Official Report 966KB pdf
Rural Affairs, Land Reform and Islands
Good afternoon. The first item of business is portfolio question time, and the first portfolio is rural affairs, land reform and islands.
I remind members that questions 4 and 8 are grouped together; therefore, I will take any supplementaries on those questions after both have been answered. Question 1 is from Jamie Halcro Johnston, who joins us remotely.
Fishing Sector (Science and Data)
To ask the Scottish Government how it ensures that the most accurate and up-to-date science and data are used when making decisions that impact Scotland’s fishing sector. (S6O-03877)
It is critical that the best available science is used for the management of Scotland’s fisheries. The marine directorate makes a significant investment of £9 million in an annual programme of data collection, dedicated fisheries surveys, stock assessments and scientific advice. Much of that programme is delivered in partnership with the industry and academia and through international collaboration under the auspices of the International Council for the Exploration of the Seas, and it follows standardised, transparent and quality-assured procedures. Fisheries managers also draw on socioeconomic evidence such as that which is published in the sea fisheries annual statistics report.
After I repeatedly raised with the Government the issue of a derogation from catching squid, the cabinet secretary finally wrote to me in May, admitting that
“We have concluded that there is not sufficient evidence to support the immediate introduction of a derogation but there is also not sufficient evidence to refuse it”,
so no derogation was granted.
I recently met the industry to discuss other restrictions that were announced in May, which used data that was collected between 2016 and 2019 to restrict some larger shellfish vessels from fishing their traditional grounds. Both of those decisions, which impact on fishermen’s livelihoods, were made using old or insufficient data, and fishermen do not believe that the data reflect what they are seeing on the grounds. Does the cabinet secretary have confidence in the data that is being used to make these decisions?
On the crab and lobster fishing restrictions that came into force on 12 May, can she tell me when the assessment of the restrictions, which was meant to be concluded later this year but has been pushed into next year, will finally be published?
The member raises a few different points, which I will try to address as best I can. On the last question, about crab and lobster fishing restrictions, we said at the time that those are interim measures that we will keep under review while we look at measures more widely. If, as we develop those discussions, any changes are to be made, we will make those with stakeholders and the industry.
Going back to the member’s initial question about the squid fishery, it is important to note that Scottish ministers granted a limited trial—a pilot project—in which a limited number of inshore vessels will gather more information to support a longer-term policy decision on fishing for squid. That is a positive step forward.
I believe that the first stakeholder co-management group meeting took place on 1 November. The group includes representatives from industry as well as from environmental non-governmental organisations. I believe that the first meeting was thought to be very productive, and there was a lot of enthusiasm in the industry for establishing the project ahead of the next fishing season.
We are moving in the right direction when it comes to that fishery.
Will the cabinet secretary outline what the economic impact of Brexit has been on Scotland’s fishing sector, according to the available data?
One thing that we can say for sure is that all the promises that were made for Brexit, particularly in relation to our fisheries, simply did not materialise. We did not see the sea of opportunity come to fruition as we had been promised at that time.
We also see an impact when we look at our seafood industry, at exports and at the costs and the bureaucracy that have been added for our businesses. We know that Brexit has had a devastating impact on businesses more widely, but we will always continue to do what we do for our industry in Scotland. That is why our negotiators are working really hard at the moment to secure the best opportunities for our fishing industry.
The cabinet secretary will know, from our earlier correspondence and discussions, about the concerns around the failure to designate Scapa Flow, in Orkney, a designated mud area, which risks completely undermining the important prawn fishery. The Scapa Flow sea bed is similar to that of Burgh Head, which has been designated. All the data to support the case for designating Scapa Flow has now been provided to the Scottish Government. Will the cabinet secretary take the necessary steps to ensure that Scapa Flow is designated as soon as possible, so that the valuable and sustainable local fishery in Orkney can continue?
I appreciate that Liam McArthur has raised that point with me previously and has been driving this issue forward in Parliament. I understand that officials met Liam McArthur as well as the Orkney Fisheries Association and local fishers just a couple of weeks ago to discuss that request.
What I can commit to today is that we will continue to have those discussions with the member. I appreciate that we need to see movement on that, so I am more than happy to keep the member up to date as it progresses and, of course, to treat the matter with the seriousness that it deserves.
The cabinet secretary will be aware of the request to undertake a trial reopening of the Solway cockle fishery. In the absence of regular monitoring of stock levels by Marine Scotland, the sector has carried out that work and has provided data to Marine Scotland. However, the data has sat with Marine Scotland for months. When will we hear the Government’s response to the request? Given the delays, does the cabinet secretary think that the Government is really meeting its obligations under the Fisheries Act 2020 when it comes to using the best available scientific advice and data in its decisions?
