Official Report 1039KB pdf
The next item of business is a debate on motion S6M-16252, in the name of Jackie Baillie, on supporting Scotland’s health and social care workforce. I invite members who wish to participate to press their request-to-speak buttons.
14:56
Let me begin on a note of consensus. The staff of NHS Scotland and those who work in social care do an incredible job. They are the backbone of the national health service and of social care; without them, the services would collapse, so they deserve our heartfelt thanks. However, they are firefighting in a broken system, and they are telling us that things cannot go on like this. Staff are leaving the NHS and social care in their droves and far too many are being signed off with exhaustion and poor mental health. They are burnt out because our NHS and our social care system are in a state of crisis. Responsibility for that lies squarely with the Scottish National Party Government.
Right now, more than 863,000 Scots are stuck on an NHS waiting list, and more than 100,000 of them have been there for over a year. In Scotland, more than 7,000 patients have waited more than two years for surgery. In contrast, in England—which has a population more than 10 times the size of Scotland’s—only 151 people have been waiting more than two years. Cancer patients are being let down as treatment targets are not met. Thousands of children are stuck on child and adolescent mental health services waiting lists while countless others are turned away. Health inequalities are widening and life expectancy is declining. Two thousand Scots are currently stuck in hospital who have been medically cleared to leave but are unable to do so.
I say very politely to the First Minister—who was very animated with me last week—that, across a whole host of measures, things are getting worse and not better. To deny the pressures that the NHS in Scotland is facing is, frankly, delusional, and I am tired of the Cabinet Secretary for Health and Social Care telling me that things are actually okay. The situation is causing moral injury to the staff. It compromises patient safety and results in worse outcomes. However, members should not just take my word for it. In the Royal College of Nursing’s damning report on corridor care, which is now the norm, one nurse said:
“I am now in the process of leaving the nhs … It is fraying at the seams and has left me with mental health problems and trauma.”
The crisis cannot be blamed on winter flu cases or Covid-19. The NHS was sailing into troubled waters long before 2020 and the SNP has been in charge for all of that time. For 18 years, it has failed time and time again to protect the health service and to plan for its future.
Let me be honest: attempts at workforce planning have been woeful. The SNP must own the consequences of that, because the evidence is there for all to see. Audit Scotland reports that the target of 800 more general practitioners by 2027 is unlikely to be met. The British Medical Association tells us that an extra 1,000 GPs are needed just to stand still and meet current demand, and it also points out that, despite the Government’s promise, GP numbers are declining and not increasing. At the same time, patient numbers are rising. GPs simply cannot care for more people with the current capacity. It is little wonder that people vote with their feet and head to out-of-hours or accident and emergency departments because they cannot get appointments.
Last night, we were told about GPs in the Lothians who are unemployed. I will repeat that: they are unemployed. At least one is working for Uber. Others go to Australia to work for one month on and one month off. At a time when we are short of GPs and patient demand is increasing, what is the Government thinking? It is a shocking waste of talent that could be deployed in our NHS.
Will Jackie Baillie give way?
I will do so briefly.
Does Jackie Baillie recognise that the problem in Lothian is particularly bad among GP locums?
I do indeed. That is the situation that I was describing. Alex Cole-Hamilton and I are of one mind on this.
The BMA says that there are more than 1,000 consultant vacancies, which is enough to staff two large hospitals, but the Scottish Government reports only 397. That shows yet more understaffing, which does not help to tackle waiting lists. Since 2019, the NHS has spent more than £900 million on private agency nurses and locum consultants in a desperate attempt to plug the gaps. That is a sticking plaster instead of real solutions, and it comes at a cost that is greater than the cost of employing those staff directly in the NHS. We also know there are not enough nurses in the NHS to meet demand and provide safe care. High vacancy levels persist, and the latest data shows that 2,380 nursing and midwifery jobs are lying vacant.
The Royal College of Paediatrics and Child Health produced a report last year called “Worried and Waiting”. It includes a number of recommendations to deal with critical workforce pressures, including a call for a specific strategy for the child health workforce. It also highlights rota gaps, which are not good for patient safety. Has any of that been addressed? Macmillan Cancer Support warns about a “cancer care gap” as the numbers of people with cancer rise but that is not matched by an increase in the workforce. Marie Curie tells us about the lack of palliative care staff and even a lack of training for generalist staff about end-of-life care.
I turn to mental health. Scottish Action for Mental Health reports a significant increase in demand for services for adults and children, and we also know about that from our constituency casework. The SNP promised access to a mental health worker for every general practice. A thousand new people were to be recruited, but the budget was cut in 2023. That is another pledge that was jettisoned by the SNP.
We all know that the SNP Government received record funding from the United Kingdom Labour Government in the latest budget, yet it has chosen not to invest in a proper workforce plan. To be clear, I note that that is a political choice that the Government has made. The SNP has the money and the power but it has simply chosen not to use them. It knows that staff are crying out for support, yet those staff are being ignored—so much so that the First Minister could not be bothered to invite Unison to his health meeting last week. He is happy to use health and social care staff as his human shield, but he is not happy to sit down with them to understand the challenges that they face.
I mentioned the Cabinet Secretary for Health and Social Care. He is supposed to be responsible for health and social care at the top table of Government, but he has been distracted by limogate and sidelined by his boss. However, to be frank, I am not sure that the First Minister is any more competent. As finance secretary, John Swinney cut £70 million from social care while people were stuck in hospitals because they were unable to get care packages. As finance secretary, he cut £65 million from primary care services, making it more difficult for people to get a GP appointment. As Deputy First Minister, he was at the heart of Government and was responsible for overseeing delivery when delayed discharge soared, A and E waits went up and the Scottish Government failed to meet the 62-day cancer target in every year since 2012.
Will Jackie Baillie give way?
I will not.
I genuinely worry about what John Swinney will do next.
Instead of taking any responsibility, the SNP hides behind the staff and repels every criticism as, somehow, the Opposition talking down the staff and suggesting that they are incapable. For the record, I note that it is not NHS staff or social care staff that are incapable—it is this SNP Government. I will give the Parliament a few examples. The Scottish Government spends around £60,000 for each student nurse to train at a Scottish university, when we take into account study and bursary costs. That is money well spent for such an important role. However, last year, almost 100 graduate paediatric and adult nurses were told that there were no jobs for them, despite staff shortages. Budget cuts meant vacancy freezes. In fact, last year, the SNP quietly cut 1,500 nursing and midwifery jobs from the establishment records before any budget cuts had even begun. Posts were simply wiped out overnight.
Since then, I have been contacted by paramedic graduates who have experienced the same problem, and by junior doctors who have been told that they will need to undertake their speciality training in Northern Ireland as there is nothing happening in Scotland. I have heard from graduate pharmacists, such as Abbie, who have been told that, due to a lack of funding, there will be no foundational training year for them in Scotland and that they will have to go to England if they want to continue. The Scottish Government is paying to train health and care staff for the benefit of every NHS in the UK except NHS Scotland. If that is not incompetence, I do not know what is.
The current pressures in our hospitals are due in part to this Government’s failure to fix the problems in social care. More than 9,000 Scots are waiting on care assessments or packages. We know that there is a chronic shortage of support because we do not have the staff, but we do not have the staff because they are not treated with the respect that they deserve so they head for the exit door. Is it any wonder that many of them are going to work in retail, where they are often paid more and have less stress? Year after year, Labour has consistently argued for a minimum of £15 an hour with finance ministers Kate Forbes and John Swinney, who are both deaf to the plight of social care staff. What happened to the missing £50 million for fair work to improve terms and conditions for social care staff? It was cancelled by ministers at the 11th hour. That tells us all that we need to know about how much the SNP values social care.
Scotland cannot keep paying the price for the SNP’s financial mismanagement and waste. Its recklessness is a betrayal of the NHS and social care staff who have gone above and beyond to keep services going and patients safe. After nearly 18 years of failure and decline from the SNP, it is time to change the team. Scottish Labour will ensure that our NHS and social care sectors have a 10-year workforce plan that creates enough medical and nursing training places; values nurses, doctors and all NHS staff; and meets the needs of future generations?of patients. We will deliver faster access to GPs and tackle long waits for treatment once and for all by taking full advantage of our untapped potential.
Scottish Labour is and has always been the party that is willing to stand up for workers, protect our NHS and invest in social care. Scotland’s NHS needs a new direction and Scottish Labour is ready to deliver it.
I move,
That the Parliament deeply regrets that there is a continuing crisis in both the NHS and social care; recognises that staff are the backbone of the NHS and that the Scottish Government has failed to effectively workforce plan; understands that the consequences of this failure are that patients are suffering from poorer outcomes, hard-working staff are experiencing moral injury, and NHS graduates are not being employed, and calls on the Scottish Government to urgently bring forward a 10-year health and social care workforce plan that meets the needs of the people of Scotland.
I call Neil Gray to speak to and move amendment S6M-16252.1.
15:08
I welcome this debate, which is very timely in the light of the speech that was given by the First Minister on Monday on protecting and renewing our health and social care system—a plan of substance, and that is to deliver. In his remarks, the First Minster acknowledged the central role that those most cherished of public services play in all our lives, which is why we, as a Government, attach so much importance to supporting our health and social care system and the people who work in it.
I agree with Jackie Baillie that staff are the backbone of our health and social care system. Without their skills, expertise and endeavours the system simply could not operate. I have been privileged to witness at first hand their dedication and professionalism in my role as health secretary.
We also know that services are struggling. People are waiting too long for treatment and there have been periods of real crisis in recent weeks linked to the unusually high flu prevalence that we have seen. I want to record my thanks to staff and my admiration for their resilience in the face of those extreme pressures. We are all grateful to them for their efforts. We must also acknowledge that the sustained and significant pressure that the system has faced, and continues to face, places real pressure on staff. Change is clearly needed.
Although a shift in demographics and changes in the burden of disease mean that reform of our health and social care services would always have been necessary, the pandemic has undoubtedly impacted on the scale of change and pace of change that are required.
Our efforts to recover have certainly not been helped by decisions that have been taken at Westminster. A decade and a half of austerity, coupled with the shock of inflation, has meant that our already stretched resources have been able to deliver less.
Furthermore, Brexit continues to impact on staffing in our social care sector and will, coupled with the UK Labour Government’s decision to continue the Tories’ cruel policy of preventing care workers from bringing dependants to the UK, have deep and lasting consequences. Home Office statistics show a staggering 82 per cent drop in health and care worker visa applications between April and December 2024, compared with the same nine-month period in 2023.
Will the cabinet secretary take an intervention?
I will make some progress, first.
More recently, the decision that has been made by Jackie Baillie’s colleagues in the UK Government to increase employer national insurance contributions is expected to cost the NHS alone more than £191 million, with those costs rising to around £315 million when we take account of NHS contractors including GPs, dentists, optometrists and pharmacists, as well as the adult social care workforce. It is therefore vital that the UK Government fully funds the increase in order to avoid Scotland being punished for investing in key public services.
I give way to Clare Adamson.
I should have waited, as the cabinet secretary has almost answered my question.
Does the cabinet secretary share my concern that the national insurance rise has been described by the British Medical Association as presenting an “existential threat” to general practice?
Yes, I do, and I could list the names of those who signed the letter on that subject that was sent by the First Minister and the president of the Convention of Scottish Local Authorities. The wealth of experience and dedicated commitment of those signatories from civic Scotland underline the need across health, social care and all elements of public service to see the issue being resolved at source.
Looking ahead, I believe that the draft budget provides strong foundations for the improvements that we all want and need to be delivered, including our commitment to providing funding to enable social care workers to continue to be paid at least the real living wage.
The budget represents a package of investment to reduce the immediate pressures across the NHS and to speed up the rate at which individuals can be treated by delivering an additional 150,000 planned care procedures over the coming year.
The investment will also shift the balance of care from acute services to the community by expanding the hospital at home service, opening more frailty units and ensuring that a greater proportion of new NHS funding goes to primary and community care. Furthermore, it will enable use of innovation—digital and technological—to improve access to care.
Our NHS workforce is central to delivering all those improvements, and we simply cannot afford to underestimate the role that social care staff will play in enabling and realising the ambitions.
The cabinet secretary knows of my interest in technology. The pandemic demonstrated to us the impact that technology can have on healthcare and the speed at which it can be deployed. Why has the ability to do that been lost since then? Now, we have only the option of an app that is already being deployed in the rest of the United Kingdom.
