Official Report 1222KB pdf
The next item of business is a members’ business debate on motion S6M-14408, in the name of Tim Eagle, on improving access to health and social care in rural Scotland. The debate will be concluded without any question being put.
Motion debated,
That the Parliament considers that people living in remote and rural areas face unique challenges when it comes to accessing health and social care; understands that the recruitment and retention of staff, poor infrastructure, and the inability to access certain services are all common issues that impact health and social care in rural and remote areas; notes what it sees as the failure of the Scottish Government to deliver infrastructure investment in the Highlands and Islands region and elsewhere, including the failure to deliver a new Belford Hospital in Fort William, complete upgrades to Dr Gray’s Hospital in Elgin, and build a replacement hospital for the Isle of Barra, among other delayed projects; understands that many communities in rural areas face a reduction of services, such as the reduced access to NHS dentistry in Dunoon and loss of care home beds across the Highlands and Islands region; believes that all of these factors contribute to the wider issue of rural depopulation, and notes the calls for the Scottish Government to properly invest in health and social care in rural and remote areas and deliver better health outcomes for residents.
17:02
I remind members that my wife is a general practitioner partner in a practice in Buckie and that I previously served for five years as a councillor in Moray.
When I first came to the Parliament, nearly a year ago now, the one thing that I really wanted to address was rural depopulation, and I focused on that issue in my first members’ business debate. In this debate, I want to focus on arguably one of the most fundamental issues that impacts rural depopulation: access to healthcare.
Following the debate on the Health, Social Care and Sport Committee’s inquiry into remote and rural healthcare, I raised some of the pressures that rural communities face, but I wanted more debate on such a big topic and to give other members an opportunity to highlight their local issues and stories. I am grateful to everybody in the chamber today.
I will not lie: there is an element of politics in this, as I fundamentally do not believe that the Scottish National Party Government has served residents of rural Scotland well. That is not just my view; I have heard too many stories of appalling failures to deliver healthcare from the people I represent—a lady who slipped and fell having to lie on her back for eight hours while waiting for a 20-minute ambulance journey; a man having a heart attack sitting outside a local district general hospital; the fact that it takes five, six or seven years to reinstate maternity services; and cancer diagnoses taking longer in rural areas than in urban areas. Those are appalling failures, but, as I know my colleagues will show, that is what is going on.
I think that I can split the issue into two areas. First, there are the macro problems: the big issues that fundamentally lead to poor health outcomes in rural areas—the topics that are discussed around the dinner table and are much discussed in this chamber, such as rural transport, connectivity, roads, local provision of services, housing and employment. Then, there are the smaller issues: the niche technical issues around rural healthcare delivery.
I asked a range of doctors across the north-east and the Highlands to tell me in their words what the issues are. They said that smaller teams are less resilient, so a small reduction in staffing has a bigger impact, whether temporarily or in the long term. They noted that there is less third sector community support than there was before, and they spoke of significant recruitment challenges.
One GP said that the role of a GP has fundamentally changed over the years, with most GPs now working part time, partly due to the workload and partly for a better work-life balance. A higher headcount is therefore required, which, in turn, is harder to deliver in rural areas. GPs need a realistic funding model that can sustain smaller establishments. The current system does not work.
Another GP spoke about the lack of any real push on remote and rural training programmes and said that a specialism in rurality should be encouraged in early work at medical schools. One doctor said that, due to their sheer size, larger hospitals tend to have a responsive and dynamic learning environment—something that is not easily delivered in smaller hospitals. There is also a lack of specialist trainees rotating through smaller rural hospitals to provide support to consultants and doctors in their foundation years. Another doctor pointed out that, when a long-term generalist who is amazing in their field is expected to retire in a few years’ time, there should be a mechanism by which another doctor can be brought in earlier to learn their core skills.
I am sure that the cabinet secretary is aware that, at present, maternity and orthopaedic services—and even basic screenings—are not being delivered in some areas. In my region, there are serious staff shortages in Elgin, Thurso, Campbeltown, Stornoway and Uist—I could continue. There are also recruitment challenges in general practice, as we saw with the first group of graduates from the Scottish graduate entry medicine programme. Of the 52 students who graduated, two have taken up posts in my region and eight others have taken up other rural posts.
If I had longer to speak, I could talk about social care, community nursing, mental health support, cancer diagnosis, vaccines and immunisations. We have unique challenges in rural Scotland, but we should never feel that we are being treated as second-class citizens.
In the spirit of commending workers in rural areas, I note that one advantage of smaller teams is that they are able to adapt, innovate and trial things more effectively. For example, Ross memorial hospital in Dingwall has been far more effective at reducing delayed discharge because it knows the teams on the other side a lot better. Does Tim Eagle agree that freeing up healthcare professionals and empowering them to take decisions on the ground is often more successful in rural areas?
I agree. I do not have time to go into this in my speech, but I would argue that some of the centralisation in relation to community treatment and care nurses and mental health support has not worked, because local teams are better at making local decisions.
Too often, the pressures that we are put under in rural Scotland manifest themselves in unfair treatment of staff, who are part of our rural communities. That is never acceptable. However, I understand that patients are anxious, worried and in pain and that they are never getting appointments or are, perhaps, being sent further away for treatments. We need to reflect those concerns in the Parliament and through our national health service boards. Health professionals on the ground should never face punishment for lack of delivery by those who sit on the Government benches here. I have a small plea: rather than leaving behind frustration or anger the next time that we need healthcare, let us consider leaving a packet of biscuits or a cake—maybe even a thank you.
We need bold, brave and common-sense policies that can deliver real and lasting change. If we want more doctors in our rural communities, we need to incentivise them to come. If we want rural healthcare to be strong and sustainable, we need to accept the costs that come with that and to provide working environments that offer educational opportunities and a fair work-life balance. We need to ensure that, in 21st century Scotland, we are providing the services that people need.
Other countries have been successful: in Estonia, the Government has developed an artificial intelligence-powered health information system; Brazil has taken on large volumes of community health workers; Chile has put in place a rural practitioner incentive programme, which provides financial and housing incentives and professional development opportunities; and Australia has the Royal Flying Doctor Service. The four key themes that underpin those global approaches are decentralisation, the use of technology, the use of incentives and ensuring community involvement. We need a campaign that brings all that together, continues to raise awareness and brings together people from across Scotland to show what is happening with absolute clarity. That is why I will start an awareness campaign for rural healthcare.
What I have said is no political trickery. It is a reality that must be fixed. We do not need more talk; we need positive action. Our communities feel the daily pain of a weakening health system, our staff are too often exhausted, district general services are depleted and health boards seem to have adopted an attitude of, “You come to us—we do not come to you.”
One person in the chamber could change that. They could grab those four themes and go wild with common-sense and actionable policies, shake up the system, support our rural staff and provide the change that is needed. If the cabinet secretary does not do that, I hope that the people of Scotland will let the Scottish Conservatives do it in 16 months’ time, because—rest assured—we would.
Before we move to the open debate, I advise members that we are heavily oversubscribed for this debate. It is inevitable that we will have to extend it by half an hour but, even then, we might struggle to accommodate everybody. I am keen to include everybody who wants to speak in the debate, but that might mean that later speeches have to be truncated somewhat. I ask that all members stick to their speaking allocations and do not go beyond them, because they will be cut off.
