National Health Service (Waiting Times)

– in the Scottish Parliament on 9th May 2018.

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Photo of Linda Fabiani Linda Fabiani Scottish National Party

The next item of business is a debate on motion S5M-12108, in the name of Anas Sarwar, on waiting times.

Photo of Anas Sarwar Anas Sarwar Labour

In March 2012, the then Cabinet Secretary for Health, Wellbeing and Cities Strategy—who is now the First Minister—enshrined in law a legal guarantee for patients in Scotland. The guarantee was clear—I will read it out to members. It said:

“You have the right to start to receive agreed inpatient or day case treatment within 12 weeks of agreeing to it ... Some examples of treatments include hip or knee replacements ... If your agreed treatment has not started within 12 weeks, your Health Board must explain the reasons for this, and ... Your Health Board must also take steps to ensure you start your treatment at the next available opportunity”.

The document “Your health, your rights: The Charter of Patient Rights and Responsibilities” is explicit and clear. There is no ambiguity, unless you are the Scottish Government or a health board. When is a guarantee not a guarantee? Apparently, it is when you are given that guarantee by this Government and this health secretary. As we now know, tens of thousands of Scottish patients are waiting longer—much longer—than the 12-week guarantee that they were promised by Shona Robison and Nicola Sturgeon. Since Nicola Sturgeon made that promise—gave that legal guarantee—to the people of Scotland in 2012, it has been broken nearly 120,000 times. That equates to 120,000 broken promises to individuals and families across our country.

What is the consequence of that failure? Patients are in limbo, waiting on treatment. They are told by their health board that there is a 12-week guarantee, and yet, in some cases, they are still waiting 20, 30, 40 or more weeks later. That impacts on their family life and social life, and on their ability to work. In some cases, we are actively prolonging people’s time off work, which impacts on their income and further encourages their isolation. It also impacts on their physical and mental wellbeing.

For many patients, not knowing is worse than if they knew they had to wait longer than the 12 weeks in the first place. Every single day, the health secretary and the Scottish Government break that law. Every single day, individuals are let down and left in limbo. That is a shocking breach of a guarantee that is enshrined in law.

I will share just one shocking example of a lack of honesty and transparency with patients. In a recent case, one of my constituents was referred for orthopaedic surgery. He received the following statement in writing from NHS Greater Glasgow and Clyde. It said:

“Under the Patient Rights (Scotland) Act 2011 you have a guarantee to be admitted for treatment within 12 weeks. This is the maximum you should wait. We will of course endeavour to see you sooner.”

He thought, “Great”, but he waited for 12 weeks and heard nothing. When he spoke to his general practitioner, the GP called for an update and was advised that the actual wait would be 40 weeks. That would be laughable if it were not so serious. Why was my constituent not simply told the truth? Why was he deliberately misinformed?

Sadly, we know that that is not an isolated case. Nearly 120,000 patients will have received similar letters, which will have given them false hope. They will have read the word “guarantee” and taken it at face value. That is a breach of a guarantee and a breach of trust. There has been a lack of transparency that has been surpassed only by a clear lack of honesty on the part of health boards. There has been a complete failure to communicate honestly with patients.

That behaviour has been condemned by the Scottish Public Services Ombudsman. Over the past decade, the number of complaints to the ombudsman that relate to the national health service has trebled. At the weekend, Rosemary Agnew said:

“Increasingly our public reports seem to be about health matters and the theme that has emerged to me is one of communication. That is clinicians to patients and communication across different parts of the NHS.”

It is simply not good enough for patients to be treated that way.

We need to recognise the stress and the impact on staff, too. With the rise in complaints, staff often bear the brunt of concerned patients expressing their frustration at their delay in treatment. Staff are under increased pressure and being overworked, undervalued and underresourced by the Government.

Therefore, I welcome the Scottish Government’s commitment to amend “The Charter of Patient Rights and Responsibilities” to ensure that health boards are open, transparent and honest with patients at all times. That is a real win for patients across the country, but the Government should commit to delivering that by the end of the month. I accept, in good faith, the Scottish Government’s amendment and its new commitment to ensure that patients receive honest communications from health boards on waiting times, but it is absolutely unbelievable that the Scottish Government is admitting today that patients have not always been able to expect that honesty.

There is a wider point. The amendment of the charter cannot just be a fig leaf for a much greater failure by the Government. Tens of thousands of patients in Scotland’s NHS are being forced to wait longer for treatment than they should. If the Scottish Government was not failing patients and Scotland’s NHS, it would not need to worry about changing guidance on patient communication in the first place.

The charter sets out six clear principles by which patients should be treated, and the Government is in breach of at least three of them. Number 1 is:

“Access: your rights when using health services”.

That is not being met by the Government and the cabinet secretary. Number 2 is:

“Communication and participation: the right to be informed, and involved in decisions, about health care and services”.

The Scottish Government’s own amendment recognises that there has been a complete failure in that regard, with that principle not being met by the Government and the health secretary.

Another principle is on respect. In that area perhaps more than any other, patients are being disrespected by the system, by health boards and by the Government and the cabinet secretary. That can no longer go on. We must stand shoulder to shoulder with all our patients who are being failed by the Government, and with all our NHS staff who continue to go above and beyond in the most difficult of circumstances.

I move,

That the Parliament notes that the Patient Rights (Scotland) Act 2011 establishes a legal 12-week treatment time guarantee for eligible patients who are due to receive planned inpatient or day case treatment; further notes that Audit Scotland has shown that this has not been delivered for all patients; acknowledges the impact that long and unknown waits can have on an individual’s work, family life and mental and physical wellbeing, and believes that, in the interest of patient care and the principles of honesty and transparency, NHS boards should communicate an accurate expected waiting time range to patients.

The Deputy Presiding Officer:

I call Shona Robison to speak to and move amendment SM5-12108.1. You have up to six minutes, cabinet secretary.

Photo of Shona Robison Shona Robison Scottish National Party

Our NHS is a remarkable institution. It is our nation’s largest employer, and its staff, along with those in the care sector, work day in and day out to provide care for the people of Scotland. As I said last week, it is a large and complex system, and sometimes things go wrong and fall below the standards that we would expect—I am sure that we will hear examples of that today. Those challenges are not unique to Scotland, but we are committed to doing all that we can to address them.

Since the introduction of the 12-week treatment guarantee on 1 October 2012, more than nine out of 10 patients—1.5 million people—have been treated within the target. That is down to the tremendous effort of NHS staff—not only doctors and nurses but porters, administrative staff and cleaners, who all contribute to the running of our hospitals and community services every day.

We want to drive improvements in acute performance and shift the balance of care where possible. That is why we are taking forward the twin approaches of investment and reform of our NHS to meet the rising demand and challenges now and into the future. Throughout that, clear engagement and communication with patients is vital, whether on the subject of their wait for treatment or in the broader design of services. That is why we are happy to support the motion today, and we make clear in our amendment the actions that we will take.

