I want to start by thanking the Cabinet Secretary for Health and Sport for the time that she has given to me on this subject. I know that she agrees with me on many of the problems that we identify in the motion. Although we cannot support the amendment in her name, because it would delete much of the reference to the problem, I welcome its tone and the apology that is in it.
There is a law that this Parliament passed, which this Government has broken more than 190,000 times since the Patient Rights (Scotland) Act 2011 received royal assent. The legal bonds of the legally binding treatment time guarantee are routinely broken—upwards of 200 times every single day.
Let me put that in the local context. In NHS Lothian, 34,000 people have had to wait for longer than 12 weeks this year. In NHS Greater Glasgow and Clyde, the number is 32,000 and in NHS Grampian, it is 27,000.
There is no sanction for that. No minister has resigned and no one gets a fine. It is a legally binding guarantee in name only. However, the human cost of the issue is measured in anxiety, frustration, pain and suffering. Lives are put on hold and potentially life-saving treatment is put just out of reach.
The issue comes up every week in all members’ constituency surgeries. Every one of those patients has been let down by the false hope that this Government offered them, and each patient tells a similar story.
A letter arrives shortly after diagnosis, advising them of their legal guarantee to have treatment begin within 12 weeks. For most people, that sounds manageable. Twelve weeks is a season; they could get their diagnosis in early spring and be seen before the holiday in July. It might mean spending a bit longer on pain medication than they had hoped, but they can tough it out.
Accordingly, the person plans for their recovery, as everyone would do. They plan for the time after convalescence, when—free of pain and disease, they hope—they can start to live their lives again. They accept wedding invitations. They agree to host Christmas for the family. They book a holiday in six months’ time, because—according to that letter—they will be well out of the woods by then.
After about nine weeks, they begin to wonder why the hospital has not yet booked them in. A gnawing sense of doubt begins to creep in, so, perhaps on the Monday of week 10, they phone the surgical ward.
That is when they get the bombshell. They are not going to be seen in two weeks’ time after all. More to the point, they are not likely to be seen for at least another 40 weeks, in some cases. That must be devastating to hear. The person asks about their holiday and is told, “Don’t leave the country.” They ask about the wedding that they plan to go to and are told, “Don’t risk it; you might get a cancellation.” They ask about Christmas and are told, “It’s doubtful, because with any luck you’ll just be coming out of surgery by then.”
Aside from all the havoc that that causes a person in the basic administration of their lives, there is all the pain or immobility that they might be suffering. There might also be anxiety about the condition getting worse and even becoming life threatening.
I could offer many, many real-life examples from west Edinburgh of what I have described, and I am sure that every member in this chamber could talk about a case in their constituency. I will single out one person.
In December, I was contacted by Jane Ross. Over the past three years, Jane has suffered several failures of the treatment time guarantee, in relation to urology at the Western general hospital in Edinburgh. After developing bladder issues, she waited six months for a consultant appointment, then was referred for tests, which took more than a year to be performed. By that time, her bladder was so inflamed that it had shrunk to a fifth of its normal size. The pain was so severe she had to control it by not drinking at all until around 4pm in the afternoon, which allowed her to struggle through her part-time job. Dehydration started to affect her kidneys and gave her heart palpitations. It caused issues with her diabetes.
In August last year, after the test results came back, she and her consultant agreed that she would need to have her bladder removed and a urostomy performed. Like most people, she received a notification about her rights under the treatment time guarantee. And so she waited, in a worsening state of physical health and suffering.
All told, it took 36 weeks for her to have her operation. The wait was bad enough, but she had to lurch from week to agonising week, existing in this excruciating state, under the misapprehension that treatment was just around the corner. I wanted to weep for her. Hers is one of the hardest cases I have dealt with.
To its credit, the Government has set great store by the concept of realistic medicine, and I am a fellow traveller on that, believing in the basic precept that we should give patients all the facts and options about their condition and credit them with the maturity and mental capacity to direct their care. That should not be just about end-of-life issues; it should apply to every aspect of a journey through our national health service.
People are not stupid. They know that our NHS is oversubscribed and that, in all likelihood, they might have to wait for a protracted period for treatment. That is not really what bothers them—they accept that and understand. That is part and parcel of why our NHS is deservedly still the most well-regarded institution in our country. Patients just want doctors and politicians to be straight with them.
To have someone tell them from the outset that their wait will be 40 or 50 weeks would mean that they could plan accordingly. Some people might well decide to go private when faced with that reality, which might relieve pressure on other waiting lists and give other people a shorter waiting time to treatment by freeing up capacity.
Whatever our world view, I hope that we all agree that we cannot go on giving people false hope like this. I understand that aiming to stop breaking its own guarantee by 2021 might be an unavoidable reality for the Government, especially given workforce issues, the strain on capacity, our ageing population, the various issues that we are facing and the fires that we are fighting. I accept that, but all I ask is that the Government stops sending out letters that give people false hope. It should explain to them why their treatment has been set back and apologise for the discomfort that that causes.
People are mature and they understand that the NHS is under pressure, but they still value it immensely and give thanks every single day for those hard-working staff toiling for hours and hours for days on end to make them well and to get through those waiting lists. We just need to be straight with people, because they deserve to know where they stand.
That the Parliament notes that the Scottish Government’s legally-binding 12-week treatment time guarantee has been broken at least 190,000 times since its introduction; notes that it is currently being missed by the largest ever margin, approximately 200 times a day; understands that the Scottish Government currently plans to stop breaching its own law by 2021, a full decade after the Patient Rights (Scotland) Act 2011, which established it; is concerned that there is no effective redress for patients or penalty for the Scottish Government in the event that it is breached; believes therefore that every patient who is subject to the treatment time guarantee should be given a realistic estimate of their waiting time from the outset, and calls for every patient for whom the 12-week legally binding guarantee is missed to be sent a letter by the health secretary apologising for the Scottish Government’s failure to abide by its law and providing details of how many times the 12-week target has been missed to date.
I welcome this debate on what is an important issue for patients across Scotland.
