Official Report 1017KB pdf
Accident and Emergency Waiting Times
To ask the Scottish Government what action it is taking, in light of reports by the Royal College of Emergency Medicine that the number of people waiting in A and E for over 12 hours is almost 100 times higher than in 2011. (S6T-02340)
Our acute system, like others across these isles and beyond, is under considerable pressure, and that has resulted in too many patients waiting for too long in accident and emergency departments. Those waits often occur because of a wait for an in-patient bed, which is why we are working to address capacity challenges.
As part of our overall budget offering of £21.7 billion for health and social care, we are investing £200 million to improve front-door services, tackle delayed discharge and expand hospital at home, which will improve patient flow through our hospitals and ease pressures on accident and emergency.
Earlier this month, I met representatives of the Royal College of Emergency Medicine. I took that opportunity to listen and to provide updates on the action that is being taken to support improvements and reduce delays for patients and staff.
The cabinet secretary needs to wake up to the reality that is getting worse on his watch. Ambulances are queuing outside emergency departments and waiting to admit patients, sometimes for hours. Patients are lying in corridors, seriously unwell, as evidenced by nurses in the recent Royal College of Nursing report. In this year alone, more than 10,000 Scots have waited in A and E for more than 12 hours, and the Royal College of Emergency Medicine estimates that that is likely to have resulted in 309 excess deaths.
Waiting too long is dangerous. When will the cabinet secretary get a grip and fix this mess?
I have always recognised that there is a relationship between long waits in accident and emergency departments and the increased risk of harm, which is why we remain committed to delivering improved A and E performance. I set out to Jackie Baillie in answer to her first question the measures that we are taking through the budget, although I note that the Labour Party is not voting for it. Those are around hospital at home, improving front-door services and making sure that we tackle delayed discharge and ease the pressures on A and E. We are working with boards on the issue to deliver, and the most recent delivery meeting to discuss that with boards and with the First Minister was earlier this afternoon.
In December 2011, 78 people waited more than 12 hours to be seen in A and E. In December 2024, that figure was 8,904 people. That is how badly the Scottish National Party is letting down the people of Scotland. That is not improved performance.
We know that delayed discharge is putting strain on patient flow through hospitals and that it impacts on A and E. Around 2,000 patients who are fit to be discharged are stuck in hospital, largely because of a lack of social care, and £1.5 billion has been squandered on delayed discharge since the SNP promised to eradicate the practice. Does the cabinet secretary understand that health and social care partnerships, which are responsible for delivering social care across Scotland, are facing significant challenges and are cutting care packages? It was John Swinney who took funding from them when he demanded the return of reserves to help to balance the SNP’s books. What will the cabinet secretary do to reverse the cuts that his boss put in place?
I am clear that there is a direct relationship between hospital flow and the issues that we are seeing in accident and emergency departments, which is why—to repeat this to Jackie Baillie—we are making the investments that we are making in the budget.
I will tell Jackie Baillie about an area of great concern that I have that has a massive impact on the potential capacity in social care, and on which I had a meeting with social care leaders just last week. [Interruption.] That is the Labour United Kingdom Government’s increase in employer national insurance contributions, which will be devastating to our social care sector in Scotland, because it will rip jobs and capacity out of the sector. [Interruption.]
Ms Baillie!
That is why it is critically important that the UK Government fully funds that incredibly damaging move, instead of relying on Scottish public services to pay for a UK Government’s decision on a reserved tax.
I am sure that we all agree that any long wait for patients in our A and E departments is regrettable. Will the cabinet secretary set out any further measures that we have outlined in the upcoming budget as we look to alleviate pressures on A and E services across Scotland to ensure the optimal and most efficient care possible for patients? Will he again encourage members across the chamber to support the budget at stage 3 so that the key funding is put in place?
Absolutely. I thank Emma Harper for her point about the importance of the investment that is coming through the budget. Our health and social care services need the budget to be passed, so, of course, I pass on that encouragement.
We have a clear plan to reduce waiting times and delayed discharges. That is supported by the full weight of the £21.7 billion that is going to health and social care and specifically by the £200 million targeted investment as part of our budget. We will shift the balance of care from acute to community, by ensuring that every A and E department has a frailty service that is linked to community re-enablement. That will enable people who are experiencing frailty to be referred directly by general practitioners and the Scottish Ambulance Service to specialist frailty services as an alternative to admission or attending A and E, where their needs might not be met in the same way.
Additionally, we plan to deliver 150,000 extra appointments and procedures this year, with more GP access, which will ease accident and emergency pressure.
I declare an interest, as a practising national health service GP.
Hundreds of people have died needlessly during the course of this session of Parliament as a result of having to wait more than half a day in A and E. That is hundreds of families who have lost a loved one: a mum, dad, brother, sister, son or daughter. NHS staff are overworked and overstressed and are suffering moral injury. Enough is enough. The situation is not “regrettable”, as Emma Harper suggested; it is wrong and distressing. Will the cabinet secretary apologise to those families? How can the public, families or NHS staff have any confidence that the Government is taking the crisis seriously?