All parties in the chamber have been consistent in recent years in their support for and advocacy of shifting the balance of care and spend towards community health services, to help people live longer, healthier lives at home or in a homely setting. That is one of the reasons that, by the end of this parliamentary session, we will ensure that at least 11 per cent of front-line NHS spending is on primary care and, as a result, 50 per cent will be outwith acute settings for the first time.

Boards around the country are working very hard to try and deliver the waiting time standards and the guarantee. I have made it clear to boards that exceptionally long waits must be eradicated and improvement must be made on delivery.

We are actively working with all boards to implement better demand and capacity planning and delivery. We also have specific work under way with clinicians and managers in a number of specialties that are experiencing the most significant pressures, for example orthopaedics and ophthalmology. In the past year, that was supported by £50 million across the whole patient pathway.

On communication of waiting times, boards are required to advise patients by letter that they are covered by the legal guarantee. We also expect that, if a board experiences difficulties in seeing patients within 12 weeks, it advises the patient of the reason for the delay and an indication of the likely wait. Communication is very important in a patient-centred NHS, and patients should be kept informed of any changes or delays in treatment. We will address that through the revision of “The Charter of Patient Rights and Responsibilities”, and we will work with boards to ensure the communication of the revised guidance.

Photo of Neil Findlay Neil Findlay Labour

What advice would you give my constituent who waited 44 weeks just to see an orthopaedic specialist—not even to receive treatment—and, in that time, was threatened with dismissal by her employer?

The Deputy Presiding Officer:

I remind you to speak through the chair, Mr Findlay.

Photo of Shona Robison Shona Robison Scottish National Party

As I have already said and will shortly say more about, we recognise that long waits have an impact on not just patients, but their families. That is why we are taking action to address the increasing pressures on the system.

Last autumn, in partnership with patient representation, the Academy of Medical Royal Colleges and Faculties in Scotland and health service leaders, a new Scottish access collaborative emerged. That clinically led initiative is designed to make the connections between existing services, put patients more in control of their care and ensure that primary and secondary care clinicians and patients lead on service reform. I have committed £4 million to support the development of that programme, which will ensure that people experience timely care with the most appropriate staff in the most effective place. Further, as part of our programme for government commitments, £200 million will be invested during this parliamentary session to expand elective capacity for routine operations at the Golden Jubilee hospital and in new treatment centres around Scotland, including in Neil Findlay’s region in the east of the country.

The Labour motion talks about honesty, and I firmly believe that that is vital. However, that works both ways. In the past week, Labour has sought to actively misrepresent a report on waiting times that was recently produced by cancer clinicians. As the report makes clear, the 31-day and 62-day targets for cancer care are being retained and, sadly, a number of cancer clinicians are very angry that the report was misrepresented. Leading cancer doctor David Dunlop, from Anas Sarwar’s home city of Glasgow, said in response to his comments last week:

“It is disappointing that Labour has sought to cherry pick from the text of the remit and report of the group and seek to exploit the sensitivities of patients and the public in relation to cancer waiting times. The report states from the outset that the agreement was to retain the current standards, and the intention was to improve them. The remit was to source professional opinion on whether the standards could be improved to better select patients for the urgent suspicion of cancer pathway and consider whether additional cancer types should be subject to the cancer waiting times target of 31 and 62 days, actually potentially increasing the number of referred patients subject to the standard. Wide cross-professional engagement has taken place.”

So there has been no scrapping of cancer targets, but rather a potential extension of those who are covered by those cancer targets.

The Deputy Presiding Officer:

No, she is just closing.

Photo of Shona Robison Shona Robison Scottish National Party

I would like there to be some honesty in the debates that we have about our health service. Our clinicians and patients deserve nothing less.

I move amendment S5M-12108.1, to insert at end:

“; supports the Scottish Government making any necessary changes to the Charter of Patient Rights and Responsibilities and guidance to NHS boards to ensure that this is delivered, and believes that, to meet the evolving needs of the people of Scotland, NHS and care services must be supported to shift the balance of care from acute to primary and social care where possible, and that effective engagement with the public will be key to this being achieved.”

The Deputy Presiding Officer:

Before I call Miles Briggs, I remind those who wish to take part in the debate to press their request-to-speak buttons or we will not have any speakers.

Photo of Miles Briggs Miles Briggs Conservative

I thank the Labour Party for bringing this debate to the chamber today. It is right that we are debating the 12-week treatment time guarantee for patients who are due to receive planned in-patient and day-case treatment as this subject does not often come under the same focus as Government accident and emergency targets, for example.

Planned in-patient and day-case treatment is another area in which, sadly, the Scottish National Party Government’s rhetoric on our NHS fails to match the reality for too many patients across Scotland. Ministers, including the First Minister, who steered the legislation through Parliament, must be embarrassed that the number of patients waiting more than the target treatment time has increased tenfold since the guarantee was introduced in October 2012. That means that one fifth of all eligible patients are having to wait for more than 12 weeks to receive the vital treatment that they require.

We will all be aware of extreme cases when some patients have faced waits of up to 22 months for out-patient appointments or day-case treatments. The impact on individual patients and their families can be severe, as Anas Sarwar has outlined. In my region, Lothian, between the end of 2012 and the end of 2017, no fewer than 25,288 patients had to wait for longer than 12 weeks, which is the worst performance by far of any NHS board in Scotland. That is yet another indication of the particular pressures affecting capacity in NHS Lothian as our population continues to grow and the demand for services rises year on year.

Although I acknowledge that some individual cases might be complex and the specific needs and requirements of a patient, based on clinical advice, might prevent a 12-week treatment time, the majority of the missed targets are down to capacity and staffing pressures within our local health services. The failure to put in place a proper national workforce plan is the thread that runs through all of this SNP Government’s NHS failings.

The motion rightly talks about transparency and the need for NHS boards to communicate honestly and accurately about expected waiting times. I whole-heartedly agree. As Anas Sarwar stated, nothing is more disheartening for a patient than to be expecting treatment within a set period only to be told towards the end of that period that they will have to wait for longer—often for weeks or months more. Rather, NHS boards need to be open and honest with patients about the likely waits that they will experience before they can be confident of receiving in-patient or day-case treatment, and they should be up front about that from the very beginning of the process. Procedures vary across health board areas and there is vast room for improvement here, but we need best practice to be spread right across Scotland.

The treatment time guarantee has failed many patients in Scotland. One constituent recently said to me that they felt as though they had simply been given false hope. We need to see action to help drive improvements in waiting times for planned in-patient and day-case treatment so that we can reduce excessive waits.

Clinicians across Scotland want to see a focus on best outcomes and, crucially, to ensure that all patients are communicated with about their treatment on a transparent, open and realistic basis.