There can surely be no doubt that I have been very clear from the outset that long waits are unacceptable and that improving performance against waiting times is one of my three key priorities. I therefore take this opportunity to again offer my unreserved apologies to everyone who is currently experiencing, or has experienced, a delay anywhere in the health system.
As I have said previously, too many people are waiting too long for out-patient appointments and treatment. I know only too well the impact that that has on the physical and mental health of the patient, and on their families. However, knowing that is not enough; p eople quite rightly expect us to do something to change it. My determination to do just that is exactly why I published the waiting times improvement plan in October last year to substantially and sustainably improve waiting times, particularly for those waiting the longest, backed by significant additional financial investment.
While we increase capacity in the NHS to deliver on that plan, for those people who have to wait longer than 12 weeks, health boards need to ensure that each and every person is given a realistic timeline from the very beginning of their journey and kept up to date with any changes that affect that timeline. Around a year ago, my predecessor, Shona Robison, said that health boards should be advising patients of their likely wait and the reasons for delay. We committed to reinforcing that through the revision of “The Charter of Patient Rights and Responsibilities”, which is routinely reviewed every five years, with the latest review beginning in 2017. That revision has gone through a rigorous engagement process, including with stakeholders such as the patient advice and support service. I am pleased today to advise members that the revised charter will be laid in Parliament before the summer recess and will be applicable from autumn this year. We have also been working with our health boards and key stakeholders across the country to deliver on our commitment to give patients clarity on the length of time that they can expect to wait before treatment, and the revised letter and guidance will be used nationally and issued to boards by the end of this week.
Since the introduction of the waiting times guarantee, around nine out of 10 patients have been seen and treated within 12 weeks. That is more than 1.7 million patients, and every bit of that achievement is down to the staff working in the health service. Recognising that matters, but it does not and will not deflect from my determination to see improvement. Our work to improve performance is not confined to the treatment time guarantee but extends to mental health, our cancer targets, and attendances at accident and emergency departments. Our A and E performance is the best anywhere in the United Kingdom and has been so for more than four years, despite a significant and sustained increase in A and E attendances. However, there is more to do: continuing our work with the Royal College of Emergency Medicine in Scotland; consistently implementing the six essential actions across Scotland, with no variation; and improving hospital flow and discharge.
Since October, we have invested £26.7 million from the total of £850 million to make immediate reductions in waiting times across a range of procedures and, importantly, to focus board by board on the most pressing areas of longest wait. That varies board by board, and it is important that the resources are targeted in that way. Last month, I announced a further £70 million for this year. That will see additional recruitment of specialists and healthcare professionals, increased numbers of orthopaedic and cataract procedures and an increase in the number of out-patient appointments and diagnostic procedures. All of that is aimed at meeting the first waiting times milestone this autumn.
However, although increasing activity is important, we need to build resilience into the system so that we have future sustainability. That comes by increasing capacity through the network of elective and diagnostic centres that we are creating and the work of the Scottish access collaborative, which brings together clinicians, healthcare professionals and others to ensure that the design of our patient care and pathways are as streamlined and effective as they can be. NHS Scotland is recognised as a world leader in quality improvement—it is the central underpinning of our patient safety programme. It must therefore be embedded in the delivery of all our improvement programmes, including the waiting times improvement plan. Alongside all that I have outlined—and much more besides—runs our access quality improvement work to increase our capacity to consistently improve patient pathways and patient experience and existing access improvement programmes.
Our performance on waiting times must improve, and I believe that our commitment to that is clearly evidenced by the many actions that we and staff across the NHS are taking. All of that—the immediate activity and the long-term sustainable solutions—is focused on delivering the care that patients need in the timeframe that they rightly expect and in reaching a better balance between demand and capacity, so that we are better placed with sustainable solutions now and for the future.
I move amendment S5M-17281.4, to leave out from “Government’s legally-binding” to end and insert:
“Government offers an unreserved apology to any patient who waits longer for treatment than they should do; further notes that this extends beyond patients covered by the treatment time guarantee to those receiving any form of NHS care, including through outpatient, A&E, and mental health services; believes that every patient should be given a realistic estimate of their waiting time in writing, that anyone not being seen within their target should receive an apology in that letter, and that this should be underpinned by updating the patients’ charter; understands that the Scottish Government’s waiting time improvement plan sets a trajectory of investment and recovery, and believes an early aim of this work should be to ensure that there are no patients with very long waits for treatment.”
I thank the Liberal Democrats for using their business time for this important debate.
No one can be in any doubt that, since Nicola Sturgeon and the Scottish National Party Government introduced the patient treatment time guarantee in 2011, patients and their families have been let down. I believe that it is also important to look at the wider patient treatment targets that the Scottish Government is failing to meet, which I outline in my amendment.
This is mental health awareness week. I welcome the positive campaigns to raise awareness and the need to tackle the stigma that still exists around mental health. However, the question that I am asked again and again is what the point is in trying to encourage people to come forward as they will often be failed when they seek help.
Alex Cole-Hamilton, Alison Johnstone and I represent Lothian. I am sure that they, too, will be acutely aware of the unacceptable waiting times for psychological treatment and the failure to meet the child and adolescent mental health services waiting times for our constituents. I am sure that I am not the only MSP who has parents at my advice surgeries desperately trying to navigate the CAMHS system, telling me how they have been told that the waiting time is more than a year for children and young people and two years for adults. I have to say that the parents and families whom I represent are way beyond wanting an apology from SNP ministers—they want action. Those parents and families feel abandoned by a Government that has been in office for 12 years. The situation in Lothian is getting worse, and mental health waiting times here in the capital are now beyond crisis levels, with the situation showing no sign of improvement.
Parents in Lothian have been told by general practitioners to go private if they want to access support for their children, as NHS Lothian clearly does not have the capacity to see them. Children who are in desperate need of support are being told that there is a wait of more than a year. In some cases, as the Health and Sport Committee heard recently, parents are being told that their child would likely be seen earlier if they were self-harming. Scotland’s young people—our future—are being failed.
