Health and Social Care (Investment)

– in the Scottish Parliament on 20th November 2019.

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Photo of Linda Fabiani Linda Fabiani Scottish National Party

The next item of business is a debate on motion S5M-19940, in the name of Monica Lennon, on investing in Scotland.

Photo of Monica Lennon Monica Lennon Labour

Last week, it was my pleasure to attend the Scottish health awards, which celebrate some of the most inspiring people who work in our precious national health service. I am so grateful for the work that all our NHS staff do and I want to take this opportunity—I hope on behalf of all members—to say thank you to them.

For the sake of all patients and the workforce, the NHS must have the right resources, at the right place and the right time, so that people get the care that they need and deserve. Scottish National Party ministers introduced a legal right to treatment within 12 weeks. That was a good thing to do, but the treatment time guarantee has been breached more than 230,000 times. Despite coming into effect seven years ago, the duty to ensure that everyone is seen within 12 weeks has never been met. It is disappointing that the Cabinet Secretary for Health and Sport’s amendment to the motion in my name deletes that fact. Any attempt to downplay the extent of the widespread challenges that our NHS faces is an insult to patients who are in pain and to staff who are stressed and who are worked to the bone.

Audit Scotland has warned that the NHS in Scotland is “running hot”. SNP ministers have failed to do the long-term planning around workforce. A sticking-plaster approach to running the NHS has put the future of our health service at risk. NHS staff must be properly resourced to do their jobs. Instead, they face increasing pressure and the expectation that they will do more and more with less.

The Government published a waiting times improvement plan last year, but things continue to get worse instead of better. Targets have been consistently missed and life on the list is causing misery for too many patients. Last year, more than 5,000 children and young people waited more than 18 weeks to access mental health services. Over a third of chronic pain patients waited longer than four months for their first appointment—patients like my mum, a cancer survivor who waited 42 weeks for a bowel operation.

We must not lose sight of the other challenges, including the tragic drug deaths emergency, the high number of alcohol-related hospital admissions, and the growing mental health crisis. My heart goes out to people like my constituent Alison Larkin, whose teenage son Kyle completed suicide days after being told by his general practitioner about long waits for child and adolescent mental health services.

On cancer, which is Scotland’s leading cause of death, too many patients are waiting longer than six weeks for key diagnostic tests. Shockingly, overall cancer waiting time targets have not been met since 2012.

Miles Briggs is right to note in his amendment the report from the cross-party group on cancer, which was published this week. Macmillan Cancer Support warns that the current system cannot fully support the needs of people with cancer, so will the Scottish Government publish the national health and social care workforce plan that Macmillan and others have called for?

On wider workforce pressures, there are more than 4,000 vacant nursing and midwifery posts, and more than 500 consultant vacancies—the highest vacancy rate since the Government came to power. That is putting enormous strain on staff. Scottish Labour research revealed that, in the past year alone, 3.5 million NHS staff hours were lost due to stress, anxiety and mental health causes. Overall, nearly a quarter of NHS staff sickness absence hours—an increase of almost 17 per cent in the past few years—were for mental health reasons. Those are some of the challenges that the Government must address.

Audit Scotland’s latest annual report on the NHS confirms that its slow progress on the integration of health and social care means that the Government will not meet its 2020 ambitions. The failure to end delayed discharge is another broken promise. The Royal College of Emergency Medicine is concerned that accident and emergency departments will struggle to cope this winter. They are already struggling. It warns that at least an additional 320 beds are needed to avoid patients experiencing the indignity of corridor care.

Scottish Labour wants to see an end to delayed discharge through an ambitious reform of social care, with proper times for care visits and good working conditions for our workforce. Barnett consequentials from a United Kingdom Labour Government could support that by delivering an additional £600 million pounds for social care.

Audit Scotland says that, without significant reform, the NHS in Scotland faces a financial black hole of almost £2 billion in five years. Earlier today, we touched on the fact that, instead of being a cause for celebration, not one but two flagship hospitals are mired in scandal and subject to public inquiries.

Our NHS is in urgent need of more investment to tackle the growing health inequalities in Scotland, to improve the overall health of Scots, to fix the workforce crisis and to create social care that is fit for the future. A UK Labour Government will unlock the opportunity for more investment, not only in acute health care, but across our public services. We have had enough despair and scandal. We need dignity and safety, and Scottish Labour will always put the NHS first. We would end the complacency, strengthen the NHS and deliver transformation in health and social care.

I move,

That the Parliament believes that the Scottish Government is not fulfilling its promise to the people of Scotland on the legal right to treatment within 12 weeks; considers that current NHS waiting times are too long and that the impact on patients is unacceptable; thanks NHS staff for their dedication and hard work and is concerned about the increasing pressures on the workforce due to a lack of adequate workforce planning and investment; agrees that there has been a lack of focus on reducing health inequalities, and believes that the future sustainability of the NHS is reliant on more investment, better long-term planning and a transformational delivery of health and social care that is fit for the 21st century.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

This Government is absolutely committed to a publicly owned, operated and commissioned NHS in Scotland. That is why we are determined, and why we demand, that the next Westminster Parliament passes an NHS protection bill to protect our health service from any future trade deals and to give this Parliament an explicit veto over any deal.

Photo of Joe FitzPatrick Joe FitzPatrick Scottish National Party

I have a lot to get through, so I will continue. If there is time, I will come back to the member and he can tell us that he supports giving this Parliament an explicit veto to deal with those matters.