As, I hope, the member will appreciate, even from just the round of questions that we have had so far this afternoon, a lot is happening in our marine space at the moment and a lot of work is going on across a number of different fisheries in a number of different areas. I know that the work has been done on that data. I have not seen a copy of that report yet, and I will need to get advice on that before we determine the next steps. As soon as that information becomes available, I will be happy to discuss it with the member and set out what the next programme of work will look like.
Protected areas such as the Lamlash Bay no-take zone are vital in allowing Scotland’s marine life and stocks of commercially important species to recover from overfishing. A skipper was recently found guilty of scallop fishing in the zone and was fined £4,175 at Kilmarnock sheriff court. The Community of Arran Seabed Trust—COAST—believes that the incident and the outcome raise issues around the challenges for fisheries management, monitoring and enforcement. Can the cabinet secretary advise whether her officials will discuss the incident with COAST and say what lessons can be learned to prevent such incidents from happening again?
I will state right from the outset that the marine directorate takes incursions into any protected area of our seas seriously and will continue to promote the prevention of non-compliance and respond where non-compliance has been detected. I understand that marine directorate officials have met COAST members to discuss that case.
Kenneth Gibson also raises important points about our overall enforcement. We spend around £23 million a year on our compliance, and we have a number of vessels and aircraft. We take a risk-based assessment approach to all of this and we take any reports very seriously. I encourage members of the public to continue to report cases where they think that there may have been incursions.
Agricultural Property Relief
To ask the Scottish Government what assessment it has made of the potential impact of the United Kingdom Government’s decision to reform agricultural property relief on the future of family farms in Scotland. (S6O-03878)
To say that I am disappointed that the chancellor did not listen to the comments from NFU Scotland and Scottish Land & Estates and chose not to work with the Scottish Government to consider the impact of these changes would be an extreme understatement.
The Government, farmers and rural communities now need to come together to think through how the UK Government’s decision will impact on family farms. In the meantime, I urge the UK Government to engage in immediate dialogue to ensure that any tax changes take account of Scotland and its distinct features where family and tenant farms and crofting are key parts of rural life. We want a tax system that supports, not hinders, orderly succession planning and transfer of land to the next generation of custodians of the land.
I share the minister’s disappointment in what we have seen unfold. Labour has betrayed Scottish farmers in its budget by introducing a family farm tax, and it is disappointing to see so few Labour members in the chamber today. It is estimated that the tax will affect 70,000 family farms across the UK. Our food security will now be put at risk and local people will be forced to pay higher prices in the supermarket as a result. Will the minister support the Scottish Conservative campaign to reverse Labour’s deeply harmful family farm tax?
I disagree with very little of what Sue Webber has said. In fact, I will quote the NFUS:
“From a farming and crofting perspective, the Inheritance Tax and changes to Agricultural Property Relief will be devastating to the vast majority of farms and crofts. This is something we will demand the UK government to review and amend as the pressures both financially and mentally this will put on family farming businesses will be immense. The shear lack of understanding of how agriculture works throughout the UK has been highlighted by this Government which has clearly gone back on its word.”
It continues:
“Changes to Inheritance Tax and Agricultural Property Relief will affect the liquidity on succession for farms above the £1 million threshold set, hitting many family farms, regardless of size or type. Decisions to reinvest in these farming businesses will be shelved and the knock-on ramifications for the wider rural economy, and businesses up and downstream will be significant.”
That is not a Scottish Government political statement—the NFU is saying that.
The Labour Party’s actions at Westminster have been catastrophic for the farming industry in Scotland. We would seriously urge the UK Government to rethink its position.
I am thankful that this very important issue has been raised in the chamber, as it affects many of my constituents. As we have heard, NFU Scotland has said that it will be devastating to the vast majority of farms and crofts. What engagement has the minister had with the NFUS and farming stakeholders in the light of the very disappointing UK budget? Can you outline the support that is available to the sector in Scotland to ensure its viability for the years to come?
Members should always speak through the chair.
At the very start, when the new Labour Government was elected, I and the cabinet secretary were hopeful that there would be a better line of engagement, a better dialogue and a much better relationship than the one that we had with—dare I say it?—our colleagues who are sitting to the left of me. We have discussed the importance of providing sufficient ring-fenced multiyear funding to support agriculture, rural and marine sectors across the UK and to provide those sectors with long-term clarity as soon as possible, noting that the UK Government would consider a funding settlement for future years at the next spending review. Well, all of that has now gone out the window.
