. However, the minister will be aware that the debate on my Assisted Dying for Terminally Ill Adults (Scotland) Bill has shone a light on gaps in access to palliative care. What assurances can she give that, through the palliative care strategy and additional funding, some of those access issues can be addressed?
I recognise the role that the Liberal Democrats played in ensuring that the hospices received additional funding. I agree that, in the light of the bill that Liam McArthur is taking through Parliament, it cannot be one or the other, which is why I am very pleased that we had our palliative care consultation, which closed in January. That is an important way of working to ensure that people in Scotland get the right options on end-of-life and palliative care.
Rape Crisis Scotland Guidance
To ask the Scottish Government what its response is to the reported guidance issued by Rape Crisis Scotland, and its definition of the word “woman”. (S6O-04303)
The Scottish Government is clear that the needs of survivors of rape and sexual assault must be the utmost priority of support services.
Although we cannot intervene in the running of independent organisations, we are clear that access to separate or single-sex provision for survivors is a legitimate and proportionate response when providing support to rape survivors. We therefore welcome the fact that Rape Crisis Scotland is currently consulting member groups and survivors to agree a clear approach to the matter within the terms of the Equality Act 2010.
It was recently reported that Rape Crisis Scotland has dropped its pledge to define the word “woman”, after a series of scandals over the service’s embracing of gender ideology. That does not give reassurance to survivors of rape and sexual assault that the charity will be a safe, single-sex space for them. Does the minister agree that “adult human female” is the only appropriate definition of the word “woman”?
A woman is an adult female—that is clear. However, it is simply a fact that trans people also exist and have always done so. That is not new.
Bereavement Education (Schools)
I remind members that I am the convener of the cross-party group on funerals and bereavement.
To ask the Scottish Government what consideration it has given to making bereavement education a formal part of the school syllabus. (S6O-04304)
The curriculum for excellence includes health and wellbeing as one of three core areas that are the responsibility of all schools. Schools develop the curriculum to suit their local context and meet the needs of their pupils, which includes delivering learning on bereavement.
Education Scotland has developed teaching resources to raise awareness of childhood bereavement and the impact of adversity and trauma while helping to mitigate the effect of those experiences. Young Scot has also developed advice and resources for children who are dealing with bereavement. That work aligns with recommendations to improve support for children who are experiencing bereavement.
Whether of a beloved relative or a pet guinea pig, all of us will face bereavement at some point. However, Cruse Scotland and other organisations have pointed out that there is still a lack of a core curriculum to help children learn how to deal with it. Will the minister meet me, Cruse and other organisations to discuss how we can take that forward to benefit children across Scotland?
All children and young people who have experienced bereavement should be supported. As I have alluded to, and as Mr Balfour is aware, the curriculum for excellence is not a statutory curriculum but more a broad framework that is designed to give schools the flexibility that they require.
That being said, programmes are delivered in Scotland to support children and young people through grief and loss, such as the Seasons for Growth programme, whose core element is the promotion of social and emotional wellbeing after a loss.
We continue to work with Education Scotland to build on the work to date and to identify any gaps. I am aware of Cruse Scotland’s work in supporting children and young people, and I am happy to meet Mr Balfour to explore that further.
Police Scotland (Non-criminal Complaints)
To ask the Scottish Government what the current average timescale is for non-criminal complaints against the police to be allocated for investigation by Police Scotland. (S6O-04305)
The Dame Elish Angiolini review recommended that the complaints and conduct committee of the Scottish Police Authority should hold Police Scotland to account for delays in investigations into complaints and misconduct.
Police Scotland reports on the average timescales for completion of complaints and the proportion of complaints that are completed within 56 days. It does not break those figures down to measure the time that is taken for the allocation of a complaint.
The Police Scotland professional standards department provides a quarterly report to the complaints and conduct committee and Mr Smyth can access a full breakdown of its performance on the Scottish Police Authority website.
It is now routine that, when I write to Police Scotland on behalf of a growing number of constituents who have made complaints about Police Scotland but have heard little or nothing about that complaint—often after months and, in some cases, more than a year—the response is not only that there is no timescale for dealing with the complaint, but that Police Scotland cannot give a timescale for when a complaint will even be allocated for investigation.
When will that growing level of unacceptable waits be tackled? How can the public have confidence in the police if, when something goes wrong, the police do not seem interested in investigating that on time?
The statutory guidance is very clear that complaint inquiries need to be completed with a letter explaining the outcome. That has to be done within 56 days. I have listened very carefully to the member’s comments. I have also given a commitment to other MSP colleagues that I will raise the issue with the chair of the SPA when we next meet, as the SPA has responsibility for holding Police Scotland to account on such matters.
The most recent data that went to the SPA has shown a decrease in complaints year to year and in the five-year average. I will pick up the specific issues that the member has raised when I next meet the chair of the SPA.
That concludes general question time.
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First Minister’s Question Time