Radiologists

– in the Scottish Parliament on 4th October 2017.

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Photo of Linda Fabiani Linda Fabiani Scottish National Party

The next item of business is a members’ business debate on motion S5M-07538, in the name of Edward Mountain, on a shortage of radiologists. The debate will be concluded without any question being put.

Motion debated,

That the Parliament congratulates all of the people in NHS Highland and across the country who are working to overcome the reported shortfall of radiologists, which, it believes, is severely delaying the treatment of patients; recognises the additional work of the radiologists who are covering the staff shortages, and notes the view that the Scottish Government should match the commitment of these NHS employees and urgently address this issue.

Photo of Edward Mountain Edward Mountain Conservative

I thank all members who signed the motion, giving the Parliament the chance to debate what I believe is one of the most urgent issues impacting on the standard of patient care across Scotland. I would also like to thank the radiographers and radiologists across Scotland who are shouldering the additional burden that the shortfall in their numbers is causing, especially those I have met not only at Raigmore hospital but in other places and those who have contacted me from across Scotland asking for help.

By bringing this matter to our attention, they have shown a dedication to their profession. It is now time for us politicians to stand with them, to support and to help them. Let us be under no illusion—radiology is the heart of modern medicine. It is an essential part of speedy and accurate diagnoses of many conditions. In so many cases, patients rely on the expert opinion of a radiologist—and in some cases, a radiographer—to help to diagnose their ailments, which then allows for surgical operations to take place. The shortfall in radiologists across Scotland means that diagnosis and operations are delayed and patients are left waiting too long for vital treatment. It also means that radiologists and radiographers are working under intense pressure. The evidence speaks for itself: between 2010 and 2016, the number of scans undertaken increased by 65 per cent per year, while the number of radiologists to read them rose by 1 per cent per year.

What does that mean? Imagine that someone is waiting for a scan to be read, having been told that they might have lung cancer. Every day they wait seems like an eternity; they want and deserve a quick result. It is very frightening and I can tell members, personally, that it is very hard to bear.

This is a problem that is not going away any time soon, with at least 20 per cent of consultant clinical radiologists expected to retire in the next five years. According to the Royal College of Radiologists, only one Scottish health board is able to meet reporting requirements within staff contracted hours, which meant an annual bill of nearly £4.5 million on overtime and outsourcing alone in 2015-16.

The radiology recruitment crisis is being felt by all across Scotland, but perhaps no more so than by people in the Highlands, where imaging examinations have increased by 250 per cent. NHS Highland is unable to meet reporting targets, with around 8,000 scans still waiting to be reviewed. Just how many patients is that waiting to be told what is wrong with them? I can tell you: too many.

Safety fears have been raised internally by radiologists at Raigmore since 2014, when there were 13 of them. Now there are just 7.8 full-time equivalent staff members—two have left in the past six months; let us hope and pray that two more do not leave in the next six months. More than £300,000 is being spent annually by NHS Highland to have scans read. How many radiologists and radiographers would that employ? Probably enough to prevent the need to have those scans read outside the Highlands.

Here is another fact: at present, there are only two interventional radiologists at Raigmore and, frankly, that is not enough to deal with the problems in the Highlands. It is clear that the radiology team at Raigmore is overstretched and understaffed. They are almost below critical mass and, statistically, they are having to do one night on call every week.

The publication of the Scottish Government’s NHS Highland radiology review cannot come soon enough. The review must identify not only how many radiologists are needed, based on current demand, but why they cannot be recruited and why they are not being retained. It must also find solutions that will improve patient care in the short term.

This is not a time to hide behind the problem or to use political spin. Delivering an improved service for patients is the number 1 priority here; the issue is just too important for anything else. I believe that this is about people, not about politics.

The chairman of the Royal College of Radiologists standing Scottish committee stated earlier this year:

“A perfect storm of increased demand, no significant increase in consultant numbers or trainees, chronically unfilled posts and a tsunami of expected retirements in the next three years means that we need a sustainable solution now for the sake of our patients.”

Thus, I welcome the Scottish Government’s—albeit tardy—announcement of an additional £3 million to try to increase the number of radiology trainees in Scotland by at least 50 in the next five years. It is just a pity that that was not done three years ago, so that the current situation could have been avoided. However, I have to ask the Cabinet Secretary for Health and Sport how many of those trainees will be coming to the Highlands, because they are sorely needed. What has been announced is a step in the right direction, but it will take time to filter through to the front line.

Radiologists across Scotland must be recognised and praised for their dedication to their patients at a time when they are struggling under an increased workload. Highlanders are sceptical about losing local hospital and medical services, whether in Portree, Thurso, Wick, Raasay, Golspie or Strathspey, and seeing them centralised in Raigmore. They will now be even more concerned—rightly so—when they hear that there are not sufficient staff at Raigmore to provide the services that they are losing because of staff shortages at their hospitals.

It is time for the Scottish Government to match the dedication of radiologists and radiographers across Scotland, and I hope that we can do more to resolve this crisis. I look forward to hearing the other speeches in the debate.

The Deputy Presiding Officer:

We move to the open debate, with speeches of four minutes, please.

