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National Health Service (Staff Shortages) (Cancer Survival Rates)

– in the Scottish Parliament on 19th November 2019.

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Photo of Jamie Greene Jamie Greene Conservative

2. To ask the Scottish Government what its response is to reports that NHS staff shortages are putting cancer survival rates at risk. (S5T-01888)

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I thank the cross-party group on cancer for its helpful report and recommendations, which fairly set out the key challenges that we face and the work that we need to do.

We have invested £1.6 million in radiotherapy training and staffing to date, which has meant that, in the past two years, there have been significant increases in the number of patients accessing modern radiotherapy. The number of consultants with a speciality of clinical radiology working in the health service in Scotland has increased by more than 45 per cent since September 2006. With 290 more training posts in place since 2014, earlier this month I announced that there will be recruitment in 2020 for 70 additional training posts in key specialisms including radiology and oncology. All those staff and many others are working hard to deliver the high quality of care that our patients need, which results in 95 per cent of patients rating their overall experience of cancer care positively.

Photo of Jamie Greene Jamie Greene Conservative

I thank the cabinet secretary for that update. I add my thanks to the cross-party group, which did an excellent job in producing the report, and I thank the organisations that were involved in the drafting of it. The report was considered, measured and informative for MSPs.

However, the report found that, by June this year, one in five cancer patients were not seen within the six-week target—a threefold increase in just three years. The report was clear in its conclusion that, in relation to diagnostics, workforce issues seem to be the greatest concern impacting outcomes, and that ministers must take urgent and sustained action to address shortfalls in long-term workforce planning.

In addition to the cabinet secretary’s comments in her first answer, what action will she take to ensure that radiology and oncology departments in Scotland are adequately staffed now, not just in the future? Will she commit to a date by which we can expect the Government’s six-week target to be met across all health boards?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

On the last question, if Mr Greene cares to refresh his memory, he will see that the date is set out in great detail in the waiting times improvement plan that I published a year ago.

The report has three key recommendations; I will give the member a brief update on those. With regard to developing a national model of workforce planning, I have made the commitment that our integrated national workforce plan will be published before the Christmas recess, in addition to the other workforce plans that we have already published. Unlocking the potential benefits of linked patient data is a critical part of the report with which I could not agree more—it is easier to write than it is to do; those matters are complex—and members will be pleased to know that we have almost reached an agreement on joint data controllers and data sharing. On delivering a step change in the provision of holistic cancer patient services, our joint work with Macmillan Cancer Support services, totalling £18 million, does precisely that through the provision of a holistic wraparound service.

I will make two final points, if I may, Presiding Officer. It is worth noting that our 31-day diagnosis-to-treatment target has been met at 96.5 per cent, which is 1.5 per cent over target, in quarter 2, which was September 2019. Progress continues to be made, as it does on the 62-day target.

I am sure that the member will be delighted to know that the final statistics for medical trainee recruitment in 2019 tell me that, in clinical radiology, ST1 recruitment has a 100 per cent fill rate.

Progress is being made. There is more to do, but as the member will see, we are utterly committed to delivery.

Photo of Jamie Greene Jamie Greene Conservative

The cabinet secretary is right: there is much more to do, as the statistics show. Behind every statistic is a cancer patient waiting to be diagnosed and treated. That is the reality of the situation.

The problem is that consecutive health secretaries have been warned repeatedly about these challenges over the years. As far back as 2015, the Royal College of Radiologists issued warnings about low uptake in radiology. In 2017, an Audit Scotland reported flagged up similar workforce planning issues, and in 2018, a leading radiologist, Dr Grant Baxter, warned that our services were on “red alert”. He went so far as to say:

“If we do not address this issue now, there simply won’t be a service in the next three, four, five years.”

Why, after years of repeated warnings from health professionals across the sector, has so little progress been made? Will the cabinet secretary respond formally and in writing to the recommendations in the cross-party group’s report?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

All I can say is that it is a good job that the Scottish Government listens a lot better than Mr Greene does. I answered all those questions. Why does he think I gave him all that factual information about what we have done since 2014, what we have done recently, and the considerable progress that has been made?

Mr Greene is absolutely right to say that behind every one of those statistics

“is a cancer patient waiting to be diagnosed and treated.”

I am more conscious of that than he is. However, I also know that behind all those statistics are staff who are working hard every single day. We have a 100 per cent fill rate in medical trainees in radiology. These things are important; they count, and progress is being made. [Interruption.] Mr Greene’s muttering at me from a sedentary position does not take us much further.