Almost six years on, it is welcome that the SNP Government has realised that the treatment time guarantee has failed too many patients in Scotland and has now committed to amend the charter of patient rights and responsibilities to ensure that patients get an accurate waiting time estimate.

Under the SNP’s stewardship, the NHS saw more than seven out of 10 waiting time targets missed last year. What we need now is improvement and renewed focus on patients receiving the treatment that they need and a driving down of unacceptable waiting lists. I hope that today’s debate will help achieve that and start a real debate about how we can give patients realistic wait times for their treatment. I support Anas Sarwar and the Labour Party’s motion.

Photo of Ross Greer Ross Greer Green

I imagine that very few MSPs have not been contacted by a constituent about NHS waiting times. Although the majority of people receive treatment within 12 weeks, that is far from the reality for everyone. As has been mentioned by others, severe delays sometimes have a big impact on those who have to wait.

I have recently been helping a constituent to get some clarity on how long they will have to wait for a hip operation. They were told that it would be 12 weeks and that NHS Greater Glasgow and Clyde was meeting the target. They were even specifically reassured that the recent severe weather would not impact on that 12-week waiting time. The problem was that, having been put on the list in December, they had still heard nothing by late April. They were checking their mail every day. It is fair to say that they were—and still are—quite desperate for that much-needed operation.

When my office got involved we found out that, not only was the person assigned to a hospital other than the one that they expected to go to—which they found understandable, although they wished that someone had told them—but the queue for their operation was nine months. We can all understand how frustrated and angry that person was to find out that an operation that they had expected to be imminent would take place around September—hopefully. They said that, if they had just been told that from the start, it might have been frustrating, but it would have dramatically reduced their anxiety and the stress that they felt every single morning when the post was coming through their door. In this case, it was clearly inappropriate for a member of staff to go as far as to reassure them that the 12-week target would be met, despite the weather, at a point when it was about to be missed and when the real nine-month waiting time was clearly well known and had been for some time. It should not have taken the intervention of an MSP to get that information for a patient.

We know that that is not an isolated incident. Members have cited other examples. Only about 70 per cent of patients receive treatment within 12 weeks of being referred, and the situation is getting worse. Audit Scotland reports that demand for healthcare services is increasing, and that more people are waiting longer to be seen.

We need to understand why waiting times are increasing. I understand that funding for the NHS has increased under the present Government, but we need to ensure that money is well spent and matches demand.

At this point I should wear my usual European affairs hat and point out the harm that is already been done to our health service by the UK Government’s irrational and hostile immigration policy, including the minimum income threshold, which in many cases even prevents the nurses we so desperately need from coming and staying here—and that is before we deal with the coming disaster for our healthcare and other public services that European freedom of movement ceasing to apply after Brexit will bring.

Given how dependent our NHS is on citizens of other European nations and how dependent our care service is—a service that should be preventing avoidable hospital admissions and extended stays—it is clear that, although the current waiting time situation may be very far from ideal, the cack-handed anti-evidence approach of the UK Government is about to make it much worse. We have learned over the past few weeks that Theresa May overruled her own ministers to veto a plan to allow more overseas doctors to come and work in the UK. Last year we found out that the number of European Union nurses registering to work in the UK dropped by 96 per cent in a year, thanks to Brexit. With the UK Government’s chaotic infighting and the uncertainty that that imposes on EU citizens, it is little wonder that nurses are not coming to work here.

We also face the impact of sanctions, universal credit and social security cuts, which are driving more people into avoidable health problems and, in turn, increasing demand.

Today’s Labour motion is one that the Greens are more than happy to support. It is a reasonable proposal, which will be welcomed by patients across the country, including constituents who have got in touch with me—and, as I have said, with every other member in the chamber, I am sure.

Beyond that, we need to examine the wider preventive measures that will reduce demand on the NHS. Our healthcare challenges cannot be solved in a silo. A holistic, whole-system approach is needed, and the Greens would be more than happy to support one, were the Government to put it on the table.

Photo of Alex Cole-Hamilton Alex Cole-Hamilton Liberal Democrat

I thank Anas Sarwar and the Labour Party for securing time for this important debate this afternoon. The motion that we are debating is very elegant. It is easy for us as Opposition parliamentarians to throw rocks at the Government about waiting times, sometimes unfairly and sometimes for reasons beyond its control, but that is not what the motion does. The motion looks in granular detail at a profound failure of expectation management, which our constituents are experiencing every single day.

We all have examples of constituents who have been failed in this manner. It starts with that profound mismanagement of expectations. It is often then characterised by pain and anxiety as the delay becomes manifest. Then, almost universally, that leads to deep frustration and anger.

That is typified in one example. At the turn of the year, I was visited by an elderly woman in my constituency. She had been referred to the dental hospital for investigative surgery regarding signs that could be linked to an early stage of mouth cancer. That was a very worrying prognosis. She got her automatic letter, which we have heard about this afternoon, telling her about her 12-week waiting time guarantee. A few months later, she got another letter, saying that her wait would actually be nine months rather than 12 weeks. That was troubling for her as she had to cancel a holiday that she had booked, because it was going to fall in or around that timeframe. However, what added insult to injury for her was an astonishing admission at the top of the piece of paper on which the letter was written: somebody had thought to write that the date that the message had been dictated was 15 October and that the date that it was typed was 17 December. For two months, that letter had lain in a dictaphone somewhere, waiting to be typed up. This is 2018 and we are relying on 1970s technology in the cogwheels of our NHS. For all that time, she had to wait with a troubling anxiety about what was causing the pain in her mouth. I am sure that every member in the chamber has a story like that.

This issue is not about the waiting times themselves; it is about the profound mismanagement of expectation that we are subjecting our constituents to through the current misapplication of the waiting time guarantee.

I used to think that the problem was all to do with delayed discharge. That is a huge part of it, because delayed discharge causes an interruption in the flow at every level of our health service. I will take a moment to put on record my thanks to the cabinet secretary for intervening in the case of William Valentine, which I raised with her last week. I am happy to say that he got home before the weekend.

Although I used to think that addressing the problem of bedblocking and ensuring that we do not have 1,000 people who are fit to go home but cannot do so because they do not have a social care package in place would be the solution, but that issue is just part of the problem. Yesterday, we learned in the Health and Sport Committee that, although NHS Greater Glasgow and Clyde has the lowest level of delayed discharge of any health board in the country, it has some of the worst failures of that 12-week waiting time guarantee—the figure doubled last year, going up to something like 30,000 in-patient waits. The issue, therefore, is not just to do with delayed discharge; it involves care pathways, bureaucracy—people leaving letters lying around in dictaphones waiting to be typed up—demand and workforce planning. All those aspects are key to solving the problem of waiting times.

However, it is the issue of expectation management that the Labour Party is rightly bringing to the attention of Parliament today. If people are given the facts in a brass-tacks way about the delay that they will have to endure—if people are open and honest with patients at the start of the process—we should expect our patients to accept and tolerate that. However, what we cannot expect them to tolerate is the dangling of the false hope of a 12-week treatment time guarantee that their health board has absolutely no way of meeting.