As the co-chair of the Parliament’s cross-party group on cancer, I regularly hear about the mental health impact that suspected cancer brings to individuals, including weeks and months waiting and not knowing, sleepless nights and unimaginable stress. The latest cancer waiting times show that only 82.9 per cent of patients in Scotland with suspected cancer and an urgent referral started treatment in 62 days. As Cancer Research UK stated,
“These figures show a service under huge strain with too many patients waiting too long.”
Does the member accept that the 31-day target is being met? In his amendment, the member calls for additional resources for the NHS. Will he explain how we will be able to do that, given the Tory Party’s plans to cut tax and its refusal to back a budget that included £850 million for waiting times and an additional £250 million for mental health?
I had hoped that the debate would rise beyond such comments. The fact is that the Government has been given £2 billion in additional health resources. Today’s debate should be a wake-up call for the cabinet secretary and not just an opportunity for her to try to score cheap points. She should know just how desperate things are in the system, and it is happening on her watch.
Almost since the day the Government passed the treatment time guarantee, we have heard excuse after excuse from SNP ministers. That has to end. Patients want and should be receiving timely treatment. Our NHS professionals want and should be able to provide the person-centred care that we all want to see, not constantly juggling patients in a desperate attempt to meet SNP targets.
The cabinet secretary has mentioned and made much of the £850 million waiting times improvement plan, which was published in 2018. Early information on the plan points towards NHS boards accessing funds for new pieces of medical and investigatory equipment but, on the ground and across the boards, there are not the staff in place to utilise that equipment to its full capacity or provide additional clinics. The expected improvement is not being realised.
Perhaps the only area where ministers have achieved progress is in the increased use of private capacity in Scotland. The plan sets out actions to ensure the future delivery of waiting time standards and guarantees for patients across Scotland by the spring of 2021. However, SNP ministers have already publicly accepted that they have failed to deliver on the promises that were made to patients across Scotland; the waiting times improvement plan will reduce the target for the proportion of in-patient or day cases that must be seen within 12 weeks from 90 per cent to 75 per cent by October 2019. It seems that the SNP ministers’ answer to not being able to meet the target is to water it down even further.
I believe that we need a national debate on the wider impact of targets on our health service. Every week, I meet NHS professionals who feel that the target culture that has built up in our NHS is focusing resources on the wrong priorities, at the same time as demoralising our NHS professionals, who are often unable to meet those very targets.
SNP waiting times promises that were made to patients across Scotland have been broken. The minister asked which ones. She read out all the targets that she has broken. Patients feel totally let down by this Government. It would be good if ministers listened to that fact.
I move amendment S5M-17281.1, to insert at end:
“; notes the health secretary’s comments that there are still too many people waiting too long for the treatment that they need; further notes that the treatment time guarantee is not the only waiting time target being missed, with others including the 18-week referral to treatment standard, the 62-day cancer urgent referrals standard, psychological therapies waiting times and the CAMHS waiting time standard; is concerned that waiting times are too long, and believes that the Scottish Government needs to take action to give the NHS the resources and the leadership that it needs to tackle this crisis.”
The treatment time guarantee is law. It should have ensured that people receive treatment within 12 weeks, but the most recent figures tell us that since Nicola Sturgeon—then Cabinet Secretary for Health, Wellbeing and Cities Strategy—introduced it in 2012, the Scottish Government has broken its law about 190,000 times. Nicola Sturgeon is now Scotland’s First Minister, and she recently said that she is “not surprised” by long waiting times.
Jeane Freeman, the current Cabinet Secretary for Health and Sport, has admitted that waiting times are too long. I agree, and I think that we all agree that it is a broken promise too far. Is the cabinet secretary’s best response really to continue breaking the law until at least 2021? The law is not worth the paper that it is written on. If it were any other law in Scotland, and if it were anyone other than the Scottish Government breaking it, there would be consequences. However, as things stand, there is no penalty.
We will get to the point about what the law actually says, but the main point is that we have just heard that 190,000 patients have been let down. That is a disgrace. [
I wish that I had more time for interventions, but I do not.
In a Scottish Labour debate in May last year, we forced the Scottish Government into a commitment to amend the “Charter of Patient Rights and Responsibilities” to ensure that patients get an accurate waiting time estimate. A year later, we have the Labour amendment to the motion, because no changes have been made to the charter.
It is our concern that health boards have not been communicating well enough with patients. We hear what the cabinet secretary has said today by way of an update, but Parliament and the country have been waiting long enough. I hope that she can convince us that we can believe her this time, and that action and real change will happen. The changes must not happen at a snail’s pace, which is why Scottish Labour's amendment highlights our disappointment about the lack of progress in a year.
Today, I am sure that we are all thinking about constituents who have been let down. Behind the figures are people who are in pain or distress and are waiting too long for treatment. As Miles Briggs said, this is mental health awareness week, so it is timely that we acknowledge the emotional upset and nervous anxiety that people can experience while waiting for treatment. Long and indefinite waits can have far-reaching consequences for people, touching all areas of their lives. It is easy to see how people can quickly be plunged into financial difficulty or poverty because of ill health. Long waiting times can have terrible consequences for people who are low paid, self-employed or in insecure employment.
The implications of illness and pain extend beyond the individual: they impact on families, communities and workplaces. The workforce crisis in the NHS has many consequences, and too often it is the most vulnerable people who pay the price.
Long waiting times are a recurring issue for my constituents. Last year, one woman in Hamilton waited more than 80 weeks for surgery on her wrist, and is now worried about permanent or long-term damage.
My family has benefited hugely from the NHS in the past few years, for which I will be forever grateful. My mum’s GP probably saved her life. She has been successfully treated for cancer and will celebrate her 60th birthday this month. Thank goodness for that. However, after her cancer treatment, my mum needed another operation for which she had to wait longer than 12 weeks: she had to wait 42 weeks, which set her progress back. My mum is not looking for an apology; she just does not want other people to have in the future to wait so long.