Photo of Kate Forbes Kate Forbes Scottish National Party

First, I apologise to you, Presiding Officer, and to members for the fact that, because of a long-standing commitment, I cannot stay until the end of the debate.

It is standard practice to thank members for proposing a debate, and I thank Edward Mountain for this members’ business debate. I was speaking at a school last week when a child asked me how I got on with the regional members for the Highlands. My response was that there is a pile of work to do in the Highlands and Islands and that we will make more meaningful progress if our united aim is to serve the Highlands and Islands.

I am pleased that Edward Mountain references the commitment of national health service employees in his motion. I know at first hand, as will many of us, that nurses, doctors and other healthcare staff do a power of work for our patients. Having seen what our nurses in particular do from the vantage point of having been a patient and being related to or friendly with staff, I know that they deserve our continual and authentic praise. The challenge for managers and for decision makers like us is to make sure that they are as well supported as possible, which brings me to the subject matter before us this evening.

This is, of course, a timely debate—I do not know whether the timing was intentional—because it comes immediately after the Royal College of Radiologists welcomed a statement from the Scottish Government and commended the Government’s efforts to resolve the challenges that, we all accept, face us in radiology services. Last week, the Cabinet Secretary for Health and Sport, Shona Robison, announced an additional £3 million to increase the number of radiology trainees in Scotland by at least 50 over the next five years. That is absolutely the right thing to do, because the proportion of radiology trainees to consultants, compared with the proportions in other hospital medical specialties, is one of the lowest in Scotland.

There is particular work to do, then, in getting trainees interested in choosing radiology and then going on to train as consultants. Of course, that takes years, which is why long-term funding is critical. It is a case of looking to the next five, 10, 20 and 30 years to ensure that we are not revisiting this debate. In five years’ time, we want to be able to look at the power of work that will have gone on and commend staff for what they are doing.

Edward Mountain mentioned the unique situation in the Highlands. There has been an increase in the number of consultant radiologists everywhere in Scotland, except in the Highlands. That demonstrates to me that it is not just a simple matter of throwing money at something. We know fine well that when it comes to recruitment, there are unique and special challenges in the Highlands that will take more than hard cash to resolve. We must ensure that key housing is available in the right places; that consultants can access continuing professional development and link them up with hospitals elsewhere; and, critically—this is not often talked about—offer trainees opportunities to work in rural areas early in their careers. A number of colleges have told me that if rural modules—for want of a better phrase—or traineeships are provided early in people’s careers, they are more likely to come back. As an add-on to that, if we can get more pupils in Highland high schools to choose to go and train as consultants in different disciplines, they are more likely to come back to the Highlands. The solution is bigger than just throwing money at something, although clearly we need to solve the long-term funding.

I end by noting that, in Scotland, 20 per cent of consultant radiologists, or one in five, are from outside the UK. For that reason, putting in place more stringent visa requirements and deporting people are not going to help. We need to make sure that working in Scotland is an attractive proposition and make it easier to recruit.

Photo of Jamie Halcro Johnston Jamie Halcro Johnston Conservative

I congratulate my colleague Edward Mountain on securing this important debate.

In June 2017, only 86.9 per cent of patients in Scotland who had been urgently referred with suspected cancer began treatment within the 62-day target time. That is significantly below the target of 95 per cent. In NHS Grampian, which covers part of my Highlands and Islands region, the figure was even lower, at only 82.3 per cent. That was due in part to delays in diagnostic services such as radiology and is hardly surprising given that NHS Grampian saw a decrease in the number of whole-time equivalent consultant radiologists per 100,000 people between 2014 and 2015, compounding the region’s problem of already having one of the lowest numbers in Scotland of radiologists serving its population.

However, the problem affects not only radiology services and exists not only in the Highlands. Health services across Scotland are increasingly under pressure, and patients are facing increasing delays to services. The report on workforce planning that Audit Scotland published in July points to a range of specialties with similar consultant vacancy rates to radiology. That is not talking the national health service down and is not a criticism of the hard-working staff in our NHS, who are being let down by those higher up and by a Scottish Government that is getting workforce planning wrong across Scotland.

In August, I was contacted by a constituent in Moray who, having been diagnosed as needing cardiac surgery, had waited since the beginning of the year for treatment. On their behalf, I wrote to both the Cabinet Secretary for Health and Sport and NHS Grampian, which is their local board. In her reply, the cabinet secretary admitted that the three-month delay for my constituent’s surgery was

“totally unacceptable” and said that, in this case, care had

“fallen well below the level I would normally expect a Board to deliver for their patients”.

However, a month after NHS Grampian acknowledged that it had received my letter, I am still waiting to hear back from it, and my constituent still waits for the surgery that they so desperately need to allow them to get back to their work and to their life.

The delays are not just affecting my constituents in Moray. In Orkney, which has an agreement with NHS Grampian, one constituent has been forced to wait for over 10 months for an out-patient clinic. They are still waiting, and they are not alone. The Orkney heart support group has said that it is

“aware that patients waiting to see cardiologists are experiencing extended waiting times often well in excess of the 12 week national limit”.

It goes on to say:

“We have expressed our concerns to NHS Orkney and they have acknowledged there is a problem but to date have no solution”.