Photo of Jackie Baillie Jackie Baillie Labour

Four minutes is not a long time, so I will cut to the chase. Waiting times are far too long, and they are growing longer with each day that passes. It is a problem in NHS Greater Glasgow and Clyde, and it is a problem across Scotland. Almost 120,000 people in Scotland have had their waiting time guarantee breached. In effect, that represents the Scottish Government breaking the law—its own law—120,000 times. Almost 16,000 people have been affected in the NHS Greater Glasgow and Clyde area alone. Behind those statistics lie patients who are desperately in need of treatment and who are waiting in pain for months and, in far too many cases, more than a year.

In my constituency, the waiting list for ophthalmology is too long. I have cases in which patients who require cataract surgery are being told that it will be 13 weeks before they see the consultant, never mind receive treatment. That means that there are delays that do not even count against the treatment time guarantee. The NHS is front-loading the wait in order to massage its figures, which is nothing short of gaming the system.

The waiting list for orthopaedics is, frankly, shocking. People are waiting in excruciating pain and are now housebound because they have not received treatment. One constituent has crushed discs and can barely walk—she screams with pain—but she had to wait seven months for the results of a scan. One year on, she has been told to go back to her GP for a further assessment even though everyone acknowledges that what she needs is surgery. That is another example of gaming the system.

Another constituent required a hip replacement. They got their treatment time guarantee letter—oh yes, they did—but, when they phoned, they were told that the wait would be at least 50 weeks, although that would not be put in writing.

I raised numerous cases directly with the cabinet secretary in the chamber, months ago, and I have written to her on several occasions on behalf of individual constituents. In fact, I could paper my walls with all those letters and her formulaic responses. Every letter tells me how concerned the cabinet secretary is to read some of the information contained in my correspondence about the delays in the wait for treatment. Every letter tells me how grateful the cabinet secretary is for my bringing the matter to her attention and how it is vital that she hears about patients’ direct experiences. However, despite all of that—

Photo of Jackie Baillie Jackie Baillie Labour


Despite all of that, nothing changes. The health boards are simply not listening to her. The cabinet secretary tells us that an extra £50 million was made available last year—£11 million for Glasgow alone—but I have to tell her that I do not see evidence of that in my constituency. Waiting times are not improving; the same problem remains.

For people in my constituency, the Golden Jubilee hospital—

Photo of Jackie Baillie Jackie Baillie Labour

No—put it in writing.

The Golden Jubilee hospital—the national waiting times hospital—is just down the road. The staff there can carry out the orthopaedic surgery and cataract surgery that my constituents are in desperate need of, but NHS Greater Glasgow and Clyde rations access. It does not want to pay for patients to go to the Golden Jubilee hospital, although, the last time that I looked, it is all one NHS. It would be quicker and more convenient for patients from my constituency to go straight to the Golden Jubilee hospital without NHS Greater Glasgow and Clyde’s interference.

Audit Scotland has reported on waiting times on many occasions, and it does not make pleasant reading. It has also suggested that strengthening patients’ rights and giving them more choice about where they are treated will reduce waiting times. When she was in opposition, the cabinet secretary—perhaps she should listen to this—agreed that she wanted patients to have greater involvement in and choice about where and when they were treated. She believed that patients should be given a clearer indication of what their waiting time was likely to be.

Photo of Kenneth Macintosh Kenneth Macintosh Labour

That is your time, Ms Baillie.

Photo of Jackie Baillie Jackie Baillie Labour

That, Presiding Officer, was in 2006. It has taken 12 years, but I am glad that it is now going to happen. I welcome the commitment today that all my constituents who are waiting beyond their guaranteed treatment time will actually be told how long they will have to wait.

The Presiding Officer:

Conclude, please, Ms Baillie.

Photo of Jackie Baillie Jackie Baillie Labour

I invite the cabinet secretary to make one other commitment, which is that my constituents can have their operations quickly, in the Golden Jubilee hospital, without any more gaming of the system.

Photo of Ivan McKee Ivan McKee Scottish National Party

The motion before us aims to tackle the lack of predictability around waiting times by requiring health boards to

“communicate an accurate expected waiting time range to patients.”

That is a fine objective, and it is one that we all share. We recognise the human impact of poor waiting time predictability, including the economic cost to individuals and to society as a whole. However, as is often the case with instant solutions to complex problems, the devil is in the detail, and many questions arise about how such predicted waiting times are to be calculated, communicated and verified. In my brief remarks, I will consider some of the many issues that we need to address in order to implement that process improvement.

The motion introduces the concept of output predictability. It calls for health boards not only to achieve targets for the 12-week waiting time requirement but to predict the degree by which they will miss those targets and to do so at the level of individual patients. Although that is superficially attractive, it raises some interesting questions. If health boards are to communicate anticipated waiting time ranges to patients, what steps will be in place to ensure the accuracy of those predictions?

Photo of Neil Findlay Neil Findlay Labour

Mr McKee does business analysis of the health service all the time. Does he not understand that the health service is about people who are waiting in agony on waiting lists? When he tries to apply a business principle to everything, he takes away that human element.

Photo of Ivan McKee Ivan McKee Scottish National Party

Does Mr Findlay not understand that his standing up and ranting for 30 seconds does absolutely nothing to solve the problem? The problem will be solved by people understanding it and implementing solutions to make the situation better for the people of Scotland, not by Mr Findlay standing there and ranting.

Let us go back to the real world, where we solve real problems.

Photo of Ivan McKee Ivan McKee Scottish National Party

Thank you very much. [



I hope that I will get some extra time for that, Presiding Officer.

The Presiding Officer:

Please continue the debate.

Photo of Ivan McKee Ivan McKee Scottish National Party

Supply and demand variation—I am sorry, but where were we? The process would require us to measure whether a health board’s expected waiting times were realised or not. I know that Mr Findlay does not care about that, but this is important if Labour members are serious about implementing what they have in their motion. Supply and demand variation and unforecast events mean that waiting times today, at the point when an operation is scheduled, may well be very different from the waiting times that are realised several months down the line.

Once indicators are in place, it is but a small step to setting targets against those indicators.

Further questions exist around the terminology. What is meant by “range”? A wide range could be specified by the health board, which would meet the requirement but would, of course, be of limited value to patients. Work needs to be done to delineate the parameters of the anticipated allowable ranges. Similarly, the term “accurate” requires some clarification. What level of accuracy is acceptable and how would it be measured?

To track performance, health boards would need to collect data not only on the number of procedures that failed to meet the statutory targets, as they do at present, but on the variance between the predicted and actual outcome for each individual procedure. Verification would require information technology systems to be in place to collect that data, and what would the costs of that data collection be?