17:10
I thank Tim Eagle for, as he said, giving us all the opportunity to raise important matters. I wish to focus, as I have intimated to the cabinet secretary, on one of them—namely, the forced removal of vaccination services from GPs in 2023.
Last spring, an infant in Highland died. No doubt, as is appropriate, the fatal accident inquiry will investigate the circumstances in due course. The family seeks total privacy: that must be respected. However, as the cabinet secretary knows, it is the belief of GPs who have been consulting, informing and advising me—notably, Dr Alastair Noble and Dr Adrian Baker from Nairn and, more recently, Dr Ross Jaffrey from Beauly—that the case arose because of lack of access to vaccination following the loss of provision of the service by local GPs.
That change was brought in in 2023. When I took up the case, I challenged whether it should take place at all. I have challenged Humza Yousaf, Michael Matheson, Neil Gray and the current and previous First Ministers, in the chamber, in meetings and, repeatedly, in letters. What has happened is that the GP contract has enforced removal of that service from GPs, despite the fact that three quarters of GPs in Highland voted against the contract.
Now, 90 per cent of GPs want to have the service back. I am informed by Dr Jaffrey in a paper that he provided recently—I have furnished the cabinet secretary with a copy of it—that the 10 per cent of GPs who do not want it back are largely members of a Highland health board practice who are, no doubt, taking their lead from NHS Highland.
There are many problems with that. There is cost—the old system cost roughly £1.5 million, and it is believed that the new system costs £6 million. If we extrapolate that across the whole of rural Scotland, it is a massive waste of money.
However, the cost is not as important as the harm. I think that we would all accept that. One of the truly utterly shocking facts is that details of who has and who has not received immunisation—whether it is for flu, measles, mumps and rubella, whooping cough or Covid—cannot be shared with GPs. Immunisation is done at centralised locations, and when they see a patient, GPs do not know whether the patient, particularly when the patient is child, has been immunised. As Dr Jaffrey pointed out in his recent paper, that is leading to a drop-off in immunisation rates. He said that they used to have a surge and do 60 per cent in October to get herd immunity up, but that has all gone. The facts are there in Ross Jaffrey’s report. I cannot go over them all, but the levels of immunisation in things such as—
Will the member take an intervention?
Yes.
Be very brief, cabinet secretary.
I have met Fergus Ewing and those GPs’ colleagues, whose advice I am very grateful for. I hope that he will accept that I have also provided clear guidance and authority to NHS Highland to use the flexibility that is contained in the 2018 contract to ensure that, where general practice-led vaccination can take place in order to remove barriers to access to vaccines, it should and can do that.
You need to conclude.
I appreciate that the cabinet secretary’s intentions are entirely honourable and good. I entirely accept that. However, as a former minister, I gently say to him that good intentions are not enough. Given what the cabinet secretary said, I do not know why NHS Highland has not restored the service to GPs. In 25 years here, I have never wished to be alarmist about a health issue, but if action is not taken soon, what will the cabinet secretary say if another infant’s life is lost because they cannot access life-saving vaccinations for diseases that we thought had gone for ever—
We need to move on. I call Finlay Carson. You have up to four minutes.
17:15
I congratulate Tim Eagle on bringing this crucial topic to the chamber.
Living in rural Scotland remains a massive challenge and it is certainly not getting any easier, thanks to the centralist approach that the SNP Government is taking. I was born and raised and, thankfully, still live in beautiful Galloway, so I know the many benefits of residing in a rural community, not least of which are the stunning scenery, the abundance of fresh air and—which is most important—being part of the strong bond that rural communities represent.
However, the pros are rapidly being overtaken by the cons, especially when it comes to accessing health and social care, for starters. People are having to travel greater distances to access an ever-increasing range of services that are often taken for granted by people who live in towns and cities. We are seriously struggling to recruit and retain staff across a wide spectrum of skills, from dentistry to midwifery to nursing and social care staff. The large number of unfilled vacancies places an even greater strain on an already under pressure NHS workforce.
As we heard earlier in a members’ business debate that was brought to the chamber by Rhoda Grant, the Scottish Human Rights Commission’s 2024 report on the Highlands and Islands highlighted the pervasive issues of rooflessness, hunger and limited access to healthcare. Although the report’s findings are specific to the Highlands and Islands, they resonate deeply with us in Galloway.
I am delighted that the commission will now look more closely at similar problems that are being experienced in my constituency. Access to healthcare remains a significant challenge where long waiting times and limited availability of services are barriers to the care that residents need. That is not only a violation of their rights, but a threat to their health and wellbeing.
As in other rural and remote communities, there is a serious crisis in midwifery, particularly in Wigtownshire, which I have raised on countless previous occasions in the chamber. According to two former GPs—Dr Gordon Baird and Dr Rod White, to whom I am indebted for their forthright opinions and advice—the current maternity arrangements fall well below any minimum standard.
NHS Dumfries and Galloway’s integration joint board carried out a review to examine the current system, which has failed women and families for the past six years and has led to many distressing stories of roadside deliveries and dashes to the maternity hospital in Dumfries. Women in labour are simply being told to bypass their local community hospital’s accident and emergency department and, with no access to a local midwife out of hours, are forced to travel up to 90 miles along the A75. It should be pointed out that Stranraer is in many ways deprived. There, 40 per cent of people lack access to personal transport—never mind public transport—so we can add that to the equation in getting to Dumfries, which might involve waiting for an ambulance.
It is little wonder that Dr Baird and Dr White insist that, without appropriate action, the system falls way below any minimum standard that could be regarded as fair or reasonable. They insist that the integration joint board’s review was not independent in its structure or conclusions.
Data has often been ineptly handled to mislead politicians. Indeed, the board’s record on implementation of such reviews affecting Wigtownshire, including on the future of our four cottage hospitals, is dismal, to say the least. As well as overruling mothers-to-be, who wanted the birthing suite at the Galloway community hospital to reopen, and instead forcing them to make that journey to Dumfries, the IJB ignored the findings of an independent review that was carried out by health experts from Ayrshire, which recommended that local maternity facilities be reopened.
All of that flies in the face of the advice of Minister for Public Health and Women’s Health, Jenny Minto and, indeed, that of Maree Todd, who visited Stranraer and who wrote to me last October, stating:
“The Scottish Government expects all NHS Boards to provide maternity services that are delivered as close to home as practicable, and to offer a full range of birth place options within their region.”
You need to conclude.
In nobody’s mind is 90 miles “close to home”.
You need to conclude.
Once again, I urge the cabinet secretary to consider an urgent review of the matter.
Neither of the last two speeches has been within four minutes. We will need to do better, otherwise members who want to speak in the debate will be deprived of the opportunity to do so.
I call Douglas Ross. You have up to four minutes, Mr Ross.
17:19
I congratulate Tim Eagle not just on securing tonight’s debate but on the tour de force speech that he gave on issues affecting his constituents—our constituents—in the Highlands and Islands and other people across rural Scotland.
The issues that I raise tonight will not be a surprise to the cabinet secretary; I have raised them many times in the chamber before, and I will keep coming here and raising them until we see improvements and change.