In 2024-25, the Scottish Government will invest more than £1 billion in the rural affairs, land reform and islands budget. We have committed to supporting active farming and food production with direct payments to provide certainty to the industry, and we have brought forward payment dates in order to pay farmers and crofters at the earliest possible opportunity, to assist with cash flow. The UK Government’s autumn statement does not provide the uplift in agriculture funding that stakeholders have called for to reverse the real-terms cuts of recent years, nor does it provide the multiyear certainty that we lost when we exited the European Union. The imposed settlement compounds the issues that were created by the former UK Government, and some serious conversations need to be had going forward.
One Labour member at the back of the chamber is shaking their head and one at the front is looking at his phone. Some pretty shameful spin has come from Labour about the inheritance tax, which is destroying family farms.
That is rubbish!
Please.
Members can shout all they like, but both the minister and I know that it is spin and that engagement is the key. The industry is hurting. I am pleased with what the minister has said, but will he do all that he can to engage with the industry? It needs that now more than ever.
I cannot disagree with Tim Eagle’s sentiments. We are actively engaging with the sector—we did that as soon as we received the budget—and we will continue to engage, because we need to get the issue sorted in order to ensure the viability of family farming in Scotland.
Although the Scottish Greens support the use of inheritance tax measures as a means of redistribution, the lack of information about the impact of the UK budget changes is making small farmers in the Highlands and Islands nervous. Concerns have been raised that those changes could inadvertently lead to small farms ending up in the hands of big agribusiness. What steps will the Scottish Government take to provide more information to the sector and ensure that the changes do not have a negative impact on Scotland’s land reform journey?
All that I can say to Ariane Burgess is what I have already said to members on the left-hand side of the chamber. We will continue to do all that we can to ensure that we have a successful, viable family farming sector in Scotland.
Question 3 has not been lodged.
Basic Payment Scheme
To ask the Scottish Government by what date it expects all farmers to receive payment through the basic payment scheme. (S6O-03880)
The payment strategy, published on 9 February 2024, sets out our regulatory targets. For the basic payment scheme, that is 95.24 per cent of the BPS value by June 2025, which is on course to be met. As in any year, there can be a number of complex cases that require investigation to determine eligibility, and we will work with customers to pay the remaining claims at the earliest opportunity.
Although early payments are welcome, I understand that, to date, only some smaller farms have received their single farm payment. On 4 September, the cabinet secretary stated:
“Rural payments and inspections division staff will continue to work through remaining payments as soon as possible over the coming weeks.”
That was eight weeks ago.
Following what has been, for many, a difficult harvest, it is now imperative that all farmers get that vital funding. Can the minister give clarity to the industry by confirming when it will receive the rest, and will he guarantee that?
If Sandesh Gulhane has specific cases that he wishes to raise with me, he should by all means bring them to our attention. I am more than happy to look at them.
There have been some delays, but we are still well on track to cover the vast majority of payments well within the timeline that we have.
Basic Payment Scheme
I remind the chamber of my entry in the register of members’ interests, which states that I am a partner of a small family farm in Morayshire and that, as such, I am entitled to grants for the farming enterprise.
To ask the Scottish Government what percentage of payments under the basic payment scheme had been made to farmers by 15 October 2024. (S6O-03884)
My answer will go some way towards giving further clarity to Sandesh Gulhane, too.
As of 15 October 2024, 76 per cent of the overall value of the basic payment scheme had been paid out, with 83 per cent of the total number of eligible businesses having received payment.
I am slightly concerned that a disastrous and expensive computer system that was installed to distribute the basic farm payment scheme has caused the delays that we have seen. Can the minister confirm whether that is the case? If that is not the case, were any delays caused by software issues?
We are delivering in line with our payment strategy. I fully understand the premise of Edward Mountain’s question, given some of the issues that we have had historically, but there was a planned pause in the payment-run processing from 12 September to 2 October 2024 to allow the Scottish Government to incorporate wide upgrades to the Oracle cloud.
The basic payment scheme and greening advance payment runs started again on 2 October, and all claims that progressed to ready-for-payment status during the pause were processed by 15 October. The normal payment run is progressing and payments resume from this point onwards.
It is vital that we press ahead with work to ensure that we are giving farmers and crofters the support that they need. Can the minister say any more about the total funding that has been provided to support farmers through the basic payment scheme this year?
It is fair to say that the Scottish Government absolutely recognises the importance of that support to farmers and crofters. As I said, at 4 November 2024 more than £367 million-worth of payments had been processed. That means that 87 per cent of the overall value of the basic payment scheme has been paid out, with 92 per cent of the total number of eligible businesses receiving a payment.
Last month, I wrote to the cabinet secretary on behalf of a Moray farmer who normally gets his basic payment in September and has still not received it. Would it be possible to get a response from the cabinet secretary?