The question then arises as to the definition of the indicator. The simplest solution may be to track the percentage of operations that were completed within the predicted time range. That then raises the question of which is more important—predictability or speed. [



The Presiding Officer:

Mr Johnson, either intervene or keep your comments to yourself, please.

Photo of Ivan McKee Ivan McKee Scottish National Party

The member might want to listen; he might learn something.

If a waiting time of 16 weeks is initially communicated to the patient and the operation is then completed in 13 weeks, meaning that the initial prediction was inaccurate, is that a good thing or a bad thing? That may depend on the individual circumstances of the patient. As always with target setting, there is the issue of unintended consequences. Any indicator to track predictability performance will need to be aligned with Harry Burns’s review of indicators and targets and with the Scottish Government’s national framework indicators review.

I welcome the intent of the motion. I have gone through it in a bit of detail—clearly unlike the members who proposed it. Predictability is a virtue, and I look forward to the many hours that we can spend on the Health and Sport Committee discussing how best to implement this process improvement.

Photo of Edward Mountain Edward Mountain Conservative

It was only last week that I stood up in the chamber and discussed with the Scottish Government its mismanagement of the national health service. It is of little surprise to me that I am back here again to discuss the same issues as I discussed last week.

When I thought about which waiting time issues to talk about, I was spoilt for choice. I could have gone with issues based on NHS Highland figures, such as the fact that Highland patients have to wait 26 weeks for routine orthopaedic surgery and 47 weeks for routine ophthalmic surgery. Those figures mean that, from receiving a referral from their GP for treatment, they are waiting for more than a year in many cases.

Local consultants who deliver care in the Highlands know and state that highlanders are resilient and uncomplaining. However, there are times when those strengths—which I perceive them to be—become weaknesses. When they first become ill, many people decide not to make a fuss about their poor health too soon. The result is that GPs and consultants in the Highlands are alerted to health problems much later than they should be, and symptoms are often more advanced when they are diagnosed. That is why the issue of waiting times in the Highlands is critical.

What ties diagnosis and treatment together is radiology—that is a simple fact, to my mind. Last year, I spoke about the poor state of radiology in the Highlands following the publication of a letter signed by more than 50 members of the department of medicine and general surgery at Raigmore hospital that expressed their deep concerns about the current state of the radiology department there. Why were they concerned?

Staffing shortages had led to serious delays in elective and emergency reporting, with more than 8,000 films being unreported. Eight months on, there are still far too many unreported films. Yet, in many cases, neither medical diagnosis nor surgical operations can take place until radiologists have interpreted scans and X-rays.

The radiology department at Raigmore hospital is now lacking a clinical director, a head of service and a radiology services manager. The Scottish radiology transformation programme was meant to link up all departments across Scotland to cover short-term staffing issues and allow the reporting of images to be undertaken by any radiology unit.

That was an admirable idea, but the NHS IT system is so clunky that it does not assist the speedy sharing of patient data between health authorities. I am therefore unclear about whether that is a realistic solution without huge technological advancement.

The cabinet secretary’s recruiting plans seem not to be working, and it seems that new thinking is desperately needed. I will make a suggestion. One solution would be for her to consider starting a radiology training scheme based in Inverness, to encourage more consultants to live and work in the Highlands. I am sure that, once they were there, we could encourage them to see the benefits of staying there. Similar schemes have been developed in remote areas of Australia, Canada and Alaska and have proven hugely successful. I know that that is not a short-term solution, but let us not forget that the problem has been 10 years in the making and we need time to sort it out. That much I will give the cabinet secretary.

We should all be really proud of our NHS, and I think that, in many ways, we are. The staff who deliver healthcare have risen to the challenge that has been created by a lack of leadership and innovation. Across Scotland, the shortcomings in our NHS emanate from the top. It is time for the cabinet secretary to step up and provide the leadership that has been severely lacking but that our NHS desperately needs and truly deserves.

Photo of Kate Forbes Kate Forbes Scottish National Party

It is probably appropriate for me to follow Edward Mountain because I, too, want to focus on some things that are going on in the Highlands.

The Scottish National Party Government introduced the Patient Rights (Scotland) Act 2011, which Anas Sarwar mentioned, to ensure that patients are supported properly, that their voices are heard, and that they are seen as quickly as possible. Since then, more than 1.5 million in-patients—although not all patients—and day cases have benefited from the 12 weeks to treatment target.

The Government’s amendment recognises that there is still room for improvement. Like Ross Greer, I am contacted by constituents who have been affected by systems or processes not working perfectly and things falling through the cracks. Long waits have serious implications, as Jackie Baillie outlined. Patients experience pain and discomfort that none of us can properly understand. For improvement, there needs to be targeted investment in services and reform of services.

Although we are often faced with challenges and difficulties, we had a breakthrough yesterday on the Isle of Skye in the NHS Highland area. I want to share some lessons from that experience, which demonstrates that proper engagement with patients, a focus on community services and money being targeted well all make a difference. As Alex Cole-Hamilton said, it is very easy to throw rocks—in fact, that must be the easiest politics going—but it is far harder to build consensus, to seek solutions, to deliver results and to be honest along the way.

After months—if not years—of severe challenges in the north end of Skye about the future of Portree hospital, the tide has started to turn in the past three months. I am sure that my fellow Highlands MSPs in all parties would agree that light was seen at the end of the tunnel yesterday, when Professor Sir Lewis Ritchie shared his findings of the review of Portree hospital in Skye and unequivocally stated that it would remain open. The review was announced last October after meetings with campaigners early in the year to discuss their legitimate fears and concerns about the future of Portree hospital, where out-of-hours services and new admissions were fairly regularly suspended. Campaigners were deeply concerned about local services, but the issue is a lot bigger than that. The example demonstrates that when services are cut in one area, that adds pressure in another.

Photo of Kate Forbes Kate Forbes Scottish National Party

Yes—after my next comment.

Last summer, I spoke to a healthcare professional at Raigmore hospital—that person shall remain nameless—about local residents’ fears about Portree hospital. She said to me in frustration that the problem with closing Portree hospital is that it would put greater pressure on the big hospitals, including Raigmore, and would make it even more difficult for such hospitals to meet waiting time targets. The Government’s amendment states that we need to get more services into the community. In so doing, we will reduce pressure on hospitals such as Raigmore—which, incidentally, requires a minimum two-hour drive for most patients’ journeys for basic services. I will take an intervention from Edward Mountain.

The Presiding Officer:

It will have to be very brief, Mr Mountain.

Photo of Edward Mountain Edward Mountain Conservative

It will be, Presiding Officer.

I join Kate Forbes in welcoming the report from Sir Lewis Ritchie, which I think shows a novel and innovative thought process, which has not been shown by NHS Highland. Does she agree with that?