The situation gets worse. I have now been advised by two different sources that some heart attack victims in Orkney are having to wait in beds in Kirkwall’s Balfour hospital for over a week for a bed to become available for specialist treatment in Aberdeen. If that is the case, delays in NHS Grampian now mean that beds are being blocked in Orkney and patients who have suffered heart attacks are being forced to wait for treatment. I have written again to NHS Grampian and to the health boards in Orkney and Shetland to get a fuller picture of the delays to services, how they are impacting on local patients and what is being done to reduce the delays and get patients seen and treated.

I thank Edward Mountain for bringing this debate to the Parliament, and I thank the thousands of NHS workers across Scotland who are doing their very best to see and treat patients as soon as they can. However, I say to the cabinet secretary and the Scottish Government that they must get on top of the delays. NHS services must be properly staffed and resourced, and workforce planning is a key part of that. Waiting-time targets should not just be aspirations; they are there to be met. I have heard the issue described as a looming crisis, but there is nothing looming about it.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I remind members that I am the parliamentary liaison officer to the Cabinet Secretary for Health and Sport. I also thank Edward Mountain for bringing this important issue to the chamber. I do not necessarily agree with the overall approach that he took, but it is an issue that needs to be raised.

I will relay some statistics on what the Government has done. The number of consultants in NHS Scotland with a specialty in radiology has increased by more than 41 per cent, to 317 full-time equivalents, in recent years. As Kate Forbes said, it is ironic that this debate has been brought to the chamber today, when the health secretary made announcements last week about £3 million of additional funding to increase the number of radiology trainees. As far as I can tell, that has been very well received by the radiologists and those working in the profession.

The Scottish Government has also enhanced the supply of doctors to fill radiology posts, with 26 new training places over the past four years—an increase of 20 per cent—and further training places coming in 2018. In addition, the national radiology implementation programme aims to develop a longer-term vision. Those are just some of the things that the Government has done, and I am sure that the cabinet secretary will talk a wee bit more about that. Edward Mountain raised the point that it is an issue that needs to be addressed, and that is why I am glad that the cabinet secretary and the Government have done that.

Kate Forbes finished on a very important point about the Brexit scenario, which is hanging over everything in United Kingdom politics at the moment. When Edward Mountain said that we should not hide behind politics, I wondered whether he actually meant that nobody should mention Brexit, but that is an important barrier.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I have only four minutes. Will I get extra time?

The Deputy Presiding Officer:

I might think about that.

Photo of Miles Briggs Miles Briggs Conservative

I understand the problems around Brexit, and it is something that we have raised at the Health and Sport Committee. However, the problems in our health service did not start on 23 June 2016; we are debating this because, after 11 years under Fulton MacGregor’s party’s Government, we have a crisis in our health service.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I accept the member’s point, but that is why I started by giving some of the stats on what the Scottish Government has done to address the problem. What I am saying about Brexit is that it is not going to make things easier. It is not making it easier to attract highly skilled European staff to the country, and the Conservatives need to recognise that that is an issue.

I am not a Highland MSP and I know that the issues there are a wee bit different, but I want to talk about the issues in NHS Lanarkshire. I spoke to Calvin Brown at NHS Lanarkshire today to get some stats. All three of our major hospitals—Monklands, Hairmyres and Wishaw—are served by a fully staffed and equipped radiology department. Approximately 360,000 radiological examinations are carried per annum in NHS Lanarkshire, and each hospital is staffed and equipped for plain radiographs, ultrasound, computed tomography scanning and magnetic resonance imaging, so a lot of work is going on locally.

I had the privilege of visiting the Beatson institute, which is based at the Monklands hospital, a few months ago. I saw some of the radiograph work that is going on there in a staff team who certainly seem to be very enthused about their work; Edward Mountain also rightly mentioned that enthusiasm, which is found throughout the wider hospital community. In NHS Lanarkshire, there is a shortage of 3.3 full-time posts over those three hospitals. I am assured that the health board is working extremely hard to fill that gap and looking at all the different recruitment options.

To finish, I would like to say thanks to all the radiographers and everybody else in our NHS. They are working really hard, day in and day out. Keep up the good work.

The Deputy Presiding Officer:

Due not entirely to Mr MacGregor but to the number of members who still want to speak in the debate, I will be happy to accept a motion under rule 8.14.3 that the debate be extended by up to 30 minutes.

Motion moved,

That, under Rule 8.14.3, the debate be extended by up to 30 minutes.—[

Edward Mountain

.]

Motion agreed to.

Photo of Colin Smyth Colin Smyth Labour

I thank Edward Mountain for lodging the motion on this important subject, and I echo members in thanking our incredible and hard-pressed NHS staff for all the work that they do.

The shortage of radiologists in Scotland is pushing the field to “the brink of collapse”—those are not my words but those of the Royal College of Radiologists. According to the royal college, at a time when radiology has seen a significant increase in demand, imaging workloads having increased by 55 per cent between 2010 and 2015, the number of consultant radiologists has increased by just 3 per cent.