The first issue is that of the save our surgeries Burghead and Hopeman group. Some of the campaigners were going to come down to the Parliament to watch the debate when it was previously scheduled, and they had hoped to be here today; however, because of illness, they are not. When I met them on Monday, they wanted the cabinet secretary and his ministers to know that they will be watching the debate at home in Moray to hear—they hope—a positive response.
Last month, when I raised the campaigners’ concerns and their proposals for a nurse-led unit in Burghead to replace the GP surgeries in Burghead and Hopeman that they have lost, they hoped to hear positive news, but they did not get it: from Jenni Minto, they got a point-blank refusal.
I asked the campaigners for their words, because I do not want to make this a party-political issue. They said that I could tell members that they were “bitterly disappointed”. They also said that it is “very frustrating”, given the positive meeting—which I attended—that they had had with Jenni Minto in Burghead in the summer. I hope that, following the proposals from the save our surgeries Burghead and Hopeman group, the cabinet secretary and his ministers will reconsider the plan, because, without Scottish Government support, it will go no further.
There is an opportunity to show the local group—campaigners who are dedicated to services in their area—that there is an opportunity to have a nurse-led service in Burghead. I have written to the cabinet secretary to ask that, if ministers continue to say that they will not support the plan, they tell us the funding calculation that they have made on the proposal. Without that, it will seem as though the local group is being fobbed off when there is a real opportunity to provide a local service.
The other issue that I want to raise, which has been on-going since 2018 and which I have mentioned repeatedly in the chamber is the lack of consultant-led maternity services at Dr Gray’s hospital. I spoke to Marj Adams and Kirsty Watson of the keep MUM—maternity unit for Moray—campaign group ahead of the debate. The points—both positive and concerning—that they want to get across are important.
On a positive note, Marj and Kirsty said that they are really encouraged by the system of consultation that is being held locally and by the local staff at Dr Gray’s hospital, who are pushing that forward. Like me, they are positive that elective caesareans could return to Dr Gray’s soon. If we could get a date for that, that would be welcome news in Moray.
Marj and Kirsty are slightly more concerned about the Dr Gray’s strategy planning paper that went to the NHS Grampian board on 12 December. Quite apart from anything else, it was quite a concerning report. What public consultation was there by NHS Grampian in order to hear from people in Moray, Aberdeenshire and Aberdeen city—in particular from those in Moray who rely on Dr Gray’s? Where was the public engagement? There does not seem to have been much. Marj and Kirsty stated that they have heard from several NHS staff that they fear that, at NHS Grampian board level, the commitment to the restoration of the consultant-led maternity unit at Dr Gray’s is weak.
The reason why we need the unit back again is clear from a freedom of information response that I have received about the number of babies born to Moray parents since 2018 who were born outwith the area. Of the more than 5,500 babies born to Moray parents since 2018, just over 1,000 were born at Dr Gray’s; more than 4,200 were born in either Aberdeen or Inverness. They need to be born locally. We need that service back up and running, because, on top of that, almost 550 Moray mums, including my wife, have had to have a blue-light ambulance transfer to give birth. It needs to get a lot better, and I hope that the cabinet secretary will listen to those points and act urgently.
17:23
I, too, thank Tim Eagle for securing the debate.
Access to health and social care in the Highlands and Islands is poor, which is borne out by the Scottish Human Rights Commission spotlight report that we debated earlier today. The availability of social care is declining. Since 2022, 218 social care beds have been lost in the Highland Council area alone, and the lack of social care is putting pressure on primary care when people await discharge to suitable accommodation. The lack of suitable support or accommodation means that people are trapped in hospital and, because of that, hospitals cannot admit other people for treatment, which leads to lengthening waiting lists all over the place.
Back in 2021, the Feeley review recommended a human rights-based approach, whereby people are aware of and can advocate for their rights, and can easily access and maintain the care that they need. That recommendation has not been met and, sadly, things have simply got worse. The situation is even more distressing for those who are in their final days. Time that should be spent at home, surrounded by loved ones, is spent trapped in hospital.
The Scottish Human Rights Commission recommends human rights-based budgeting that provides services that fit the needs of the people who access them. The lack of access to gynaecological services and maternity care in rural areas is unacceptable.
On Rhoda Grant’s point about social care, the progress that we are seeking to make in relation to a national care service is about enshrining a human rights-based approach to decision making and budgeting. Does she agree that, as we seek to reconsider the issues around a national care service, we should maintain a human rights-based approach to decision making and budgeting at all levels on social care?
I agree that a human rights-based approach to budgeting must be taken at all levels to meet people’s human rights. That was clear from the Scottish Human Rights Commission’s report.
I return to the issue of gynaecological services and maternity care in rural areas. It is unacceptable that mothers are having to travel 100 miles to give birth when they are in middle of labour. That is surely not a human rights-based approach. The situation is even worse when the roads are blocked.
Hospitals and services in the Highlands and Islands have been impacted by budget cuts. The Caithness health review is on hold, as is NHS Highland and NHS Grampian’s joint maternity redesign. We have had more positive news about the Belford, but the go-ahead for the replacement hospital has been given only for the planning and design stage. The planning and design stage for the new hospital on Barra was completed, but then the project was unceremoniously dropped by the Scottish Government. That provides cold comfort to the people of Lochaber in the context of the Belford, who must keep up the pressure for their hospital. In relation to Barra, the Scottish Government must reinstate its commitment to the Castlebay campus and provide people with the hospital that they need. I could cite many other issues.
I know that we are tight for time, but I want to turn to the Government-initiated Scottish graduate entry medicine programme. Although it aims to boost rural GP numbers, it has delivered only two trainee doctors in the Highlands since 2016. We know that allied health professionals are not available, so people cannot access services that are no longer provided by GPs. We need a review to be carried out of the GP contract, and we need that to be done with a vision for rural areas in mind. I urge the Government to do that as soon as possible.
17:27
As other members have done, I thank Tim Eagle for bringing the debate to the chamber. The number of speakers and the pressure that is being brought to bear highlight just how important the issue of access to health and social care is to those of us who live in rural Scotland and, of course, on our islands, and to our constituents and communities.
There are a number of areas that I would have liked to cover today, but I am very conscious of time, so I will not be able to go into detail on all of them. However, I hope to cover some key areas of concern. As Tim Eagle did, I will start with GPs.
I recently met GPs in Orkney, who raised some of the challenges that they face, which have only increased over the years, seemingly with little response from the Scottish Government. The waits to see a GP have grown, as has the paperwork that they have to deal with—they spend hours on repeat prescriptions or meeting data requests from patients. Because all of that has to be delivered by GPs themselves, they have less time to spend dealing with patients, which only increases the pressures on the system.
I know from personal experience the pressure that social care is under. There are not enough carers, and there are not enough places in suitable accommodation for people who need care, so our hospitals are full of people who simply do not need to be there. That situation is not getting better; it is only getting worse.
Only last year, the Moss Park care home in Fort William was threatened with closure. The residents were prepared for resettlement in new homes. Understandably, they and their families were concerned that those new places would not be local and would not be in the communities that they grew up in, where they wanted to stay. There was also understandable concern in the community that the loss of places at the Moss Park care home would mean that staying in Fort William or even Lochaber would be impossible for local people in the future.
Although it appears that there has been a reprieve for the home, for how long will that be the case—a few years or slightly longer? That community in Fort William—current residents of the home and those who may need it shortly, and their families—deserve to know that care places will still be available locally in the future. At present, they cannot be confident that that will be the case.
