The next item of business is topical question time. In order to get in questions from as many members as possible, short and succinct questions and responses would be appreciated.
Psychiatrists
To ask the Scottish Government what action it is taking to address the reported growing concerns over the shortfall of psychiatrists employed by the national health service to deliver psychiatric care. (S6T-02138)
We are actively encouraging medical students to consider a long-term psychiatry career. We have created 42 additional posts in core psychiatry since 2014, and, with one exception, 100 per cent of entry-level posts have been filled for the fourth year.
The psychiatry recruitment and retention working group will report back to ministers in spring 2025. The Royal College of Psychiatrists in Scotland is a critical partner in this work, and the Cabinet Secretary for Health and Social Care is meeting with college representatives on Thursday. Ensuring the provision of high-quality and safe patient care remains our utmost priority.
That sounds like a lot of things in the future—but I thank the minister for the answer. I thank The Guardian and the BBC, which have done some investigation into the matter. They have found that health boards are paying up to £837 an hour for locum psychiatrists. Last year, total payments exceeded £35 million. Not only that, but there are serious concerns that some locums are being used in remote consultations from places outside the United Kingdom, such as India, meaning that they are not even members of the Royal College of Psychiatrists. Does the minister accept those concerns, and does she accept that mental health services in Scotland are at breaking point? [Edward Mountain has corrected this contribution. See end of report.]
I certainly do accept those concerns. I am aware of the incident that Edward Mountain raises with me of a psychiatrist who was working outside the UK. I am assured that the arrangement happened only when there were no consultant psychiatrists available to work in that particular health board and that the practice has been stopped. It is not a common practice. I am absolutely aware of the challenges that exist across the workforce, which can be particularly marked in more remote and rural areas. It is helpful to see the latest statistics, which show an increase in full-time posts in the past year and, indeed, an increase since 2014. I have absolutely no doubt that there are concerns.
As I mentioned in response to a question last week, there are concerns in specific areas of the country—particularly remote and rural areas, where boards find it difficult to recruit and there are concerns about certain specialties. We are working closely with the royal college and others to improve the situation.
Well, there’s a surprise: emergency locums are being used because there is an emergency. When the minister and I were elected as regional Highlands and Islands MSPs, we both knew the problems that patients in the Highlands faced. New Craigs hospital was reducing bed numbers, there was a shortage of psychiatrists, and constituents were having to travel vast distances or were having online consultations via Near Me with different psychiatrists.
It is clear, minister, that you have no idea of the extent of the problem, and you had no idea of it before it was flagged up to you as a result of the investigation. Surely, if you did, the Scottish Government would have done some workforce planning years ago—and you have not. Do you think—
Always speak through the chair, please, Mr Mountain.
Thank you—[Interruption.]
Do continue, Mr Mountain.
Sorry, but I am hearing a lot of barracking from my right and it is difficult to ask the question. [Interruption.]
I would be grateful if members could resist any temptation to contribute.
Thank you, Presiding Officer.
I do not believe that the minister had any idea of the problems until they were flagged up as a result of the investigation. Otherwise, the Scottish Government would have done proper workforce planning to ensure that that did not happen. Trying to solve the problem now is like bolting the door after the horse has bolted. Minister, do you think that you really are in charge of what is going on?
Again, Mr Mountain, I would ask that you always speak through the chair.
The member is aware that, before I came into politics, I worked for 20 years as a mental health pharmacist in NHS Highland. The issue is very close to my heart, and it has been throughout my working life. Not only that, but it is important to my constituents.
Many of the issues that the member raises in the chamber today have been raised with me, and I, in turn, have raised them with NHS Highland. I am well aware of the challenges that exist right across the workforce. It is really helpful to see that the latest statistics for NHS Highland mental health nursing staff show an increase of 3.6 per cent in the latest 12 months to 30 September 2024, while the number of psychiatry staff increased by 10.5 per cent in that period. Despite that huge improvement, and in view of the on-going challenges that NHS Highland faces, my officials continue to offer enhanced monitoring and support to NHS Highland’s mental health services.