Any party that refuses to protect our NHS in law leaves it open to the threat of being used as a bargaining chip in future deals, with the Trump Administration or anyone else.

Delivering improvement and reform in our health and care services takes investment. In 2019-20, we are investing record funding—more than £14 billion for health—with funding for front-line NHS boards increasing by £430 million. Statistics that were published yesterday show that front-line health spending per head in Scotland is 6.3 per cent—that is £136 per head—higher than in England. That is more than £740 million more spending on health in Scotland compared with the levels in England.

Our increased health investment comes despite Westminster reducing Scotland’s fiscal resource budget by £1.5 billion, or 5 per cent in real terms, between 2010-11 and 2019-20. Our medium-term financial framework, which was published last year, enables longer-term planning and shifting the balance of care. It allows boards to focus their attention on delivering reform in a safe and appropriate way. Audit Scotland recently recognised that the framework is

“an important step towards supporting improvements to achieve financial sustainability of the NHS.”

We recognise that too many patients are still waiting too long for treatment. That is why, last year, the cabinet secretary launched our £850 million waiting times improvement plan. We are already seeing the first fruits of that plan. In the past two years, there has been an overall reduction, by 14 per cent, in the number of those who are waiting longer than 12 weeks for an out-patient operation, with more than 13,500 fewer patients waiting longer than 12 weeks. In spite of what some members have said, our A and E departments have been the best performing in the UK for more than four years.

Although that is welcome, we are determined to go further. To support that, we have published workforce plans covering the NHS, primary care and social care. Our integrated national workforce plan, when published in the very near future, will be the first of its kind in the United Kingdom. It will build on the progress that has been made in recent years on training and recruitment. For example, compared with 2015, the number of doctors in training in 2019 is up by 19 per cent; the number of doctors appointed to GP training programmes is up by 36 per cent; and the overall trainee doctors recruitment position is at 92 per cent, which is up from 86 per cent last year and is equivalent to 64 new posts. I am particularly pleased to note that 100 per cent of radiology training posts are filled in 2019.

Hanging over all this is Brexit, which poses one of the greatest challenges to our health service. We believe that continued European Union membership best protects Scotland’s interests and those of the rest of the UK. Since the 2016 referendum, we have worked tirelessly to prevent EU exit and specifically to prevent a no-deal Brexit. Our NHS has benefited from staff from the EU and other countries. Their contribution is vital and we must protect their rights. The cabinet secretary has written to staff on three occasions, including earlier this month, to assure them that we value them and want them to stay. I hope that all members back that sentiment.

I would have liked to have more time to talk further about the importance of addressing health inequalities, supporting mental wellbeing and acting to prevent ill-health, although I am sure that we will have opportunities to do so in future. However, as the debating time has been split, time is far too short, so I close by observing that our NHS faces significant challenges and that, to protect it long into the future, we must invest, reform and absolutely exempt it from any future trade deals.

I move amendment S5M-19940.2, to leave out from first “believes” to end and insert:

“thanks NHS staff for their dedication and hard work as they care for the people of Scotland; welcomes the work being taken forward by the Ministerial working group to further promote and encourage a positive and caring workplace culture; believes that sustained investment through plans for waiting times improvements can support boards to better deliver for their patients; further believes that such investment, reform and planning is necessary as too many patients are waiting too long for treatment; understands that, in 2019-20, NHS Scotland will be £758 million better off because it has received better than real-terms increases since the beginning of the current parliamentary session; calls for the incoming UK Government to pass, as a matter of urgency, NHS protection legislation to absolutely exempt the NHS from any future trade deals, and to provide a veto over such deals to the devolved legislatures; notes that any form of Brexit could have a potentially devastating impact on health and care services; considers that Brexit will damage the economy and the ability to attract specialist staff for years to come, undermining the sustainability of the health service; notes that a focus on addressing health inequalities and prevention of ill health is essential for the long-term wellbeing of the people of Scotland, and believes that the future sustainability of the NHS is reliant on more investment, including in communities, better long-term planning and working with partners in local government for a greater pace of transformational delivery of health and social care that is fit for the 21st century.”

The Deputy Presiding Officer:

All members can be assured that I will ensure fairness in time allocation.

Photo of Miles Briggs Miles Briggs Conservative

We have families demanding answers to what happened to their children, patients being given blankets to keep warm in hospital, cancer survival rates being put at risk due to staff shortages and operating theatres being closed and handed over to private operators. That is all on the cabinet secretary’s and ministers’ watch. Yet again, we are having to hold an Opposition debate on the issue. The ministers have failed our health service. Despite all that we have just heard from the minister, he should have summarised it in one word by saying sorry to patients across Scotland.

I welcome the opportunity that the Labour Party has given us to talk about our health service, because we never get that from this Government in its time. The empty rhetoric that we have heard from the Government needs to be put to one side.

I begin where Monica Lennon, too, started by thanking our NHS staff in Scotland for all that they do. Winter is often when most pressure are seen, and we owe those staff a huge debt of gratitude.

The Labour Party motion rightly highlights that this Government’s 12-week treatment time guarantee, which was introduced by the First Minister when she was the Cabinet Secretary for Health and Wellbeing, has never been met—not once—since it was introduced in 2011. It is not so much a guarantee as a false hope for too many of our fellow Scots. SNP ministers are further away than ever from meeting that target, with the last quarter’s statistics being the worst on record.