I hope that the member will recognise that, along with the constituency member, Kate Forbes, I met residents and family members at Moss Park and that interventions by the Government and Highland Council have seen the home being saved. I recognise the strength of feeling in that community and will continue working with Highland Council to see a long-term and sustainable approach.
Saved for how long? That is the problem.
What will the loss of care provision mean for the Belford hospital, which is itself in need of replacement? I joined the local community, campaigners and other politicians in Fort William last year to highlight the increasingly desperate need for the much-promised but much-delayed replacement finally to be delivered. A clear message was sent to the SNP that Lochaber would not accept more delay. There has been positive news about the Belford recently, but, like many in the community, I will not accept that real progress has been made until we see spades in the ground as work on the build begins. That community has been let down too many times before by SNP ministers in Edinburgh who are big on promises but not so big on delivery.
Colleagues have spoken about the long journeys faced by young mothers in Caithness and Moray and those are also faced by many living on Skye. A former paramedic described to me a high-speed drive, with blue lights on, from Skye to Inverness. It was winter, it was dark and the roads were unsuitable for anything other than careful and often slow driving. That situation is not acceptable and I am sure that even those on the SNP front benches will recognise that.
That story also highlights the pressure that the Ambulance Service is under. I held my own members’ business debate just a few years ago on the pressures faced by the Ambulance Service and its crews and I know that the service continues to be called on to help or provide cover in areas outwith what should be its remit. That is only exacerbated on Skye when promises to return 24/7 urgent care to Portree hospital fail to be delivered time and time again.
I must conclude, but I could have spoken, as others have done, about the pressures on mental health provision, the loss of local dentistry, a lack of the physio support that is important for many older residents, nursing shortages and the lack of accommodation. I hope that this debate will leave the health secretary under no illusions about the severity of the pressures on our rural health services and the desperate need and public demand for a reverse to the running down, centralisation and loss of services that we have had during the SNP’s 18 years in power.
17:31
I am grateful to my colleague Tim Eagle for bringing forward this debate on rural healthcare.
At 5 past 4 this afternoon, just over an hour ago, I received an email from a constituent, which I will read out word for word. It states:
“Dear Rachael I’m waiting for cataract surgery at Borders General Hospital. I was told in December it would be possibly a year. Now I’ve just had a call from BGH telling me if I don’t accept the Jubilee Hospital as an option I’ll be removed from the waiting list. This I find to be totally unacceptable as I’m 82. I can’t travel to Glasgow; I’m not able. So as from today I am no longer on the waiting list. Just thought I’d let you know this because I believe it’s the SNP government who has made this decision. Listening to First Minister’s questions today I was shocked at what I was hearing about the NHS and replies from John Swinney as if everything is ok. I just can’t believe this.”
Will the member write to me with the details of that case? We are investing in making sure that we can get through the waiting lists and are using the national resource that is the Golden Jubilee hospital, as well as regional resources, on matters such as cataract surgery. I want to see more detail about what has been communicated to the constituent, because that is certainly not the way that we would want, or expect, patients to be communicated with.
I am very grateful to Neil Gray for that response and will certainly write to him. I have also written to him in the past couple of days to invite him to come to the Borders to thank the hard-working front-line staff and to see what more can be done to improve the terrible outcomes that we are seeing in the Borders, an issue that was covered last night on the “Representing Border” programme on ITV Borders.
Only 58 per cent of patients are seen within the four-hour target. Those figures are the worst on record since 2007 and the third worst in Scotland, and Neil Gray knows that. I put on the record that that is not caused by the influx of flu patients, because those figures are from November and so are not about that.
In the brief time that I have, I will cover the financial situation of health boards across Scotland. We received an email earlier saying that NHS Grampian is going into stage 3 of the intervention framework. In my constituency, the financial situation of NHS Borders is critical, and the cabinet secretary knows that. In just two years, the deficit has doubled to £33.6 million. The board has been at level 3 since 2021, but what support has the SNP Government offered? In my opinion, it has put the board under further strain by asking it not only to balance the books but to make cuts at the same time. Ironically, one of the cuts that has been outlined is a 10 per cent reduction to a workforce that is already struggling to cope with demand.
Wait until you hear these figures. In the past four years, NHS Borders has lost 10,000 working days every year to staff absences related to mental health. I have brought that figure to the chamber before—it is unbelievable. The staff who are carrying the burden
“are running out of goodwill.”
That is a direct quote from the chief executive, Peter Moore. Even when NHS Borders manages to achieve financial balance, it will still have to pay back outstanding brokerage, which may have reached a staggering £100 million by March 2027.
I realise that we are short of time. There is so much more that we need to do, and I would like the cabinet secretary to come to the Borders to meet the hard-working staff.
17:36
I thank Tim Eagle for raising this important topic in the chamber. In addition to the list of facilities that need replacement that is included in the motion, I once again raise the need for a new-build Gilbert Bain hospital to serve residents in Shetland. The hospital also serves a wide maritime area because of Shetland’s geographic position. It is often the closest available medical facility for fishing vessels, offshore energy sites and passengers from cruise ships in the North Sea.
Last year, 134 ships carrying more than 138,000 passengers visited Shetland, and some had to visit the Gilbert Bain hospital. The coastguard rescue helicopter regularly flies to Lerwick to land patients who have been airlifted from vessels or oil rigs for treatment at the hospital. It is long past time that the 1950s-designed hospital was replaced with a modern, fit-for-purpose facility. I once again put on the record my call for progress on a new hospital for Shetland.
There is much that could be said on the subject that we are debating this evening but, as time is not on my side, I will limit my remarks to some of the issues that Shetland patients face. The first is travel. NHS Shetland has arrangements with mainland health boards, such as NHS Grampian, to provide the healthcare that is not available in Shetland. However, the impact that communication, or miscommunication, between different hospital departments can have on island patients was raised with me recently.
One of my constituents was required to stay in an Aberdeen hospital for a night longer than necessary because they were waiting for a prescription from the hospital pharmacy. Had there been a more pragmatic approach, they could have been discharged and the further night in a hospital bed in Aberdeen would have been avoided. The script could have been handed to the patient and they could have taken it to a pharmacy in Aberdeen and been able to fly home that evening.
The rules on the reimbursement of travel costs also impact on access to healthcare. For Shetland residents on the island of Bressay, the only way to reach the hospital or health centre in Lerwick is by ferry across a mile of water. The current travel rules allow reimbursement only when patients travel more than 5 miles by sea, which raises the question of why 5 miles was set as an arbitrary limit. Either there is a stretch of water that needs to be crossed or there is not.
That, too, needs a pragmatic approach. I welcome the fact that NHS Shetland is running a six-month pilot scheme in which Bressay residents may claim for a trip to the Lerwick health centre. That follows both the community council and I raising the financial impact on patients, which can be significant when a series of frequent and recurring appointments is necessary.
Underlying all those issues are the challenges of depopulation that rural and island Scotland faces, which are highlighted in the motion. The lack of infrastructure, housing and digital connectivity impacts on recruitment and retention of NHS staff and, in turn, the reduced healthcare provision exacerbates depopulation.