Scottish Labour strongly supports the Liberal Democrat motion, which rightly holds the Scottish Government to account over its failure to comply with its own law. We also support the Conservative amendment, which highlights the other important NHS targets that have been missed.
We welcome Jeane Freeman’s apology to patients in her amendment, and her agreement that patients should be told their expected waiting times in writing. However, we cannot support that amendment because it does not acknowledge the extent to which the Scottish Government has broken its own law, its plan to continue breaching it until 2021, or the fact that there is no redress.
Scottish Labour calls on the Government to honour its commitments and the people of Scotland.
I move amendment S5M-17281.2, to insert after “from the outset”:
“; notes that 12 months have passed since the Parliament called on the government to ensure that accurate waiting times are given to patients; is disappointed that no changes have yet been made to the Charter of Patient Rights and Responsibilities to deliver this; considers that long and unknown waits can adversely affect an individual’s family life, mental and physical wellbeing, education, income and employment”.
I, too, extend my thanks to our NHS staff, who work tirelessly to improve our health—too frequently doing so in an extremely pressured environment.
I welcome the fact that we are debating the treatment time guarantee. However, the Green amendment was not selected for debate, which in this instance is particularly frustrating, because neither the motion nor the other amendments outline the problem and potential solutions in a way that the Greens feel would be of greatest benefit to patients.
Alex Cole-Hamilton is right to have described the severity of the problem, but I do not agree that a letter to patients, which has the potential to make them feel like another statistic, is an adequate response.
I appreciate the proposed actions that are set out in the cabinet secretary’s amendment, but I regret that it would delete entirely the text of Alex Cole-Hamilton’s motion.
I agree with the contents of Monica Lennon’s amendment and I agree with Miles Briggs's amendment, but I cannot square his party’s commitment to a great tax cut for the wealthiest people with increased funding for the NHS.
Shorter waiting times can reduce patient anxiety, improve patients’ quality of life and improve clinical outcomes. We are all in agreement that the sooner a patient can access treatment, the better. That is why waiting times are important. However, as we know, there are considerable workforce pressures across NHS Scotland, which is treating patients who have increasingly complex conditions and multiple morbidities.
Of course, Brexit will not help. The British Medical Association has repeatedly raised concerns about the impact of Brexit on the health workforce. I am concerned that, if we cannot recruit sufficient numbers, the onus for improving waiting times will be placed on the existing workforce. The Scottish Government’s waiting times improvement plan states that it will
“Encourage more capacity ... by working with Staff Side and Employers to reduce sickness absence rates with a focus on staff health and wellbeing”.
A recent BMA survey showed that 91 per cent of the doctors who responded were working more than their allotted hours, so I would argue that many NHS workers are already working over capacity.
People who work in the NHS must be able to take a day off when they need to because of their own ill health. It is, of course, hugely upsetting and disappointing for patients when the treatment time guarantee is not adhered to, but we must, because they are working incredibly hard, also ensure that we avoid making staff feel that they have failed.
Opposition parties are right to criticise the Government, but it cannot be beyond us all to find a way forward with constructive steps that can be taken to bolster our struggling health service. The Scottish Government needs to be honest about what level of service the NHS in Scotland can realistically provide, given workforce pressures and current funding.
In its 2018 report, Audit Scotland said:
“The NHS in Scotland is not in a financially sustainable position. NHS boards are struggling to break even, relying increasingly on Scottish Government loans and one-off savings.”
It recommended that the Scottish Government, NHS boards and integration authorities
“work together to develop a clearer understanding of demand ... and capacity ... within primary and secondary care” and
“publish clear and easy to understand information ... including how much funding was provided, what it was spent on, and the impact” that it had. I urge the cabinet secretary to take that on board and to hold a national conversation on the NHS—one that would be far broader than the one that Miles Briggs outlined. It should cover what we all expect from the NHS and how much we are all willing to pay to meet those expectations.
Missed targets are a symptom of wider issues, so placing more pressure on boards and staff to meet targets will not solve the problem. Let us ensure that health boards have the resources that they require and that there is a greater focus on the preventative health agenda in order to lessen that strain, which will enable us to meet the treatment time guarantee.
In anticipation of the debate, I looked up the definition of the word “guarantee” in several dictionaries. One defined it as
“a formal assurance (typically in writing) that certain conditions will be fulfilled”.
Another said that it is
“a legal term more comprehensive and of higher import than either a warranty or security”.
So, what is the guarantee? It seems to me to be nothing more than an unfulfilled promise to the 27,000 patients in NHS Grampian who, since the guarantee took effect, have had to wait longer than 12 weeks for treatment. In the last quarter of 2018, the figure represented 42.5 per cent of all the patients in the NHS Grampian area who were waiting for treatment.
I want to make it clear that I do not blame the hard-working staff who work for NHS Grampian for that sorry state of affairs, nor do I blame them for the fact that NHS Grampian has regularly had the worst records in Scotland for operations being cancelled for non-clinical reasons and for treating child and adolescent mental health problems.
In other areas, too, NHS Grampian’s record in treating patients is less than spectacular. For the final quarter of 2018, the board had the second-worst record for treatment within the 31-day standard period from decision to treat to first cancer treatment. Furthermore, in the final quarter of 2018, 85 per cent of patients who were referred to clinics in Grampian for chronic pain treatment received their treatment outwith the guaranteed time.
I could go on with a rather lengthy list of various treatments and illnesses for which patients in NHS Grampian come out worse, or almost worse, than those in any other health board area in the country. Presiding Officer. I am not going to do that, because you have given me only four minutes, so I would not have time.
We often talk about a postcode lottery for various treatments, but it is worse than that for the 11 per cent of Scotland’s population who happen to live in the NHS Grampian area. Earlier, I said that I do not blame NHS Grampian’s hard-working staff for the situation in which we find ourselves. I want to lay the blame for that sorry state of affairs fairly and squarely at the door of the Scottish Government, because, over the past 10 years, the Scottish ministers have failed to provide £239 million of funding that should have come to NHS Grampian. That is not my figure—it is one that has been provided by the Scottish Government and is available to everyone through the Scottish Parliament information centre.