The most recent figures from the royal college show that Scotland has just eight radiologists per 100,000 people, compared with a European Union average of 12. The figure for consultants is even more dire, at 5.4 per 100,000. Across Scotland on average, 8 per cent of radiologist posts and 13 per cent of consultant positions are unfilled at any given time. Interview panels are regularly cancelled due to a lack of suitable candidates, and the college’s 2015 survey found that 68 per cent of advertised consultant vacancies initially failed to find anyone suitable. The problem is set to get worse, because 19 per cent of radiology consultants are due to retire within the next five years, and as many as 53 per cent will retire by 2030.

That is only half the story. According to the royal college, there are significant regional differences, and rural areas are struggling most. In my home region of Dumfries and Galloway, half—that is right, half—the consultant radiologist positions are not filled with a permanent member of staff.

The recruitment crisis is placing a significant financial burden on the NHS. In 2015, £5.25 million was spent on outsourcing radiology services to the private sector—an increase of £1.75 million on the previous year. Spending on locums and private agency staff has spiralled out of control under this Government; it increased by 113 per cent between 2011 and 2015.

It is clear that the crisis is impacting on patient diagnosis and treatment, not least in oncology. Cancer waiting times are the worst for a decade. Some 13 per cent of urgently referred patients are not receiving specialist cancer treatment within the target time.

I am sure that the cabinet secretary will tell us today that the Scottish Government has committed to increase the number of radiology trainees by 50 over the next five years. That is welcome, but not only is the number way below the 20 to 25 trainees per year that the Royal College of Radiologists estimates are needed, it takes at least five years to train a consultant radiologist. More needs to be done now to mitigate the crisis.

I hope, therefore, that the Government will listen to the proposals by the Royal College of Radiologists, including its call for a sustained programme to recruit more international medical graduates to fill vacant posts. That is an issue on which there seems to have been a lack of engagement by the Government and little progress towards resolving challenges that relate to General Medical Council requirements, visas, and NHS human resources.

Cancer Research UK, too, has put forward proposals to increase the number of radiologists in the short term. Those include making consultant contracts more flexible, to minimise early retirement; incentivising radiologists to train and work in health boards such as NHS Highland and NHS Dumfries and Galloway, where shortages are most acute; embracing a skills-mix approach, so that there is widespread and safe radiographer reporting; exploring international models for interpreting scans; and considering ways to support health boards through artificial intelligence, networked solutions and telereporting.

Ultimately, the solution lies in tackling the acute shortage of staff. I am sad to say that the recruitment crisis is not confined to radiologists. Earlier today, during parliamentary questions on health and sport, I highlighted the recruitment challenges that face NHS Dumfries and Galloway. The board has almost 150 nursing and midwifery vacancies, 26 allied health professional vacancies, 28 consultant vacancies—that is almost 22 per cent of posts—and vacant general practitioner posts in almost 42 per cent of GP practices.

Those figures and the subject of today’s debate are a damning indictment of 10 years of abject failure when it comes to NHS workforce planning by this Government.

Photo of Maree Todd Maree Todd Scottish National Party

I remind members of my work as a clinical pharmacist for NHS Highland prior to my election last year.

Sir Edward Mountain identified a serious issue. Throughout the UK, there is a shortage of consultant radiologists, so imaging departments are having to work incredibly hard to keep up with demand for services. I thank them for their hard work in ensuring that quality is maintained in these challenging times.

Let us look at the context. Demand for radiology has risen steeply in recent years. Why? Rapid advances in technology have meant that imaging can be used much earlier in the diagnostic process. It is also frequently used to monitor the progress of disease and to perform image-guided treatment. The ageing population, which of course is very welcome, is another driver of demand. Radiology is a cornerstone of diagnosis and treatment, and radiologists are at the heart of patient care for almost all clinical specialties. Retirements from the profession are likely to sharpen the situation in coming years.

That is the current UK-wide picture, but those issues are much more pronounced in rural areas such as the Highlands. I assure members that the situation in Cornwall is every bit as acute as it is in the Highlands. The minimum 50 new training posts that the Scottish Government has announced, which the Royal College of Radiologists welcomes, will certainly improve the situation in the longer term.

I was extremely heartened to see this advice from Nicola Strickland, president of the royal college, to her colleagues:

“Obviously it is crucial that you all start planning immediately where these trainees will be sent, and it might be wise to consider some new rotations especially designed to encourage struggling hospitals to take and nurture trainees in the hope that they will ultimately choose to apply for consultant posts there.”

It is clear from evidence that was given to the Health and Sport Committee that folk who experience Highland life during their training are drawn back there. It is not just me who thinks that the Highlands are a great place to work and live.

That is the long-term solution, but we will also require more creative short-term solutions. One of the reasons why radiologists are such a precious resource is that they take more than a decade to train. I assure members that it takes a lot longer than three years—or five years, which is the figure that Colin Smyth mentioned. These guys are medics first; they do a five-year undergraduate degree, two years of postgraduate foundation training and then five years of specialist training to be radiologists.

It is important to recognise the key role of advanced practitioner and consultant radiographers in imaging departments, but we must also recognise that there are certain tasks that only radiologists can do. Local interim solutions, such as short-term imaging outsourcing and identifying future insourcing capacity using imaging IT networks between hospitals and possibly health boards, could be explored, but those will be options for local management and health boards.