Photo of Kate Forbes Kate Forbes Scottish National Party

I absolutely agree. The point that I have been making strongly is that it is easy to identify where the challenges are, but this entire process has demonstrated that where a clinician or independent reviewer can come in and build trust and faith between healthcare providers and the public, and find novel solutions, we can indirectly reduce waiting times by ensuring that investment is targeted well and services are reformed. In the case that I am talking about, that was all done with the very welcome backing of the cabinet secretary, which demonstrates that leadership right from the top is working in Scotland and is having a direct impact on patients’ concerns in the north end of Skye.

Photo of Neil Bibby Neil Bibby Labour

I support the motion in Anas Sarwar’s name and I am pleased that other parties in the chamber intend to do so, too.

Patients should get the treatment that they need on time, but if they do not, health boards need to be open and up front about how long patients will be expected to wait and why. It is important to tell people why, because all too often breaches of the treatment time guarantee and other waiting times standards are symptoms of the wider problems in the NHS. We always hear lots of rhetoric from the SNP on staffing levels and resources, but the reality is that health boards have already had to make what Audit Scotland described as “unprecedented savings.”

We also know from Audit Scotland that operating costs are up, demand for services is up, improvements in life expectancy have stalled, health inequalities persist, recruitment is in crisis and the NHS remains underfunded. Those challenges are significant, but none of them is new.

The Scottish Government put in place the Patient Rights (Scotland) Act 2011, but the problem is that it has not put in place a proper plan or adequate resources to deliver it. For years, the SNP Government has been warned about mounting pressures on the NHS. For years, it has been told that it needs to deal with the NHS workforce crisis, but we see the NHS being overstretched and underfunded and NHS workers being overworked.

The Government’s failure to rise to foreseeable challenges has prevented patients from getting the care that they need when they are entitled to get it. It is time that the Government admitted that and addressed it.

Across the country, patients are waiting too long for the care that they need. In my region, a constituent recently phoned the hospital about an appointment only to be told to go to accident and emergency to complain of heart pains because, otherwise, she would be waiting months to see a specialist about her heart complaint.

A number of families who once had open access to the Royal Alexandra hospital children’s ward—which the minister closed—have told me that they now have to wait longer to see a doctor in Glasgow. As Jackie Baillie said, official statistics show that there are thousands of cases of patients in the NHS Greater Glasgow and Clyde area and throughout Scotland for whom the treatment time guarantee has been breached.

Of course, the SNP’s waiting time guarantee is a legal one—it has been written into law. To put it simply, if the guarantee has been broken, that means that the law has been broken. The First Minister tells us that we are to judge the SNP on its record. We can do so—when it comes to health, its record is criminal. We have already heard this afternoon that the SNP Government and the health secretary have broken their own waiting times law more than 118,000 times.

Breaking that law can hardly make Shona Robison Scotland’s Al Capone, but she is certainly guilty of failing Scotland’s NHS and, in the next reshuffle, she might find out that she is not untouchable. The health secretary is running out of excuses. Shona Robison told us last week that adequate funding is being given to the NHS. Scottish Labour disagrees. If sufficient resources are going to the NHS, why are 3,000 operations being cancelled this year, why are A and E waiting times up, why are children’s wards being closed, and why are 118,000 people waiting longer than the SNP’s treatment times guarantee? That is 118,000 people who are waiting for hip replacements, knee replacements, stents, cataract treatment and heart surgery—real people with real needs who are being let down by the Government.

It is welcome that patients should start to get open and honest information on how long they will be expected to wait for treatment and why, but that is the very least that they deserve. We now need urgent action, so that far more of Scotland’s patients get their treatment on time. That is why I urge members to support the Labour motion.

Photo of Michelle Ballantyne Michelle Ballantyne Conservative

Waiting times is not a new issue for debate. Back in 2006, Audit Scotland reported that the NHS in Scotland had made significant progress in reducing waiting times. However, some of that had been achieved by using the Golden Jubilee national hospital, private providers and waiting times initiatives, all of which came at relatively high cost. Evidence suggested then that short-term increases in activity at particular points in the system did not lead to sustained reductions in waiting times. Despite that knowledge, the Government promoted the Patient Rights (Scotland) Act 2011, which enshrined 12-week waiting time guarantees in law. For many of us, it is not surprising that we are here today listening to statistics about breached waiting times and stories about the distress and suffering behind those statistics.

Why do we have waiting time targets and what do they mean for us as decision makers? For Government, and indeed for our communities, waiting time targets signal that healthcare is being monitored, governance is in place and patients’ rights are being protected. As a nurse and an operational and strategic manager in the NHS for more than 25 years, I witnessed the impact that Government targets and guarantees have on our care systems, and how the operational imperative of not breaching a target can drive decision making, which has led to some of the scandals that we have seen over the years.

Waiting times targets are not clinically led. If someone is in pain or suffering with acute mental health problems, the 12 weeks that they are told they will be treated within feels like a lifetime, but then to discover that the information that they have received is not accurate and that their expectations will not be met can be devastating to their physical and mental wellbeing. Patients want accurate and timely information.

Health and community care is a complex system, the efficiency of which is dependent on all its interrelated parts. Waiting lists and waiting times are affected by each part of the system and by the links between them. There is, of course, a place for short-term approaches to tackle delays, but they need to be part of a wider strategy that looks at the whole system for achieving a sustainable reduction in waiting times.

At about £12.9 billion, our NHS spending accounts for 43 per cent of the overall Scottish Government budget, while rising operating costs have meant that health boards have had to make unprecedented savings of almost £390 million just to break even. In October 2017, Audit Scotland concluded that simply adding more funding was “no longer sufficient” to achieve

“the step change that’s needed across the system.”

Members in the chamber can trade insults, cast aspersions of blame and try to outdo one another on who is most virtuous, but that will not address the very real problems that our NHS faces.

In conclusion, I will say this. Do I blame the SNP and its Government for the failure to meet waiting times? No, I do not. The SNP does not control patient demand or many of the bottlenecks and realities in individual areas that impact on waiting times. Do I, however, hold the SNP and its Government responsible for the failure to meet waiting times? Absolutely, I do. The SNP introduced the Patient Rights (Scotland) Act 2011, established the measures and took responsibility, and it would want to take the credit if the targets had been achieved, so yes—of course the SNP is responsible when the promises are broken. That is the bottom line in this debate.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I remind the chamber that I am the parliamentary liaison officer to the health secretary.

The Patient Rights (Scotland) Act 2011 created a statutory treatment time guarantee of 12 weeks and more than 1.5 million in-patients and day cases have already benefited from the 12-week treatment target since it was introduced, as other members have mentioned. We can see a programme of record investment and reform taking place in our NHS that is resulting in care being removed from hospitals, where appropriate, and integrated into the community. That is the right thing to do.

Our budget for health has seen significant increases under the SNP Government, and we will continue to increase that spending by £2 billion. We must accept that such changes will not happen overnight, but we are taking the correct steps towards real change and reform in our NHS and we will have the best possible treatments readily available in future.