I would love to do so, but unfortunately I do not have time.
The Scottish Government’s own NHS Scotland resource allocation committee formula still underfunds NHS Grampian’s population, which has never, unlike the populations of other health board areas, been fully funded. Without doubt, that cumulative underfunding over the past 10 years has led to worsening patient care in the north-east. Every time I have raised that point in the past three years, the Cabinet Secretary for Health and Sport has said that more money is coming into the NHS or that the gap in its NRAC formula is closing. Actually, this year, it is increasing again—and it still does not address the £239 million that NHS Grampian has already lost.
The Scottish Government should address the funding shortfall to enable the staff of NHS Grampian to receive the resources that they need to do their jobs and meet the treatment time guarantee. The people of the north-east demand action from the Scottish Government to put the situation right, and they want it now. I am glad that the health ministers are here to listen to that.
We are again in the chamber, discussing healthcare in our NHS. At the outset, as always, I put on the record my thanks to our incredibly skilled and competent NHS staff across Scotland, many of whom are my former colleagues.
Our NHS delivers a wide range of complex specialist care and treatment to the people of Scotland. The diverse services that are provided in NHS hospitals range from complex diagnostic procedures to life-changing—and indeed life-saving—surgeries, both planned and emergency. There are a wide range of waiting times targets—surgical, medical, out-patient, in-patient and mental health.
I am interested in the Lib Dem motion. I recognise that there are challenges in our NHS when it comes to waiting times, but, under the SNP Scottish Government, the NHS in Scotland is outperforming the NHS in the rest of the UK.
The bill that became the Patient Rights (Scotland) Act 2011, which is mentioned in the motion, was introduced by the Scottish Government in 2011. Its principal aim was to enshrine in law that patients must be supported properly and their voices must be heard. Since October 2012, the act has set out a 12-week treatment time guarantee for planned in-patient and day cases. The 12-week target applies once the patient has been diagnosed and has agreed the treatment with their clinician. It is worth noting that it is the health boards’ responsibility to ensure that eligible patients receive their treatment within 12 weeks. That may mean that, with the patient’s consent, the health board will arrange for them to be treated in another health board area.
I am interested in addressing the points that Alex Cole-Hamilton raised about surgery being performed at private clinics in order to free up time. That is not the answer. Surgical procedures—
Surgical procedures that do not require high-dependency unit or intensive care unit beds, such as day case herniorrhaphy or arthroplasty, can be done privately, but those procedures help to support staff learning and knowledge in patient care, airway management and observation of vital signs as part of a clinical care pathway.
It would take me longer than the four minutes that I have to explain how continuing professional development, the addressing of complications that arise, which the NHS has to deal with, and the clinical care pathways require a multidisciplinary team who all know and work with one another. The use of private hospitals to free up time is not the answer. It may be one answer, but the issue is complicated and complex.
I am pleased that the Scottish Government recognises that there have been challenges in meeting all waiting times across Scotland. It is important to ensure that no one is waiting too long for appointments and treatment. I was pleased when the Cabinet Secretary for Health and Sport published the £850 million waiting times improvement plan in October 2018, but that was not long ago. We need to allow time for health boards and everybody else to look at what they are doing to improve waiting times, given that the cabinet secretary introduced the plan only last October.
Jann Gardner, the chief executive of the Golden Jubilee national hospital, welcomed the announcement and plan, saying that the plan provides direct funding for specialists to provide an additional 200 general surgery operations, 600 ophthalmic procedures and 1,200 endoscopies and colonoscopies each year across Scotland—action that will help to reduce waiting times.
The strategy proposes that some patients, particularly those who are waiting for a routine check-up or test results, will be seen closer to home by a team of community healthcare professionals with close links to the hospital.
The Government is committed to addressing the challenges that we have heard about this afternoon and, as we have seen, the cabinet secretary is taking a proactive approach.
Let us be clear: the Government made the 12-week waiting time guarantee. Patients want it to be met and clinicians want to deliver it but, to be frank, they do not have the resources to do so. I appreciate that the cabinet secretary has said sorry, but sorry is not going to be enough.
The latest figures on NHS Highland show that, in the most recent quarter, 45 per cent of patients waited more than 12 weeks for treatment and 20 per cent were not treated within 18 weeks of the referral date. On targets, the NHS is not on the same page as the Scottish Government. Indeed, I venture to say that they are in different books.
Patients feel let down, and clinical staff feel the burden of responsibility. They should not. They are not to blame. The truth of the matter is that NHS Highland, like many health boards, is understaffed and overstretched. Members may ask why, and I can tell them that it is because the Government, having managed the NHS for 12 years, has mismanaged the recruitment of health staff. We do not have enough GPs, nurses or even radiologists, yet huge pressure is placed on clinicians to deliver treatment time guarantees.
Thank you. I point out that, in the initial additional funding that I talked about, NHS Highland received significant additional funding of more than £2 million for ophthalmology, general surgery, endoscopy and so on. That was additional funding that Mr Mountain voted against when he voted against the Scottish Government’s budget. I would be grateful if he could explain to me how he squares that particular circle.
It is always nice to hear the cabinet secretary make such comments, so that I can respond to them. How was ophthalmic treatment delivered? It was delivered not by NHS staff, but by private companies that were brought in because this Government did not have the staff in place to deliver it.
Let me take the cabinet secretary back to John Sturrock’s report, which we discussed very briefly the other day. It is a report into bullying and harassment in NHS Highland, which he describes as having a terrible impact on the staff and their wellbeing.
I will focus on just one passage—I will make sure that I read it out right. It says:
“Unrealistic or unachievable expectations can lead managerial staff to pressurise clinical and other staff to improve performance ...
Thus, these policies may have an adverse impact on the people charged with delivering them, leading to dysfunction and loss of morale which can tend to cascade down through the system.”
That is a damning indictment, cabinet secretary. I believe that the way in which those policies have been rolled out in NHS Highland, and the lack of delivery, is not only bad for our health, but bad for the health of the staff who work there.