The target is being missed across numerous health boards, and it is a complete and on-going failure of this Government. The 18-week referral time has also been missed, patients are waiting too long for crucial diagnostic tests and more than one fifth of patients are waiting too long for mental health services and treatment, with almost one third of vulnerable children now waiting too long for mental health services. In addition, almost one fifth of patients with urgent cancer referrals are now waiting more than two months for treatment; that issue was flagged this week in a report by the Parliament’s cross-party group on cancer. Furthermore, the SNP’s A and E target has not been met for two years. The SNP’s failure to plan for the future and to put in place a long-term and comprehensive NHS workforce plan is leading directly to our health service not being able to meet the targets that ministers have set it.

Sadly, it is not just on targets and the NHS workforce that the SNP is failing, but on physical infrastructure and new hospital projects. The deaths of children at the Queen Elizabeth university hospital in Glasgow have been utterly heartbreaking for the families and all involved, and those families, quite rightly, demand and deserve the truth.

The Scottish Government must ensure that parents get the answers that they need, and that both transparency, and parents and families, are at the heart of what the cabinet secretary and the health board take forward. In my region of Lothian, the new Royal hospital for sick children fiasco sums up everything that is wrong with this Government’s oversight of these vital NHS projects and infrastructure, which we all want to see and invest in, but which have been failed on these ministers’ watch.

The new hospital, which was due to be opened years ago, lies empty, yet NHS Lothian is paying £1.4 million per month to the developer for a facility that we cannot use and which is not open to Lothian families. I do not believe that SNP ministers realise just how angry Lothian voters are about that; those families are being failed by this Government as a result of the mismanagement of our health service. Families in West Lothian are also extremely angry and unhappy about ministers’ on-going inability to reopen the children’s ward at St John’s hospital on a full-time basis after promises that were made to them by the cabinet secretary, which have also been broken.

The Deputy Presiding Officer:

Mr Briggs is just closing.

Photo of Miles Briggs Miles Briggs Conservative

No. I do not have time.

Information that I obtained recently under freedom of information legislation indicated that the Royal College of Paediatrics and Child Health is telling NHS Lothian that it could now take up to five years for a full reopening. Ministers have deliberately kept that from the public.

The Deputy Presiding Officer:

Mr Briggs is closing.

Photo of Miles Briggs Miles Briggs Conservative

I welcome the

UK Government’s recent announcement of extra funding for general practice, which will see an extra £200 million for Scotland in Barnett consequentials. That comes on top of the more than £2 billion in actual Barnett consequentials that our health service has received since 2010.

Scottish Conservatives have campaigned consistently to save our surgeries and to see the family doctor put back at the heart of our Scottish NHS. Again, I call for 11 per cent of that funding to go to general practice.

The Deputy Presiding Officer:

Come to a close, please.

Photo of Miles Briggs Miles Briggs Conservative

We need to see a long-term strategic plan for our NHS, not only in workforce planning but in actually taking forward these serious problems. Our Scottish NHS is crying out for real leadership—all that it is getting from SNP ministers is crisis management.

I move amendment S5M-19940.1, to insert at end:

“; recognises the workforce crisis within NHS Scotland; notes the recent report from the Cross-Party Group on Cancer, which highlighted staff shortages as a reason for progress on treating cancer stalling; believes that Scotland’s GPs are at the forefront of the NHS; calls on general practice to receive 11% of the overall Scottish NHS budget, and further calls for a long-term workforce plan to be developed for the health service in Scotland.”

Photo of Alison Johnstone Alison Johnstone Green

I, too, thank all those who work in the NHS. It is important that we express our thanks to those who work in social care, who are so often underpaid and underappreciated.

I welcome the chance to debate the future of our health service. Given the challenges that are faced by all those who work in the NHS and all who rely on it, I do not think that it would be possible to give it too much of our focus and attention.

Monica Lennon’s motion makes some extremely important points, and I thank her for lodging it. Too many patients are waiting too long for treatment, and that is unacceptable. We are still waiting for an integrated workforce plan, and we need to invest more in our NHS workforce.

The Government’s amendment reflects that and accepts the just criticism that too many patients are waiting too long for treatment and that more investment and better long-term planning are needed. I welcome the acknowledgment of the need for a renewed focus on prevention and health inequalities, which the Scottish Greens believe must be priorities for a truly sustainable health service.

The amendment also recognises a fundamental threat to the sustainability of the national health service: the catastrophe that a hard Brexit would be and the possibility that a Boris Johnson Government would desperately pursue a trade deal with the United States. I will, therefore, support the Government amendment.

The hard Brexit that the Tories are pursuing represents one of the greatest threats to our health and social care system in recent memory. The health service has always relied on workers from the EU and beyond. The British Medical Association has warned that Scotland will need to continue to recruit from the European Economic Area and overseas to sustain staffing levels across the NHS in years to come. We simply cannot afford to put up barriers to medical or other healthcare staff, or to deter staff from coming to work in our health service at a time when they are needed most.

It is also the case that around three quarters of the medicines and more than half of the clinical consumables that we use come from, or via, the EU. The Royal Pharmaceutical Society has explicitly said that health organisations are unable to guarantee patients that their health and care will not be negatively impacted by the UK’s exit from the EU.