Photo of Edward Mountain Edward Mountain Conservative

You raise a very interesting point about—

The Deputy Presiding Officer:

Speak through the chair please, Mr Mountain.

Photo of Edward Mountain Edward Mountain Conservative

Sorry. The member raises a very interesting point about outsourcing. We currently spend £4.5 million a year on outsourcing, much of which goes on extra payments, and we use private firms to make up the shortfall. The £3 million that the cabinet secretary has put forward therefore seems quite light. Does the member agree that it might be better to increase that figure so that we can reduce the amount of outsourcing we need and do not continue to spend £4.5 million a year?

Photo of Maree Todd Maree Todd Scottish National Party

I have already established that it takes 12 years to train a radiologist. There will not be a quick fix without using outsourcing.

The Royal College of Radiologists suggests that a possible UK-wide solution is to recruit more graduates from abroad to meet our short-term requirements. I do not know how easy that would be, given that, as others have mentioned, the current UK Government is clearly anti-immigration and aims to reduce it.

To begin to take on these challenges, we have to acknowledge that they are complex and that they will require equally complex solutions. They will require Governments to work with groups such as the Royal College of Radiologists, the Society and College of Radiographers, postgraduate deaneries, local health boards and management to achieve a balanced, coherent and sustainable approach to the problem and to ensure that appropriate workforce planning is in place for services across Scotland, particularly in rural areas.

Photo of Miles Briggs Miles Briggs Conservative

I congratulate and commend my colleague Edward Mountain for bringing the debate to Parliament, and for the excellent work that he is undertaking on behalf of his constituents across the Highlands and Islands to highlight a major concern.

I thank Cancer Research UK for its useful briefing for the debate, and I pay tribute to the outstanding efforts of all the people who work within radiology in Scotland’s NHS.

We should be in no doubt about the seriousness of the situation that we are in as a result of the shortfall in qualified radiologists across Scotland. Earlier this year, the Royal College of Radiologists spoke out in the starkest of terms. Dr Grant Baxter, who is the chairman of the college’s standing Scottish committee, stated:

“Having been a doctor for 34 years I have never seen it as bad as this. Scottish radiology is on the brink of collapse, and if that happens there will be no medical diagnoses or surgical operations at all, since none can occur without radiologists interpreting the scans and X-rays. A perfect storm of increased demand, no significant increase in consultant numbers or trainees, chronically unfilled posts and a tsunami of expected retirements in the next three years means that we need a sustainable solution NOW for the sake of our patients.”

The Scottish Government has known about the situation for 11 years.

Photo of Shona Robison Shona Robison Scottish National Party

We need to get the facts clear here. Since 2007, we have seen a 41.9 per cent increase in the consultant radiologist workforce. Demand has grown and we need more consultants, but it is not true to say that there has not been an expansion.

Photo of Miles Briggs Miles Briggs Conservative

For my colleague’s constituents across the Highlands and Islands, that response confirms what they are concerned about: this Government is not addressing the issues that the region faces.

Scotland has a much lower proportion of radiologists than the European Union member state average. The latest workforce statistics show a vacancy rate of more than 14 per cent for clinical radiology consultants, which is much higher than the general consultant vacancy rate and almost 10 per cent higher than the rate five years ago.

Almost a fifth of clinical radiology consultants plan to, or will, retire within the next three years, while 36 per cent will retire by 2025. Cancer Research UK warns that NHS Scotland simply does not have the workforce capacity to meet current demand. There can hardly be a clearer example of the Government’s failure in NHS workforce planning.

Radiology is a key part of our cancer diagnostic services, but the pressures on radiology mean that too many patients who were originally referred for suspected cancer are waiting too long for the early diagnosis and subsequent treatment that we all understand and agree are so vital.

The lack of capacity means that significantly more money is being spent on outsourcing, as we have heard, with more X-rays being sent to countries including Australia for analysis. The cabinet secretary will no doubt say that the Scottish Government is committed to increasing the workforce numbers. As my colleague Edward Mountain said, we have welcomed the 50 new training places. I hope that the cabinet secretary will outline how many of those will be Scotland-domiciled.

We do not consider that the Scottish Government’s action will be enough to deal with the crisis at its heart, or that it will meet the ever-increasing demand for imaging services, given that imaging workload increased by 55 per cent between 2010 and 2015.

Kate Forbes mentioned that we need a 10, 20 or 30-year solution. I call on ministers to initiate a comprehensive national review of radiology services that addresses and plans for the needed increase in capacity that our health service faces.

As part of a review, the Scottish Government should work closely with the Royal College of Radiologists and other key stakeholders to take forward their proposals to improve the situation. I hope that the cabinet secretary will commit to a national review when she closes the debate. The issue is too important for sticking-plaster solutions, and patients across Scotland need to have confidence that the Government will put in place a radiology service that is truly world class and meets the needs of our population.

Photo of John Finnie John Finnie Green

As ever, I am enthusiastic to congratulate all public sector workers, including those at NHS Highland.

Although Mr Mountain told us that the issue is about people and not politics, the last part of his motion says:

“the Scottish Government should match the commitment of ... NHS employees”.