Of course, it is the responsibility of health boards to ensure that eligible patients receive their treatment within 12 weeks. That may mean that, with the patient’s consent, the health board makes arrangements for them to be treated in another health board area to ensure that the 12-week guarantee is met. In today’s debate, no one is saying that all waiting times are met. We know that that is not the case, and the cabinet secretary herself has never said so. As a constituency member of the Scottish Parliament, I often have exasperated patients coming to me, who have waited over their time. As other members have said, such cases often relate to orthopaedic operations. I work with the NHS board to try to resolve the situation and, many times, we have been able to do so to the constituent’s satisfaction.

The vast majority of waiting time targets are met, but staffing is of course an important issue when they are not. That is why, last week, I was in the local press, defending agency staff against what I perceived to be attacks from both Labour and Tory politicians. That is not because I want us to have agency staff per se, but because I realise that, with health staff leaving in the face of Brexit and other factors, such as the UK Government’s austerity policy, there is a reality about how we meet the needs of the service and I recognise that when agency staff are there, they do a good and very valuable job.

Photo of Fulton MacGregor Fulton MacGregor Scottish National Party

I will not have time, Mr Briggs—I am sorry.

The Scottish Government has always made it clear to boards that patients with the greatest clinical need, such as cancer patients, should continue to be seen quickly. NHS boards are asked to deliver against the two national cancer standards, which are that 95 per cent of all patients who meet the criteria should wait no longer than 62 days or 31 days, as set out by the Scottish Government. I am pleased to say that, according to my briefing from NHS Lanarkshire this morning, it has consistently delivered on both cancer standards. The most recently published figures show that NHS Lanarkshire had 96.1 per cent of patients starting treatment within 62 days of urgent referral with a suspicion of cancer, and 98 per cent of cancer patients starting treatment within 31 days of decision to treat. The targets were met in other health board areas too, but those figures are evidence of NHS Lanarkshire’s continued excellent performance in that area, and of the dedication and hard work of its staff. I know that they will continue to work to maintain and improve performance to ensure that patients continue to receive the highest standards of care while also avoiding delays where possible.

In the short time that I have left, I would like to end on a positive story, because in the chamber we often hear of situations in which things have gone wrong. For some months now, I have had the pleasure of assisting my constituent—who, sadly has been diagnosed with stage 4 colorectal cancer—in accessing various treatment programmes for his terminal cancer diagnosis. Although he was faced with aggressive treatment for an aggressive cancer, my constituent, who is an otherwise healthy father to a young adoptive family, was keen to explore all available treatment options, including those available through clinical trials. Unfortunately, my constituent was placed in the placebo group for the trial that he joined and, seeing no benefit in continuing with the treatment that was offered, as it was essentially no different to standard-line chemotherapy, he sought to access a course of treatment that was not routinely funded by the NHS or by any other means. Without going into any great detail, my constituent was devastated to be informed by his multidisciplinary team that that treatment was not considered to be appropriate at that point in time. However, the UK lead clinician for the treatment in question found him to be the optimal patient for that course of treatment and, feeling that he should be offered it, agreed to support him in his appeal to be treated in Scotland with NHS funding. I am delighted to say that that funding has been agreed, and my constituent’s treatment is due to start later this month. At the start of this year, my constituent expected to have a short number of months left to live, but can now look forward to having possibly many more years with his young family.

I will end my contribution on that note, Presiding Officer.

The Presiding Officer:

We move to closing speeches.

Photo of Brian Whittle Brian Whittle Conservative

I start by referring members to my entry in the register of members’ interests, in that I have a close family member who is a healthcare professional in the Scottish NHS.

We are debating the patients’ charter, which states that there is a guaranteed 12-week maximum waiting time for treatment, which was set in stone by the SNP. Conservatives say that, in the interests of patient care and the principles of honesty and transparency, NHS boards should communicate an accurate expected waiting time range to patients.

I am sure that we all agree that it is the Opposition’s responsibility to scrutinise Government policy and to hold the SNP to account wherever it has failed to deliver for Scotland. That scrutiny is being exercised in the Labour motion, which the Conservatives will support.

The fact that we are debating such an obvious point is one that should concern us all. It should not take an Opposition debate to raise such a fundamental principle and to get the SNP to take action, as Anas Sarwar pointed out in his opening address.

It is important that, when we debate health policy, we do so in a manner that does not undermine the work that is being done on the front line every day, as Michelle Ballantyne was at pains to highlight. She emphasised—she has 25 years of nursing experience—how important it is that, when we debate, we try to improve the health outcomes for patients and the outcomes for healthcare professionals.

The debate has given all the speakers in it—including Miles Briggs, Anas Sarwar, Ross Greer and Jackie Baillie—the opportunity to raise local issues. Edward Mountain used his speaking time to talk about healthcare in the Highlands and radiology services at Raigmore hospital. To his credit, he came up with positive solutions for the cabinet secretary to consider.

As I have said, this is not a typical health debate. It was obvious from the tone that was set in the opening speeches that this would be a non-debate. We need to address waiting times in the round. We need to look at acute waiting times, including waiting times for mental health treatment, given that people’s conditions deteriorate over time, with increasing financial and personal cost, as we heard all too clearly in the previous debate on NHS Tayside. The physiotherapy waiting time of one year for musculoskeletal conditions that in essence require immediate treatment turns an acute issue into a long-term and costly matter, with a potential impact on physical and mental health.

Alex Cole-Hamilton highlighted the anxiety that his constituent has experienced when waiting for treatment for what could have been a very serious issue. The delay and the false hope of treatment that she has experienced impacts in all areas of her life, and we wish her well.

As I said, this is a non-debate. The net result is that Labour’s debating time has been taken up with what the Scottish Government has already agreed to do in law. We could have been debating how we deal with waiting times, what they mean and the language that we use when we discuss them. If you were cynical, Presiding Officer, you might consider that the Scottish Government has agreed to the obvious in order to take the heat out of an issue that it should have dealt with already. Perhaps it has become so paralysed for fear of doing anything wrong that it is reticent to do anything of note at all.

There is so much more to do if we are to tackle the issues that we face in the health service. We have to talk about education, nutrition, physical activity, planning, the environment and the rural economy, because they all have a footprint in improving the health of our nation.

If waiting times are the barometer for the health of our NHS, it reads “Change is required.” I welcome the change that will take place as a result of this debate, but I struggle to see how the debate will impact on the real issues facing our NHS staff and their patients. It is important that waiting times are addressed, so I thank Labour for bringing the motion to the chamber. Given that what it says is so obvious, it needs no amendment from the Scottish Conservatives. However, the fact that the issue had to be raised should concern us all.