I do not believe that that is the case. Progress is being made through the likes of the accelerated national innovation adoption—ANIA—pathway and, on Monday, I was able to see the incredible innovation that is coming through the National Robotarium. I look forward to my scheduled meeting with Mr Whittle to discuss some such areas.
We know that improvements to social care will strengthen our NHS and our communities, and we remain determined to invest and deliver the vital changes that are needed. I recognise the problems and challenges. It is easy just to point to them; we, however, are focused on resolving them.
Will the cabinet secretary take an intervention?
I need to make some progress.
We will never shy away from the challenges that are facing our NHS and social care services. We will act quickly to deliver much-needed change and we are starting from strong foundations. The Scottish Government has overseen a 26.6 per cent increase in NHS staffing, including 12 consecutive years of workforce growth, which contradicts the false assertion that is made in Labour’s motion regarding graduates.
Will the cabinet secretary take an intervention?
I will make some progress, then come back to Ms Baillie.
We have planned for and driven workforce growth through investment in training our workforce of the future, with an increase in funded undergraduate places for health and social care professions. Our workforce planning will continue to evolve to account for the shift that is required in the shape and size of the workforce. Part of that will be consideration of the skills mix that is needed to deliver the service improvements and reforms that have been mentioned. We will set out more detail as part of our medium-term approach to health and social care renewal, which we are committed to publishing before the summer recess.
Some required changes are already taking place, including in pharmacy education, in which, from 2026, all graduates will be independent-prescriber trained at the point of registration. That, coupled with our planned expansion of the pharmacy first service, presents a new opportunity for patients to benefit from that expertise and for GPs to be freed up to focus on the care that only they can provide.
Our budget will also enable the number of domestic intakes to university dental courses to increase by 7 per cent, which will ensure that we build a strong workforce pipeline in the medium and longer terms.
Since 2021, we have increased the number of medical undergraduate places by 300, while also offering alternative routes to medicine as a career and doing more to support a pipeline of doctors for our remote and island communities.
Retaining and recruiting GPs is vital, and we remain committed to increasing their number. There are currently over 5,000 GPs in Scotland, the number of which we have increased by 307 since 2017. There are just over 1,200 GPs in training in Scotland, which is extremely encouraging. We have published a GP recruitment and retention plan, which includes new actions that will support the attraction and retention of GPs, including work on expanding fellowships and flexible retention schemes.
In the coming weeks, we are due to publish the nursing and midwifery task force report, which is also focused on recruitment and retention.
Finally, through continuation of work on the national care service, we will continue to support improvement and innovation across the system via the establishment of an advisory board, which will have a clear focus on national and local workforce planning, high-quality learning, and development and leadership support for social care staff.
Growth in the workforce alone cannot be the solution to the challenges ahead: we must also take account of emerging opportunities in order to enhance workforce productivity and wellbeing, including reducing workload through use of new technology and artificial intelligence, and enhancing the quality of care for patients across the country by using staff expertise in different ways.
That is why, last year, we published “Improving Wellbeing and Working Cultures”, which sets out our ambition to enhance working cultures across the system, and why we continue to support national wellbeing, leadership and equalities interventions. That approach, and the support that is offered, have been and will continue to be shaped by the voices and lived experiences of our staff.
The joint social services task force has also taken forward important work to present a range of opportunities to improve the experiences of our valued social care, social work and allied health professional staff.
Those are great examples of the practical steps that we are taking to support the workforce of today and tomorrow.
The immediate steps that I have outlined are critically important as we seek to improve the experience of staff who work daily in our hospitals and communities. They form part of a comprehensive package that will allow us to deal more effectively with the immediate challenges that the system faces and, at the same time, support staff to respond to future demands.
In closing, I reiterate my heartfelt thanks to health and social care staff across the system for all that they do. Although I am the first to recognise that the system is not without its challenges, their efforts continue to make a real difference to the lives of people across Scotland every day, and this Government will continue to do everything that it can do to support them.
I move amendment S6M-16252.1, to leave out from “there is a continuing crisis” to end and insert:
“current high wait times mean that too many are waiting too long for treatment; thanks hardworking NHS and social care staff who provide extraordinary care across the country; recognises that there are crises facing too many parts of the NHS; notes investment of over £11 billion in the NHS workforce and an estimated £950 million to ensure that adult social care workers, including those in the third and private sectors, are paid at least the real Living Wage; recognises that the biggest threat to the health and social care workforce comes from the UK Government’s decision to increase employer national insurance contributions, and demands that the UK Labour administration reimburse the Scottish Government in full; supports the calls for the publication of a medium-term approach to health and social care reform, including workforce planning, before the Parliament’s 2025 summer recess, and believes that the aim of the medium-term reforms must be to ensure that everyone can access the treatment and care that they require, in the right place, at the right time.”
I call Sandesh Gulhane to speak to and move amendment S6M-16252.2.
15:18
I refer members to my entry in the register of members’ interests, which states that I am a practising GP.
Today, I speak not only as a politician but as someone who has witnessed at first hand the consequences of years of SNP mismanagement in our health and social care sectors. There is groaning from members on the SNP back benches, but they should listen to this. The SNP has had 18 years to deliver on its promises to improve Scotland’s NHS and support Scotland’s health and social care workforce, and yet, here we are again, discussing the same problems, which have worsened due to its managed decline of services.
A decade and a half of neglect and a failure to act has left Scotland’s health service at breaking point. Under Neil Gray’s tenure as health secretary, our NHS has been allowed to slip further into a permanent crisis. Waiting lists have hit record highs, with one in six Scots now stuck waiting for care.
More than 9,000 patients have been left languishing on waiting lists for more than two years—two years, Deputy Presiding Officer. Those are not just statistics; they are our families, our friends, and our communities.
Patients are waiting at A and E departments. Recent figures revealed that around 40 per cent of A and E patients are not being seen within four hours—a target that the SNP has not met anywhere since July 2020. Meanwhile, Scotland has the lowest life expectancy in western Europe, and delayed discharges are at a record high, occupying 650,000 hospital days in 2023. That is the SNP’s legacy: unmet targets, broken promises, and a health service that is in decline.
Let us not forget cancer treatment waiting times, which is another area in which the SNP has failed miserably. The target to start cancer treatment within 62 days of urgent referral has not been met in more than a decade. That is utterly unacceptable.
It is clear that one health secretary after another has failed Scotland, including the current office-holder, Neil Gray. The problems go far beyond his incompetence; they are systemic and the result of a Government that is more focused on excuses than solutions. When Neil Gray admitted that there was, effectively, nothing new in his most recent plan to prevent the NHS from winter collapse, he confirmed everything that we already know. He has no vision, shows no leadership and has no ideas. What is his role now if John Swinney must step in to clean up his mess? John Swinney’s sudden involvement as interim health secretary speaks volumes about the SNP’s lack of confidence in its health secretary, and his empty-rhetoric speech was heavy on spin. Our NHS staff and patients deserve a health secretary who is not sidelined by their own Government and distracted by personal scandals.
The blame does not end with Neil Gray. For 17 years, the SNP has failed to plan effectively for Scotland’s health and social care workforce. Staff are the backbone of our NHS, yet they have been treated as an afterthought. Nurses, doctors and social care workers are burning out under the strain of staff shortages, increased demands and insufficient resources. Our healthcare workers have experienced moral injury. Dedicated professionals have worked in a system under the SNP that has treated staff as though they are expendable resources, rather than the essential lifeblood of our health service.
Social care remains in chaos, and patients are paying the price. Just look at the SNP’s handling of its flagship policy, the national care service. We could see how flawed it was; so could the trade unions, the Convention of Scottish Local Authorities and other experts. However, the SNP pressed on regardless, led by an overmatched, though self-assured, minister for public health, and flushed £30 million down the drain—money that could have gone to the front line. That is what oblivious incompetence looks like.
As Matt McLaughlin of Unison put it, John Swinney’s promises are little more than “reannouncements” of pledges that the SNP has already failed to deliver. Colin Pullman of the Royal College of Nursing described the state of Scotland’s hospitals as “distressing”, with staff forced to provide patient care in corridors and other inappropriate locations. Dr Iain Kennedy of the BMA warned that without urgent reform, the NHS might not survive another year.
We cannot afford more dithering from the SNP. The Audit Scotland report could not have been clearer. There is no credible plan for NHS reform. Instead, the SNP continues to lurch from one crisis to the next, with no strategic vision and no leadership. The Government is failing both patients and staff.
The Scottish Conservatives are not here just to criticise; we are here to propose solutions. We have a policy paper, “Modern, Efficient, Local: A new contract between Scotland’s NHS and the public”, which sets out how we would implement a 10-year workforce plan that prioritises recruitment, retention and support for front-line staff. We would reinvest the funds wasted on the SNP’s failed national care service into localised, effective social care. Mental health spending would reach 10 per cent of the NHS budget, ensuring support for the growing number of Scots who are struggling with mental health issues. We would hold Scottish Government ministers and NHS managers accountable for their failures and focus resources where they are needed most. We would also take decisive action to reduce waiting times by standardising best practice across Scotland’s hospitals, introducing initiatives such as super Saturdays for elective surgery and making better use of off-peak scanning.
It is time for change. The SNP has had 18 years, and it has failed. Patients are suffering, staff are burned out, and our NHS is on life support. Neil Gray is not the answer; he is not the leader that Scotland’s health service deserves. Today, we urge Neil Gray to do the right thing and resign as health secretary, and for Maree Todd, who said she was in charge of the failure of the flagship national care service, to be held accountable—although I will not be holding my breath that the SNP Government will do the right thing. The people of Scotland deserve better: better leadership, better care and a better future for our NHS.
I move amendment S6M-16252.2, to insert at end:
“; notes that the Scottish National Party administration has failed to deliver improvements to social care in Scotland, despite wasting nearly £30 million and years of civil servants’ time on its failed National Care Service, and calls on Neil Gray to resign as Cabinet Secretary for Health and Social Care, following his disastrous tenure in office.”
I call Gillian Mackay, who joins us remotely, to speak for around six minutes.
15:25
I will start by apologising to the chamber. My Surface has had a moment with Zoom over the past five minutes, so I currently have my phone propped up while I try to make this speech. I hope to get the issue fixed ahead of my closing speech.
I thank Labour for bringing this important debate to the chamber. I hope that, together, we can recognise the importance of our health and social care workforce. Despite the workforce’s dedication, it continues often to face significant challenges that require not only urgent attention but concrete action. I hope that we can use this opportunity to highlight the key issues raised by those working on the front lines and to discuss the steps needed to ensure a sustainable and effective workforce for the future.
I will start by talking about mental health. I thank Scottish Action for Mental health for the support and briefing provided ahead of this afternoon’s debate. We know that access to timely mental health support remains a serious concern in Scotland. The on-going lack of meeting the 18-week waiting time for NHS psychological therapies and child and adolescent mental health services points to a system that is struggling to meet demand. Although there has been a 69 per cent increase in the NHS psychological services workforce over the past decade, and a 128 per cent increase in the CAMHS workforce since 2006, demand continues to outstrip capacity. That is particularly evident in the lack of community-based mental health provision and the vacancies in some health boards, including in NHS Forth Valley in my region, which has a significant number of unfulfilled psychiatrist roles.
The Scottish Government’s mental health and wellbeing workforce action plan sets out some priorities that are generally welcome, including a commitment to evidence-based workforce planning. However, SAMH points out that there are clear gaps that need to be addressed. The plan does not provide essential benchmarking or mapping, nor does it set out targets or an assessment of workforce needs. It also fails to fully recognise the third sector’s vital role in delivering mental health treatment and support. SAMH poses the question to the Scottish Government whether it will conduct a needs assessment of the mental health workforce, including the third sector, to establish clear targets. In addition, we need to see the Government guaranteeing sustainable funding for third sector mental health providers, which are doing huge amounts of work.
In the 2021 programme for government, a commitment was made that, by 2026, every GP practice would have access to a mental health and wellbeing service, which would be backed by funding for 1,000 additional dedicated staff. That was to be supported with an annual investment of £40 million by 2024-25. However, it is disappointing that the commitment has been paused due to financial pressures. I hope that, with additional money coming from Westminster, we will see it restarted.