Given those challenges, it is essential that we include Brexit in every debate about the future of Scotland’s health service. The current UK Government has already made clear its intention to prioritise negotiating a trade deal with the US if a hard Brexit happens, and Donald Trump has said that the NHS is “on the table”. Although Boris Johnson denies that, I am afraid that we all know that he cannot be trusted. Indeed, senior civil servants have met big pharma representatives from the US to discuss trade negotiations. The impact of that on the NHS and patients throughout Scotland as a result of rocketing drugs bills could be devastating.

That is why it is essential that the Parliament sends the clear message that our NHS must be exempted from any future trade deals. Given the impact that trade deals will have on the constituents whom we all represent, it is critical that the Parliament and other devolved legislatures are given a say.

I welcome the fact that Miles Briggs’s amendment

“calls on general practice to receive 11% of the overall Scottish NHS budget”.

I support that whole-heartedly. Parliament backed that call when it voted to support my motion on GP recruitment and retention in April, and I am happy to support that amendment. If we are serious about integrating health and social care, it is essential that we have the support and the facilities in our communities that people need and rely on. The majority of patient contacts take place in our local GP surgeries, but those surgeries are simply not getting the level of investment that is essential.

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

Like other members, I have recent cause to give thanks to our hard-working NHS staff, so I am delighted to join others in thanking them.

The topic is very important, and I am grateful to Monica Lennon and the Labour Party for making time to discuss it. It visits each of us in our constituency surgeries every single week. Usually, the people who come to see us are in abject pain and a certain degree of distress. More often than not, they are clutching a letter telling them when they would be seen but it is now weeks and weeks beyond the time when they were told to expect treatment.

That is precisely why the Liberal Democrats led a debate in the chamber on the matter in May. At that time, the Cabinet Secretary for Health and Sport admitted that performance “must improve”, and Parliament agreed. I will not repeat what I said that day; instead, I will look at what has happened in the intervening months. The headline performance figure has not budged. The treatment guarantee was not being fulfilled for 27 per cent of patients then; the latest figures show that it is not being met for 27.5 per cent of patients. We saw the guarantee being missed by a larger margin than ever before. The number of times that the First Minister’s treatment time law has now been officially breached has surpassed 200,000. That is an uncomfortable milestone for any minister.

Research by the Scottish Liberal Democrats found more patients waiting staggeringly long times—in breach of the law—in dentistry. A patient waited 38 weeks for oral surgery in NHS Borders, 39 weeks in NHS Greater Glasgow and Clyde and 40 weeks in both NHS Fife and NHS Forth Valley. Incredibly, a patient waited 126 weeks for oral and maxillofacial treatment in NHS Grampian. Those patients included patients who needed to restore functionality and appearance after serious injuries and cancer. David McColl, who is the chair of the British Dental Association’s Scottish dental practice committee, did not mince his words as he said that that situation was the result of years of underinvestment and that patients

“shouldn’t be waiting eons for life-changing surgery.”

We have heard how ministers have set out a plan to stop breaking their own law by 2021, which is a full decade after it was passed on the signature of Nicola Sturgeon. However, my confidence in the Government even on that has faded because now, a full year into the new waiting times improvement plan, we have seen many measures take a turn for the worse. The recovery plan has not had the desired effect in year 1, which calls into serious question where it will be at the end of year 2 and year 3. That recovery plan hinges on there being enough staff, which is what the integrated workforce plan was always meant to secure.

Overstretched staff were promised that they would see the integrated workforce plan a year ago—their good will has been relied on for much too long and it is running out—but December became January, that became February and then that became “this year” and now it has become “the very near future”. We are now at the end of November and the plan is still nowhere to be seen. That delay and deflection will hinder progress towards meeting that guarantee in 2021. More immediately, it means that the staff will not get the respite that they need and it means more long waits for treatment and, with those, more pain, disruption and anxiety.

On the amendments, Miles Briggs made some important points and I will be glad again to support the call for more investment in primary care. I agree with the cabinet secretary that our NHS must not be a bargaining chip in future trade deals. The Liberal Democrats believe that the best way to keep the NHS out of the grubby hands of Donald Trump and to build a brighter future is to stop Brexit entirely. The Scottish Government’s amendment is, as a whole, complacent. I stand by Monica Lennon’s motion, which makes the same points that the Liberal Democrats did in May. The Scottish Government is breaching the law on an unprecedented scale and, as a first step towards fixing that, we urgently need to see that workforce plan.

Photo of Mary Fee Mary Fee Labour

The national health service is our most beloved and essential public service. It looks after us regardless of race, gender, social status or wealth. In the 71 years since its creation, it has faced an array of challenges and obstacles, but it strives to care for and treat all of us. Personally, I have a lot to thank our NHS for and I will never apologise for standing up for it and for people like me, who rely on that care and support on a daily basis.

Investing in healthcare is one of the most important functions of Government, no matter the party in control. Investing in healthcare is crucial to the nation as a whole, but it is also crucial to the NHS staff, who work with tireless dedication in often the most difficult and challenging circumstances. That is why we lodged our motion for debate today: to highlight that investing in the NHS is investing in both patients and staff.

Today is transgender day of remembrance, which is a day to honour, commemorate and memorialise trans people who have died as a result of transphobia. On this day and during this debate, it would be remiss of me not to highlight some of the health inequalities of transgender people. Statistics show that 25 per cent of trans people have been subjected to domestic abuse, 30 per cent of trans people have attempted suicide and, worldwide, 331 transgender and gender-diverse people have been killed in the past year.