I, of course, apologise to anybody who is having to wait for too long to access services and to staff who are having to communicate that news and are not able to deliver the job in the way that they wish to.
I absolutely understand the point that Sandesh Gulhane has made, and I was discussing the moral injury point with the Royal College of Emergency Medicine. That is why the investments that we are making in the budget are so important: they are setting us on a trajectory of relieving the pressure in the health service, which is why I encourage Sandesh Gulhane and his colleagues to vote for the budget.
Scottish Water (Executive Bonuses)
To ask the Scottish Government for what reason Scottish Water continues to pay bonuses to its executives, when public sector pay policy reportedly prohibits this. (S6T-02350)
Scottish Water has a long-standing exemption on the point of public sector pay policy, in recognition of its operating model and the need to retain staff as it competes with the private sector. That arrangement has been in place since 2011.
The framework for bonus payments has to be approved by the Scottish ministers. The current framework was approved in advance of the 2021-27 regulatory period. The Scottish Government is satisfied that the correct process has been followed by the Scottish Water board. Scottish Water is publicly owned, which means that, unlike at the private companies that operate elsewhere, money raised is reinvested in our water industry, while our water charges remain lower, on average, than is the case in other parts of the United Kingdom.
If the minister thinks that this is an acceptable situation, I ask him to rethink, because some of the bonuses are, as unions have described them this week, “obscene”.
Yesterday, The Herald revealed that the bonuses of three Scottish Water executives amounted to £330,000 in 2023-24, and that £70,000 went to Alex Plant, the chief executive, as a “relocation handout”. We now have a situation in which water bills are going to rise by an inflation-busting amount of almost 10 per cent across the country, and workers are in dispute with Scottish Water. Does the minister not see that it is completely wrong to hand executives massive bonuses while squeezing the pay of ordinary Scottish Water workers?
In his original question, the member suggested that public sector pay policy prohibits what has taken place, which is not the case. As I mentioned, public sector pay policy has a presumption against non-consolidated bonuses and suspended bonuses. However, with the agreement of the Scottish ministers, Scottish Water has had a pay structure that includes performance-related pay since its creation, in 2002. That is simply because Scottish Water operates in an environment in which the other water companies around the UK are in the private sector and Scottish Water has to recruit from the same pool of people.
I do not think that the minister gets it. When the public see big awards of cash being made to public sector executives, as in this case—we have seen that before, have we not? At Ferguson Marine, executives were handed massive amounts of money and there was, quite rightly, a big hoo-hah about that.
The same concerns apply here. Scottish Water is publicly owned by all of us, and we should not be giving massive amounts of money to executives. Only three of them are getting that money. The minister ought to reflect on the situation, particularly at a time when Scottish Water staff are in dispute. He needs to think about how that looks. Again, I ask the minister to rethink.
As I mentioned, the decisions by Scottish Water had to come to ministers for approval. On the point that the member has made about Scottish Water and the industrial action that workers have been balloted on, I urge both parties to resume negotiations to find an agreement on that.
On his wider point, I will not comment on the details of the bonuses, but it is worth saying that, despite the suggestion that performance-related bonuses are irrelevant in this situation, Scottish Water’s performance in relation to pollution, overflows and so on has improved. For instance, there was improvement in the overall number of sewage overflows that were graded as unsatisfactory in Scottish Water’s annual return. The Scottish Environment Protection Agency, an independent body, has assessed 86.5 per cent of Scotland’s entire water environment as having a high or good classification, which represents an improvement since 2014. Scottish Water continues to represent good value for those who pay for it, particularly when it is compared with comparable water bodies in other parts of the UK.
I remind members of my voluntary register of trade union interests.
Can we go back to the central question here? Does the minister agree with me that it is wrong that the bonuses of Scottish Water bosses have risen 10 times more than the pay rise that is now being offered to the workers? Yes or no? If he does, what does the Government intend to do about it?
The Scottish Government seeks to ensure that executive pay is kept under control, and I can comment on the situation in the wider public sector in that regard. As I said, public sector pay policy includes a presumption against non-consolidated bonuses. When new chief executives have come into post, we have sought controls on wages and bonuses to be put in place.
I do not dispute Richard Leonard’s central point about the scale of the bonuses, but I return to the point that I made in my original answer, which is that, contrary to the inference in the question, the bonuses were provided publicly and within the rules.
Twenty-four per cent of Shetland’s total water system is reliant on old asbestos cement piping—twice the national average—so why is public money being spent on bonuses, not on a swifter pipe replacement programme?
As I mentioned, Scottish Water has a good story to tell about its wider performance, but I recognise Beatrice Wishart’s point about the need for continuing investment. There is continuing investment—in fact, £1 billion has been invested in the water network around the country, and we will seek to provide more investment. Scottish Water is taking action and is committing up to £500 million to improve water quality, increase monitoring of the highest-priority waters and, as I mentioned, deal with spills and overflows.
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