On the point that we have heard about information technology, that farmer has also been told by the department in Inverness that the software upgrade is going to delay future payments. He describes this as
“a pretty stupid time to do an upgrade, and it must be a pretty slow one at that”.
Does the minister agree?
The upgrade happened across the entire Scottish Government: it was not just to do with the system for rural payments.
As I said in my previous answer, the payment system is back on track. We will have completed the process well before the deadline of June 2025, and I hope that that gives farmers confidence that the payments are coming.
Question 5 has been withdrawn, and question 6 was not lodged.
Carbon Emissions Land Tax
To ask the Scottish Government what discussions the rural affairs secretary has had with ministerial colleagues regarding the potential implications for its policies on land reform and land use of a carbon emissions land tax. (S6O-03883)
Ministers meet regularly to ensure that work that is under way across Government takes into consideration potential cross-portfolio implications.
As a member of the Net Zero, Energy and Transport Committee, I am currently scrutinising land reform legislation. Under initial Scottish Government plans, large landowners will be required to consult on, produce and comply with land management plans, and constraints, such as lotting, will be placed on the sale of land.
Given that there might soon be a requirement for large landowners to pay a carbon emissions land tax, will the Scottish Government give consideration, with some potential exemptions and caveats, to aligning the qualifying threshold for all three measures to ownership of land of more than 1,000 hectares? Such an approach might benefit communities, nature restoration and net zero goals.
I am grateful for the committee’s scrutiny of the Land Reform (Scotland) Bill. Ultimately, we set out the different thresholds to ensure that the measures are justified in relation to the policy aims, and do not have a disproportionate impact on smaller landholdings. I welcome the committee’s consideration of those issues.
The Scottish Government is committed to exploring options for a carbon land tax to support emissions reductions, but any potential new measures in relation to that would have to be rigorously assessed and based on strong evidence to ensure that they meet the objectives of introducing such a policy.
In the development of that work, we would collaborate with stakeholders, including landowners, to consider all available options, including any relevant thresholds and what they might look like.
That concludes portfolio questions on rural affairs, land reform and islands.
On a point of order, Deputy Presiding Officer. I am sorry that, in my frustration over Labour’s family farm tax, I forgot to declare my interest as a farmer who is in receipt of funding from the basic payment scheme.
Thank you, Mr Eagle.
There will be a short pause before we move on to the next portfolio, to allow front bench teams to change positions, should they wish to do so.
Health and Social Care
Monklands Hospital Replacement
To ask the Scottish Government whether it will provide an update on what recent discussions it has had with NHS Lanarkshire about the replacement Monklands hospital. (S6O-03885)
NHS Lanarkshire provided an update to the national health service capital investment group on 25 September on the progress that it is making with the development of the full business case. The update session confirmed that good progress is being made and that the board remains on course to submit the full business case in late 2025 or early 2026.
I thank the minister for that answer, but good progress does not mean money on the table, and that is what is required. A recent NHS Lanarkshire report dubbed Monklands hospital a “risk to life”, highlighting floods, bacterial outbreaks and major heating failures. Colin Lauder, director of planning at NHS Lanarkshire, has said that Monklands
“is not suitable for 21st century medical practice.”
A recent briefing for elected members told us that not replacing Monklands is simply unthinkable.
Will the minister commit to funding Monklands hospital? In the spirit of collaboration, will she agree to host a meeting of interested MSPs from the area to discuss that?
I will take the several points that Mr Simpson raised in turn. It is not the case that NHS Lanarkshire has not adequately made the case for replacement. The situation is that we are still in the process of finding the money. In the meantime, we expect all health boards to undertake appropriate maintenance work in their healthcare facilities in order to manage and mitigate risks. We continue to work with health boards to manage estate-related costs.
I absolutely recognise the importance of national health service infrastructure in supporting services. To that end, we are working with all our health boards to develop a whole-system infrastructure plan. In the context of a very challenging financial position, it is a positive and practical approach that reflects on the needs of the whole of Scotland and will support the continued safe operation of existing NHS facilities as well as the determination of longer-term investment priorities.
In answer to the question about meeting members, I am happy to meet them at any time to discuss the issues that interest them.
A report that was leaked just last month reveals that the existing Monklands hospital is “beyond its serviceable life”. The replacement hospital has been delayed by three years already. A week ago, the Scottish Government learned that it will have significant additional resources for the NHS from the new Labour Government. Will it use those additional resources to get the new hospital built as a matter of urgent priority?
The consequentials from the budget last week turned out to be £89 million of capital, which, as we all know, does not build a modern hospital.
We welcome the clarity from the United Kingdom Government around our 2025-26 capital funding envelope and we will target that funding to deliver on the Government’s priorities. However, we need longer-term assurance on multiyear capital investment in order to commit to some of the enormous capital costs that are building within our NHS in Scotland.
Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders Care Pathway
To ask the Scottish Government whether it will provide an update on what it is doing to establish a care pathway for people living with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders. (S6O-03886)
I assure members that the Scottish Government, through the rare disease implementation board and wider engagement, remains committed to exploring how care for rare conditions can be improved through the use of pathways and resources that support healthcare professionals. Given how important it is that people with a rare or long-term condition receive effective care, and with predicted increases in the number of people in Scotland with such conditions, we believe that it is time to revisit our approach to long-term conditions. We are exploring how to better support people with long-term conditions, as many of the outcomes that we seek for patients are similar across different conditions.
I am grateful to the minister for meeting me last week to discuss the issue further. Research that was published by the University of Edinburgh earlier this year found that people with EDS and HSD in Scotland endure an average wait of 20 years for a diagnosis, and a significant number resort to private healthcare or to travelling abroad as a result. I know well the knock-on impact that such a lack of support can have, as well as the frustration that comes from a lack of public awareness. Will the minister outline what steps the Government is taking to ensure that the provision of training and education around EDS is enhanced?
I acknowledge the work that Emma Roddick is carrying out to raise awareness of EDS and I thank her for that. As was noted in the August progress report on Scotland’s action plan for rare diseases, our rare disease implementation board, in conjunction with NHS Education for Scotland, is developing awareness-raising video resources to support healthcare professionals in thinking rare.
We will also be encouraging the use of digital tools such as the right decision service that is hosted by Healthcare Improvement Scotland, which provides tools to build guidance, pathways and other decision-support resources. Guidance for hypermobile Ehlers-Danlos syndrome has already been developed by NHS Dumfries and Galloway and is available on the right decision service website to support healthcare staff across Scotland.
Question 3 was not lodged.
Gender-Affirming Surgery Referrals (18 to 24-year-olds)
To ask the Scottish Government, in light of recent reports that Chalmers gender identity clinic has paused gender-affirming surgery referrals for people under 25, what work it is doing to ensure that such referrals for 18 to 24-year-olds can be reinstated as soon as possible. (S6O-03888)
Before I answer Lorna Slater’s question regarding NHS Lothian, I reassure the member and anyone listening to this session that there has been no change in national policy in relation to the provision of gender identity healthcare or related surgical referrals for 18 to 24-year-olds.
National health service boards are responsible for the care of patients. I understand that NHS Lothian is currently reviewing its internal clinical governance procedures to ensure that its assessment and referral processes are meeting patients’ needs in a holistic way. That work by NHS Lothian is on-going, and I have asked that it is done at pace to reduce anxiety for the patients who are involved and to ensure that referrals resume as soon as possible.
I thank the minister very much for her answer. In the wake of the gender identity healthcare protocol for Scotland being published by the Scottish Government in September, a number of constituents have written to me with the specific concern that the Chalmers gender identity clinic is waiting for the national work on gender identity healthcare provision for young people, which is mentioned in point 8 of that protocol, to be completed before it reinstates referrals.
Knowing that timeliness of care is vital, that gender-affirming care saves lives and that lives are potentially at risk while referrals are unavailable, I ask the minister how long the national work will take. Did she anticipate clinics pausing support for patients while the work was undertaken? I note that NHS Greater Glasgow and Clyde has not paused referrals.
I understand that a short-life working group that was established by NHS Lothian is progressing work at pace to consider pathways for 18 to 24-year-olds and that the group is expected to report early in the new year. I also understand that, if there are any interim steps as part of the process, those steps can progress before the report concludes and they will be put in place as soon as possible by the board.
The overriding premise of healthcare professionals is to do no harm. Can the minister confirm that the pause to gender-affirming surgery has happened at least in part because of concern about the health outcomes from those treatments, and that it can be reinstated only when a full investigation into harms or otherwise has taken place?
As I understand it, the question was on the process of referrals and suchlike. That is what the short-life working group is looking at. As I said in my response to Ms Slater, we expect the report to be concluded early in the next year.
I call Colin Smyth to ask question 5.
I apologise to you, Presiding Officer, but the member is not in the chamber.
I thank Mr Whitfield for that helpful clarification, which we have all noted. I think that the member was in the chamber not so long ago. I apologise to those who were seeking to ask supplementary questions, because that will not be possible.
Disadvantaged Communities (Life Expectancy and Health Inequalities)
To ask the Scottish Government how it plans to improve life expectancy and tackle any health inequalities affecting the most disadvantaged communities. (S6O-03890)
The Government has an unwavering commitment to increasing life expectancy and reducing health inequalities across our communities by undertaking a range of actions to address the underlying causes. They include allocating around £3 billion a year since 2022-23 to tackle poverty, initiatives to promote healthy lifestyles through tobacco control, preventing alcohol-related harm, and promoting healthy eating and being physically active.