I will address what we are doing nationally to tackle those issues. The mental health and wellbeing workforce action plan is committed to the on-going work of the psychiatry recruitment and retention working group, which is considering how we can better support the recruitment and retention of psychiatrists. As I said in answer to the member’s first question, the psychiatry working group is actively exploring possible solutions to issues such as the use of locums. The group will meet in December 2024 and will report back to me in spring 2025. I look forward to seeing that report and taking forward the group’s recommendations.
It is welcome to hear the minister outline what is happening right now. Will she set out the changes that have happened in the psychiatry and mental health workforce over the past decade? What impact are the pension rules set by the UK Government having on the retention of psychiatrists?
The member asks really good questions. Although record numbers of staff are providing mental health support to a larger number of people than ever before, we acknowledge that it does not feel like that on the ground. That is why we have continued to invest heavily in our mental health workforce—that is, the broad, multidisciplinary health workforce.
I have already referenced the increase in mental health nursing and psychiatrists in Highland. In 2024-25, in order to support multidisciplinary teams, the Scottish Government provided national health service boards with approximately £2.7 million for mental health pharmacists and technicians, and we provided NHS Scotland with around £30 million for continuing education and training and for workforce expansion. [Interruption.] Mr Mountain is now barracking me from a sedentary position, which I find profoundly unhelpful as I am trying to get on the record the work that we are doing, in response to the question that he asked.
We have exceeded our commitment to provide funding for 320 additional staff in child and adolescent mental health services by 2026. We have also funded more than 800 additional mental health workers in accident and emergency departments, general practices, police custody suites and prisons.
The issue of pension taxation is reserved. We have raised it with the UK Government, in recognition of the fact that we have limited ability to influence that space. We have taken the action that we can, by devolving powers to NHS boards to use local flexibilities within NHS pension arrangements and to offer pension recycling.
Despite that, Scotland’s mental health has worsened, according to all measures. The most recent Scottish mental health survey found that the CAMHS waiting time target has never been met and that a total of 28,000 Scots are waiting for mental health support. We have seen the Government’s response, which has taken the form of an extortionate sticking plaster through more than £130 million being spent on locum psychiatrists over the past five years. As we have heard, health boards have been paying up to £837 per hour to plug the gaps. Does the minister’s idea of a robust NHS workforce strategy involve anything resembling such a figure? Does she consider such expenditure to be an appropriate and good-value use of taxpayers’ money?
NHS Scotland’s staff pay bill is more than £10 billion a year, with spending on locum psychiatrists being a tiny fraction of that. As Paul Sweeney will be aware, spending on such locums is managed by local health boards. Boards should always seek to secure the best value when they enter into arrangements for the use of locum psychiatrists.
At a national level, as I mentioned in response to the question last week, we have established a medical locum task and finish group to review and improve the processes and practices that are adopted when locums are engaged locally.
In reference to the first part of the member’s question, I agree that there is undoubtedly a rise in demand. In some parts of the country, for example, we have seen a 1,500 per cent increase in requests for neurodevelopmental assessment. Those pressures could not have been predicted. That relates to the reduction in stigma associated with those causes, which is a really good thing, but it undoubtedly adds to the challenge in managing the current situation.
Accident and Emergency Departments (Winter Planning)
To ask the Scottish Government what its response is to the reported view of the Royal College of Emergency Medicine that its winter planning is “not doing enough” to support accident and emergency departments as they approach their busiest time of year. (S6T-02142)
We know that there are challenges to come for our health and social care system this winter, and in particular for our accident and emergency departments. Our health and social care winter preparedness plan sets out how we will ensure that people in Scotland receive safe and timely access to health and social care services and support over the winter.
We have a number of specific actions that will help to reduce pressure on our busy accident and emergency departments, such as improving discharge planning, enhancing our hospital at home services and treating more people in the community, when it is clinically appropriate to do so.
In addition, we have recruited a record number of NHS 24 call handlers, who will be available this winter to direct people to the most appropriate care, thereby helping to reduce unnecessary accident and emergency attendances.
Public Health Scotland recently revealed that levels of delayed discharge from hospitals reached a record high in August, which is one of our warmest months. The Royal College of Physicians has said that that should be a cause for huge alarm. Does the cabinet secretary think that hospital staff will gain any confidence from the Government saying the same thing it says year after year?