As a trans ally, I will always work to tackle the health inequalities that this much maligned and denigrated community faces every single day. Investing in our NHS means that we can provide better support for transgender people, especially when it is investing in mental health services and supporting the many fantastic third sector and charity organisations that support transgender and gender-diverse people.

As a representative of West Scotland, I see the causes of health inequalities all too often. Poverty is at the heart of those causes. The life expectancy of men in West Scotland is among the lowest in Europe. The difference between the life expectancies of men living in neighbouring West Dunbartonshire and East Dunbartonshire is around five years. Ending austerity would go a long way to ending that shocking statistic. By investing in public services such as the NHS and investing to better support our communities, we can tackle the health inequalities for men in West Scotland and across Scotland.

Cuts to local government and cuts that have been forced on health boards are causing suffering for far too many people. The children’s ward at Paisley’s Royal Alexandra hospital has been moved to the Queen Elizabeth university hospital, which is facing serious problems of its own. Social care is in crisis, resulting in more people staying in hospital for longer than they need to. There are shocking figures for drug-related deaths. Child and adolescent mental health services are under extreme pressure, and there are high numbers of rejected referrals. Those are a few examples that show that, under this SNP Government, the NHS is unsustainable and investment is crucial.

I urge members to support our motion on investing in the NHS and to support its hard-working staff.

Photo of James Dornan James Dornan Scottish National Party

Last year, the NHS celebrated its 70th birthday. Over the decades, every one of us will have used it in one way or another, whether through being born in the NHS, seeing a GP, having an operation in a hospital or simply visiting an optician for a free NHS eye examination. Despite what we have heard from the likes of Monica Lennon and Miles Briggs, our healthcare system is undoubtedly the best in the world, and that is primarily because of the incredible people who work in it.

The current time of year is often difficult for the staff, so I put on the record my appreciation for the work that they do, often in challenging circumstances. Unlike our opponents, I will not go on to criticise what has been happening in the hospitals. Despite the pressures, it is down to the staff that, according to the recent Audit Scotland report, the NHS is seeing and treating more patients than ever before. We all rely on our NHS, and that is why we in the SNP want to make sure that it is fit for the future.

Since the NHS was created in 1948, it has seen many changes, but none greater than the transformational integration of our health and social care sectors. That is the biggest reform in that period and it is changing for the better the way in which key services are being delivered. The necessary reform and investment will ensure that our NHS is fit for the changing needs of 21st century Scotland.

Of course there are aspects of our health service that are not performing to the standards that are expected of them. I have a constituent whose daughter is facing an excessive and unacceptable wait for paediatric ear, nose and throat services at the Royal hospital for children in Glasgow. My local health board admits that my constituent’s daughter’s wait is too long, and the Scottish Government accepts that such waits are unacceptable. However, that is why we are taking vital steps to address waiting times through the waiting times improvement plan, which is backed by more than £850 million of funding.

I hope to sit in the chamber one day and hear a member from one of the Opposition parties being honest with the public about their plans—or lack of plans—to help with the running of our NHS. Unfortunately, today is not that day. As I said, I accept that we must do more, but neither Labour nor the Tories have ever come up with the plans or the answers. The Scottish branch of Labour demands everything all the time, yet not once in 12 years has it come to the finance secretary with costed proposals during the budget process.

On the other hand, health spending under the SNP is at a record high. We have committed to increasing the NHS revenue budget by half a billion pounds over inflation in the current session of Parliament. Under the SNP, NHS staffing is at a record high. Scotland has the highest number of GPs per head of population in the UK, and we have increased staffing levels in the NHS by 10 per cent. Under the SNP, 86 per cent of NHS Scotland patients rate their care and treatment positively, which is a record high since 2014, and A and E performance in Scotland’s hospitals has been the best in the UK for over four and a half years.

To be fair—that is my way, as you know, Presiding Officer—at the UK level, Labour has come up with a couple of positive plans to improve the health service in England. The plans are for free prescriptions, which have already been introduced by the SNP in Scotland, and free personal care for the elderly, which was also introduced by the SNP—

Photo of James Dornan James Dornan Scottish National Party

Sorry, sorry—my apologies. Sit down, Alex—I do not want to give you a heart attack.

Free personal care for the elderly has been extended by the SNP to anyone who needs it, regardless of their age, condition, capital or income.

Opposition parties need to be honest with the public and remind them of the fact—[


.] We can all make mistakes—such as mine just then—but the Opposition parties do dishonesty. They need to remind the public that, under Tory tax giveaways, the Scottish Government’s budget would have been reduced by £650 million in 2019-20, and that, if Labour had been elected in 2016 and implemented its manifesto, our NHS would be £758 million worse off this financial year than it is now. Clearly, that could only mean cuts to our health service. Would Labour and the Tories slash the number of nurses by up to 19,000, or would they scrap the waiting time improvement funding, which would mean that people who are on the paediatric ENT waiting list, such as my young constituent, would wait much longer?

Scotland is not immune to the challenges that the NHS faces, but it is only the SNP Scottish Government that has a credible plan to improve it. As the Opposition plays cheap and, sometimes, nasty politics with the NHS, we will continue making the necessary reforms and investment to improve the NHS for all patients.

Photo of Edward Mountain Edward Mountain Conservative

Presiding Officer, now we come back to the real world.

I thank the Labour Party for bringing the debate to the chamber.

It was only last week that I raised in the chamber the Scottish Government’s poor healthcare performance in the Highlands. It is of little surprise that I am back today to do the same thing. Last week, I raised with the First Minister the long waiting times in NHS Highland after it was revealed that some patients wait 78 weeks for orthopaedic treatment. That is simply unacceptable and means that some patients are suffering excruciating pain and putting their lives on hold for a long time.