We are working with our partners to develop a collective preventative approach to tackling health inequalities through the creation of a population health framework. The most recent life expectancy figures, which were published last month by the National Records of Scotland, indicate a moderate increase for both men and women, compared with previous estimates.
The leading causes of avoidable deaths include alcohol and drug-related conditions. People living in the most deprived fifth of areas are two to three times likely to die from such causes, which are categorised as being potentially preventable through treatment. What is the Scottish Government’s response to calls from the Royal College of General Practitioners Scotland to increase investment in general practice, alongside the review of all funding streams to channel more spending to the most deprived areas?
I thank Annie Wells for her question and welcome her to her new portfolio. I look forward to meeting her with regard to women’s health. She has raised some important points about dependency on alcohol and drugs in our deprived areas, and we are very receptive to her suggestion with regard to discussions with GPs and that particular funding.
I refer members to my entry in the register of members’ interests as a bank nurse employed by NHS Greater Glasgow and Clyde.
How successful has the inclusion, health and general practice programme been in tackling health inequalities across disadvantaged areas of NHS Greater Glasgow and Clyde, and how will that work be supported over the next year?
Since March 2023, we have invested £2.3 million in the inclusion health action in general practice project in NHS Greater Glasgow and Clyde. More than 60 GP practices in highly disadvantaged communities have used the funding to take practical actions to tackle health inequalities.
An early evaluation that was published in July clearly shows that the funding is driving improvements in those practices. Those improvements include enhanced care through more than 7,000 extended and outreach consultations with patients who have complex health needs but are often excluded from healthcare. More than 200 staff have also undertaken training related to health inequalities, and £1 million was paid to practices this financial year to continue their work to address such inequalities.
We have a supplementary from Paul Sweeney, who joins us online.
The reality of health inequalities in Scotland is persistently laid bare in the national dental inspection programme data. For example, last week’s figures showed that just 60 per cent of children in the most deprived areas showed “no obvious decay experience”, compared with 84 per cent in the least deprived areas. Has the Government accepted that level of inequality in dental health as standard in Scotland?
No, the Scottish Government has not accepted those levels of dentistry as standard; indeed, we continue to invest in the childsmile programme to ensure that our children get the best support when they are learning to brush and keep their teeth clean. We all recognise that the mouth is a key area for showing your general health, and that it is important for our teeth to be as healthy as possible.
Breast Cancer Outcomes
To ask the Scottish Government how it is improving outcomes for people affected by breast cancer. (S6O-03891)
We are implementing the cancer strategy and cancer action plan for Scotland, which take a comprehensive approach to improving patient pathways in cancer, from prevention and diagnosis to treatment and post-treatment care.
We continue to invest in our detect cancer earlier programme. We have invested £11.3 million in cancer waiting times funding in 2024-25, and that funding is directed towards our most challenged tumour types, including breast cancer. We have also commissioned the Scottish cancer network to publish the first national clinical management pathway for breast cancer in 2023, to bring consistency to the patient journey from diagnosis onwards and to improve outcomes.
I urge any woman who is invited to a screening programme to take up that opportunity.
In light of the national cancer medicines advisory group issuing advice supporting the use of anastrozole, raloxifene and tamoxifen for the primary prevention of breast cancer, what steps have been taken to establish the necessary national health service pathways to ensure that those medicines are readily available to women who choose such risk-reducing treatment options?
I recognise that Clare Adamson’s interest in this area is long-standing, and I reiterate her call for women and all others to take up cancer screening opportunities when they present themselves.
I welcome the national cancer medicines advisory group’s decision to support the use of anastrozole, tamoxifen and raloxifene treatment to reduce the risk of breast cancer. The Scottish Government is currently working with national genetic and clinical colleagues to consider the implications of undertaking a nationally agreed pathway for chemoprevention of breast cancer. In the meantime, the Scottish Government expects health boards to explore the safe, effective and equitable introduction of those medicines.
I understand that there has been recent confirmation of significant shortages of radioisotopes across the world, including those which are mainly used for diagnosing cancers, including prostate and breast cancer. Will the cabinet secretary outline the Scottish Government’s latest position following that announcement and advise how the Government will support affected patients and their loved ones?
I thank Colin Beattie for raising an important issue that has been of concern to me over recent weeks. Work is on-going with suppliers. Given its responsibility in relation to medicine supplies, the United Kingdom Government has a responsibility to resolve the shortage of generators that are used in the preparation of radioisotopes in nuclear medicine for diagnosis and treatment, particularly for cancer.