As at March 2023, 17 per cent of GP practices in Scotland reported having no access to mental health workers. The need for investment in primary care is clear, and we must ensure that people can access the mental health support that they require at the first point of contact.
The Royal College of General Practitioners has shared important information on GPs. The single most impactful outcome for primary care would be an increase in the number of general practitioners—and that needs to be measured by whole-time equivalent rather than by headcount.
Data shared by the royal college, which originated from the GP workforce survey, reveal that the number of WTE GPs has decreased, with a reduction of 0.7 per cent between 2023 and 2024. Since 2015, the WTE GP workforce has declined by 4.2 per cent, while the number of WTE medical and dental consultants has increased by 21.2 per cent. The divergence is particularly concerning as GPs carry out 90 per cent of NHS patient consultations on any given day.
It must be recognised that some progress has been made, and the royal college welcomes the Scottish Government’s general practitioner recruitment and retention action plan. However, the royal college stresses that the plan must be adequately resourced and effectively implemented, as must other plans.
Workforce and workload data for Scotland’s GP workforce remains poor.
The number of GP practices in Scotland has already decreased, reflecting a concerning trend towards fewer practices overall. Evidence consistently shows that countries with strong primary care systems have better health outcomes and lower rates of unnecessary hospitalisations. The RCGP has also welcomed the First Minister’s recent speech on renewing the NHS, and his commitment to increasing the proportion of new NHS funding that is allocated to primary and community care. However, we need that to be progressed at pace.
The BMA highlights its on-going frustration with Scotland’s workforce plans, which in its opinion have lacked the necessary detail and long-term solutions. It continues to call for a comprehensive plan that sets out the required number of doctors in both primary and secondary care, along with clear strategies to improve recruitment and retention at every stage.
Alcohol Focus Scotland is calling for urgent action, as many feel undervalued and at risk of burnout. The alcohol and drug workforce survey highlighted high workloads, large case loads and heavy performance-reporting burdens. Among respondents from statutory services, 63 per cent reported feeling under pressure most or all of the time. Additionally, Audit Scotland has noted slow progress in implementing the Scottish Government’s drugs and alcohol workforce action plan, particularly in workforce mapping and developing a competency framework.
Scotland’s health and social care workforce is the very backbone of our country’s wellbeing yet, across mental health, primary care, general practice, social care and addiction services, we see challenges, staff shortages, unsustainable workloads and a lack of long-term workforce planning. Reform and workforce planning need to happen at the same time, and we need to ensure that we have the workforce to sustain and improve services and produce the workforce plans that we need to realise ambitions on reform. Both have to be done at the same time; otherwise services will continue to struggle to meet demand.
I welcome the First Minister’s renewed focus on supporting and strengthening the NHS. His commitment to increasing the share of new NHS funding that is directed to primary and community care is a step in the right direction. However, now is the time for the Scottish Government to deliver the solutions, investment and commitments that our workforce and the people whom they care for deserve.
15:32
I am grateful to the Labour Party and Jackie Baillie for making time in the chamber for this important debate. As I am sure is the case for all members in the chamber, hardly a day goes by when I do not receive an email, phone call or visit to the constituency office from someone who has been waiting for months, often in pain, for a routine operation or procedure, weeks for an important diagnosis or days just to speak to someone on the phone at their GP surgery.
That is part of our day job, but it is also part of our daily and personal life. Before Christmas, my father had a significant health event in October. He went for scans, but it was three weeks before those were properly looked at, because no consultants were available to process his readings. He is in mortal danger and is still waiting for a procedure that will make him well.
I have lost count of how many such debates we have had over the past few years, yet the frighteningly long waiting lists just are not getting shorter, and patient experience is not getting better. Our NHS is on its knees—it is in dire straits—and we simply cannot continue merely to talk about how bad things have become; we need meaningful action to make things better, both for the patients who rely on our health service and for our hard-working doctors, nurses and support staff, who are on the front lines and who, on a daily basis, are in increasingly difficult circumstances. None of this is their fault. In fact, they have to bear the brunt of it daily, and many are at breaking point. They are the first point of contact for frustration and for the patients who cannot be seen. That is laid bare by the large increase in absence due to mental ill health and staff burn-out.
At the heart of the debate are the on-going workforce issues, which have been well rehearsed already this afternoon, and in particular the SNP Government’s failure to properly plan ahead through workforce planning. Members do not need to take my word for it. In response to the First Minister’s speech on NHS recovery this week, the chair of BMA Scotland said:
“there is now an urgent need for a plan to deliver the kind of reforms that are required to make the Scottish NHS sustainable for generations to come.”
He went on:
“we still lack the detail and comprehensive vision needed to make any plan a reality.”
We still lack the vision. The Government has been in power for nearly two decades, and it has no vision as to how to make things right.
A BMA survey that ran just before Christmas was utterly damning. Of the respondents to that survey, 70 per cent said that they believed that the health service
“is operating on ... crisis mode all year round”
and not just in the winter months; 84 per cent did not think that
“the NHS is staffed adequately to cope with”
winter pressures; and 86 per cent
“had no ... confidence in the Scottish Government to put the NHS on a sustainable”
long-term
“footing.”
The personal impact of that is huge—it is demonstrable. I know one person in Glasgow who worked as a midwife for 30 years and quit last year because of the utter mental and physical exhaustion and a chronic lack of safety on the ward as a result of inadequate staffing. That is happening again and again.
Last month, an investigation revealed that mothers and babies at the Simpson maternity unit in Edinburgh came to harm in part due to short staffing. In total, 17 safety concerns were flagged, and the toll that the situation has taken on staff has been evident in the form of a 200 per cent increase in absence rates due to sickness.
Across the NHS, we are seeing the same vicious cycle at play. We know from a survey that Unison Scotland conducted that stress and burn-out are also primary causes of sickness absence among social care staff. Again and again, survey respondents are saying that stress has been exacerbated by staff shortages and having to work long hours—it is the same story.
We have to start undoing the damage that has been caused by the Government’s mismanagement of our health service for the entirety of its tenure. Liberal Democrats believe that we need to make a serious about-turn if we are finally to alleviate this crisis—the state of permacrisis that we are warned about every week—and take steps in the right direction. We need to retain existing staff by making working for our NHS less of an ordeal. We want Government to get to grips with recruitment—something that successive health secretaries have singularly failed at, both in our NHS and in the social care sector, which underpins the NHS in our communities.
We can no longer rely on agency staff to fill the gaps and to put out the fires. I am pleased that the Government is finally listening to the Lib Dems, who have been opposing the ill-fated national care service from day 1, and is no longer attempting its ministerial takeover of our social care sector. That will save hundreds of millions of pounds—there is no question about that—and that money is desperately needed to make care the profession of choice on the front line once again.
Everyone is entitled to fast access to their GP and to a wider range of skilled local healthcare staff, which should increase access to mental health support and physiotherapy. That is why my party has fought for, and won, extra funding for both social care and local healthcare in the coming budget.
Supporting primary care is one of the routes out of the crisis—there is no question about that. The Government must also finally listen to Liberal Democrat calls for a staff assembly that puts the lived experience and expertise of front-line staff at the forefront of designing a solution and a pathway forward.
I finish with this. Although I am glad that, this week, the First Minister finally admitted to the crisis that is engulfing our health service, I make it clear that the real change that our NHS needs and that its hard-working staff and patients who are waiting in pain need—indeed, the real change that Scotland needs—is a change of Government.
We move to the open debate. For the avoidance of confusion, I note that Labour Party members have opted for more, but shorter, speeches.
15:38
Broken promises, missed targets, poor delivery and lack of ambition—that is the truth of the SNP NHS. Ask any constituent—they all have a story about the dedication of NHS staff and the dismal failure of the SNP Government.
The SNP Government has fallen short on so many national commitments that it is simply too hard to keep track of all its failures. Today, I, along with many other Scots, feel what can only be described as frustration over the Government’s inability to deliver many of its pledges and develop an NHS that is fit for our future and for our patients and staff.
The Government cannot argue with the facts. One in six Scots are on an NHS waiting list; more than 5 million bed days have been lost to delayed discharge in the past decade; and Scotland has the worst life expectancy rates across the UK, and one of the worst rates in western Europe—
I want to correct the record, as it is important that we have a healthy debate and discuss the actual facts. I recognise that people are waiting too long, but it is factually inaccurate to suggest, as Carol Mochan suggested—and as Sandesh Gulhane did, too—that nearly one in six Scots are on NHS waiting lists. Public Health Scotland has had to correct that publicly, as it causes alarm among the public—
Briefly.
—and I ask the member to correct the record.
I can give you the time back, Ms Mochan, but interventions will have to be briefer.
Thank you, Presiding Officer. In Scotland, 863,000 people are on waiting lists. Scotland has the worst life expectancy rates across the UK and the worst in western Europe. Under the SNP Government, inequality has widened and our national health service is crumbling. The minister has to accept those points.
Staff are forced to deal with rising demand without sufficient planning or action from the Government to help. It is not just MSPs in the chamber who are saying that; respected professional bodies, such as the royal colleges and others in the medical profession, are saying it, too. In its briefing for today’s debate, the BMA says that there is no serious plan and that the Scottish Government is failing to provide a true picture of the stark reality of the challenges in recruiting and retaining senior doctors.
The latest Royal College of Nursing report, which has been mentioned, highlights the damning consequences of the lack of planning in relation to corridor care. It has become accepted in hospitals that that is how patients are cared for. Staff are caring for multiple patients in single corridors and are unable to access oxygen, cardiac monitors or other life-saving equipment. Nurses have reported feeling ashamed, demoralised and distraught that they cannot care for patients in the way in which they have been trained to do and in which patients deserve to be cared for. Frankly, it is shameful that things have got as bad as they have. It is undeniable that NHS staff and patients are bearing the brunt of the Government’s failure—the Government’s failure.
When the Government clearly lacks ambition and competence in workforce planning, how do we solve a workforce crisis that has cost the taxpayer more than £9 million in spending on temporary nurses, locum doctors and consultants? Scottish Labour has been telling the Government for years that ineffective planning has led hard-working staff to breaking point. Graduates cannot get jobs, and a lack of staff has meant that remote and rural communities continue to experience inequalities when accessing services. That is why the Parliament must support Scottish Labour’s motion.
The Government needs to develop a 10-year health and social care workforce plan that meets the needs of the people of Scotland. The people of Scotland are crying out for a new direction, and they deserve a lot better than what the SNP Government is delivering. I hope that members will support our motion to move things forward.
15:42
In my view, four key determinants are affecting the pressures on, and the delivery of, health and social care in Scotland today.
Covid disrupted the delivery of health services for two years. It brought a direct impact through deferred diagnoses, increases in mental health issues and long Covid. Covid meant that cancer was diagnosed at a later and more critical stage; many health services were paused during lockdown, which had an impact on health inequalities; and mental health was impacted. Therefore, the delivery of health and social care today has been profoundly altered. The idea that Covid is done and dusted is for the birds. That page has not been turned.
Brexit, too, had and is having a long-term impact on recruitment and retention across the health and care sectors. That has been well documented.
The next issue is Scotland’s demographics. With our population getting older, there are now more than a million people aged 65 or over in Scotland—20 per cent of the population. That is more than a quarter of a million higher than the number of people under 15. Pressures on the NHS and the care sector grow with ageing, as I know, as I am having to use NHS services more often.
The final issue relates to inflation, austerity and poverty. Inflation has an impact on energy, food and building costs, just for starters, and it has led to an increase in the number of people falling into poverty. Thankfully, the Scottish child payment—£26.70 for each child under 16 in a family that qualifies for certain benefits—is helping. For the coming winter, there is the £100 winter fuel payment for all pensioners who are not on pension credit. Getting rid of the two-child benefit cap will also help, because poverty, at whatever age, inevitably leads to both physical and mental ill health.
The Labour Secretary of State for Health and Social Care, Wes Streeting, admitted that, when it comes to NHS funding, Westminster is damaging Scotland’s NHS because of the austerity that we have suffered for 14 years. That page has not been turned; Wes can add the impact of the hike in employer national insurance contributions, which will have an impact across the health and care sector. I know that there are GP practices that are not taking on GPs because of the national insurance hike.
Those are the four things that have affected health and social care in Scotland: Covid fallout, Brexit, demographics, and inflation and austerity.