Technology allows us to embrace new forms of healthcare, which can be transformative for healthcare provision, particularly in rural and island areas with small populations, but the lack of reliable digital connectivity makes the credibility of that prospect distant until real action is taken to improve rural and island high-speed broadband. Age Scotland found that, in Scotland, 25 per cent of people aged over 60 do not use the internet, which is another barrier to healthcare through technological means when we consider that 27 per cent of the population in rural areas are aged 65 plus. Addressing healthcare needs in rural and island healthcare includes investment in infrastructure.
I just about have time to let members know that, when I visited the Out Skerries community last summer, the poor information technology connection at the nurse’s house was the subject of debate. I had been told that, when the general practitioner had been in the isle a few days previously, they were unable to get online.
I am out of time.
I advise the chamber that there remains significant interest in the debate. I am, therefore, minded to accept a motion without notice, under rule 8.14.3, to extend the debate by up to 30 minutes. I invite Tim Eagle to move the motion.
Motion moved,
That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[Tim Eagle]
Motion agreed to.
17:40
I thank Tim Eagle for this important debate. Like my colleagues, I also thank our exceptional healthcare workers. My daughter was recently taken into Aberdeen royal infirmary, so I know that staff are working extremely hard and doing a fantastic job under pressure.
I take this opportunity to raise some of the concerns about our declining health services that I hear of every single day as the constituency MSP for Aberdeenshire West. Our local services are at risk of collapse and our GPs are crying out for help. The cabinet secretary will be aware that I have long campaigned to keep our community hospitals open, particularly Insch war memorial hospital, which was closed at the start of Covid and remains so, despite broken promises made by two First Ministers.
Elsewhere, closures such as that of the Scolty ward dementia unit at Glen O’Dee in Banchory see services removed. The minor injuries unit in Huntly has had its overnight provision slashed, which causes a serious worry that GMED services will also soon face cuts. Those local units would relieve pressure on ambulances and the ARI, but the health board simply does not have the funds to keep them open. As has been mentioned, NHS Grampian was escalated to stage 3 of the finance framework today, which will no doubt lead to further cuts and closures.
Like others, we have also seen a reduction in services being provided locally. The SNP Government’s one-size-fits-all approach simply does not recognise the reality of our rural communities, and that has very real consequences in people’s lives. Centralisation has resulted in elderly constituents being forced to make lengthy journeys, often in areas without public transport, for something as routine as a flu jab. Some residents in Alford were even told that they should organise taxis with other patients, which is a ridiculous suggestion, considering that they would not know other patients’ appointment times due to the general data protection regulation.
As others have touched on, ambulance provision affects my whole constituency. In October, a baby was delivered under traumatic circumstances, and the family had to do CPR for half an hour on a newborn baby before an ambulance arrived.
Although I am grateful that the health secretary has agreed to meet me, I have little confidence that the SNP will implement any meaningful change after mismanaging our NHS for 18 years. Where communities find solutions—such as covering the capital cost of a new 4x4 first responder vehicle in Braemar—the Scottish Ambulance Service rejects them, saying that it will not cover the maintenance costs. I look forward to the cabinet secretary’s response to that when we meet; it is a decade after the Braemar ambulance was stripped from the community.
For rural communities, the decline of healthcare provision is now literally a matter of life and death.
17:43
I thank the member for securing this debate. For obvious reasons, I will focus on my constituency, which is part of the rural Borders. Of course there are pressures in rural areas on the broad range of health services, which by the nature of distance, topography and demographics—with more elderly people—differ from urban areas. I know that not only because I am constituency MSP, but because in earlier times I lived in Minnigaff, in rural Galloway, which is 60 miles from either Ayr or Dumfries hospital.
However, although there are pressures, as there are across the UK, there are advantages to being rural. Everyone across the professional and voluntary sector seems to know someone who knows someone else, whether GPs or pharmacists, or housing agency, social work or NHS Borders staff. Collaboration, which is so difficult in urban areas, is personal. Of course, volunteers interact not only professionally but socially, and in smaller communities, there is even closer-knit collaboration.
Regarding Rachael Hamilton’s comment, I have had similar situations and have intervened successfully for a constituent when an alternative offered to them simply was not practical. What was said was wrong—not what Rachael Hamilton said, but the message that her constituent received.
In recent years, NHS Borders has successfully taken on 33 international recruits. The figures are slightly historical, but they show that a further 27 had not yet started and they demonstrate success. How did the health board do it? It set in place contacts with local services, schools, key worker housing and so on for the recruits and their families. Things were made comfortable for people who wanted to come to work professionally in the Borders.
I turn to hospital at home, which does what it says on the tin. It was launched as a pilot in the Borders in 2023. On a recent visit to Borders general hospital with the Cabinet Secretary for Health and Social Care, we learned of the success of hospital at home for the wellbeing and recovery of patients, particularly the elderly. NHS Borders benefits from the largest slice of the Scottish Government’s funding to continue to develop that service, having been allocated £600,000 from a £3.6 million pot. Evidence shows that those who benefit from the service are more likely to avoid hospital or care home stays for up to six months after an acute illness. It frees up hospital beds, and more than 90 per cent of people who took up the offer had nothing but praise for it. It is so much better if people can be treated and recover at home, in the comfort of familiar surroundings.
The voluntary sector is integral to the delivery of healthcare and wellbeing across the Borders. The Royal Voluntary Service has a Scottish Borders hub. Volunteer drivers can take clients to regular NHS appointments in the community, and patient transport for cancer care appointments, which may be outwith the local area—even as far as Edinburgh royal infirmary—is covered. Similarly, Borders Wheels, which I visited in Galashiels, is available to take people to health appointments and respite care. Such services are difficult to connect in urban areas.
We Are With You—formerly known as Addaction—is a drug and alcohol support service in the Borders that I have visited a few times. It is free and provides non-judgmental support and advice from what it now calls the with you team. Everything, whether in person or online, is confidential. The only time that that might change is if the service has serious concerns about the safety of a client or someone else. We Are With You provides support groups, as well as support for family and friends. There is a free syringe service, which is very discreet.
Finally, Dementia Friendly Tweeddale is very supportive, not just of people who have been diagnosed with dementia but of their families. I commend all the NHS services and volunteers across my constituency for what they do.
17:47
We have heard a number of accounts today of how remote and rural communities suffer from a lack of attention from the Scottish Government when it comes to health and other services. Ayrshire, in my region, is no different. Doctors at Girvan community hospital recently came to the conclusion that they were unable to continue the valuable overnight service for patients in the area. They cited “sustainability and workforce issues” as the reason for the withdrawal; in other words, a lack of money, a lack of resources, a lack of trained GPs coming through the system and a lack of focus by the Scottish Government on the needs of rural Scotland. It is the first time that local medics will not staff the facility. Until now, the 20-bed unit has been nimble and quick in its response to patient needs. The fear now, with doctors coming from further afield to deal with urgent cases, is that a quick and reliable response will be placed in jeopardy.
Those in charge have maintained that patient care will remain a priority. Some rejigging of the region-wide urgent care service means that there will at least be some help at hand. However, that downgrade is even more concerning to locals, given the availability of ambulances in the rural Carrick area, which has already been highlighted. To add to their concern, there are constant road closures and diversions on the main route—the A77—to hospitals. I have been assured that ambulances are given priority access through road closures, but anyone travelling by themselves to hospital can be faced with substantial diversions that make their journey take hours.