There have been positive developments, with the affected reactors in Poland and the Netherlands coming back online sooner than expected. Consequently, we should shortly be able to confirm that all radiopharmacies in Scotland will receive their normal generator capacity.
I thank the radiopharmacy and associated clinical teams for working collaboratively to minimise the impact of the shortage on patient care in Scotland and for the work that has been done across the UK to co-ordinate that. I intend to keep colleagues across the chamber, and the Health, Social Care and Sport Committee in particular, updated as matters progress.
I declare an interest as a practising national health service general practitioner.
My constituent Shareen Auckbarallee was diagnosed with breast cancer and underwent a mastectomy, which, as members can imagine, was devastating for her. She requires breast reconstructive surgery at the Glasgow royal infirmary but, on asking when she might receive it, she was simply told, “Years.”
When Pam Gosal raised the issue at First Minister’s question time last November, she was told by the First Minister that the Scottish Government was working hard to reduce waiting times. However, a freedom of information request has shown that Glasgow’s average wait has increased, the maximum wait has increased and the number of patients waiting has increased, too. That is unacceptable. When will the cabinet secretary take steps to improve the situation, and will he apologise to Shareen?
I very much recognise the trauma that Dr Gulhane’s constituent Shareen will be feeling at this time, and I am very sorry for the delay in that important reconstructive surgery. We are investing in support to boards to provide capacity for that work. In Dr Gulhane’s question and narration, he referenced the fact that there is an increased demand on those services. In both the 62-day and the 31-day cancer pathways for breast cancer, we are seeing increased demand, and we are treating more people in those pathways compared with the situation before the pandemic.
However, I recognise that that is cold comfort to Shareen. I am more than happy to hear more from Dr Gulhane in writing about the individual circumstances and to consider whether anything more can be done to help.
The cabinet secretary will know from public health figures that the gap between our most and least deprived communities remains stubbornly high. Women between the ages of 50 and 70 from our most deprived communities are less likely to attend their routine breast screening appointments and have a 64.2 per cent screening rate, compared to 82.8 per cent in the most affluent communities. Given that I have raised screening inequalities in the chamber on a number of occasions, and given the Government’s commitment to reducing inequalities in cancer screening, will the cabinet secretary agree to bring to the chamber a debate in which he can update us on the status of the equity in screening strategy and allow scrutiny of the Government’s commitment to targeted work in that area?
Obviously, the scheduling of parliamentary business is a consideration for all of us, but I recognise Carol Mochan’s request and the figures that she narrates, which I have seen. I am as concerned as she is about the current inequity between the most and least deprived areas in the uptake of screening opportunities. That serves to illustrate the need for us to reiterate the importance of people taking up screening opportunities, as I mentioned in response to Clare Adamson. If there are structural barriers to accessing those opportunities for people in the most deprived communities, we need to tackle them, and I would be interested in working with local boards and health and social care partnerships on how that can be brought about.
We will give due consideration to the member’s request for chamber time. In the meantime, I would be more than happy to discuss those areas with her at a further meeting.
Accident and Emergency Waiting Times
To ask the Scottish Government whether it will provide an update on what steps it is taking to eliminate long waits in A and E departments across Scotland. (S6O-03892)
I am committed to addressing long waits in our emergency departments, which is why we are supporting health boards through our urgent and unscheduled care collaborative improvement programme to improve patient flow through our acute sites.
The key issue impacting performance is in-patient capacity and the block that that causes for people who need to be admitted to hospital. Through our improvement approach, we are working with the centre for sustainable delivery and local systems to implement actions that will release in-patient capacity, such as strengthening same-day emergency care services, optimising flow navigation centres and enhancing the discharge process to ensure that people are discharged as soon as they are medically fit.
A and E waiting times have risen and remain critically high across Scotland. In the week ending 27 October, more than 9,000 patients were not seen within the Scottish National Party’s four-hour target. In Ayrshire and Arran, only 63.9 per cent of patients were seen within four hours at emergency departments. What immediate actions will the cabinet secretary take to protect staff from burnout and improve the patient experience as we prepare for increased winter pressures?
I thank Sharon Dowey for bringing that important issue to the chamber. We have too many people waiting too long in our accident and emergencies, particularly to get admitted. I was able to see that for myself not only when I was at University hospital Ayr on Monday, but when I was visiting the accident and emergency there earlier in the summer. It has brought in good innovations, including the frailty assessment unit.
However, there is clear variation in performance among our health and social care partnerships, including around delayed discharge. We can see that in Ayrshire and Arran: in South Ayrshire, the number of delays was sitting at 91 in September; in East Ayrshire it was 25; and in North Ayrshire it was 74.