Each and every member of our health and care workforce became a hero during Covid. The Scottish Government values them, and so do I. Scotland remains the only country in the UK to have successfully averted NHS strikes over pay, and the pay deals that were offered by the Scottish Government played a crucial role in retaining Scotland’s NHS workforce, recognising their value and improving their wellbeing.
In September, unions voted unanimously to accept the pay uplift of 5.5 per cent for 2024-25. That is investment of more than £448 million and takes the total investment in pay over the past two years to over £1 billion. The Scottish Government puts its money where its mouth is.
Contrast that with Labour-run Wales, where, in January 2024, junior doctor strikes led to the cancellation of 6,500 outpatient appointments and 4,000 planned operations, which undoubtedly impacted on waiting times. That was dwarfed by the situation in England, where over 1.5 million medical appointments have been cancelled due to strike action since March 2023, at an estimated cost of over £3 billion.
I began by stating that, since Covid, the delivery of healthcare has changed—sometimes for the better and sometimes not. Increasing demands have led to innovatory improvements such as hospital at home, which was piloted in the Scottish Borders—where £600,000, the bulk of the national funding pot for the programme, has been allocated. Hospital at home does what it says on the tin and is delivered depending on clinical suitability and—of course—on the consent of the patients, most of whom are elderly. Over 90 per cent of patients who opted for it thought that it was grand to be treated in their own home and, of course, it freed up much-needed beds.
Pharmacy first is another innovation, and it will be expanded where there is an appropriately-qualified pharmacist, which can allow community pharmacies to give people expert help for treating conditions like sore throats, earaches and cold sores. That will divert them away from GPs and A and E. Thirty-two per cent of the Scottish population used pharmacy first in the most recent 12 months that were reported on—April 2023 to March 2024. It is early days, but those are good signs.
On the downside, the pandemic exposed the inequalities across the care sector, despite the dedication of the care workers who delivered care above and beyond expectations, and often did not even go home. We need to tackle that inequality and I would rather that the national care service had been labelled “national care standards”, because the issue is about standards.
I find that the accessibility of some GP practices is not the best. It is not uncommon to be required to phone for an appointment between, say, 8 am and 10 am, and then to have a phone call from the GP rather than a face-to-face appointment. Of course, that is a matter for GP practices, which are, in the main, contracted to the NHS. It is not a matter for the NHS and it is not a matter for the Scottish Government; it is a matter for GP practices. I hope that, if we can shift the balance to pharmacies, opticians and other allied health professionals, more GPs will revert to the personal touch.
I welcome this debate, but let us not ignore context, whether that is the pandemic, Brexit, an ageing population, inflation eating into NHS budgets, the national insurance tax hike on GP practices and allied professionals, and increasing poverty. All of that matters and cannot just be ignored in this debate.
15:49
I welcome the opportunity to speak in support of the motion in the name of Jackie Baillie, which calls on the Scottish Government to urgently bring forward a 10-year health and social care workforce plan. As Jackie Baillie said, we will not solve the crisis in our NHS if we do not solve the staffing crisis that is affecting patient care.
As Alex Cole-Hamilton and Carol Mochan said, we are reminded by our constituents every day of the impact that the crisis is having on them. Just this week, I was contacted by a concerned and terrified constituent who will have to wait three to four weeks just for results to be sent to their GP from an urgent X-ray appointment. Such situations induce even greater anxiety in patients. That is just one of the countless stories that I hear from my constituents day in, day out.
It is clear that despite the very best efforts of our staff, our NHS is in crisis, is inefficient and, on too many occasions, is failing to get the basics right for patients. One of those key basics is having enough beds. It is no wonder—although it is shocking—that people are being treated in corridors when the SNP has significantly reduced the number of beds over time. Compared with 2012, there are nearly 100 fewer beds at the Royal Alexandra hospital in Paisley, which is a reduction of nearly one in eight. The Vale of Leven hospital has had one in eight beds cut during that time, too. Over the past decade, more than 60 beds have been lost at Inverclyde royal hospital, which is a cut of almost one in six beds.
As we heard from Jackie Baillie, that process started while John Swinney was finance secretary, and now John Swinney as First Minister plans for a further 22 beds to be cut at the RAH in Paisley, with the proposed closure of ward 36 for older adults. That is despite the views of nearly 6,000 local people who signed a petition opposing the closure of that important ward. Serious concerns about the impact that that will have on patients and the pressure that it will put on the wider hospital have been raised and, so far, ignored.
There should be a full public consultation, but there has not been any, and the health board is pressing ahead with its controversial plans. Unison reps at the RAH tell me that they want to work in partnership, but not on the closure of that ward. The Scottish Government therefore needs to intervene. We heard from Jackie Baillie that the Cabinet Secretary for Health and Social Care and the First Minister had a meeting last week to discuss the NHS but, regrettably, did not invite Unison. Unison reps, who raised concerns about staff morale at the RAH, want to meet the cabinet secretary to discuss the need for a consultation and to keep ward 36 open.
I have said repeatedly that the cabinet secretary should attend sporting events when appropriate, but if he has time to attend football matches and intends to stay in post, surely he has time to take the ministerial car to the RAH in Paisley and meet representatives of the staff there who are working on the front line. If it helps, we can call it a boxing match. I look forward to hearing from the cabinet secretary whether he will take time to accept that invitation from NHS staff or duck it.
I have also spoken to workers at Inverclyde royal hospital, who are deeply concerned about the impact of staffing shortages there. The accident and emergency department does not have enough staff, particularly at night, and the overreliance on agency staff working in the accident and emergency department, who, through no fault of their own, are not familiar with working there, creates what the staff have warned is a dangerous situation. That sticking-plaster approach is simply not good enough. Although staff there have not seen instances of corridor care, they have seen instances of care in ambulance queues, which puts even more pressure on our Ambulance Service.
Like their counterparts at the RAH, staff at Inverclyde royal are working extremely hard in difficult circumstances. The reality is that the common denominator in such situations is SNP mismanagement. The NHS workforce, patients and our constituents deserve better. Our NHS needs a new direction and a proper workforce plan.
15:53
I welcome the fact that Labour has brought this debate to the chamber—it is important that we discuss the NHS and lengthy waiting times—just as I welcome the fact that the Scottish Conservatives used their debating time last week on education and rising violence in our schools.
It is telling that it is Opposition parties that bring those issues to the chamber. When Christine Grahame spoke about context, I thought that one context that she missed was one that we do not discuss enough—the SNP’s record in government over the past 18 years. The reason why these debates always come from Opposition parties is because the SNP does not want to or cannot defend its record.
This is a vital issue. I know that we have statements and questions but, yet again, on the crucial issues for our constituents, it is Opposition parties that use their debating time to hold the Government to account.
Does Douglas Ross recognise that we debated the investment that we are making in public services just yesterday?
The SNP loves to have those general debates, but this is a very specific debate about waiting times in our NHS and the crisis in our NHS and social care. The SNP likes general debates because it can pick and choose the bits that it can defend best. The SNP’s record is on show here, and it does not make for pretty reading.
[Made a request to intervene.]
I would give way, but I have only six minutes.
Many members have spoken about individual constituency cases today, and I want to add to their number, because the shocking waiting times are simply that—they are shocking, they are unacceptable and they are indefensible. One issue that I wrote to the cabinet secretary about earlier this year—I got a response to it on Monday—concerns a constituent who came to speak to me about her referral from her GP to see a gynaecologist. She phoned up the department in NHS Grampian to get her appointment, and she was told the waiting time—I will come on to that. I got a lengthy, three-page letter from the cabinet secretary, which starts off with an apology. He accepts that things are not good enough. He finishes his letter by saying:
“I understand that she”—
my constituent—
“will naturally be concerned by the delay. However, please be assured that her treatment and care is the utmost priority for the Scottish Government ... I fully expect NHS Grampian to schedule your constituent’s appointment as soon as possible.”
My constituent was told, following her GP referral, to see a gynaecologist, and the waiting time is two years and seven months. Is that really as quickly or as soon as possible? Does the cabinet secretary honestly believe that my constituent could read his letter and think that her treatment was of
“the utmost priority for the Scottish Government”
and for NHS Grampian if she has to wait for two years and seven months to see a gynaecologist?
I move on to another case that I have written about—and I have had a response, so far, from NHS Grampian. This is a constituent I met in Elgin who, by the stage that she spoke to me, had already suffered significantly. She struggles to sleep, because she has issues with sleep apnoea. She went to her GP, and she has been referred to the sleep apnoea clinic in Aberdeen. From the health board, we again get an apology. It accepts that things are not good enough. She was referred by her GP on 2 June 2023, which is now well over 18 months ago. Her letter from NHS Grampian told her that
“The current waiting time”—
for what is a routine appointment—
“is over 5 years.”
People go to their GP, in Scotland, to be told that their issue means that they need to be seen by a specialist, only to wait 18 months and not know anything. They contact their representative and then find out what information that representative has got from the health board: a further five-year wait to be seen at that clinic. How can that happen? As I said, such cases are unacceptable and indefensible.
On the national care service, the Conservative amendment is right to examine the shambolic nature of the attempted passage of the National Care Service (Scotland) Bill through the Parliament. I was reminded about it earlier, and I have raised this point before, but it was in May 2023 that Maree Todd told the Health, Social Care and Sport Committee:
“it has been a little hard for me to get my head around”—[Official Report, Health, Social Care and Sport Committee, 9 May 2023; c 12.]
the issues of the national care service. Neil Gray is shaking his head, but that is what the minister said to the committee scrutinising the National Care Service (Scotland) Bill. Even the minister in charge of the bill was struggling to get her head around it, yet, £30 million later and a lot of money down the drain, the bill was finally dropped.
There were so many warning signs. If the Government had not been so determined to forge ahead with its views and had instead listened to Parliament, to COSLA and to others, we would have been in a better situation.
In the final minute of my speech, I must address a point on which I have tried to get answers. The cabinet secretary’s future revolves around trust. He needs to ensure that he has the trust of the Parliament and of health professionals outwith it, but he has still not been straight on the issue of what he knew about his misleading of the Parliament and his correction of the record.
Can the cabinet secretary now answer the question that John Swinney avoided last Thursday and that Jamie Hepburn avoided last Wednesday? When did Neil Gray know of the responses to the freedom of information request that showed that there were no minutes of the meetings—minutes that he said did exist? When was he made aware of that? That was the point when he became aware that he had misled Parliament. Would Neil Gray like to set the record straight on that point today?
Mr Gray will not. He stares straight ahead. At some point, Mr Gray will have to answer those questions. I do not know why he will not take the opportunity today to set the record straight.
I ask you to resume your seat, Mr Ross. Knowing the procedures of the Parliament very well, as you do, you will be aware that, while challenges to opinions and the accuracy of facts are perfectly in order, the chair will not tolerate an accusation that a fellow member has been deliberately untruthful or has knowingly misled the Parliament. I just put that out there; I hope that you were not intending to do either of those things.
I genuinely did not intend to do that. If I did so, I apologise. Neil Gray corrected the record, and the point that I was trying to make is that the question is whether he did so as soon as he became aware. He has chosen not to set the record straight in the chamber today. I think that he will have to at some point.
Patients deserve better, but all that they get from the SNP Government at the moment is deflection, dithering and denial. They need a health service that delivers for them day in, day out. Under the SNP for the past 18 years, it has not done so. It must and needs to get better.
16:00
I welcome this afternoon’s debate, which—once we have removed the raw politics that are clearly at play—is a hugely important debate about how we support Scotland’s health and social care sector to deliver for the communities that we all serve.
There is also—and I must only whisper it—probably broad agreement that, in addressing the significant pressures and challenges that clearly exist, we must ensure that an appropriately structured, skilled and resourced health and social care workforce sits at the heart of any solution.
The Labour motion speaks of the need to
“urgently bring forward a 10-year health and social care workforce plan”.
If someone took that at face value, they might reply, “Absolutely, we should!” However, the Labour motion completely fails to acknowledge that much of the work that it is calling for is already well under way by our SNP Government.
In March 2022, the Scottish Government published a national health and social care workforce strategy. I had a look at it ahead of this afternoon’s debate. Although the strategy is very detailed and thorough—with 71 short-term, 26 medium-term and 12 long-term action points—I noted that it would benefit from a clearer, more slimmed-down approach to summarising the strategy and from being focused on clear milestones for delivery.