However, that is not an isolated incident; it is the tip of an iceberg. The Auditor General pointed out that only 54 per cent of patients in the Highlands are getting operations within the 12-week treatment time guarantee period. I challenged the First Minister on what her Government was doing to resolve that situation, but her answer will have brought little comfort to those in the Highlands who are waiting for treatment. I welcome the £850 million initiative to cut waiting times, but the First Minister failed to mention that only £7 million of that money has been spent in the Highlands so far, which gives me the distinct impression that this Government is again ignoring the Highlands.

I agree with what has been said by other members: we owe a huge debt of gratitude to our hard-working doctors and nurses. I believe that this Government is letting them down. Right now, NHS Highland and many other health boards in Scotland are overstretched and understaffed. Health staff are under more and more pressure to deliver on waiting times, and they feel the burden of responsibility. In the Highlands, staff have also had to deal with the bullying that has been going on in that service. They should not be in that position, and the blame lies with this Government. It must improve recruitment levels to reach a point at which staff have a realistic chance of achieving the waiting time targets that we all very much want them to achieve.

I regularly speak with consultants who are based in the Highlands, and they tell me that highlanders are resilient. However, at times, that strength becomes a weakness, because people decide not to make a fuss about their ill health. 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 patients are diagnosed. That is why the waiting times issue is so critical in the Highlands.

Across Scotland, the shortcomings in our NHS emanate from the top—from this Government. That is why I despair at the thought of NHS Highland being escalated to level 5 and the Scottish Government centralising control of what should be local healthcare and decisions that are made locally.

This Government does not have a good record—a record that inspires confidence. It has let down the workforce through poor workforce planning and through not ensuring that its workplace is one that we should all be proud of.

There has been a decade of failure that has caused waiting times to grow longer and longer and pressures on our hospitals to grow bigger and bigger. Something must change—and that change must start at the top.

I totally support Monica Lennon’s motion.

Photo of John Mason John Mason Scottish National Party

I am pleased to speak in today’s debate.

We should recognise that we have a world-class health service. People want to work in it and people want to be treated by it. It is the envy of most other countries and compares very favourably with health services in neighbouring countries, such as England. For example, A and E patients are seen within four hours—7 per cent ahead of patients in England. Cancer patients are treated within 62 days of referral—also 7 per cent ahead of those in England. That is not to say that there is no room for improvement, but we should be proud when we do things well.

Photo of John Mason John Mason Scottish National Party

I am afraid that there is no time for interventions.

Labour’s motion mentions investment a couple of times. It mentions

“a lack of adequate ... investment.” and says that

“The future sustainability of the NHS is reliant on more investment”.

I assume that Labour means financial investment.

The NHS has had better than real-terms increases since 2016, and has therefore been better protected than other sectors. In fact, there has been criticism from people in the business world and elsewhere that the NHS has been treated too generously in comparison with training or job creation, for example.

If Labour members or anyone else want more finance for the NHS, they have to tell us where it will come from. Would they cut funding for local government or colleges? Monica Lennon suggested that £600 million would come from the UK. That would be welcome, but I fear that that means that Labour will just borrow and borrow and borrow, and the UK, which is not in a good financial state, will continue to go from boom to bust.

On workforce planning, we are fairly close to full employment, and we have a pretty stable, and ageing, population. If the suggestion is therefore that we should have more staff in the NHS, they would presumably need to come either through immigration or through cuts to the workforce in some other sector.

Photo of John Mason John Mason Scottish National Party

No, I will not take interventions. The member should have listened the first time.

We are arguing strongly for control over immigration because that would give us that extra and necessary workforce. We are not arguing for more people for the sake of it; we need more people to grow our economy and to provide the services we all expect. If Labour members will not support us in achieving more immigration into Scotland, where do they think the extra nurses and doctors will come from? Do they want to take young people out of agriculture, engineering or hospitality? Is that what they are saying?

There is a link to the cross-party group report on cancer that has been commented on this week. The CPG also wants workforce planning to “address long-standing vacancies”. Is it saying that too many staff are in maternity or elderly care and can be transferred to cancer care? If not, where are those extra people to come from?

With regard to financial and human resources, I accept that we can increase efficiency and improve the way we do things; I also accept that technology can help us, too. However, I suggest that those things are likely to give us only marginal improvements in the short term. Some Opposition members need a reality check. They need to remember that, when he was First Minister, Jack McConnell said, that the population was

“the single biggest challenge facing Scotland”.

Scotland faces a huge challenge: we just do not have enough people for what we want to do. If immigration is not to be allowed, we will need to start curtailing our ambitions, be that in business, universities, the NHS or wherever.

On preventative spending, the Conservative amendment has some merit in stressing GPs, but we should be realistic about what the amendment really means. Out of every £100 of NHS spending, around £8 is spent on GPs. If the GPs’ share went up to £11, the share for the rest would have to fall from £92 to £89. There is merit in that argument, but the Conservatives need to be realistic and accept that hospital spending would fall and that—at least in the short term—A and E waiting times might go up.

The NHS is not perfect but I urge the Opposition to acknowledge what a world-class health service we have.

Photo of Neil Findlay Neil Findlay Labour

I declare an interest: my wife and daughter work in the NHS.

