Health and Social Care

– in the Scottish Parliament at on 11 January 2018.

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Photo of Ruth Davidson Ruth Davidson Conservative

1. In recent weeks, we have again been reminded how stretched hospitals are right across the United Kingdom, as they seek to cope with demand. Once again, we thank doctors and nurses for all that they do.

Will the First Minister confirm whether the number of hospital beds has gone up or down over the last five years?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I suspect that Ruth Davidson is fully aware that, in line with the position in all parts of the UK, as the pattern of hospital attendances and the nature of treatment that people require has changed, so has the number of acute beds. Not just across the UK, but across the western world, we will see the number of acute beds decline as more care is carried out on a day-care basis and as more care is delivered in the community. Our responsibility is to ensure that we have the right number of beds. The health secretary and her officials monitor that on an on-going basis.

In relation to the pressures on our health service over the winter period so far and particularly during the festive period, I put on record my thanks to those who work extremely hard at the front line of our health service. We have seen an unprecedented increase in demand in recent weeks. The health secretary set out some of the figures in her statement earlier this week. They include a 40 per cent increase in calls to the ambulance service, a doubling of calls to NHS 24 and a 10 per cent increase in accident and emergency attendances over the festive fortnight with a 20 per cent increase in the week before Christmas. In addition to the increased volumes of attendance at A and E, we are seeing more people present with more severe illness.

Much of that increased demand has been down to an increase in flu rates over the winter. It was reported last week that in the seven days up to hogmanay, flu rates were more than double those in the same period last year. I can advise Parliament that the figures for the first week in January are about to be published by Health Protection Scotland and show a further doubling of flu rates in Scotland: last week the rate was 46 per 100,000 and that has increased to 107 per 100,000, which is four times the level of flu in the same week in 2017.

Despite all that, thanks to winter planning and the efforts of our national health service staff, our NHS is coping admirably. Even at the height of those pressures, we continue to see almost eight out of 10 people attending A and E being dealt with within four hours. We have not required to sanction a blanket cancellation of planned operations, as has happened elsewhere in the UK. We all owe an enormous debt of gratitude to those in the NHS.

Photo of Ruth Davidson Ruth Davidson Conservative

The First Minister seemed unable to give the figures that I asked for

, so I will give them: five years ago, there were more than 23,000 hospital beds in Scotland and there are now nearly 2,000 fewer. We know the Government’s rationale for that: it says that more care should be delivered outside of hospitals, closer to people’s homes and in social care. That is a laudable aim, but if it is to work, there need to be places in the community available for patients.

Can the First Minister answer this question: has the number of social care places for elderly patients in Scotland increased or been cut in the last five years?

The First Minister:

First, we now have around 700 more intermediate care beds in our NHS as part of the process of shifting the balance of care and—to go back to the point about acute beds—during the winter, including this winter, we have seen hundreds of additional winter surge beds, as part of the planning for increased capacity.

When it comes to social care, as Ruth Davidson is, again, very well aware, while I do not stand here and say that all is perfect—we all have work to do and we all face pressures, particularly during the winter—the Scottish Government is, in many respects, ahead of any other part of the UK. Over the past two financial years, we have transferred significant sums of money from the NHS into social care to support the shift in the balance of care; and earlier this week, we saw the health secretary in England being given responsibility for social care for the first time, as England is presumably now looking to integrate health and social care, which is something that the Scottish Government has already done.

Yes, there is pressure on services and our NHS is, in common with not just the health service in the rest of the UK but health services in many different parts of the world, undergoing a transition as it adapts to the needs of an ageing population, part of which is about transferring care from the acute service into the community. However, the Government has already done a lot of work on this and will continue to do so.

Photo of Ruth Davidson Ruth Davidson Conservative

I often ask the First Minister about health and social care in Scotland, and she often answers me by talking about the situation in England. I think that people in Scotland want to hear about what is happening in Scotland.

However, if the First Minister wants to bring England into the chamber, she should be aware that hospital beds in Scotland are being cut at nearly double the rate in England and, in England, the number of elderly social care beds has actually gone up in five years, while, under her tenure, the number in Scotland has gone down.

The number of hospital beds and the number of elderly social care places in Scotland are both falling, with the obvious consequence that hospitals get filled up; thousands of elderly patients cannot be discharged, because there is nowhere for them to go; and the cost of delayed discharge to the NHS is Scotland is over £100 million per year. If there are fewer hospital beds and fewer social care places for the elderly, is it any surprise that we have a problem?

The First Minister:

The number of beds lost in our health service because of delayed discharge is down; indeed, the most recent published figures show that it is down 10 per cent over the past year. We do not yet have published figures for the festive period, but the information that we have—after all, we are obviously monitoring the situation carefully—is that delayed discharge has reduced further over that period. As a result, an increase in delayed discharge is not the reason for the pressures that we are seeing in our hospitals.

Ruth Davidson talks about comparisons with England. I know that the Opposition does not like us making such comparisons, even though it makes them when it suits it on plenty of issues. Let me be clear: for this Government, the benchmarks for success are the targets that we set ourselves, not what is happening elsewhere in the UK. However, when Opposition parties come to this chamber and try to make out that the pressures on our national health service are somehow uniquely to do with mismanagement by the Scottish National Party Government, it is perfectly legitimate to compare performance in Scotland with that in the parts of the UK where their parties are in power. I do not know whether Ruth Davidson bothered to look at the news this morning, but clinicians in England have said that they have “run out of beds” in the NHS.

Our responsibility is to make sure that our NHS is performing, and that is what we support our front-line clinicians and health boards in doing. The fact of the matter is that, in spite of all of the pressures—which are actually higher than they are in other parts of the UK; for example, flu levels are higher in Scotland, with more influenza A, which affects elderly people disproportionately—Scotland’s NHS remains the best-performing NHS anywhere in the United Kingdom. It is about time that the Opposition recognised the achievements of those working so hard on the front line of our national health service.

Photo of Ruth Davidson Ruth Davidson Conservative

Presiding Officer, Opposition leaders come to this chamber to ask the Scottish Government to take responsibility for the Scottish health service.

Here is what doctors and nurses have been saying to us over the past fortnight: people are waiting too long in A and E departments, because there are no beds for them on wards and because many of those hospital beds are taken up by patients who are waiting for their social care arrangements. This SNP Government has cut both hospital beds and elderly social care places, so when something like a flu crisis hits, the system breaks down. We need a moratorium before the next crisis, so will the First Minister promise to stop cutting hospital beds until patients have somewhere to go?

The First Minister:

The hypocrisy of the Tories when it comes to these issues is breathtaking. They criticise things that are happening in Scotland, such as the changing pattern of care, which they presumably support in England, where their party is in power.

In a few weeks’ time, we will again debate the budget for next year. At that point, Ruth Davidson and her colleagues will stand up in this chamber and ask us to deliver tax policies that introduce tax cuts for people at the top end of the income spectrum—tax policies that, if we were to follow them, would take £500 million out of the money that we have available to invest in our national health service. Does Ruth Davidson know what £500 million amounts to in terms of nurses? It is equivalent to 12,000 nurses that the Tories would remove from our national health service.

We will continue to get on with the job of delivering healthcare for the people of Scotland and supporting our health service as it responds to the unprecedented demands that it is facing, and we will continue to thank and be grateful to those who are working hard across our country.