I accept the fact that delayed discharge is too high and that variation in performance of local systems is too wide. That is why I have been meeting the Convention of Scottish Local Authorities and local chief officers weekly to monitor progress. If it had not been for the intervention, support and whole-system approach that we took over the summer, there would be an even worse picture of delayed discharge.
I hope that the work that has been put in at pace by local systems—in particular those that have had the most challenging positions to address—will bear fruit and we will see a reduction, going forward. However, we need to reduce much faster so that we give confidence to the staff who work in our acute sector to ensure that they feel prepared for winter.
According to the care homes census, one in five care homes has closed since 2014, which means that there are 18 per cent less care homes than there were a decade ago, while demand is going rapidly upwards. Many more are likely to close over the coming years. That is the root cause of hospital overcrowding: people have nowhere to go. Cabinet secretary, is it not the case that the Government has lost control of social care?
Always speak through the chair, please.
No, that is not the case. We continue to work with local government to look at areas such as the national care home contract and improving the advice and guidance that are available for treating and supporting adults without capacity, to ensure that we support the position in local areas. There have been challenges in relation to care home closures and the decisions that have been taken at the local level in that regard, but there is more cause for optimism in some of the more challenging areas, where local authorities are looking at innovative ways of bringing some of those care homes back into use. That will be important.
We must also recognise that residential care is not the right place for everybody, and that we need to support more people at home. Hospital at home is an important investment that we are making. It is now the eighth-largest hospital for geriatric services in Scotland, and we will continue to support the work on expanding that, both as a means to support people to stay at home for longer and as a means to avoid hospital in the first place.
I refer members to my entry in the register of members’ interests. I hold a bank nurse contract with NHS Greater Glasgow and Clyde. What additional support is the Scottish Government providing to health boards to implement its winter planning?
A record number of NHS 24 call handlers are available this winter to direct people to the most appropriate care. We have also strengthened arrangements to alternative services, including flow navigation centres and same-day emergency care, to support people to receive the right care in the right place and to help to reduce unnecessary A and E attendances.
Over the months ahead, we will continue to work with boards to enhance patient flow at our acute sites, to improve discharge planning and hospital at home services and to reduce conveyance of people from care homes where it is clinically appropriate. We have baselined the funding that is available for health boards to support all-year-round surge planning, rather than its just being a focus in winter, as we recognise that such pressure could be faced at any point in the year.
The Royal College of Emergency Medicine has said:
“We are seeing lots of discussion, but we haven’t seen any useful measures so far that will make it any better for people working in A&Es this winter”.
That sums up the situation perfectly. Cabinet secretary, you have been in post for eight months and you are wheeled out time and again to provide smokescreens—
Speak through the chair, please.
The cabinet secretary has not delivered any meaningful action. Why has the cabinet secretary failed to improve A and E times?
First, I fully respect the views of the Royal College of Emergency Medicine—I went to Forth Valley hospital with representatives of the royal college to see the work that is being done there to improve the flow through the accident and emergency department.
I recognise the pressures that exist in our accident and emergency services. That is partly due to the delayed discharge picture and the need to make more beds available in hospitals, but we also need social care packages in place to enable people to leave hospital and return home without delay. We are supporting local systems to try to achieve that, both by getting the processes right and exemplifying best practice and by supporting those who have further to travel in order to ensure that they are able to meet our expectations for a much better service for the people whom we are here to serve.
The cabinet secretary mentioned hospital at home a couple of times in his answers. Can he say any more about the steps that the Scottish Government is taking to further develop the programme, which, as we know, plays an important role in reducing pressure on hospitals and ambulance services?
I thank Joe FitzPatrick for raising an important issue. To continue to develop the hospital at home service, the Scottish Government has made available £3.6 million of funding for 2024-25, which takes the overall funding for hospital at home for older people to more than £15 million since 2020.
The Scottish Government’s continued investment demonstrates that it is committed to hospital at home and sees the programme as a national priority. By providing care in that way, we are enabling more people to receive treatment in the comfort of their own home, rather than in an acute ward; we are relieving the pressure on front-line services in traditional hospital settings; and, crucially, we are getting better outcomes for those patients, which means that they are re-enabled at home and are more likely to stay at home for longer, and will require a smaller social care package as a result. That is a win-win, which is why we are continuing to invest in the hospital at home scheme.
That concludes topical question time.
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