The NHS is our greatest public service. It is staffed by skilled, caring, compassionate people who, every day, go above and beyond the call of duty. They care for the young, the old, the newborn and those who are about to leave this world.

However, the NHS is a tough and mentally and physically exhausting service to work in. Week in, week out, staff and patients come to my office—and, I bet, the offices of almost every other member of this Parliament—for help and support on a number of important issues.

What is happening in England, Wales or Northern Ireland—or Timbuktu, for that matter—means nothing to those constituents. What is happening to them, their families and their colleagues matters. If people cannot get a doctor’s appointment in Livingston, it does not make their illness any better to know that their brother or sister in Birmingham cannot get one either. If staff are rushed off their feet, walking 11 miles a day on a ward in Edinburgh, it does not make it any better that a nurse in London, Belfast or Cardiff is doing the same. What people want is action on a number of fronts, which I will set out. They are all issues that I have been approached about in recent weeks and months by constituents. None is made up; they are genuine cases.

Seven years on from when the problem was first exposed, parents from Whitburn with sick children have to travel to Edinburgh at weekends because the children’s ward at St John’s is still not open on a 24/7 basis. For the first time since the creation of the NHS, patients from Stoneyburn no longer have a GP service in their village. Orthopaedics patients from Blackburn have been told that their waiting time for a procedure is 54 weeks. Mental health patients from East Calder wait 10 months for a first consultation with a psychologist. If people are in mental health crisis today, having to wait 10 months is no good.

Nurses at St John’s, the Edinburgh royal infirmary and the Western general hospital are drowning under pressure because of staffing shortages and patients being inappropriately boarded out to their ward. Elderly patients from across the Lothians are stuck in hospital and cannot get out because there is no care home place or care at home for them.

Home carers, who are on zero-hours contracts, want to provide a good service but, because of the contracts that they work under, they cannot. In more than 50 GP practices in the Lothians, lists are closed to new patients, because they cannot recruit doctors. Neurological patients and children are waiting for treatment but cannot get access to the new sick kids hospital, which costs £1.4 million a month but still has no patients in it. NHS managers are forced to turn to private staffing agencies, which charge £1,700 a shift for a nurse; nurses who are employed by the NHS get less than £150.

Hundreds of staff at St John’s have no credible public transport option to get to work but have had their staff parking passes removed, which has resulted in tensions between the staff, the hospital and the surrounding communities.

All those people—who work in or use our NHS—believe in it. They all support it and they all want it to have a better future. The Government should address those issues.

In 2012, I said that we needed a fundamental review of the NHS to ensure that it was fit for the 21st century. Alex Neil, then the Cabinet Secretary for Health and Wellbeing, dismissed that call, saying that it was a waste of time and money. However, last week, at the Public Audit and Post-legislative Scrutiny Committee, the same Alex Neil called for such a review to take place. If he had listened to Richard Simpson and me in 2012, the review would be finished by now, we would be implementing its findings and the NHS would be in much better shape. When she considers the in-tray that she has at the moment, the cabinet secretary ought to reflect on that.

Photo of Willie Coffey Willie Coffey Scottish National Party

If there is one message that should come out of today’s short debate, it must be that money is not the real issue. We are seeing real-terms increases in what is being spent on the NHS year on year, with that spending now accounting for more than 40 per cent of the whole Scottish budget. In Scotland, we have more staff, nurses, midwives and GPs per head than anywhere else in the UK. We also have better pay and the highest public satisfaction ratings.

So, what is the real issue that we face? It is a combination of a number of factors. We are making progress against the big three—heart disease, stroke and cancer—so people are living longer. The numbers of people who present with respiratory issues and diabetes continue to climb, and the number who present with multiple conditions later in life is on the up. Demand just keeps growing.

Our previous Auditor General for Scotland, Robert Black, told the Public Audit Committee during one of his last contributions, in 2011, that we faced that challenge then, and that it was significant. However, he also said that the NHS cannot solve it alone, and that we would need help from our partners in local government to bring about the kind of service redesign that would be required to cope with those demands.

This is where we are in 2019—working to reshape the NHS so that it can continue to deliver to the people of Scotland a high-quality service that is free at the point of need. No one has said that it will be quick or easy, but the transformation process is under way.

Integration of healthcare and social care is probably the greatest challenge of all. However, as the previous and current Auditors General have reminded us, it offers the scale of transformational change that we need in areas in which we rely heavily on our local authority partners. More than half of our adult social care budget now sits with our integration joint boards. People wanted to see resources being shifted to community-based services, so it is to be hoped that that will deliver the necessary changes.

In respect of a recent section 23 report, the current Auditor General has told the Public Audit and Post-legislative Scrutiny Committee that the Scottish Ambulance Service is helping to reduce demand for GP appointments in areas where its paramedics are trained to assess and treat patients, who then do not need GP visits. Patient feedback on that approach has been very positive.

The pharmacy first service is also making an impact. We know that, in Forth Valley NHS, people can access their local community pharmacies for some conditions that do not need a GP visit. Many such pharmacies stay open in the evenings and at weekends, which makes the service even more valuable. In the service, 83 per cent of patients’ consultations are successfully completed by pharmacists, only 10 per cent had to go to GPs, and the remaining 7 per cent required only advice.

NHS 24’s triaging of people who are looking for urgent appointments with GPs also has very high levels of patient satisfaction. It is clear that it is directing people to better and more appropriate services, thereby easing demand on other parts of the service. There are plenty of good examples of service transformation all over Scotland, but the pace of change needs to pick up, as the Auditor General reflected.