That, to be quite frank, is gratuitous. It is not gratuitous in its own right, but it is gratuitous in that it comes on the back of what I thought was an ill-judged intervention on the issue, when he called for the cabinet secretary’s resignation. That lacked proportionality. It is the nuclear option, and it is indicative of a political mindset, to which I will return.

As a Highlands and Islands MSP, my obligation is clear: I must understand the issues. I am sighted on the NHS Highland paper of 26 September, in which it is quite evident that there is no denial of the scale of the problem. Indeed, the chief executive’s report says that radiology services are currently under “unprecedented” pressure as a result of the shortage of radiologists, and that that is compounded by increasing demands on the service.

We know that several groups of clinicians have expressed concern. I am sighted, too, on the letter that NHS Highland sent to them. One of the calls that the clinicians made was for improved terms and conditions. It has been suggested that there be further dialogue with the Scottish Government; it is clear that that would be a way of helping, so I encourage the cabinet secretary to participate enthusiastically in that. I appreciate that there are shortages all over the place, but there are particular challenges in the Highlands. I am also sighted on NHS Highland’s action plan.

We need to look at everyone’s roles and responsibilities. The Scottish Government has a clear role in ensuring that adequate funding is provided, and I welcome the £3 million that is to be provided. I look forward to Mr Mountain and his colleagues contributing to the debate on taxation, because we need adequate funding. Without that, it will be impossible to fulfil the Tories’ wish list. I have no doubt that what they are asking for today will be the first of many asks from them. We need to understand the funding requirements.

NHS Highland has a requirement to ensure delivery of safe services. That will require a workload assessment, workforce planning and safe staffing levels.

Whether we are in government or in opposition, MSPs have an obligation to articulate constituents’ concerns and to hold to account bodies such as NHS Highland. I have done that in relation to consultations on hospital builds, general practitioner services, nurse practitioners, drug services, waiting times and care at home. The cabinet secretary has received quite a number of representations from me.

There is also the issue of how we conduct ourselves. To represent our constituents and hold bodies to account, we must understand the issues, read the briefings from NHS Highland and attend the briefings that it provides, because there are a number of complex issues involved. That will lead to the potential for some informed comment to be made, instead of the rabble rousing and cheap headlines that we have had.

At this point, I want to talk about the shocking abuse that my colleague Gail Ross has had in relation to health issues in the Highlands. She is not a member of my party, but I know that she works tirelessly on behalf of her constituents and does not deserve the abuse that she has had from the community. In that regard, I must say that I expect a minister of religion to mediate the mob rather than to aggravate or motivate the mob. People need to pay attention to how they respond to their elected representatives and the work that they do.

In the short time that I have left, I turn to Brexit. It will fuel not just the problem of recruitment, but the problem of retention of staff. We already know that there are some people who have had enough and are heading off, which is not a good state of affairs.

I commend the work that is being done to address the problem. We do not need to recount the past; we must deal with the current situation. I urge the Scottish Government to do its very best to put in place a plan that addresses the issue of radiologists not just in the Highlands but elsewhere, and I urge my colleagues not to talk down the Highlands, but to promote it as a place to come to live and work. I say to Mr Mountain that that would be a proper manifestation of people, not politics.

Photo of Jamie Greene Jamie Greene Conservative

I thank my colleague Edward Mountain for bringing such an important issue to the chamber for debate. I do not think that he is talking down the Highlands in any way—in fact, it sounds to me as though he is sticking up for his constituents in the Highlands, which is exactly what he should be doing.

We all know that the NHS is about people. Without the committed staff our hospitals and surgeries rely on across Scotland, the NHS would be nothing more than an acronym. That is why I feel strongly about the issue that we are discussing and why I wanted to participate in the debate. I would like to provide members with examples of the problem from my region.

West Scotland has had its fair share of difficulties with radiology vacancies. In NHS Ayrshire and Arran, the clinical radiology consultant vacancy rate has reached 34 per cent. To put that into context, the national rate is less than half that level, at 14.1 per cent. To put those statistics another way, that means that there are just 4.5 consultants per 100,000 people in the Ayrshire and Arran area, compared with 5.4 per 100,000 across Scotland.

Those are just numbers but, as I said at the beginning, the NHS is about people, and those people are constituents of mine who have contacted me because they are struggling to get appointments for scans or are waiting far too long for routine scans. Many of those scans are carried out to pick up important concerns that may require further investigation or treatment as serious medical issues.

As other members have mentioned, the spokesman for the Royal College of Radiologists warned in February this year that Scottish radiology could be on the brink of collapse and that the profession faced the perfect storm. The royal college suggested that the Scottish Government should undertake a vigorous recruitment programme in the short term and at the same time begin to produce a long-term planning strategy to increase the number of radiologists who train here in Scotland. It said that both measures needed to start together and without delay. However, one could argue that a long-term strategy on planning should not happen today or tomorrow; it should have happened years ago.

To give credit to the Government, there is a recruitment drive to attract students to radiology, which is welcome. I believe that the west of Scotland radiology training scheme is the largest in Scotland, and it is training a number of students in hospitals in my region, but I would be interested in hearing from the cabinet secretary about the success of that recruitment drive relative to the demand that we know that we face. We have heard about the length of time that it takes to train someone. What will we do in the lengthy interim period while the new students are coming through the system?