However, that is not the only example of how rural healthcare in Ayrshire is suffering under the SNP. In addition to the lack of ambulances in the rural Carrick area, there have been service changes for patients of clinics in Ayr and Kilmarnock. Flagship schemes to attract more GPs to work in areas such as rural Ayrshire have fallen flat, and people find registering with a dentist challenging. No consideration is given to patient transport when local clinics are moved to centralised locations.
Health services in rural Scotland face so many unique challenges because of the geographical hand that they have been dealt. However, often, the nationwide failings of the health service are felt even more acutely in smaller countryside locations. No one pretends that there will be an easy fix. However, the SNP has been in power in Scotland for coming up for 18 years. With every year that goes by, its attempts to blame everyone else become less and less credible. As members’ contributions to the debate have shown, people often feel such failings more painfully the further away from the big cities that they live.
17:50
I thank Tim Eagle for securing the debate. It has been a popular subject, which has enabled members to talk about issues in their own rural areas. I managed to write some additional notes as previous speakers were making their contributions.
At the end of last year, just before recess, the Parliament’s Health, Social Care and Sport Committee published its report on remote and rural healthcare in Scotland. The committee made recommendations on education and training; staff recruitment and retention; the current design and delivery of services; primary care; multidisciplinary and team working; and the importance of the third sector. It was good to hear Christine Grahame mention those aspects, too.
A prevalent issue was the lack of housing in remote and rural areas, not only for full-time workers but for people who have been assigned placements as part of their training in more remote and rural areas. I have been raising these challenges in the Parliament for the past eight years: cancer pathways; maternity services in Wigtownshire; the recruitment and retention of health and social care staff; addressing delayed discharges; and ensuring that our local social care system is able to cope with increasing high demand. I have also been working with former GPs Dr Gordon Baird and Dr Angela Armstrong to raise rural Wigtownshire healthcare issues here in the Parliament.
I will touch briefly on some of those challenges. With an older population, there are more hip and knee replacements and more cataract surgery. I have a background as an operating room nurse and was previously a clinical educator for NHS Dumfries and Galloway, so I know that such surgeries are complex as far as anaesthesia and the required technique and skills are concerned. Only three or four hip or knee surgeries can be done in a day. I welcome the fact that we now have national treatment centres that can focus on addressing those issues.
Some work is being taken forward. NHS Dumfries and Galloway has successfully recruited nurses from Uganda. As part of embedding them into the work environment, it provided them with support on the Scots language and phrases, so that they would ken when somebody said, for example, that they had a sair heid or that their lugs hurt. That is really positive.
NHS Dumfries and Galloway has experienced a high number of deregistrations of dental practices. Minister Jenni Minto is well aware of that: she has been paying attention and has taken loads of questions in the chamber about it. We know that many people are now paying for private treatment and others have no dentist at all. Just last week, I met a constituent who is a retired dentist whose practice had focused on paediatrics and the prevention of dental caries. He welcomed the fact that the baby box now contains a toothbrush, which helps to prepare babies for the feeling of having a toothbrush in their mouth. That is another good news story. I know that the Minister for Public Health and Sport is working with NHS Dumfries and Galloway on dentistry. However, my dentist constituent said that he suggested 20 years ago that a mobile dental hub model should have been created for rural dental services in the area.
I will not pursue maternity issues, because Finlay Carson has covered those. I invited Mr Carson and Colin Smyth to join me at a pre-arranged meeting with the minister, because I wanted us to have a cross-party and apolitical approach. The minister met us last November. Engagement is happening.
The final area that I want to mention is delayed discharges. I know that the Cabinet Secretary for Health and Social Care, Neil Gray, is all over the issue with NHS Dumfries and Galloway. There are challenges with rural care packages and delayed discharges, but more than 90 per cent of all hospital discharges now happen without delay.
17:55
I start, as others have, by congratulating my colleague Tim Eagle on bringing this hugely important matter to the chamber.
We are all aware of the pressures that the Scottish health service is under and the incredible work that our healthcare professionals do in such a difficult environment. Those pressures are magnified when trying to deliver healthcare in rural areas. There is much that we could discuss in the debate, and much already has been discussed, but I want to focus on the part that technology could and should play in the health service, especially as a major solution for rural healthcare delivery.
We need a health service that effectively delivers healthcare across our country, and that delivers an environment that supports our healthcare professionals. We need to recognise that delivering effective and efficient care will require different approaches and adaptations for rural and urban settings. The development and adoption of technology into the health service in the United Kingdom has lagged way behind the rest of the world, and Scotland lags behind the rest of the UK. The inability to share data across health boards and between primary and secondary healthcare, pharmacy and the third sector seriously hampers our ability to deliver effective and efficient healthcare.
However, the problem that we are trying to solve is one of time. How do we give our healthcare professionals more time to deliver healthcare, as opposed to swamping them with administration and red tape? First, we need a Scotland-wide technology platform with a basic architecture that allows for interoperability between health boards and facets of healthcare, with different and appropriate levels of access. Once that is in place, we will have the ability to take out duplication that occurs in back office administration across health boards. We will also have the ability to share good practice and access patient records directly, and once that is in place, we can start to look at how we take services to the people, rather than insist that people come to the services in all cases, as was raised by Tim Eagle.
We have the ability to deliver scans, pharmacy and vaccinations, as was highlighted by Fergus Ewing, and even the ability to deliver doctors’ surgeries, from mobile units. With a basic communication and collaboration platform, those mobile units could be directed to any hotspots, and a workforce plan for rural communities could be easily established. Tim Eagle highlighted the specific problems of small teams and staff shortages. If we layer AI on top of that, diagnosis from scans can be almost immediate. While we are on the subject, imagine being able to remotely access consultants from a mobile doctors’ surgery. Multilayered access to healthcare currently takes months of appointment making, with the patient having to travel from pillar to post. That is especially relevant for people who have to take a ferry or drive hundreds of miles for a 15-minute appointment.
Those options are not fantasy or science fiction—they have been available for years. That is how we deliver access to healthcare for all. It is how we create a rural healthcare system that encourages people to stay in a rural setting, and it is how we reduce the intolerable strain on our health service.
As the old saying goes, the definition of madness is doing the same thing over and over again and expecting a different result. Continuing to increase investment in the health service without a long-term plan, as Audit Scotland said in its report on the SNP health service, is unsustainable. Change the delivery mechanism. Give more time to our healthcare professionals to do what they do best. Otherwise, all the Scottish Government is doing is continuing to manage the decline of healthcare in this country, which is felt ever more acutely in our rural communities.
17:59
As a South Scotland MSP, I am no stranger to the harsh realities that people who access health services in rural areas face, and like other members, I receive lots of correspondence on the issue. Living in remote and rural communities should not limit people’s access to basic and specialist care, but we know that it does.
I was going to cover maternity services, but other members have spoken about that very well. We need to understand patients’ wishes about local models of care, in particular for maternity services, because we all agree that women having to deliver babies in lay-bys is not safe. The pretence that we are doing something to make something else safer does not hold true in those circumstances.
I will move on to the other points that I want to raise. The intentions of the national centre for remote and rural health and care are very welcome, but I do not think that the initiative is widely understood by boards, clinicians and patients. If we want to maximise what the centre could do, we need to do some work on that.