Photo of Aileen Campbell Aileen Campbell Scottish National Party

I, too, take the opportunity to thank all our NHS staff and to recognise the phenomenal work that our NHS does day in, day out. The NHS, which is 70 years old this year, was founded on the principles of being free at the point of delivery, universal and not based on wealth, equitable and high quality. Those core principles are as relevant now as they have ever been. They remain constant but, undoubtedly, the context, the demand and the challenges that the NHS and that we as a society face have changed.

Meeting the challenges requires mature debate, and we have heard some of that this afternoon. This Government seeks to meet the challenges with a twin approach of investment and reform, and we will drive improvements in acute performance and

“shift the balance of care from acute to primary and social care”,

as our amendment to the motion makes clear.

As we—rightly—celebrate all that is good and positive about the NHS, we all recognise that, sometimes, things fall below the standards that we expect. We have heard about some of those situations today. It is important that we not only hear about them, but learn from that direct experience. Such situations are real for individuals, who require and deserve clear information and reassurance. Ross Greer’s contribution captured the essence of that.

As the cabinet secretary said, that is why we are committed to revising the charter and to working with boards to communicate the revised guidance. The experience of people and patients motivates our determination to make the improvements that we know are needed.

Photo of Anas Sarwar Anas Sarwar Labour

Will the minister commit to bringing to the Parliament for discussion the suggested amendments to the charter? Will she also bring forward her guidance to health boards, so that we can see what language they will use when writing to patients?

Photo of Aileen Campbell Aileen Campbell Scottish National Party

We will discuss the process with health boards and, in due course, we will publish the guidance.

Perhaps there is a lesson that members who seek to discuss such things in the chamber should bring constructive ideas about and solutions to the challenges that we face. However, the cabinet secretary will of course publish the revised guidance in due course.

The dedication to making improvements is why £50 million was allocated to support the reduction in hospital waiting times. It is why the cabinet secretary launched the new access collaborative, which is backed with £4 million and seeks to improve how elective care services are managed and to reduce waits. It is why £200 million will be invested over the parliamentary session in expanding the capacity for routine elective operations at the Golden Jubilee hospital and in the new treatment centres across Scotland. That will help to reduce waiting times and take the pressure off. It is also why Scotland has been the first nation in the UK to publish a national health and care workforce plan and why it is the only nation that is committed to safe staffing legislation, which will build on the record high levels of NHS staffing that have been delivered under the Government.

That is a list of actions from the Government, which is relentless in its pursuit of enabling our NHS to meet the needs of the people it serves. However, the Government is not blind to the challenges that we face or the experiences of people in the here and now. We will listen to constructive contributions that seek to solve the challenges. We will respond to Edward Mountain’s ideas about radiology and attracting professionals to the Highlands. We will not necessarily agree with everything that he or his colleague Michelle Ballantyne said, but we appreciate the attempt to be constructive and Michelle Ballantyne’s professional experience.

We will absolutely consider the example that Kate Forbes gave, in which engagement and consultation with people and communities enabled a better decision to be made in the Isle of Skye. We will think about what that means for future engagement between NHS boards and the communities that they serve.

We will heed the words of Ross Greer, who urged people to examine the issues more broadly and to understand, for instance, the impact of the hostile immigration environment that has been established and the impact of the freedom of movement restrictions under Brexit.

Presiding Officer, you will note that I have not mentioned the Labour members who come to the chamber and do well at criticising but do not do as well at bringing ideas to remedy the concerns that they have aired.

We will get on with the job of supporting our NHS, building on the high satisfaction rates across Scotland and improving on the targets. Nine out of 10 patients—1.5 million people—have been treated within the 12-week treatment time since the guarantee was introduced in 2012. We will continue to build on the strengths of our NHS to ensure that it is in a position of strength for the next 70 years.

Photo of David Stewart David Stewart Labour

This has been an excellent debate on a vital issue, and I thank members across the chamber for their insightful and knowledgeable speeches and their strongly felt views.

Waiting times are always difficult. When a patient is suffering from an illness or an injury, any time between cause, diagnosis and treatment is unwanted, because it prolongs the pain as well as putting additional stress on the patient’s mental and physical wellbeing. Members such as Jackie Baillie, Anas Sarwar, Ross Greer, Alex Cole-Hamilton, Edward Mountain, Kate Forbes, Neil Bibby and Michelle Ballantyne have illustrated that perfectly by citing dissatisfied constituents who felt let down by the system—a system that put in place the Patient Rights (Scotland) Act 2011 to guarantee a 12-week treatment time. The treatment time guarantee allowed hospitals and boards to manage expectations and gave patients a known timeframe.

We must not forget that waiting times are not just simple facts and figures. Behind every delay in an operation or a consultant’s appointment, there is often an individual who is experiencing anxiety, pain and stress. I remember when 80-year-old Inverness writer Bette McArdle came to see me because she was told that she had to wait 11 months for a relatively simple cataract operation. She said:

“It is vital that we octogenarians are able to lead independent lives and still contribute to society. And it has to be remembered that many are still caring for a partner or family member. Without the basic support of maintaining adequate eyesight we can rapidly become even more dependent on the NHS and care services and cost the state.”

Every statistic holds similar stories.

Although I cannot fault NHS Highland for trying to clear the backlog and reduce waiting times, it is concerning that procedures are having to be outsourced to private companies and other boards at great cost. For the second year in a row, NHS Scotland failed to meet seven out of eight key performance targets, according to Audit Scotland’s report. One of the key problems identified is the widespread difficulty in meeting demand and the impact that that is having on waiting times. Front-line NHS staff work tirelessly to try to ensure that staffing issues, lack of resources and underfunding do not compromise patient care, but they do so in the face of growing pressure. No one has to take just my word for that, because Audit Scotland said in its 2017 report:

“People are waiting longer to be seen with waiting lists for first outpatient appointment and inpatient treatment increasing by 15 per cent and 12 per cent respectively in the past year.”

The other big issue is that the life expectancy gap is increasing, with men from the most deprived areas now living on average 12.2 years less than their more affluent counterparts, and women from those areas living 8.6 years less than their more affluent counterparts. Those from deprived areas are increasingly likely to spend more years in ill health: nine more years for men and 11.5 more years for women. On top of that, in one key area where waiting times were missed, there are higher cancer rates among disadvantaged communities but the lowest detection rates. Those from deprived communities are most likely to be diagnosed with breast and lung cancer at stage 4, whereas those from the least deprived areas are most likely to be diagnosed with cancer at stages 1 or 2. With those from the most deprived areas being diagnosed later, early access to treatment is key to improving outcomes and reducing the life expectancy gap. That disparity must be addressed as a matter of urgency.

The NHS turns 70 on 5 July and we are still having to fight to protect it. Its founder, Nye Bevan, said that

“discontent arises from a knowledge of the possible, as contrasted with the actual.”

Debates such as this one are frustrating because we know that we can do better for the NHS, the front-line staff, the patients and the families of patients. I ask all members to support our motion at decision time.