Earlier this month, the cabinet secretary told my colleague Mr Mountain that she would be meeting representatives of the Royal College of Radiologists to listen to their concerns. I would find it helpful if, in her response to the debate, she updated the chamber on what actions were agreed at that meeting.

It is clear that the failure to adequately plan our NHS workforce across a wide range of specialisms, not just radiology, is now physically impacting on the quality and quantity of care that is available, but when we bring such issues to the chamber, we always get the same responses, and we have heard them all today. Brexit has been mentioned as something that is somehow a barrier to fixing a problem that the Government was warned about a decade ago.

Photo of Jamie Greene Jamie Greene Conservative

No, I will not. I am short of time.

The second reason that we always hear is that things are just as bad in England. We have heard that again today and we heard it last week. In fact, a week ago, I stood on the front bench to bring up another workforce planning issue, which concerned the lack of GPs in Scotland, and we had exactly the same response from the Government.

The third reason that I have heard today—this is a new one—is that demand has risen. Surprise, surprise. Of course demand has risen. Did we not think 10 years ago that demand for such services would rise? All three of those defences are absolute nonsense, and I am sick and tired of listening to them.

There is no shame in bringing up the issue in the chamber, because the people of Scotland are listening and will expect the cabinet secretary to say exactly what she is doing not just to address the problem in the short term but to ensure that, in another 10 years, whoever is sitting on these benches does not have to have the same debate. I want to go back to my region and tell people that we raised this important issue. We are not scaremongering, and it is absolutely right and proper that we raise such issues in the Parliament.

Photo of Gail Ross Gail Ross Scottish National Party

I thank my colleague Edward Mountain for bringing this matter to a members’ business debate. I have enjoyed the mostly positive contributions of other members in attempting to find solutions and highlight the challenges that we are facing throughout the country. I am particularly pleased to see the cabinet secretary here, as together we must find solutions. I also welcome last week’s Scottish Government announcement on funding and training.

Concerns have recently been raised in my constituency by the medical profession that the problem of a shortage of radiographers is, as we have heard, a considerable issue for the Highlands that is impacting on a wide range of services and on patient care and diagnosis. Radiology is a crucial part of any health service. It provides diagnosis and monitoring to assist on-going treatment. I understand from the Royal College of Radiologists that imaging studies are often going unreported because there are not enough radiologists to interpret them, which means that patients are subjected to increased stress and worry while awaiting results and which could lead to treatment delays.

I firmly believe that, as elected representatives, we must work together to achieve improvements in healthcare locally and throughout Scotland. That is why I was quite disappointed to hear members saying that this is just a Scottish Government problem and to hear no real solutions from other parts of the chamber.

Many of the constituencies that are represented this evening face the same problems with remote and rural healthcare and access to diagnostic services as my colleagues and I face in Highland, and we must insist that our health boards provide a sustainable service, particularly to those in remote and rural areas. We all agree that travelling for hours on end for an out-patient appointment is unacceptable; indeed, travelling for hours on end to attend a diagnostic clinic and then waiting weeks for a radiologist to have time to produce the report is worrying for patients and is creating resentment about how NHS Highland is managed. John Finnie alluded to the particularly difficult situation in Caithness, and I thank him for his kind words.

Like others across the chamber, I pay tribute to all the staff who work in the NHS—some, we will agree, in very difficult circumstances—and I thank them for all their hard work. Scotland’s chief medical officer, Catherine Calderwood, visited Raigmore hospital to discuss the issue and said that new ways of working should be explored to maintain a high-quality service. She said:

“We have to change some of the ways we are working if we are not going to ... have as many doctors as we did have because of recruitment issues.

But there are very good solutions—technological solutions but that also involves the use of other staff ... radiographers who can also report on X-rays.”

There is no point complaining about the issue without looking at alternatives and solutions to the problems that we face. As Kate Forbes said, this is about not just funding but recruitment and retention in the Highlands. As Maree Todd suggested, that cannot happen overnight; after all, it takes more than a decade to train a consultant radiologist. However, I suggest that, by implementing a clear strategy and policy, we can find solutions to the problems of recruiting and retaining permanent skilled staff to cope with the increase in demand in Highland and across Scotland.

Photo of Shona Robison Shona Robison Scottish National Party

I certainly welcome this opportunity to respond on this important topic, and I thank Edward Mountain for raising it. I fully agree with the respect and admiration that have been shown across the chamber for the great work that radiologists carry out and the first-class service delivered by these staff, often in difficult circumstances, to the people of Scotland.

Let me begin by assuring members that we are absolutely committed to a sustainable radiology workforce that continues to provide a high-quality service to the people of Scotland. Before coming to the chamber, I chaired the first meeting of the ministerial cancer performance delivery group, and the key item on the agenda was the national radiology transformation programme. We have reviewed the radiology service and we are now into implementation of the transformational programme, so with all due respect to Miles Briggs, with his call for a review, I point out that we are beyond the review stage and are now implementing the changes that are needed. I will say a little bit more about that programme later.