I turn to the healthcare workforce. As another member said, the Health, Sport and Social Care Committee’s inquiry into remote and rural healthcare highlighted the critical importance of the local availability of suitably trained staff and of development opportunities to support the recruitment and retention of the healthcare workforce. That applies across the board but is particularly important for some of our professional workforce, such as nurses, allied health professionals, consultants and GPs. The Government must work with trade unions, professional bodies, training providers and NHS boards to discuss opportunities to improve the flexibility and delivery of training.
That is what we are trying to achieve with the nursing and midwifery task force, which I hope that the member recognises. Its recommendations and findings are due to be published and we will seek to deliver on them as quickly as possible.
I recognise that we have discussed that before in the chamber. I suppose that some of my frustration is about the urgency. We have a lot of the evidence, and we need to move on to delivery. Some of the initiatives that Brian Whittle mentioned about the delivery of training would be very helpful.
I want to mention apprenticeships and the opportunity to introduce tailored and flexible approaches to education and training. As I have said before in debates about the NHS, I strongly urge the Government to consider those opportunities and to move them forward, because I know that they have been discussed. Professional bodies want to engage with apprenticeships as they see the benefit for both patients and staff. Does the cabinet secretary have an update on that, with particular regard to allied health professionals? I met the British Dietetic Association, a professional organisation that is keen to support work on that, which understands the importance of having people in remote areas. Those sorts of initiatives would also create good quality jobs for people. The association absolutely sees the benefits of such initiatives, but the work on education needs to come together in order to make them happen.
In the interests of time, I will leave it there. I know that the cabinet secretary and his team understand the issues; it is about how we get some of the work over the line. I thank members for their contributions to the debate.
18:03
I welcome the debate and thank Tim Eagle for securing it. The number of participants should send the cabinet secretary a clear message. I join my colleagues who have shared their testimony and concerns about the SNP’s on-going failure to address the crisis that rural healthcare faces.
I represent the south of Scotland and, from Dunbar to Dumfries, residents have been badly let down. Vital healthcare facilities have been withdrawn in East Lothian, and in the Scottish Borders, Borders general hospital repeatedly asks only those with life-threatening emergencies to attend. In Dumfries, there is a similar picture. In December, the emergency department of Dumfries and Galloway royal infirmary was operating beyond capacity.
Health boards are warning that they are operating under an extremely high degree of pressure, which is causing patients concern and their families worry and stress. Sadly, such announcements about a state of emergency have become the new normal under the SNP Government. In large part, they stem from the problem of delayed discharge, which is a result of the SNP’s failure to tackle the crisis in social care and care-at-home services. Vital services in my area, the south of Scotland, have been withdrawn as the Government pushes a centralised model of care, which clearly does not work in rural areas.
East Lothian residents are sad and angry at the loss of two well-used local facilities that have closed in the space of a year and which ministers gave repeated assurances would not be closed without consultation.
The Edington hospital provided East Lothian’s sole minor injuries clinic and offered local palliative care facilities. People who need step-down or palliative care are now sent to Haddington or they remain, undischarged, on wards in Edinburgh. That clearly does not aid their recovery.
Belhaven hospital, which offered residential care, was closed later last year, to the disgust of Dunbar residents. The way in which it was closed was nothing short of shocking.
With little or no notice, vulnerable people were taken from their beds and moved 12 miles away to a different hospital. The move was unexpected, unwanted and distressing for the residents. To add insult to injury, some patients were relocated late into the night, with some frail and elderly residents still being moved at 1 am. Our rural communities have been truly betrayed, and that is a concrete example of that.
I carried out surveys about the Edington and Belhaven hospitals. More than 500 people responded, and their views were stark. Some local residents could no longer visit dying family members because of travel and logistical issues or, simply, the financial pressures of getting to and from Edinburgh. Some elderly patients, in their dying days, were taken away from places where they said that nurses felt more like family members.
The Health, Social Care and Sport Committee recently issued a report into remote and rural healthcare. It highlighted significant problems that people in rural areas face when they seek to access NHS services.
Too often, the Scottish Government forgets about rural residents, who face specific challenges, including the need, as I said, to travel long distances to access services. Imagine how long it might take someone who has an injury or wound to get from Oldhamstocks to Edinburgh royal infirmary.
The healthcare problems that Scotland’s rural communities face are not new, but it is clear that they are getting worse. How can the Government claim to be supporting rural communities when nearly half of all NHS vacancies in Scotland are in rural boards?
Whether it relates to the model of care, social care provision or the NHS workforce, the SNP Government is failing to deliver what our communities really need.
18:07
I congratulate my colleague Tim Eagle on securing this important debate.
Rural GP practices are struggling, and too many are on the verge of collapse. Friockheim health centre in Angus, which was Tayside’s highest-ranked practice, was forced to close in 2022. In NHS Grampian, six practices have handed their contracts back to the health board. In large part, that is because of the SNP’s complete lack of workforce planning.
As we have heard today, patient safety is at stake, as is the sustainability of primary care in rural communities. Alarm bells should be ringing in Bute house, but we keep hearing the same recycled platitudes from successive SNP health secretaries, and there is nothing to show for it.
There are enduring problems in several areas. First, the 2018 GP contract still has not been fully implemented, and it has been a disaster for rural GP practices.
Secondly, having a one-size-fits-all approach has become a serious human rights issue in rural communities.
Thirdly, the NHS Scotland resource allocation committee formula is supposed to ensure that resources for the NHS are distributed fairly across the country, but figures show that NHS Grampian has been short-changed by a quarter of a billion pounds since the SNP got into power. Astonishingly, NHS Greater Glasgow and Clyde received £743 million more than it was due.
The SNP must properly invest in healthcare in rural and remote areas, which includes rural proofing in budgeting. I sit on the Equalities, Human Rights and Civil Justice Committee and I say to the cabinet secretary that rural proofing in budgeting is not happening. Rural communities are losing out in a postcode lottery for healthcare, and that must not be allowed to continue.
18:10
Those of us who represent rural communities are all too aware of the challenges that residents in those communities face in accessing healthcare. Those challenges can be found in all corners of north-east Scotland.
Tim Eagle’s motion highlights how many of Scotland’s rural communities are facing a reduction in services. That is exactly what we are seeing in Aberdeenshire, with a significant reduction in minor injuries services in Fraserburgh, Peterhead, Huntly and Turriff. That is doing nothing to help local residents and is only increasing the pressure on staff and resources in larger hospitals, such as Aberdeen royal infirmary, which recently declared a major incident and is actually turning people away. What an absolute shambles has been created by this devolved SNP Government.
To make things worse, rural patients are often confused about when local hospitals are open and what services they offer. Turriff hospital, for example, used to have a minor injuries unit, but it was scaled back during Covid and has never been fully restored. From looking at the NHS Grampian website, I am no clearer about what services it now offers.
I also want to raise the issue of ambulance waiting times. I am sure that, as I certainly have, members who represent Scotland’s rural regions will have heard awful stories from constituents who have faced agonising waits for an ambulance. Last year, patients who were waiting for an ambulance in Turriff faced a wait that was nearly three times longer than the waits that were experienced by other north-east patients. That waiting time has come down thanks to a new ambulance, which was delivered due to the hard work and campaigning of former MP David Duguid, who ran an excellent campaign to have an ambulance based in Turriff. That means so much to the local residents, and I commend him for all the work that he did on that.