On Mr Greene’s final point, I know that the cross-party group knows that I will be delighted to respond in full to its report, which I found very helpful, and to return to the group, as I did in June, for another constructive and helpful conversation. I look forward to doing that.

Photo of Anas Sarwar Anas Sarwar Labour

As co-convener of the cross-party group on cancer, I thank all 67 respondents to the inquiry, whether they be charities, researchers, patients, clinicians or academics. I am sure that the cabinet secretary will agree that the report is constructive, and it aims to inform the Government rather than purely to challenge it.

Will the cabinet secretary endorse all 10 of the report’s recommendations, specifically the one on vacancy rates and how they impact on diagnosis? This year, 16,000 patients waited for longer than the six-week waiting time guarantee for their diagnosis, compared to just 4,000 patients three years ago. That is an exponential increase. What urgent action will the Government take to look at recruitment, retention and training, and how we use our technology and upskill existing clinicians?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I am grateful to Anas Sarwar for his question and for his work in the cross-party group. I completely agree that the report is very constructive and fair, and I am happy to put on record that I endorse all its recommendations. I look forward to the discussion that we will have on the report.

We have made capital investment in radiotherapy and other equipment: £33 million from our £100 million cancer strategy is going into radiotherapy and more money is going into scope capacity and surgical robots for prostate and other cancers.

There is the capital issue and the recruitment, training and retention matters, but, as Anas Sarwar rightly says, there is also the question of redesigning the service and the pathway so that we can upskill existing clinicians and others to take on new roles.

We can look at how we streamline some of that work. We are currently looking at how we use the waiting times plan, and the additional significant investment from it, in order to group together our diagnostic capacity in certain areas, so that we can speed up the time between necessary diagnostic tests in order to detect particular cancers. I would be happy to update the CPG on that matter in due course.

Photo of Keith Brown Keith Brown Scottish National Party

One of the issues that was raised in the report is the ageing population and the very real need to expand our national health service workforce to meet the anticipated increase in demand. Given that the only population increase in Scotland comes from inward migration, and given Tory members’ complete lack of acknowledgement—far less concern—of the impact of their support for Brexit, what assurances has the United Kingdom Government given that, in the event of Brexit, Scotland will have the powers to deliver a tailored immigration system to ensure that our NHS can recruit the specialists that it will need long into the future?

Photo of Kenneth Macintosh Kenneth Macintosh Labour

That was slightly tangential, but the cabinet secretary can respond briefly.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I am grateful to Keith Brown for that question, and he is right to talk about immigration policy in the context of the recruitment and retention of staff.

Everyone in the chamber has been happy to laud the value of the work that our colleagues from the European Union mainland, as well as from beyond those shores, do for us across the health service. However, if we do not control our immigration policy and if we are dragged out of the European Union against our clearly stated democratic will, that will increase our workforce challenges. There will also be additional challenges for clinical research and advancement in medicines and technology.

The straightforward answer to Keith Brown’s question is that the previous UK Government, which is currently seeking re-election, has made absolutely no recognition of the special situation in Scotland, and its proposition on immigration in particular—aside from being quite shameful and inhumane—would cause significant damage to the Scottish economy and Scottish society as a whole.

I absolutely endorse the calls, which are increasingly being made by people across the parties and across Scotland, that Scotland should have the right to choose its own immigration policy, just as we should have the right to decide much more about our future.

Photo of Neil Findlay Neil Findlay Labour

Staff shortages across the NHS are putting at risk the health and lives of patients, especially cancer patients. As I discovered last week through a freedom of information request, staff shortages in NHS Lothian are resulting in it having to pay up to £1,715 a shift to private agencies to cover vacancies.

NHS Lothian predicts a £90 million budget deficit, it is paying £1.4 million a month for a hospital with no patients—and now this. What does the cabinet secretary say to my constituents—cancer patients and others—who are suffering because of the workforce crisis that has been overseen by successive Scottish National Party ministers?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I think that I have already answered much of what Neil Findlay has asked. The additional information that I can give him, credit for which goes to his colleague Anas Sarwar, relates to the work that Anas Sarwar and I were able to do on the safe staffing legislation, which looked at how we handled agency spend inside boards.

The legislation has now received royal assent. When it commences, we will see a significant shift over time in how boards are able to use agency spend, as opposed to investing in the recruitment of full-time employees. That will make a significant difference to the work that is under way and to the overall sustainability of our health service.