Solutions are desperately needed. The Government has to improve on recruitment levels to reach the point at which staff have a realistic chance of achieving waiting time targets. I accept that the waiting times improvement plan that the cabinet secretary has announced is a step in the right direction. I also welcome the construction of a mobile theatre at Raigmore hospital and the new elective care centre. That is indeed a good start, but we need more.
Let us be clear: we all cherish our NHS. We owe a huge debt of gratitude to our doctors and nurses, and we need to care more for those who care for us. Putting too much pressure on them to deliver on waiting times when they are not resourced to do so is not good enough, and it needs to change.
I thank Alex Cole-Hamilton and the Liberal Democrats for lodging an important motion that shines a light on a serious issue: the amount of time that patients have to wait for treatment. The statistics tell us that the treatment time guarantee has been broken 190,000 times and that 25,000 people are still on waiting lists. However, the debate is not just about the statistics and the fact that situation is not getting any better; it is about the human stories behind those statistics.
Like other MSPs, I have been inundated with cases from constituents who have had difficult experiences. I want to highlight two in particular from the Rutherglen area. It took one gentleman eight months to get his knee issue properly diagnosed and for treatment to be outlined. He was given a treatment time guarantee of January this year, but was then told that it would be October before there would be any treatment. That has caused him a great deal of stress.
The other case involves a lady who had a hip issue. Her hip was X-rayed in July 2018, and it took until the end of the year for a diagnosis to be made and proper treatment—a replacement—to be decided on. A treatment time guarantee was given of April 2019 but, again, the patient was advised that it would be at least October 2019 before the procedure was done.
The length of time that people are having to wait is unacceptable. The examples that I have given show the failings in the system around the time that it takes to diagnose someone’s issue and give them the treatment that they need. The story behind those failings involves the impact on those people—the pain and mental trauma that they have to suffer, the difficulties caused for the family and the disruption caused in people’s lives when it comes to their ability to go out and work and participate in normal, everyday activities. That is unacceptable.
I have to say that it is a sad comment on the 20th anniversary of the Parliament—there has been a lot of commentary about that over the past couple of weeks—that a law that we passed in 2011 has been broken 190,000 times.
We must think about the effect on individuals and communities throughout Scotland. People are entitled to better. I note the cabinet secretary’s apologies, but it is absolutely essential that people get effective notice of when they are going to get treatment. We need to see serious progress on the action plan to rectify the problem by 2021. What I am seeing on the ground is that that is not happening.
We have all experienced great advantages and benefits from the NHS. We see those in our lives and in our families’ lives. Unfortunately, at the moment, people are having to wait an inordinate amount of time not only for diagnosis but for treatment. That is causing real disruption to their lives. People expect better and we demand better from this Government.
We keep having debates on this issue, and we are all aware of the challenges that the NHS faces in these times. However, one of the most disappointing facets of this debate and of others is that I never hear any new ideas from the Opposition. I never hear those parties propose any options or solutions that will make any difference.
The member could have said what he wanted to say in his own time.
The Patient Rights (Scotland) Act 2011 created a statutory treatment time guarantee of 12 weeks. Over 1.7 million in-patient and day cases have benefited from the 12-week target since it was introduced, with 90 per cent being seen within 12 weeks. Although that is short of the target, it is still a move in the right direction. As the cabinet secretary has said, the situation will obviously be helped by the recently published £850 million waiting times improvement plan.
Let us take a look at the Scottish NHS. The Scottish Government is committed to delivering the investment to ensure that a reformed NHS is fit for the changing needs of 21st century Scotland. There have been major improvements in public health under our SNP Government, and there has been record health funding. In 2019-20, health and sport spending will exceed £13.9 billion—up £4 billion under the SNP. Patient satisfaction is also high, with 86 per cent of in-patients rating their experience positively.
I do not associate positivity with the Opposition in debates on the Scottish NHS, but let us continue down that positive road. As everyone has said, the successes in our health service are down to the efforts of those who work in it. That is the most important fact, but the most important people in this debate are the patients themselves.
As a constituency MSP in Paisley, when I get cases of the sort that have been raised today, my first thought is never, “Hold on, I am going to write a strongly worded motion, take it to the chamber and showboat in front of the cameras.” Instead, my first thought is to deal with the issue, get in touch with the health board and represent the people of Paisley as I should. We have to bring this back into the real world and away from the showbiz of the Lib Dems.
The poorest performance by the treatment time guarantee was in quarter 4 last year, at 72.7 per cent. The cabinet secretary has apologised and ensured that there is a robust plan to avoid such figures in the future. That is what government is all about—seeing an issue and ensuring that a plan is put in place to do something about it.
The waiting times improvement plan, which came out on 23 October 2018, ensures that we will continue to have improved access to high-quality care. The immediate focus of the improvement plan is on reducing waiting times for patients whose treatment is urgent. Initial funding for health boards will go to improving performance through the recruitment of additional nursing staff, the provision of new equipment and better staffing over the important weekend period. There is also the offer of time for people to get involved over the weekends and in evening clinics.
An important aspect of the improvement plan is that it includes £535 million in front-line spending and around £120 million in capital spending.
In this debate, we should be positive about our NHS and about the on-going work. However, first and foremost, I ask everyone in the chamber to show me their ideas and tell me what they would do differently.
This has been an excellent debate on a vital issue, and I thank members from across the chamber for their insightful, knowledgeable and strongly felt contributions. I was particularly shocked by the contribution from George Adam, in which he said that he never showboats in the chamber—well, that is news to me. [
However, I thank the Liberal Democrats for using their initiative to secure this afternoon’s debate. We all know that waiting times are difficult. When a patient is suffering from an illness or an injury, any time between cause or diagnosis and treatment is unwanted; it prolongs the pain as well as adding additional stress to mental and physical wellbeing.
Members such as Alex Cole-Hamilton, Monica Lennon, James Kelly, Alison Johnstone and Miles Briggs have illustrated that perfectly by quoting dissatisfied constituents, who felt let down by the system. As we have heard, that system was put in place by the Patient Rights (Scotland) Act 2011, which guaranteed a 12-week treatment time. It allowed hospitals and boards to manage expectations, and for patients to have a known timeframe.