However, there is some good stuff in the strategy. There are some good points with reference to acute oncology—we have heard about cancer in the chamber this afternoon. We have also heard about staff retention, and the strategy contains a health and social care career pathway endeavour. We have heard about ambulances and paramedics, and there are plans to recruit more paramedics. There is real, concrete stuff in the strategy—a strategy that already exists.
Given that the strategy was published in 2022, it might benefit from a refresh. I would therefore welcome details from the cabinet secretary as to how the strategy is monitored, how delivery is tracked and how it links into the Scottish Government’s commitment, in its amendment, to
“the publication of a medium-term approach to health and social care reform”,
including workforce planning, before the Parliament’s 2025 summer recess.
Will the member take an intervention?
Apologies, but no.
I wholly agree with the strategy’s aim to deliver reforms to ensure that everyone can access the treatment and care that they require in the right place, at the right time.
I am not sure why Labour would not acknowledge the strategy in its motion. The motion is fatally flawed from the outset, as it calls for a strategy that, well, um, already exists, and which has been built on by our SNP Government—crazy stuff.
Workforce strategies have to deliver results, and we all agree that this remains work in progress. However, the number of nurses increasing each and every year for the past decade and an additional 153 training posts for junior doctors in 2023—an extra 880 training places during the past decade—are two examples of where it is working.
There is much more to be done. I acknowledge that. It is not enough to train more clinicians; we need to retain them. I have no doubt that the 5.5 per cent NHS pay uplift for agenda for change healthcare staff—making them the best paid in the UK—will assist in that endeavour. That was an additional £448 million investment during the past year and an extra £1 billion during the past two years.
I ask the Scottish Government to say in its summing up whether Labour’s tax grab on our public services with its national insurance raid might impact on how many more staff we can recruit in the future in Scotland’s NHS and social care sector. Will Labour’s national insurance grab mean more doctors, nurses and social care staff, or fewer? We need to know the answer to that.
The challenges faced by health and social care in Scotland are not unique to our nation. They are replicated across the UK and beyond. Before I make my next point, let me be clear that the rest of those challenges are the responsibility of no one other than us in Scotland. However, sometimes, perspective and context, which Christine Grahame talked about, are very important.
Recently, there were headlines in Labour-controlled Wales about Welsh hospitals’ waiting lists being at record levels—again. At the turn of the year, the Welsh ambulance service declared a “critical incident” across Wales: 340 calls to 999 went unanswered for a long time, and more than half the ambulances in Wales were stacked up outside hospitals because the patients could not be transferred over.
I sincerely wish the Welsh Government every success in tackling those enduring, entrenched problems. I recognise the challenges that it is facing—we are also facing those challenges here in Scotland. To pretend that the pressures faced by the Scottish NHS and social care system are unique to Scotland or that they were solely created by the Scottish Government is—to use the word of one Labour speaker—delusional.
For many years, SNP Scotland and Labour Wales have been impacted hugely by Brexit, Covid and UK austerity. That is why, before Labour took power in the UK, the now UK Labour health secretary, Wes Streeting, was clear that, in relation to the NHS,
“All roads lead back to Westminster”.
However, when the Labour Party gets a whiff of power, and it gets into power in London, it forgets the reality of the matter and plays politics with Scotland’s NHS and social care system. That is why I will vote against Labour’s motion this evening, and why I will back this Government and this health secretary to turn our NHS and social care system into the one that we want to see for all the people of Scotland in future.
16:06
We have heard that the Scottish Government is going to overhaul NHS waiting times and improve access to GPs, but it has already been criticised widely for recycling old pledges. That announcement is an admission that we cannot go on like this: it is the same old promises from a tired Government, with no detail. It is not a detailed plan for progress or reform.
We have heard other members talk about how, every day, patients are failed at every level of care, because the Government did not plan effectively for known challenges. In its 17 years in power, it has known about a lot of them. People now worry about the times when they might be ill and need acute care, an ambulance or a life-changing operation, because, all the time, in their own communities, they witness ambulances that cannot get patients into hospitals when they have rushed to get there.
Public confidence in our NHS is diminishing. It is not the fault of the dedicated workforce who have worked tirelessly in the hardest of circumstances.
Pauline McNeill mentioned ambulances stacking up outside A and E, unable to discharge their patients. Does she recognise that that is not a deficiency of emergency care but a symptom of the interruption in flow caused by bed blocking as a result of there being no social care in our communities?
I have no difficulty agreeing with Alex Cole-Hamilton’s point.
It is unbelievable how many people who would never have dreamed of using private healthcare are now being forced to use their life savings to put their health first. However, many other people cannot do that. For basic operations such as hip operations and knee replacements, people are now anxious about calling their GP for a simple appointment. When people are ill, they have to go through the 8.30 phone queue and they have deep anxiety when the countdown starts.
That must change. Scottish Labour would openly say that it is something on which we will work with the Government, but it must change and there must be reform. Although support for the NHS remains unwaveringly high, satisfaction levels with NHS performance are at a record low.
GPs themselves are crying out for reform. They have asked the Government to help them to reform the system. They are willing to do more to broaden out the primary care services that are the cornerstone of our NHS. If they are given the power and resources to do it, they will. GPs are natural problem-solvers. A study in the British Journal of General Practice shows that GPs can reduce mortality by up to 30 per cent if people get to see their own GP regularly. That speaks for itself.
However, reform seems stagnant. There is really no excuse for not planning a decade ago for some of this. We might not have predicted a pandemic—albeit that some people did—but we knew that there was an ageing population and a mental health crisis. The short-term and piecemeal approach to investment and workforce planning has meant that NHS Scotland has paid a heavy price, and it will take more than money to turn things around. In a fresh report, Audit Scotland has said that the Government has
“No clear plan”
for NHS reform, while
“commitments to reducing waiting times have not been met”
and
“the number of people remaining in hospital because their discharge has been delayed is the highest on record”.
I emphasise that point. The chairman of the BMA, Dr Iain Kennedy, said:
“At this stage, we still lack the detail and comprehensive vision needed to make any plan a reality.”
The Government needs to convince the general public not only that it has a plan but that people can have confidence in the detail of that plan and in the 800 GPs that it says that it will deliver to transfer the NHS that people love so dearly.
16:11
The SNP Scottish Government values Scotland’s NHS workforce and is committed to investing in it. The staff in our NHS are the backbone of our nation’s healthcare, and I thank every member of staff for all the care and support that they provide.
I remind members that I am still a registered nurse and am a former employee of NHS Dumfries and Galloway.
The challenges that Scotland’s NHS faces are not unique. Labour’s Secretary of State for Health and Social Care, Wes Streeting, admitted that, when it comes to NHS funding, Westminster is damaging Scotland’s NHS because of the austerity that we have suffered for 14 years. He said:
“All roads lead back to Westminster”
and added:
“The NHS is in crisis and all decisions that are taken in Westminster don’t just affect England—but Wales, Scotland and Northern Ireland.”
Scotland is not alone in facing challenges that relate to the NHS, but the SNP Scottish Government is committed to ensuring that our health service is not just the best in these islands but the best that it can be.
The Scottish Government is choosing to invest more than £21 billion in health and social care in 2025-26. That will be record funding to ensure that people have access to high-quality health, mental health and social care services, driving forward the vision of a Scotland in which people live longer, healthier lives.
The budget includes almost £200 million to reduce waiting lists and reduce delayed discharge—to ensure that, by March 2026, no one waits more than 12 months for a new outpatient appointment or day case treatment.
I took a note of what Douglas Ross said about sleep apnoea assessment. I am co-convener of the cross-party group on lung health. We have taken lots of information about new AI technology that can be used to aid assessment, then diagnosis, more speedily. I look forward to hearing that NHS Grampian picks up that process, which is being trialled in Inverness and other areas, including Dumfries and Galloway.
In addition, £16.2 billion is allocated to front-line NHS boards to improve health in communities and to assess and deliver the most effective care for the people whom they serve. There is £2.2 billion for social care and integration, which exceeds our commitment to increasing funding by 25 per cent by more than £350 million.
Will Emma Harper take an intervention?
No—I am sorry.
There is £1.3 billion for mental health services, which more than doubles direct investment since 2020-21.
There is an additional £139 million in capital spending power to progress the Belford hospital, Monklands hospital and Edinburgh eye pavilion projects. The SNP Government spent £200 million to build a new hospital in NHS Dumfries and Galloway: the Dumfries and Galloway royal infirmary.
There has been sustained record funding to address the public health challenges of drugs and alcohol, including the commitment to provide an additional £250 million over this parliamentary session.
Those commitments are welcome and they demonstrate how the Scottish Government is working to address the challenges in our health service.
The Scottish Government continues to address the challenges that are faced in our healthcare system, but it is constrained at every step by UK Governments of whatever colour. The impact of the UK Labour Government’s increase in employer national insurance contributions is expected to be “catastrophic” for Scotland’s social care sector. That change was brought about without any understanding of how the care sector currently works, without any consultation with stakeholders and without modelling the impact of the change. Donald Macaskill, the chief executive of Scottish Care, has called it
“the straw that breaks the camel’s back.”
The Labour chancellor’s national insurance hike, which other members have mentioned, could impact public services in Scotland to the tune of £700 million and is likely to cost the social care sector in Scotland more than £84 million. That issue is clearly more pressing than any discussion about the medium-term and long-term improvement of our social care system; it is an immediate threat to our social care system in Scotland. The UK Government must cover the cost in full—no ifs, no buts—if Scotland’s healthcare sector is to survive that catastrophic decision by Labour. Just like the UK Government has done to our farmers, our social care sector is now being shafted, too.
The Labour motion makes reference to healthcare graduates not being employed in our NHS. That is simply not correct. The Scottish Government continues to support health boards to ensure that graduates can secure jobs in NHS roles and it works with boards to ensure that they are maximising the opportunities for newly qualified nurses to find employment. Under this Government, the number of qualified nurses and midwives has increased by 16.1 per cent, and the Government’s nursing and midwifery task force is working collaboratively with stakeholders to develop actions that will build a sustainable, attractive and respected workforce.
The Scottish Government has increased Scotland’s medical undergraduate intake from 848 in 2015-16 to 1,417 in 2023-24, which is a 67 per cent increase in the number of available medical school places at Scottish universities. Indeed, this SNP Government conceived of and implemented the Scottish graduate entry medicine programme—ScotGEM—to train the next generation of rural GPs, including across Dumfries and Galloway. I welcome updates regarding ScotGEM’s progress.
Will Emma Harper take an intervention?
The member is about to conclude.
There is so much that could be said, but, in closing, I note that Labour members are again talking down our NHS and that their colleagues in Westminster are working to constrain it, while this Government continues to support our NHS to meet the demands of 2025.
16:17
I remind members that my wife is a GP.
I congratulate Scottish Labour and Dame Jackie Baillie on holding this debate, and I associate myself with Jackie Baillie’s comments that the staff are the backbone of our NHS and something that we should cherish. There is no doubt that we are experiencing a crisis in both our NHS and social care in Scotland, but that is not because Labour is talking them down—it is because the SNP has fundamentally failed to deliver what is required. For example, we are increasingly hearing that corridor care has been normalised. A Scottish nurse who is quoted in the recent RCN report noted:
“Department with capacity for 13 beds, we had 40 in, with patients on chairs having treatments administered, also sitting in the waiting room on cardiac monitors, using privacy screens to put around patients to use the bedpan.”
We have also heard the BMA warning that the NHS will struggle to make it through another year without urgent reforms. Dr Iain Kennedy, who is the Scotland chairman, said:
“Doctors have heard a lot of warm words recently from the first minister … but words must be matched with a clear vision, a timetable for reform and action. The NHS as we know it will struggle to see out another year.”
I want to pause and repeat that statement:
“The NHS as we know it will struggle to see out another year.”
It is arguably our greatest institution and is a source of national pride, yet, for too long, both staff and patients have been let down.
What are the SNP’s priorities at this time? It has a cabinet secretary who is engulfed in a scandal that is, maybe dangerously, distracting him and his office as well as the office of the First Minister, who is repeatedly having to come to the chamber to defend him. The SNP Government is also distracted by the disaster that is its National Care Service (Scotland) Bill. The SNP ignored the warnings of a raft of experts, including trade unions and local authorities, who argued from the outset that the NCS bill was fatally flawed. It has wasted £30 million, with repeated delays and redrafts, only to scrap the flagship part of it. That £30 million could have been spent on investment in remote and rural healthcare, especially in my Highlands and Islands region, where we are still waiting for the new Belford hospital in Fort William, upgrades to Dr Gray’s hospital in Moray, and the replacement hospital on Barra.