We need to understand what can be done to ensure that we bring up the performance of all those local areas, so that we can see a better flow through the system. I just made a commitment to all health and social care partnership chairs and vice-chairs in a meeting before this question time session—I meet the collaborative response and assurance group on a weekly basis—in relation to what is needed in local areas in order to see a response and to see the numbers come down, so that we can see a better flow in our accident and emergency settings.
We know that a key way to reduce the pressure on A and E is to ensure that people know where to go to access the healthcare that they need. Will the cabinet secretary provide an update on the work to alleviate pressures on emergency departments? What can be learned from exemplar A and E departments such as those in NHS Tayside? Will he comment on how A and E waiting time figures in Scotland compare with those across the rest of the United Kingdom?
The right care, right place campaign that was launched last week promotes awareness around the appropriate use of urgent care services to help reduce pressures on the system during winter. Alongside that, a record number of NHS 24 call handlers are available to direct people to the most appropriate care, which helps to reduce unnecessary accident and emergency attendances.
The direct answer to Joe FitzPatrick’s question is that Scotland’s core accident and emergencies have been the best performing in the UK for nine years. Monthly statistics for September show that Scotland’s performance for core A and Es was 6.1 percentage points higher than that of England and 8.7 percentage points higher than that of Wales.
I do not rest on that. It is not good enough for us just to be the best in the UK; we must do better for the people of Scotland, which is what I am committed to doing.
Yesterday’s Public Health Scotland statistics revealed that A and E departments continue to struggle. The latest monthly figures showed that 13,000 people waited more than eight hours to be seen, and 5,000 of them waited more than 12 hours. We see ambulances backed up at the hospital front door, which causes huge pressure on the system and delays their getting to further emergency calls.
Will the cabinet secretary commit to using some of the new funding from the UK Labour budget to tackle the winter pressures on our NHS and social care services?
I very much agree with the first point that Jackie Baillie made about the assessment of Public Health Scotland figures in relation to the challenges across the system.
This is not about the performance of accident and emergency departments, which I think are doing very well; we need to look at the performance of the entire system, including social care, as I narrated to Sharon Dowey. I take the point that Jackie Baillie makes.
On the impact of the UK budget, I think that it is a mixed bag. Progress is undoubtedly being made. However, for this year, the consequentials were—as had been anticipated—as telegraphed by the previous UK Government as well as the current one.
We will use all possible resources to improve the situation for our health services. We will take forward progress on that front as we develop the budget process for 4 December.
It is bewildering that the cabinet secretary tells us that it is about flow through the hospital, including social care, when we have £13 million-worth of social care cuts in Fife, which were agreed to by NHS Fife. That is having a direct impact on social care packages and respite, and it has a direct impact on discharge from hospital. Why on earth is he telling us that it is about the flow through the hospital when he is imposing such cuts?
That is partly because, as Mr Rennie knows, it is not me who is imposing such cuts—those are local decisions.
However, I want to work with local systems, because I recognise that there is pressure across the public sector after a decade and a half of austerity. I also recognise the challenges that are being faced in local areas, including in Fife.
That is why I meet the whole system on a weekly basis through the collaborative response and assurance group, which includes the Convention of Scottish Local Authorities and health and social care partnerships. People are able to voice concerns about funding in that forum, and we take those points seriously in order to address the situation that is being faced by too many partnerships, and by too many individuals. At the end of the day, it is individual people who experience delays in being discharged to their home, or who are not able to get into the hospital or the accident and emergency department. I am focused on seeing a better situation for people who use our health and social care services.
That concludes portfolio questions on health and social care. I have a point of order on my screen from Colin Smyth.
On a point of order, Presiding Officer. I apologise for getting my timings wrong for portfolio questions on health, and I will write to the Presiding Officer to apologise for missing my question.
Thank you, Mr Smyth.
Finlay Carson has a point of order.
On a point of order, Presiding Officer. In the light of the response that we have just heard from the cabinet secretary, can you offer any advice to members who were preparing to ask a supplementary question on an urgent matter? An example is maternity services in Dumfries and Galloway, and the outrageous decision by the integration joint board to ignore the views of pregnant women and independent maternity professionals and withdraw midwife-led services.
I say to Mr Carson that that is not a point of order. There will be many opportunities for him to raise issues, as he well knows. However, I see that the cabinet secretary also wishes to make a point of order.
On a point of order, Presiding Officer. As ever, if questions are not taken in the chamber, I would be more than sympathetic to writing back in a timeous fashion to members whose questions could not be taken.
Thank you, cabinet secretary.
There will be a short pause before we move on to the next item of business.
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