However, we cannot forget that waiting times are not just simple facts and figures—behind every delay in getting an operation or seeing a consultant there is a person, who often has anxieties, pain and stress. I will also give an example. I remember when, many years ago, the then 80-year-old Inverness writer, the late Bette McArdle, came to see me because she had been 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 the waiting time in this individual case, it is concerning that such procedures often have to be outsourced to private companies and other boards at great cost.
There are a number of worrying statistics in Audit Scotland’s 2018 report: not one board was meeting all the key national performance targets; only three boards met the 62-day target for cancer referrals; the number of people on waiting lists continued to increase; and more people waited longer for out-patient and in-patient appointments. A key problem that was identified in the Audit Scotland report was the widespread difficulty in meeting demand, and the impact that that is having on waiting times.
Many members have made the point, which I would like to echo, that front-line NHS staff work tirelessly to try to ensure that staffing issues, lack of resources and underfunding do not compromise patient care. However, they do so in the face of growing pressure. Although it is important that we acknowledge the hard work that is being put in under tough circumstances by NHS staff across the board, that should not prevent us from expressing concerns.
I also want to flag up, as I have done many times before in the chamber, the issue of life expectancy and the difference between those from deprived areas and those from more affluent areas.
I am conscious of the time, so I will conclude. As we know, the NHS turned 70 last year, and we still have to fight to protect it. Nye Bevan, who is one of my heroes, said:
“discontent arises from a knowledge of the possible, as contrasted with the actual.”
Such debates are frustrating, because we can do much better. This debate has shone a bright light into the dark areas of the NHS. We have a legally binding 12-week treatment time guarantee. Let us try to achieve it.
I thank the Liberal Democrats for bringing this debate to the chamber.
I am a big believer in setting goals and targets. Before we begin any journey, it is really helpful to know where we are trying to get to. However, the problem for the Scottish Government is that the 12-week target is not an aspiration; it is a legally binding guarantee that has been broken more than 190,000 times—apparently, as Alex Cole-Hamilton said, with no repercussions for the Scottish Government. One wonders what the definition of “legally binding” is in the Government’s eyes.
The Government has suggested that it will reach the legally binding guarantee in 2021, which is a full decade after the Patient Rights (Scotland) Act 2011 was passed. A reasonable goal for the Scottish Government would be to try to return the number of times that the target is missed to the level that it was at when the target was introduced, because—I have to tell George Adam this—the numbers have continued to deteriorate sharply since then.
The Scottish Government cannot lay the blame at anyone else’s door but its own, much as it might try to do so. I do not think that it will hit the target in 2021, and I think that everyone in the chamber knows that it will not. That is just a way of trying to kick the can down the road a bit further until the Government can come up with another line.
The reason why the Scottish Government has not and will not hit its target is quite simple. When one sets a goal, one needs to plan the steps that will help to achieve that goal—the cabinet secretary said that in her speech. Simply setting a goal will not make it happen. There might be a nice headline at the time, but the goal will not be achieved.
Who in the Scottish Government thought about the implications on the front line of imposing such a goal, and who in the Scottish Government looked at the actions that it would have to take to enable NHS staff to achieve the goal? The answer is quite patently no one. The Scottish Government set a goal without understanding the implications, imposed that goal on our health service, and told it to just get on with it.
The goal itself has been instrumental in creating an environment in which it is impossible for the goal to be met. By holding the NHS to the goals without giving it the tools, technology and resource to help to achieve them, the Scottish Government risks driving behaviour that is not necessarily in the best interests of patient care or healthcare professionals.
The truth is that the increasingly missed 12-week waiting time guarantee is the accumulation of many policy failures. As my colleague Miles Briggs highlighted, the 18-week mental health referrals are constantly breached, and the 62-day cancer urgent referral standards are missed. The lack of competent workforce planning, which Monica Lennon highlighted, and so on all contribute to the SNP Government breaking its own legal commitment more and more each year.
The Scottish Government’s indignation when we have the audacity to point out to it that it has failed to meet its own objectives gets me. That tells us everything that we need to know about it. The Scottish Government will accept the plaudits for setting the targets and legal policy, but it refuses to take the responsibility and the appropriate action when the targets are missed. After 12 years, it is about time that the SNP Government finally looked at itself in the mirror.
As with healthcare systems across the world, our NHS in Scotland faces increasing demand and challenges, which require a long-term and sustainable solution. The landscape is very complex, and it calls for open, transparent and constructive debate. Some members’ contributions have been very positive, but some have been extremely lacking.
We regret not being able to discuss further in the debate Alison Johnstone’s call for a national conversation. We would certainly welcome further discussion of that. We also welcome her highlighting the impact of Brexit on our NHS.
I certainly do not recognise some of the figures that Brian Whittle quoted and some of the statements that he made, and I am sorry that I am not important enough to intervene when Edward Mountain is speaking.
The NHS is very much person centred, and it is committed to delivering high-quality healthcare to everyone, every time. The commitments that we have made as a Government will support the delivery of that ambition. However, we should not forget that our NHS delivers a first-class service. Although there are areas that need to improve, such as waiting times, I echo the cabinet secretary’s earlier comments and acknowledge the admirable work that is done by our healthcare staff on a daily basis.
Over and above the waiting times plan, we published three new delivery plans at the end of last year that formed the blueprint for the next phase of the mental health strategy.
I do not have time.
The delivery of our mental health commitments in the programme for government will result in a total additional investment of more than £250 million over the next five years.
I have too much to say. I am sorry that I cannot take an intervention.
The Government continues to provide support to boards so that they can improve their performance against waiting time standards, and it has invested £54 million to improve recruitment, retention and services. Under this Government, the psychology services workforce has increased by 67 per cent since 2007.