Geography will, of course, always be a challenge when communities are spread far over wide areas, but this devolved SNP Government needs to do more to reduce rural inequalities and halt the problem of rural depopulation.
I thank all colleagues for their co-operation in allowing me to call everybody who wanted to speak, and to allow them at least four minutes to speak. With that, I call Neil Gray to conclude the debate. You have around seven minutes, cabinet secretary.
18:12
I thank Tim Eagle for raising the subject, and I thank all the members across the chamber for their contributions to this important debate.
Tim Eagle opened his speech by referencing the fact that rural depopulation was the subject of the first members’ business debate that he brought to the chamber. It was also the subject of the first interaction that I had with a political chamber when, as a teenager in Orkney, I attended a meeting of Orkney Islands Council and discussed island depopulation. For him, it was his first members’ business parliamentary debate, and for me, it was my first interaction with a political chamber. We both share a sense of responsibility for ensuring that we have sustainable rural and island communities. I care deeply and passionately about the issue, as do the members of my ministerial team, both of whom represent rural and island communities.
There are opportunities for us to work together across a number of areas to better meet the unique place-specific needs of our rural and island communities. In my closing remarks, I will set out our plans to deliver good-quality services that will be sustainable in the long term, in order to improve outcomes across those communities. I will also do my best to address as many as I can of the points that have been raised around the chamber.
The motion calls for proper investment to be made. As members will be aware, the Government’s 2025-26 draft budget includes a £21.7 billion investment in reformed health and social care, which is an uplift that exceeds consequentials and takes funding to an all-time high. In recognition of the need for capital investment to support rural health services, the budget provides £139 million of additional investment for health infrastructure, including restarting the work on the replacement for Belford hospital, which Jamie Halcro Johnston referenced.
I have no doubt that the cabinet secretary understands the issues of rural Scotland, but will he commit to reviewing the national resource allocation committee formula as a matter of urgency, as he committed to doing in the chamber last year? There is no doubt that that formula is leading to the closure of maternity services and cottage hospitals across the likes of Dumfries and Galloway.
The NRAC formula accounts for the additional cost of delivering services in rural areas. All boards are within less than 1 per cent of NRAC parity—I do not recognise the figures that Tess White gave in that regard, so I will need to go back and study her assessment more closely. Of course, the NRAC formula continues to be under review, and we make sure that we do our best to ensure that all boards receive a fair settlement.
We are continuing to shift the balance of care to make it more preventative and community-based by increasing general practice capacity—which was a focus of Mr Eagle’s speech—and improving access by the end of 2026.
We have increased the funding for general medical services by £73 million this year to more than £1.3 billion. The role of the primary care team is vital in rural and island areas, where its wide-ranging expertise takes on added significance, as Christine Grahame referenced in her remarks this evening, and which the Deputy Presiding Officer referenced in response to the committee debate at the end of last year.
In November, I announced an additional £13.6 million of recurring funding to support general practices in recruiting and retaining key staff. We have also published a plan that sets out a suite of 20 actions that the Scottish Government will take to improve GP recruitment and retention, including in rural and island areas, which is an issue that several colleagues have raised. Those actions include the rural fellowship scheme, which offers GPs the opportunity to develop the required skills through direct experience of working in rural general practice. We will also be looking at the golden hello scheme to ensure that we are providing the right incentives for GPs to take up harder-to-fill posts in rural settings. That, too, is something that Mr Eagle asked me to consider: we are already doing it.
We have commissioned NHS Education for Scotland to work with the profession to redesign the current GP retention scheme in order to make it more flexible, so that it supports GPs at times in their career when that flexibility is needed.
To further support GPs, we have significantly expanded the primary care multidisciplinary team workforce, with more than 4,900 staff working in such services, funded through the primary care phased investment programme. I understand the call that is coming from some, although not all, general practices for people in those roles to be directly employed by practices. That is something that we continue to consider. In recognition that barriers to implementation can be exacerbated in rural and island settings, we are partnering with a number of areas, including in the Borders and Shetland, through the primary care phased investment programme to demonstrate what a fully functional and effective multidisciplinary team model looks like in practice.
Looking to the future, I note that the primary care route map will set out how the system operates across rural areas and fits with wider reforms. We have invested in the national centre for remote and rural healthcare, which is hosted by NHS Education for Scotland, in order to bring in a co-ordinated approach, which includes working to improve recruitment and retention and to grow skills and access to training, and to develop new models of service delivery, all of which are focused on improved outcomes for rural and island communities.
Furthermore, in partnership with NES’s centre for workforce supply, we will deliver a sustained model of direct support that will provide rural and island employers across health and social care with the whole-system approach that is necessary in order to improve recruitment and retention.
As I set out in the debate in December, we have—
Will the cabinet secretary give way on that point?
I will give way very briefly.
I can give you additional time.
I really appreciate the cabinet secretary taking this time. Currently, we are told that we are 1,000 GPs short. By adopting the technology that I was talking about, might you not find that we are not 1,000 GPs short and that we could be more effective in how we deliver healthcare?
Again, I ask members to speak through the chair. I will give you that time back, cabinet secretary.
Embracing innovation and technology is a central theme of the reform and improvement that I am seeking to take forward. On the point that Mr Whittle has put to me, it is exactly about ensuring that we are freeing clinical capacity and time for our staff to deliver the aspects that can be delivered only by humans—the caring, loving and compassionate approach that we need. Some of those innovations are already in development. NHS Near Me and the work around hospital at home are areas in which technology has been used to provide exactly that approach. I would be happy to engage more with Mr Whittle on how we could go further.
As part of that work, we are seeking to define the core services that should be delivered in our communities and to balance them with the need for specialised care, which might be provided outside the local area when it is clinically appropriate in order to ensure the best outcomes for patients. That conundrum of ensuring both that we deliver services as close to people’s homes as possible and that those services meet a patient-safety test has been at the heart of everybody’s speeches: I know that colleagues are all well aware of it.
I want to touch briefly on some speeches. Colleagues referenced maternity services. I am more than happy to get back to members on the matter, as will Jenni Minto, who is the Minister for Public Health and Women’s Health.
There is on-going work in Dumfries and Galloway, Caithness and other areas on making sure that we meet the needs of patients.
On Mr Ross’s point about the Burghead and Hopeman practice, Ms Minto continues to engage with the health and social care partnership. Another meeting on that very point is due later this month.
I am sorry that I cannot respond to everybody’s contributions today: they have been extensive, and based on the real-life experiences of constituents and members’ own experiences of the health and social care services in our communities.
I want to give the assurance that the Government continues to take the needs of rural and island communities seriously. I have set out the areas that we are seeking to invest in, which I hope colleagues can get behind. Colleagues will know that all the ministerial team’s doors are open to members to discuss any ideas or issues that are prevalent in their communities, and we will continue to work to make sure that we improve public services in rural and island communities. I am committed to driving the reform that we need in order to secure sustainable services now and in the future, across our communities—whether they are rural, island or urban—and to improve the outcomes for our population nationwide.
That concludes the debate. I thank members for their co-operation in allowing so many members to participate in the debate.
Meeting closed at 18:21.Air ais
Decision Time