I speak to a lot of medical staff, and I also speak as someone who, for many years during my time as a councillor, sat scratching my head on the local integration joint board as we were asked to shut community hospitals despite having no plan for the patients who went into them, which meant that more patients ended up in community hospitals much further away—a long way from friends and family. Managers would tell us that we should move to care in the community, but with little in the way of plans to deliver that.
I have seen health boards shut minor injuries units, de-skilling local staff and adding to pressures on ambulances and A and E departments. That approach has led to more and more pressure being put on primary care. Yesterday, I was shocked when Christine Grahame—who has, sadly, left the chamber—stood up in the debate on public services and told me that the reason why we cannot get through to our GPs on the phone is that they are private practices. That is not the reason. The reason why we struggle to get through to GP practices is, as I think Pauline McNeill pointed out, that the failures of secondary care are putting ginormous pressure on them, meaning that more people are phoning and more people need appointments. Let us not blame GPs for the SNP’s crisis in the NHS.
My new boss, Russell Findlay, talks a lot about common sense, and I am with him on that. I often wonder whether we overcomplicate things. Why can this Government not recognise the value of primary care and allow the profession to restructure itself? If we want more community care, it makes sense that GPs will be a big part of that. Money has to flow between secondary and primary care much more freely. Why can this Government not change its attitude to the caring professions more quickly? Why can it not pay more, create a better job structure and provide benefits in recognition of the fact that those professionals play one of the most important roles in our society?
Why can this Government not do more to put money into preventative health plans such as Planet Youth in Scotland? If members do not know what that is, I urge them to look it up, because I am convinced that it is a model that we can use to solve Scotland’s alcohol and drug problem in young people by getting behind sport and recreation.
We all need to be more open about obesity and food and how we educate people, young to old; we need to be better with mental health prevention and support; and I cannot shout enough about putting more and better incentives in place to encourage a strong rural workforce and accepting that rural healthcare simply costs more. We also need to widely encourage large urban centres to do more research and to invest in pioneering medical technology, which I am sure that my colleague Brian Whittle will talk about later. Some might say that we should have a modern, efficient and local health service that works for all, which just happens to be the title of the Scottish Conservative plan for the NHS, as Dr Gulhane mentioned earlier.
Everyone can see that the SNP has run out of road and out of ideas. Matt McLaughlin, Unison co-lead for health, criticised John Swinney’s recent health speech as being full of re-announcements of previous pledges. He said that Swinney
“completely missed the key issue, which was how do we improve social care to make sure that the delayed discharge problem is tackled once and for all.”
Today, the Scottish Conservatives are calling on Neil Gray to resign but, in many ways, I feel for him. He has spent a year in a job that was always going to be a poisoned chalice, under a tired and failing Government. Our NHS, our NHS staff and our communities all deserve better.
16:23
This Government continues to design and deliver services with urban areas in mind. The way in which training is delivered does not work for those who live in rural Scotland. It forces them from their communities to access training, which means that we are ignoring a potential workforce, and we know that those who leave to access training very seldom return.
In the Highlands and Islands, we have high levels of consultant vacancies—per 100,000 people, NHS Western Isles has 41 vacancies, NHS Shetland has 37 and NHS Highland has 30—and that mismanagement leads to eye-watering locum costs.
It is difficult to attract staff to rural areas because the training does not equip trainees with the skills that they need for rural practice. Training is based on superspecialism and working in teams that see a conveyor belt of patients, whereas people in rural practice need different skills, such as self-reliance and a breadth of knowledge. Depth of knowledge is valued more highly in pay and status, and breadth of knowledge is not recognised. That is true not only of consultants but in all other health careers. To be frank, I am not sure that that approach works for anyone, because diagnosis can take much longer under the system that we are pursuing.
Superspecialism also leads to centralisation, because a specialist needs a huge cohort of patients with very specific conditions in order to keep their skills honed. Patients need to travel, which comes at a huge personal and financial cost.
Social care is also suffering from staff shortages. Between March 2022 and April 2024, five independent sector care homes closed in Highland. During that period, the public sector acquired a care home that was in administration in order to prevent its closure and a further loss of bed provision. That meant that, at the end of April 2022, in-house and external social care services in Highland were able to provide 14,497 hours of care between them each week. By the end of February 2024, that had reduced to 13,423 hours, which represents a decrease of 1,074 hours in just two years even though demand has actually increased. That is placing pressure on hard-working staff, who are leaving for better-paid jobs that lead to less burn-out.
At the same time, people who experience delayed discharge in NHS Highland are delayed by an average of 88 days. One patient experienced a delay of four years and 147 days. Such cases are heartbreaking for the people who are involved. What hope is there for frailty teams where there is no alternative to hospital?
When it comes to attracting staff, there are complex issues to consider, such as housing, facilities and services. I have spoken to those in the chamber again and again—and, sadly, I will no doubt return to them—but I will not go into them today.
Previous solutions have had very little impact. What has been the impact of the national centre for remote and rural health and care? What are the outcomes? What has it done? I also note that ScotGEM has provided only two GPs since 2016. I feel that those projects are diversions to take attention away from failures and that they do nothing. We know that urban healthcare is in crisis, but rural healthcare is always lagging behind. We need both of them to improve and we need a degree of equality in service provision throughout Scotland.
16:27
I remind members that my wife is an NHS nurse.
Our NHS staff are fed up with the health service being used as a political football, and with the constant negativity from the opposition parties and their friends in the mainstream media, who continue to undermine patient and staff confidence in our NHS. It may be that that is what this debate is all about: that will come as no comfort to staff or patients.
There are challenges in our NHS, but let us put them into context, because all NHS trusts and health boards across the UK face challenges. NHS England has 7.5 million people on waiting lists and, in October, NHS Wales hit a record number of 800,000 people on waiting lists. So much for Labour having all of the answers—it cannae implement them in Wales.
In May 2007, the SNP came to power and was immediately met with the global financial crisis, as global banks collapsed and UK Government debt soared under Labour, which ushered in 14 years of Tory austerity. Cuts to public spending and welfare exacerbated inequality and increased levels of poverty and ill health which, in turn, put more pressure on NHS finances and waiting times.
In 2016, Tory Brexit happened, which brought uncertainty in our relationship with the European Union. Changes to immigration patterns created labour shortages, especially in our health and care sectors: Home Office stats highlight that there has been an 83 per cent drop in health and social care visa applications.
If that was not enough, we then had the Covid-19 pandemic in 2020 and 2021, which led to lockdowns, NHS staff falling ill and wards closing in order to stop infection spreading. The result was more delays and increased waiting times.
The inflation and cost of living crisis, which started in 2021 and continues to the present day, and which was caused chiefly by substantial energy price increases, has impacted the NHS budget. There is also the Labour job tax of around £140 million for the NHS, which is still to come, from April.
Those difficulties continue to this day, but it is more important to ask what the SNP has achieved against the backdrop of economic crisis that has been caused by Westminster mismanagement. First, it has doubled the NHS budget, from £9 billion in 2006-07 to £19 billion this year, with an additional £2 billion in the provisional budget for next year. We should compare that to Rachel Reeves’s decision last August to inform the Department of Health and Social Care in England that it had to find around £1.3 billion of savings in advance of the budget.
NHS Scotland’s staffing levels have benefited from a long-term trend of workforce investment and growth. Since the SNP took office, there are 31,300 more doctors, nurses and other staff working in Scotland’s NHS, which is an increase of nearly 25 per cent since 2006.
Qualified nurses on band 5 have a higher salary than those south of the border do, and nurses do not incur tuition fees when they are training and do not pay hospital parking fees. That is why the Scottish Government has been able to increase student nursing numbers every year for the past decade.
There has been capital investment in new hospitals, including the Royal hospital for children and young people in Edinburgh and the Queen Elizabeth university hospital in Glasgow, which is the biggest hospital in the UK, with 1,667 hospital beds.
Will the member take an intervention?
No.
In my Edinburgh Pentlands constituency we have seen, since 2011, investment in primary care, with new doctor surgeries in Colinton Mains, Ratho and Wester Hailes. People in Edinburgh also welcome the fact that the proposed budget includes funding to progress the replacement for the Edinburgh eye pavilion.
On NHS waiting times, an Office for National Statistics survey that covered the UK asked:
“Are you currently waiting for a hospital appointment, test, or to start receiving medical treatment through the NHS?”
In Wales, 29 per cent of people were on a waiting list. In England the percentage was 25 per cent, but in Scotland it was 22 per cent—the lowest in the UK.
Compared with 2019, more people are being seen within the CAMHS waiting time target, in psychological therapies more are being helped with drug and alcohol dependencies, and more people are being seen within the cancer diagnosis and starting treatment targets.
In accident and emergency departments, no healthcare service anywhere in the UK has hit the four-hour waiting time target; however, the ONS analysis confirmed that NHS Scotland has had the best performing A and E services in Britain for well over a decade. That is backed up by NHS Scotland, which highlighted that in the year to September 2024 more than 1 million patients were seen within the four-hour target.
Will the member take an intervention?
The member is about to conclude.
Let us take stock of where we are in Scotland’s NHS. We have record health spending, the best-paid NHS staff in the UK, the highest number of qualified nurses and midwives in the UK, the highest number of GPs in the UK and the best A and E services.
Ninety-five per cent of people are registered for NHS dental care, which is the highest percentage in the UK. We have free prescriptions, 96 per cent of all hospital discharges happen without delay and hospital at home services have been expanded, thereby ensuring that older Scots get the care that they need at home.
Yes, there are challenges, but there has been progress. Under the SNP, there is a healthcare system that is more resilient, more compassionate and more determined than ever to serve the people of Scotland.
16:34
I do not believe that any member of the Parliament has taken part in the debate to talk down the NHS—not at all. No one is denying that healthcare services beyond Scotland’s borders face challenges of their own. However, this is the Scottish Parliament. Our constituents sent us here to improve their lives and to make good decisions about their public services.
It is evident from members’ speeches that we all care deeply about the NHS and about social care. Scottish Labour will always champion our health and social care workforce—that is why we secured this debate. We MSPs are not unique, but through our advice surgeries and casework, we know more than most people do about the challenges, pressures, delays and barriers that people experience, and about what it is like for people who are trying to access care and for their families and the workforce. We heard from Alex Cole-Hamilton the poignant example of his father, who has had a health scare and is anxiously waiting for results. Sadly, it is the case that all of us have such cases in our casework.
Let us not sugar coat what is going on. There is a lot to celebrate in the NHS, and Gordon MacDonald gave us a good reminder of that. However, if we come to the chamber only to help out the Government front bench and to pretend that everything is okay, we do a disservice to our constituents, who are scared and who have, sadly, seen their loved ones die because they waited for an ambulance that did not come, or because they had to be parked in a corridor or cared for in a cupboard. That is the reality.
It is not a word that I use lightly, but the term that comes to mind is “permacrisis”. It is not winter pressure or a seasonal issue. It is the new normal for our NHS and for social care, but it does not need to be like that. To colleagues who want to spend their time describing waiting times and the performance of other health trusts and other Governments, I say that they should think about their own constituents and the reality that they experience. They are the people whom we have to get this right for.
Scottish Labour has come to the chamber today with solutions. We have, rightly, proposed a 10-year workforce plan, because the SNP has failed to act in the long-term interests of the NHS and social care for too long. I see that in NHS Lanarkshire, NHS Forth Valley and NHS Greater Glasgow and Clyde—the health boards that I deal with day to day—and people have had enough.
In NHS Lanarkshire, almost 79,000 nursing and midwifery days were lost to mental ill health. That shows the number of staff who are burned out. They are at breaking point.
What about safe staffing levels? Apparently, we have legislation on that. When is it going to make a difference? The NHS in Scotland has spent at least £900 million on agency nursing staff and locum doctors since 2019. The NHS is haemorrhaging money because of the SNP’s failure to recruit and retain staff.
In my final seconds, I will say a brief word about mental health and the children who are being let down. Not once has the Government met its CAMHS targets of 90 per cent of referrals being seen within 18 weeks. My constituent Karen McKeown from Bellshill lost her partner to suicide. That has affected her life and the lives of her children. She fights for reform and has a petition lodged in Parliament. I ask the Scottish Government when it will get real and respond to Karen McKeown and the many others like her who have had their lives destroyed because it is failing to listen and to act in the long-term interests of this country.