In the other important item on the ministerial group’s agenda, we heard from NHS Lanarkshire, which is something that I am sure Fulton MacGregor will be interested in. Because of changes that that board has made, it is now the best performing with regard to meeting the cancer targets and we want to roll out what it is doing across the rest of Scotland.

Photo of Miles Briggs Miles Briggs Conservative

All members across the chamber, no matter what community they represent in this Parliament, are aware of problems with shortages. The review has led to 50 new places, but are they going to be enough in the long term? That question has not, I think, been answered in the review itself. As tonight’s debate has demonstrated, demand is growing. Is the cabinet secretary confident that this will make the difference?

Photo of Shona Robison Shona Robison Scottish National Party

Yes, it will make a huge difference. I point out that we keep the numbers required in every specialty under review—of course we do—but, as I have said, I think this will make a huge difference. I will say a little more about the detail of that in a minute.

I first want to emphasise the considerable commitment that is shown, day in and day out, not only by radiologists and their staff but by those in the many other medical specialties and professions in our NHS. I certainly agree with the motion that it is essential that we match that commitment through the steps that we are putting in place to improve the way in which services are delivered and workforce planning that reflects that.

It is important that we put the progress that we are making on radiology in the context of the work to implement part 1 of the “National Health and Social Care Workforce Plan”, which was published in June this year. That is a key part of our delivery plan and it demonstrates our commitment to a sustainable workforce that continues to provide a consistently high-quality healthcare service. The steps that we are taking through the plan will help us to improve the data that we have; develop our knowledge of the effects of different supply and demand factors; and enhance our ability to recruit and retain the staff that we need at national, regional and local levels, while constantly keeping that under review.

We have seen significant expansion in the number of radiology consultants in recent years and we have implemented considerable increases in the radiology training establishment. However, as Kate Forbes pointed out, there are particular challenges in recruiting to posts in rural areas, and we are far from complacent. We recognise that there has been a marked increase in demand for the diagnostic services that are provided by radiology and we recognise how vital those services are in underpinning the wider healthcare system.

We are already working closely with NHS Highland to support improved performance of its radiology service, and we are taking forward a comprehensive range of actions to address the issues that we have discussed today. In August, the Scottish Government access support team carried out a review of NHS Highland’s radiology service to support improved performance and sustainability. As a result, work is already in hand to address immediate radiology staffing priorities. Steps are being taken to ensure that there is capacity to accommodate demand, including the development of an evidence-based staffing model to support the radiology service in NHS Highland in future. I have also asked NHS Education for Scotland to look at the distribution of radiology trainees in the north region to ensure maximum value and optimal utilisation of the training potential in the board. That will of course apply to the new training posts that I have announced.

Photo of Edward Mountain Edward Mountain Conservative

At the moment, there are 7.8 radiologists in the Highland region, despite a requirement six years ago for 13. The radiologists estimate that, to ensure that all the scans are read on time, 20 radiologists are needed. Is that the figure that the cabinet secretary is working on for NHS Highland?

Photo of Shona Robison Shona Robison Scottish National Party

That is why the work of NHS Education for Scotland is so important. We need to make sure that the distribution of trainees is right and that the establishment, in terms of the number of posts, is right. That work is absolutely essential.

On 21 September, I held a helpful and productive meeting with the Royal College of Radiologists to discuss the issues. Edward Mountain might want to listen to this, because it is important. We agreed a number of areas on which we can work constructively together to address a range of points that have been raised in relation to NHS Highland and wider radiology staffing. I also welcomed the college’s offer to support clinical leadership with consultants in NHS Highland and more widely in the north of Scotland with the aim of maximising recruitment potential, and its offer to develop effective cross-board regional working for radiology. I will meet with the college again in the coming months to discuss progress on those matters.

There is also potential to strengthen the multidisciplinary team approach and to make full use of reporting radiographers to enhance capacity and productivity across the service. I can confirm that NHS Highland is currently training additional reporting radiographers and that work is already under way to increase the reporting radiographer capacity across Scotland.

Nationally, we have enhanced the supply of doctors to fill radiology training posts, with 26 new training places over the past four years, which is an increase of 20 per cent. That is in addition to the significant expansion in the existing consultant radiology workforce, which has increased by more than 40 per cent since 2007.

We have established a national radiology implementation programme, supported by NHS boards, which aims to develop the longer-term vision for radiology and to reduce demand on services. I can confirm that the Royal College of Radiologists has kindly accepted my invitation to it to take up a place on the programme board so that it can contribute its valuable perspective and experience to that work.

On 26 September, I announced an additional £3 million to increase the number of radiology trainees in Scotland by at least 50 over the next five years, and I am pleased that members across the chamber have welcomed that. The announcement was made in the context of our wider package of measures to improve waiting times for diagnosis and treatment of cancer patients in Scotland. I am pleased to note that the Royal College of Radiologists welcomed the announcement and acknowledged that the additional training posts reflect our long-term commitment to enhance the radiology workforce. The college’s president said that it is

“a much needed step in the right direction to address this problem, and help safeguard the health of the Scottish nation.”

I look forward to working closely with the college and NHS boards as we take forward this important range of initiatives to further strengthen the radiology workforce. I am confident that they will make a real difference and help to address the many important issues that have been raised in the Parliament this evening.

Meeting closed at 18:00.