We acted quickly in response to the initial recommendation of the children and young people’s mental health task force by committing an additional £4 million, which helped to increase capacity in the workforce by providing about 80 additional CAMHS staff. As our understanding of mental health deepens, our understanding of the support that we should provide changes, too. The answer lies in whole-system approaches that draw in support from across the public sector. Mental health is no longer a health-only issue; it cuts right across our public services. We need to ensure that everyone who is around those who face mental health challenges knows how to listen with a sympathetic ear. We need to build trusting relationships and create the environment that can support honest and supportive conversations about mental health. Reducing and eliminating stigma should be at the core of what we do, because doing so is necessary if we are to achieve what we want to achieve.
In addition, to ensure that patients are treated in the most appropriate environment for them, we are using technology to support improvement in the provision of primary and secondary clinical care advice. Early indications from the initial pilots show that that is having a positive impact and, ultimately, will support a reduction in waiting times.
The annual operating plans that were introduced last year have been developed to manage performance across the whole system, including financial, quality and safety performance. The plans represent an agreement that sets out how NHS boards will deliver the expected levels of performance that will provide the foundations for delivering the Scottish Government’s priorities of improving waiting times, investing in mental health and achieving greater progress and pace in the integration of health and social care. We will use the plans to monitor performance regularly in order to ensure that NHS boards remain on track to deliver the agreed commitments and milestones. Once they are agreed, the plans will be published on the websites of individual boards over the summer.
We will continue to work closely with our healthcare partners across Scotland to improve performance and to deliver our ambition of providing sustainable waiting times.
I am grateful to everyone who contributed to today’s debate.
I am sure that I was not the only member who noticed the cabinet secretary and minister visibly crumple when George Adam got to his feet, given that his speech was so adrift from their measured tone. The fact that the speech of a Government chief whip was such an attack piece demonstrates how exposed this particular flank is for the Government.
Nevertheless, I thank the cabinet secretary and the minister for their measured tone and the way in which they have addressed the issue head on. I particularly welcome the unreserved apology that the Government offered—both in the cabinet secretary’s remarks and in the Government’s amendment—to the hundreds of thousands of patients who have been affected by the breached treatment time guarantee.
I welcome the direction that the cabinet secretary offered by saying that boards should be directed to be straight and realistic with people from the outset about the time that they should expect to wait. That is not what happens now, and we need to get this right. People are given hints that the 12-week waiting time guarantee might be missed, but people stop reading when they get to line 2, which says that there is a guarantee that people will be seen within 12 weeks. People do not necessarily notice the corollary, in that people are not able to be treated within that time in many cases.
I echo the cabinet secretary’s thanks to our hard-working NHS staff. It is always easy to look at Opposition amendments that criticise aspects of the health service and infer that they are some kind of attack on our staff, but they are not—it is not our staff’s fault that we are creating false hope among our patients about how long they can expect to wait, and anything that suggests otherwise diminishes the argument.
The cabinet secretary also expressed disappointment that we are not coming forward with solutions. At the very heart of this are the delays around which the debate centres. She asked for solutions, so I will give her one. We need to take the bureaucratic systems of the NHS out of the dark ages. I had a constituent come to see me in my surgery who had been referred to the dental hospital because of suspected oral cancer. She gave me the letter of referral, which contained the astonishing admission at the top of the page that it had been dictated in October 2017 and finally typed up in December 2017. That means that there was a full two-month delay in her receiving potentially life-saving treatment. Take our admin out of the 1970s. Do not leave the content of letters lying around on dictaphones.
I am grateful to Miles Briggs for tying this debate to mental health week. He knows my party’s position on that. If a child fell off her bike and broke her arm, she would be in plaster by the end of the day, but if she went to a doctor with anxiety or depression, she could join one of the longest waiting lists in our entire NHS. In some cases, the wait is two years for first-line child and adolescent mental health services. We need to keep saying that, because it is still a national outrage.
It is important to look at the link between the waits and poverty because, in a lot of cases, people are incapacitated by the thing that they need surgery for. If they suddenly have to wait a year, that could be a year out of employment and, potentially, out of sick pay, too.
I thank Monica Lennon for her personal remarks about her mother’s experience. We wish her mother well, and a very happy birthday when it comes.
Alison Johnstone and I usually see eye to eye in health debates, but we do not today, which I am disappointed by. She has a problem with the suggestion that the Government write to patients individually, apologising for and explaining the delays to their treatment, given the treatment time guarantee. At this point in time, no accountability exists for the fact that the legally binding guarantee is repeatedly missed. It is fundamental that we address that.
I am afraid that I do not have time.
Mike Rumbles was characteristically positive in talking about his work for his constituents. In speaking up for the north-east, he repeatedly raises the issue of the NRAC reduction in Grampian and the impact that it has had on waiting times in that health board. Each of our health boards has similar tales to tell about the problems that are particular to their region.
Emma Harper tried to suggest that I was somehow saying that contracting in private healthcare was part of the solution. That is not what I was saying at all. I was saying that giving people the facts and allowing them to make different choices if they have the means to do so would help stem the problem—it would relieve pressure on the NHS.
My father needed knee replacement surgery. He was told that he would have to wait 40 weeks. He was in a lot of discomfort but said that he would wait. I said that he could go private if he wanted to, but he said, “Oh, but I want to support the NHS.” I told him that he would be supporting the NHS by getting off the waiting list and allowing someone else into the system, because he can afford to make that choice. It is about giving people the facts and allowing them to make different choices.
Edward Mountain was right to say that sorry is not enough and that we need to change behaviours. That starts with removing the suggestion that someone will be seen within 12 weeks. We need to reform the inadequate correspondence. He was also correct to point to the psychological pressure that that puts on staff.
Finally, I want to address George Adam’s attack speech, which I found disappointing. There are some very serious issues here, which affect constituents in every constituency represented in this Parliament. He diminished his argument with his speech. Parliament’s job is to hold the Government’s feet to the fire. If we do not do that—if we are prevented from doing that—what is the point of having a Parliament?
Hundreds of thousands of patients are looking to this Parliament to be straight with them and to their health boards to be straight with them about the time that they can expect to wait. We should answer that call.