George Adam will be the last speaker in the open debate.
16:38
When I come to a debate on a topic such as this, I have an idea of how it will go and have initial thoughts on what I will say. However, if I speak near the end of the debate, I tend to change things, as the debate will have moved on.
One thing that has never changed, though, is my appreciation of the work that those in the health and social care sectors do. They do a fantastic job and are very much appreciated by me and my constituents, even though, as everyone acknowledges, they work in very challenging circumstances and environments.
There is always negative talk. I have had complex constituency cases in which we have had to work through the NHS and deal with some of the issues. However, I will give the example of my wife’s 86-year-old dad. Stacey’s dad was not feeling great over Christmas and ended up in the Royal Alexandra hospital with flu, along with a stack of other individuals of a similar age. There was an issue with the numbers—they were challenging—but staff managed to deal with him and everyone else who was on the ward.
When we have such debates, we sometimes need to balance things up and say that those who are working in health are delivering for our constituents. One circle that I find difficult to square is that, although we heard from the Conservative Party about how important the debate is, and Douglas Ross went as far as saying that it should have been in Government time, during two members’ speeches in the open debate—Pauline McNeill’s and Emma Harper’s—there was nobody on the Conservative front bench. For me, that sums up the Conservative Party. Conservative members are here for their soundbite and for a wee bit of argy-bargy, and then they go—they do not care about the rest of the debate.
We need to use this opportunity to set out the true state of Scotland’s NHS and social care workforce. Quite frankly, Labour’s motion is a masterclass in political amnesia. Labour claims to support our NHS, yet it fails to acknowledge its complicity in austerity. Labour’s Westminster front bench has already signalled its intent to stick with Tory spending plans, which will starve our public services of much-needed funding. Now, here in Scotland, Labour members stand before us pretending that they have all the answers.
Before the Labour Party was in government, Wes Streeting said that
“All roads lead ... to Westminster”,
and that
“The NHS is in crisis and all decisions that are taken in Westminster don’t just affect England—but Wales, Scotland and Northern Ireland.”
He also mentioned that the NHS suffered over the 14-year period when the Tories were in government. However, when Labour got into government, the approach seemed to change, as many things have changed.
The SNP Government has been funding our NHS, with funding more than doubling. The Government is investing more than £21 billion in health and social care in 2025-26, which will ensure that Scotland’s health service remains the best resourced in the UK. Staffing levels are at a record high, with more than 31,300 additional doctors, nurses and other professionals since 2006, which is a 24.6 per cent increase.
Crucially, Scotland remains the only part of the UK to have successfully averted NHS strikes. Unlike in Labour-run Wales, where junior doctors were forced on to the picket lines, here in Scotland, we delivered a record pay deal to make our junior doctors the best paid in the UK. That stability has protected patients from the chaos that we have seen down south, where more than 1.5 million appointments have been cancelled because of the strike action in NHS England.
Labour wants to lecture us about workforce planning, but we already have a national health and social care workforce strategy. Just last November, we announced an additional 153 training posts for junior doctors, which brings the total number of extra training places since 2014 to 880. The Scottish Government has also increased nursing student numbers every year for the past decade. The Scottish Government is taking a comprehensive approach to ensure that workforce shortages are addressed in the short term and the long term.
Labour’s motion is not just misleading; it is complete hypocrisy, but let us take a look at the Tory amendment, which is even worse. The party that gave us breakfast—breakfast? I mean Brexit. They don’t give you nothing, Presiding Officer—you get nothing from the Tories.
The party that gave us Brexit and slashed migration routes for health and care workers now wants to talk about workforce shortages. The Home Office immigration policies have been catastrophic, with an 83 per cent drop in visa applications from health and care workers last year alone. That is not an accident; it is a deliberate choice by the Tories, and it is having a devastating effect on Scotland’s social care sector.
Unlike the Conservatives, we recognise the importance of international recruitment, but we also recognise the need to support our home-grown workforce. That is why, in this budget, the Scottish Government is delivering minimum pay for adult social care workers in the third, private and independent sectors, with a 5 per cent increase on top of a 10.1 per cent uplift in 2024-25. That is real action to make social care a more attractive and sustainable career.
Speaking of funding, let us not forget the Labour UK Government’s catastrophic national insurance hike, which is a tax raid on Scotland’s public services that will cost our social care sector more than £84 million. The chief executive officer of Scottish Care has described it as
“the straw that breaks the camel’s back.”
Labour’s choices at Westminster will rip resources out of front-line services in Scotland, yet Labour members have the audacity to come here and tell us that it is the party of the NHS.
The Tories are calling for the resignation of Neil Gray, but let us be honest—that is nothing more than political grandstanding from a party that has utterly failed on health policy. Neil Gray has been working tirelessly to improve our NHS and social care—
Mr Adam, you will need to conclude.
—and investing billions in support. In closing—
No.
—the people of Scotland—
Please just conclude.
—want to hear more; they want to see what we have to do—
Thank you.
—and the Scottish Government has that—
Thank you very much.
We move to closing speeches. I advise members that there are about 10 or 20 seconds in hand time-wise, which is obviously not very much.
16:45
Many colleagues on all sides of the chamber have made robust contributions to the debate, and the discussion has made it clear that, while there is widespread recognition of the dedication and resilience of those in our health and social care workforce, there is also deep concern about the challenges that they continue to face.
Many Labour members have mentioned a lack of workforce planning, and that is a fair challenge to Government. However, we need multiple workforce plans that address variety and gaps not only across specialties and across some hospitals in the same health boards but across the country. We need a GP workforce plan in the Highlands that is different from what we need in the central belt. If some hospitals are struggling in particular specialties, we need to investigate why. We cannot pretend that we have solved all the issues of poor culture in different bits of the NHS, and we cannot take our eye off that.
One of the most important things that we can do to help NHS workers is give them the tools to be able to work more efficiently and to deliver care in the most accessible place. For example, wait times for treatment in secondary care are far too long, and some people could be helped to stay well for longer before invasive treatment is needed if they were managed properly in the community. However, that would involve more money going to primary care, both to increase the overall GP head count and to enable the diversification of the multidisciplinary team. Utilising technology has to be part of the offer in primary care. It is also well beyond the time when we should be seeing electronic prescribing being used across the NHS. Having GPs signing prescriptions for hours is not a good use of their time, and I assume—I am sure that Dr Gulhane will correct me if I am wrong—that GPs do not enjoy the task either.
We could also take some of the burden off GPs by using the pharmacy first service to its fullest extent. I was grateful—as I am sure that other members were—earlier in the month to have time to speak to the Royal Pharmaceutical Society about how it would like pharmacy first to progress. Having all new pharmacists who graduate being prescribers is fantastic, but there is currently too much risk for pharmacists to be able to fully realise the ambitions of pharmacy first. I had first-hand experience of that a few weeks ago. Because of horrendous travel sickness and being unable to take normal travel sickness tablets, I needed anti-nausea medicine. However, because the pharmacist could not see my notes, and in particular my maternity notes, they did not feel that they could recommend anything, let alone prescribe it. That meant that I had to take up a 15-minute appointment with my GP.
I would be grateful if the cabinet secretary or others looked into whether they are willing to ensure that pharmacists have enough information to be able to prescribe with confidence and provide that further avenue for quick and effective treatment.
Will the member give way?
Will the member give way?
I will take the intervention from the cabinet secretary.
I recognise the situation to which Gillian Mackay referred. We are seeking to provide more information, and the emergency care summary that was provided through the Covid period was standardised and formalised from October 2023, but there is more work for us to do. I would be happy to sit down with Gillian Mackay and with the chief pharmaceutical officer to look at what more we can do, because I recognise that we can improve in that area.
I thank the cabinet secretary for that, and I look forward to meeting him to discuss that point.
I also welcome the development of an app for the NHS. We could save so much time in out-patient clinics by ensuring that an app can add in remote monitoring of patients. I had the pleasure of meeting Kidney Research UK, which has lauded the use of the NHS app in other parts of the UK in enabling remote monitoring of those with kidney conditions, so that people are asked to come to hospital only if there is something of concern. That works by allowing patients to put kidney values into the app, which the consultant then reviews and takes action on if necessary.
The freedom for those patients in managing their own conditions is immense—there are fewer trips to the hospital, which means less time out of work, school or daily life. For consultants, it means that there is less of a need for constant out-patient review appointments for people who are otherwise managing a condition well, which frees up urgent appointments for those with concerning symptoms or concerns. That is only one example of where an app would be revolutionary.
I will touch briefly on mental health for children and young people and on another way in which I hope that the Government may look into supporting good mental health. Earlier in this parliamentary session, I visited Larbert high school to chat about the work that school nurses were doing across Falkirk to support young people. Not only were they helping young people to navigate exam stress and relationship issues but they were offering support for those having a period of poor mental health when a CAMHS referral was not appropriate or had not yet been provided. The nurses were trusted by the young people and, for some, were the preferred first line of contact with health services. However, in many areas, the number of school nurses is declining, even though they can support health and wellbeing in schools and provide support and guidance to staff and pupils alike.
NHS staff have to be a priority. During the pandemic, we all made pledges and commitments to make the working lives of nurses and other clinical staff better. Some work has been done, but it has never been more critical to do so much more. Some of that involves ensuring that there are enough staff so that burn-out is not the reality, but it is also about ensuring that the conditions in hospitals support people’s needs.
Multiple colleagues have raised the issue of waiting times. No one should have to wait the length of time that we have heard about today. However, I cannot imagine being a staff member in a health board listening to this debate, because every clinician I know wants to see people as quickly as possible. It is the structure that is failing, not our hard-working clinicians, which is why I strongly believe that the reform of services is as important as workforce planning.
Although I appreciate the strength of feeling behind the Labour motion, I worry that providing a 10-year workforce strategy before the summer recess might not balance the need for a workforce plan with the need for reform and consideration of the nuances of regional disparity. However, the sentiments relating to the urgent need for workforce planning and work to support staff are absolutely not lost on me.
As I did yesterday, I encourage Labour members to speak to their colleagues at Westminster. Labour members could remove one of the biggest pressures on public services by fully funding the increase in national insurance contributions. I also hope that they will break with Wes Streeting’s increased cosiness with the private sector. I would like our reliance on the private sector to be reduced in Scotland, particularly—
Ms Mackay, you need to close.
—which is costing us huge amounts of money. We need to do more on workforce planning to ensure that we do not exacerbate an already—
Ms Mackay, you need to close. We have no time in hand.
16:51
I declare an interest in that I have a daughter who is a medic in the Scottish NHS.
In closing the debate on behalf of the Conservatives, I thank the Labour Party for securing time in the chamber to debate what is, in my opinion, the most important issue that Scotland faces: the health of the nation. The issue speaks to productivity and it speaks to economic inactivity due to ill health—apparently, economic inactivity is higher in Scotland than it is in the rest of the United Kingdom. It also speaks to declining life expectancy as well as an extremely low healthy life expectancy in Scotland.
The debate has highlighted all that is wrong with the SNP’s approach to health. Jackie Baillie opened the debate with a very powerful line about healthcare professionals
“firefighting in a broken system”.
How true is that? Tim Eagle talked about corridor care now being normal. Public Health Scotland has highlighted that one in six Scots is now on a waiting list.
Sandesh Gulhane talked about delayed discharge being at record levels, despite the SNP’s promise not that long ago to eradicate it. If 20 per cent of step-up, step-down beds are taken out of care homes, why are we surprised that, at the other end of the equation, people cannot find places in communities in order to tackle delayed discharge? I remind members that looking after somebody in the most appropriate place for them—a care home—costs £900 a week, whereas keeping them in a hospital bed costs £1,900 a week, so what is happening does not even make financial sense.
In a very powerful speech, Douglas Ross starkly highlighted real cases involving real constituents. In these debates, during the political back and forth, we sometimes forget that real people are being affected.
Some of us sat in the chamber seven years ago when the then health secretary, Jeane Freeman, announced that she would provide 800 extra GP places within the next 10 years, despite the fact that the shortage was 864. However, one of the things that she did not take into account was that some doctors would retire during that time. If we fast forward to now, seven years into that 10-year period, we see that there are fewer full-time equivalent GPs than there were then. I say that because I listened to Bob Doris, Neil Gray and George Adam extolling the Government’s training of new GPs. It is about results. There are fewer full-time equivalent GPs than there were seven years ago, when the policy was introduced.
The First Minister said that preventing ill health
“is also about doing all we can to live healthier, more active lives.”
Given that the healthy life expectancy for those in the most deprived areas of Scotland is 46 years for men and 47 years for women, I whole-heartedly agree with what the First Minister had to say. However, we are still the unhealthiest nation in Europe, and I have been saying that since I was elected. The dial has not moved—a healthy life expectancy of 46 is an absolute disgrace in a modern, wealthy country such as Scotland.
We have a health service that is dedicated to the treatment of ill health, but all the while decisions that have been made by the Scottish Government in health and other portfolio areas have been reducing Scotland’s ability to prevent ill health, heaping ever more pressure on NHS staff.
Mental health has been spoken about several times in this debate, so I will use that as an example. Mental health in Scotland is in crisis. SAMH extols the virtues of physical activity and the prevention and treatment of mental illness—remember that it sponsors jogscotland. The Mental Health Foundation published a report called “Food for thought,” which highlighted the importance of diet in good mental health.
Members can then look at the outcomes of Scottish Government policy, which include cutting council budgets year after year. That means that councils have to close activity facilities, shut school facilities at the end of the school day, reduce investment in free school meals and cut funding to hugely important community mental health projects.
That may save the council budget, but it just increases the pressure on the health budget. Inevitably, with fewer and fewer outlets for those who are suffering from mental health issues and in desperate need—especially those who initially have low levels of mental illness and who could be prevented from developing more acute mental health problems—the GP surgery and A and E become catch-all services, and the pressure mounts on healthcare professionals.
Could SAMH and the Mental Health Foundation be on to something? I have been telling that story since I entered this place, and I have discussed it with many health secretaries. All of them tend to agree with me, yet the issues are far worse than they have ever been. Decisions that are taken in all portfolios affect others, especially health.
In a briefing for today’s debate, I was interested to read:
“General practice in Scotland is in crisis. We have a shrinking GP workforce”,
rising patient demand, and practices
“and IT infrastructure”
that
“are not fit for purpose.”
I wish I had time to go into that in much more detail. A proper information technology system would allow for integrated and effective workforce planning, swift access to effective local healthcare, a better working environment for NHS staff and greater opportunities to prevent illness rather than just treat it, and it would free up precious time for healthcare professionals to deliver on the front line.
We need a health service that allows healthcare professionals to focus on treatment times and prevention in an environment that encourages the retention of staff.
16:58
Thank you to all the members who have contributed to the debate. It is clear that, although there are some differences of opinion, there is a great deal of cross-party consensus and acknowledgement that we should do everything that we can to make the necessary changes that will improve people’s experiences of our health and care system—not least the experiences of those who work in it.
Our workforce is at the heart of delivering health and social care services to the people of Scotland. More than 400,000 skilled and compassionate people work in an integrated way in many different roles and settings. As the largest workforce in Scotland, they reach into every aspect of life and every community in Scotland.
Social care makes a difference to people every day. It makes a difference to people who are accessing care, enabling them to lead fulfilling lives, and to their families and communities. A thriving, fit-for-purpose social care system will also underpin and enhance a thriving, fit-for-purpose national health service.
However, to achieve that, we need to change the way that those systems operate. We need to shift the balance of care, create capacity and build the conditions for innovation. The First Minister has now set out how we intend to achieve that, supported by an ambitious Scottish budget, but it will only be possible if it supported by a skilled and engaged workforce that is in turn enabled by structures and technology that reflect the person-led integrated approach that people want and that we are committed to delivering.
I note the calls that have been made for a 10-year workforce plan for our health and social care system. We need a dynamic and integrated approach to workforce planning that strongly links strategic reform and direction, financial plans and a precise understanding of where we need skills and capability, whether that is provided through people or through technology and AI.
As the cabinet secretary outlined in his remarks earlier in the debate, we are committed to publishing our medium-term approach to health and social care renewal before the summer recess, which will describe how we will deliver services across our population in future. Our proposals will be underpinned by the approach to workforce planning that I have just described.
The cabinet secretary briefly touched on our plans in relation to social care and, in particular, the national care service. As I outlined in my statement to Parliament last week and in letters to stakeholders, I have worked to find a way to deliver on our commitment to a national care service that delivers much-needed change without the need to legislate for structural reform. Far from slowing down the chance to deliver reform, I am determined to take this opportunity to move rapidly.
Although Labour and the Conservatives may be happy to simply point out the problems, this Government is focused on the solutions, and we will continue to deliver the changes that our workforce so desperately needs.
I have no doubt that the two ministers and the cabinet secretary on the front bench want to do the right thing, but the Minister for Public Health visited Dumfries and Galloway and gave assurances that healthcare would be patient centred but did nothing to protect maternity services in Stranraer. We heard about the problems around our cottage hospitals and delivering care as close to home as possible. The minister says all the right things, but when we get written responses, they do not bear any resemblance to the words that the minister or her colleagues use when they speak to constituents. Why can we not get a joined-up approach, and why will the Government not be honest about what it can and cannot deliver?
Constituents, particularly in Dumfries and Galloway, do not want to hear Emma Harper telling us exactly how much money has been spent on a service. We want services to be improved, and we want there to be equality, particularly in rural areas.
Finlay Carson will recognise that the ministerial team has a great deal of rural experience. We are absolutely committed to ensuring that our rural constituents and the rural citizens of Scotland can access high-quality health and social care. I have no doubt that we will continue to engage with him and with Emma Harper, who has pursued those issues with absolute diligence.
I will move quickly to establish a national care service advisory board. It will help to advise, scrutinise and drive improvements in the sector, not only for those who access services but for those who deliver them. We continue to push forward on our fair work agenda, ensuring that our social care workforce are fairly paid and are heard and supported in their roles.
The draft budget for 2025-26 sets out almost £2.2 billion of investment in social care and integration, of which an estimated £950 million enables adult social care workers in the third and private sectors to be paid at least the real living wage. I am very proud of that progress and our commitment to our social care staff in Scotland, which means that they are paid at least £1,000 more than their equivalents in England. Because of this Government’s commitment to progressive taxation, they also pay less tax in Scotland.
We must continue to improve pay and terms and conditions for the social care workforce. We are working closely with partners to develop a sectoral bargaining approach that works for the social care sector. We are also working with the UK Government on the Employment Rights Bill, to ensure that it works for Scotland and complements the progress that we have already made.
I am afraid that I am running too short of time to pick up on all the points that members have made, but I assure members that the ministerial team is listening carefully. We will respond and rise to the challenges in the health and social care system in Scotland that we face today.
17:04
I rise to second and commend to Parliament the motion in the name of my friend the member for Dumbarton. It is a very important motion, because the national health service in Scotland accounts for a third of all public expenditure for which the Scottish Government is responsible, and for up to half of day-to-day public expenditure.
The current Government’s administration of our national health service has lasted nearly 18 years, which is approaching a quarter of the NHS’s entire existence, so the Government has had almost the largest span of control of our national healthcare system since it was set up 76 years ago. In that time, the spend in Scotland per head relative to the rest of the UK was 17 per cent more at the start of the Government’s tenure, and it is now just 3 per cent more, so a significant decline in public expenditure overall is clearly a priority for this Government. We have seen the consequences of that long decline in its relative importance to the Government as the overall pattern of expenditure has evolved.
That point has come from clinicians and from our constituents in correspondence. That is why we are here: to convey their arguments to the Government and represent their interests. As many members have said, ministers and back benchers alike are all here to back our NHS workforce and our constituents who are seeking to access healthcare that is free at the point of need, as the purpose of the NHS when it was founded was to remove
“money worries in times of illness.”
Unfortunately, as we have heard all too often today from members across the chamber, when people are in need, the NHS simply is not there for them. They are waiting so long that they are developing money worries, because they are facing the torment of pain or, in many cases, are having to pour out their life savings to fund their medical treatment. That point was put ably by my Glasgow colleague Pauline McNeill with regard to her constituents. They have been waiting for so long, often for elective treatments, that they have been forced to pay to go private—some remortgaging their homes or dipping into their pension savings in order to do so, when they should be gearing up for a settled retirement.
I support the contribution that the member is making. Does he agree that it is also really concerning that I have constituents who have paid in excess of £700 for private care just to get assessments and diagnoses for their children and young people, so that they can finally access the support and care that they need?
My colleague Ms Duncan-Glancy makes a key point. We have heard it all across Scotland. Surely every member here has received correspondence from constituents about such problems, whereby people cannot get access to the healthcare system through the front door. When they get into the system, they are not getting a speedy referral to where they need to be within it. They are not being treated quickly enough and, when they are treated—often in a state of infirmity—they cannot get out of the system to an appropriate destination fast enough.
Those inefficiencies are at the heart of what is going wrong. The flow through the system is not optimised, and none of us should be satisfied with that situation. Indeed, some of the propagandistic speeches that we heard from the Government back benches do an ill service to the constituents whom those members represent. Constituents who were listening to some of those bombastic claims will be bewildered by the arrogance. Even if the healthcare system in Scotland were the best in the world, we should not be satisfied with that, because in any human system there is always scope for improvement. That is what our constituents want to see.
If I might stop you, Mr Sweeney. I am conscious of the various conversations that are carrying on across the chamber. I would be grateful if we could treat our colleagues with respect.
Our business as parliamentarians is to ensure that the system is always getting better. We are conveying ideas on behalf of our constituents in order to achieve that. Certainly, there have been many good observations. For example, my colleague Rhoda Grant, who represents the Highlands, highlighted the urban bias that is often seen in healthcare planning, which was reiterated by several members, most notably Mr Ross, who also represents a more rural part of Scotland. He highlighted some of the appalling waiting times that constituents there are having to face.
Look at the analysis by the Institute for Fiscal Studies on six key metrics of the healthcare system in Scotland. The waiting list for elective care is longer than it was last year, and worse than it was prior to the pandemic, and on elective care, the percentage of treatment carried out within 18 weeks from referral is worse than it was last year, while, in the rest of the UK, against those metrics, performance is getting better. On emergency care and four-hour waiting times at A and E, performance is worse than last year. For cancer care—
Will the member take an intervention?
I might, in a moment.
I refer to the metric on people waiting more than 62 days between referral and treatment for cancer care. As we have heard from oncologists, waiting that length of time between diagnosis and treatment for cancer is the equivalent of a death sentence, in many cases. The Government cannot be satisfied with that. It is appalling that it can be so complacent when constituents are dying because of that lack of performance. Clinicians, colleagues and the NHS are at their wits’ end due to their frustrations and the fact that they have been unable to get the system to perform better.
I will now take Christine Grahame’s intervention.
I have a lot of time for the member, but does he agree that, as we have got rid of prescription charges in Scotland, Labour in the UK should get rid of them there, as the charge is nearly £10 an item?
I am not unsympathetic to the member’s point about getting rid of prescription charges, but prior to the SNP getting rid of 100 per cent of prescription charges, 90-odd-plus per cent of prescriptions were already free in Scotland. Moving from 95 per cent free to 100 per cent free is a very marginal change, but it got a good headline. There was a degree of sophistry on the part of the member when she suggested that everyone was paying for prescriptions before the SNP came into power.
I highlight that as an example of the lack of sincerity that we are dealing with when we are talking about the evidence-based approach that we need for our healthcare system. That is why so many members have come here with appalling stories showing what we need to do to improve the system and how we can deliver that improvement.
It is absolutely outrageous that we have 863,000 waiting list places in Scotland. We should be moving that forward at a far quicker pace. Until the minister can deliver that, we will have clinicians telling us that operating theatres are lying empty and not being fully utilised because anaesthetists and surgeons are not in the right place to perform operations.
We need to get those things correct. We need to listen to what the workforce is telling us. We need to plan the workforce properly. We need to reduce the appalling outflow of expenditure on temporary agency contracts and locums. It is an effective privatisation of the healthcare system when we force citizens to wait so long that they are tormented enough to have to pour out their life savings to access private healthcare. That is, by anyone’s measure, privatisation by the back door.
As long as that persists in Scotland, we cannot rest. We must come together as a Parliament and ensure that we work together collaboratively to find ways to improve the situation for the people of this country.
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