The cost pressures that health boards face are also clear. However, some, including NHS Ayrshire and Arran, have identified and made significant recurring savings that will help us in the future. The move to the three-year financial planning model, together with assistance with brokerage repayments, is helping boards to plan and manage their finances during this period of transformational change.

The amount that the NHS spends annually on drugs—I think it was £1.8 billion last year—seems to have stabilised, too. However, we cannot ignore or dismiss factors that are outwith our control and which are a real cause for concern for us all—for example, the impacts that Brexit might have on the NHS workforce and its potential to cause reduced access to medicines for some patient groups.

In her most recent report to committee, the current Auditor General said:

“Despite the growing demand from population changes and increasing costs of delivering healthcare in Scotland, patient safety and experience of hospital care continues to improve. There are examples of new and innovative ways of delivering healthcare and managing costs.”

However, we all know that there is a long way to go if we are to continue to deliver a high-quality healthcare service. I know that the Scottish Government and the health secretary are committed to doing just that.

Photo of Brian Whittle Brian Whittle Conservative

I remind the chamber that I have a daughter who is a healthcare professional in our Scottish NHS. I thank the Labour Party for bringing the debate to the chamber, and for once again using Opposition time to debate health services. I am grateful for the opportunity to close on behalf of the Conservatives.

Monica Lennon’s motion states that

“the Scottish Government is not fulfilling its promise to the people of Scotland” on its waiting time guarantee. Speech after speech has highlighted that continual failure by the Government. Joe FitzPatrick set the tone for the Scottish Government with what I call a head-in-the-sand speech, which called on Westminster somehow to protect the NHS in Scotland. I remind Joe FitzPatrick—because he is in the Government—that health is totally devolved to this Parliament. When on earth will the SNP start accepting responsibility for the mess that it has created?

Miles Briggs rightly highlighted not just the continual failure to meet the Scottish Government’s much-heralded 12-week treatment time guarantee—which was introduced in 2011 by the then Cabinet Secretary for Health and Wellbeing, Nicola Sturgeon—but that it has never been met. In fact, the last quarter is now the worst on record. Edward Mountain highlighted in his speech how only 58 per cent of patients in the Highlands are hitting that 12-week guarantee and that there is now a 78-week wait for orthopaedic treatment, which is completely and utterly unacceptable for patients.

Photo of Brian Whittle Brian Whittle Conservative

I do not have time.

Add to that the 18-week referral time that is consistently missed, the patients who are waiting too long for crucial diagnostic testing, the more than one fifth of patients who are waiting far too long for mental health treatment, and the one third of vulnerable children who are waiting too long for mental health support. That last point was highlighted only too starkly in an evidence session with children last night for the Public Petitions Committee, at which vulnerable young children were suggesting that they have little faith in the system. Cancer waiting times show that almost one fifth of cancer referral patients wait more than two months for treatment.

Monica Lennon brought workforce planning—more accurately, the lack of workforce planning—to the table. The Scottish Government has yet to produce a comprehensive plan, despite the matter being raised consistently by Opposition members. The figure of 800 new GPs by 2029 has been given by the Scottish Government, but Audit Scotland reported to the Health and Sport Committee that the Government could not give any workings on how it had come up with that figure, or say how it relates to forward planning. When Audit Scotland did some analysis based on current trends, it reported that the most likely outcome was that we would still have a shortfall of 664 GPs in 2029. That is not workforce planning; it reeks of fumbling in the dark to fend off further scrutiny.

I say to John Mason that we have world-class healthcare professionals who require world-class facilities in order to deliver all that they are trained for, and are desperate to deliver. That is how we would retain staff. Instead, we have the growing tragedy at the Queen Elizabeth university hospital in Glasgow coupled with the debacle of the Royal hospital for sick children and young people, which is full of modern equipment but is lying empty at a cost of £1.4 million a month to the health budget. Its opening was pulled literally hours before it should have been accepting patients. Neil Findlay highlighted the continuing failure to open the children’s ward at St John’s hospital full time. There we see the SNP’s ability to oversee NHS building projects—we see it far too clearly.

Yesterday, in the Health and Sport Committee, I said to one of the cabinet secretary’s colleagues that I thought that she was being thrown under a bus. Jeane Freeman is constantly firefighting, in this chamber and before committees, dealing with crisis after crisis that is not of her making. She did not cut the number of nurse places in 2012. That was done by Nicola Sturgeon, who was the health secretary then, but Jeane Freeman is having to deal with the fallout. She did not commission the new hospitals in Glasgow and Edinburgh back in 2008—guess who the cabinet secretary was back then—but Jeane Freeman is having to answer for the flawed procurement process that has allowed inadequate ventilation and water systems to be built in two major flagship hospitals, with tragic results. She did not implement waiting time targets and treatment targets, but Jeane Freeman is being measured against those failed SNP promises. She did not implement waiting time targets and treatment targets, but Jeane Freeman is being measured against those failed SNP promises.

The reality is that it has taken four SNP cabinet secretaries to get us to this point, at which crisis is heaped upon crisis, which is constantly letting down patients and our NHS staff. However, she will be measured against the escalating crisis and her attempts to mitigate her Government’s catalogue of failures over the past 12 years. I am afraid that that report card is not looking too good.

The truth is that there is a lack of innovation and of original thought from a tired Scottish Government. There is a lack of joined-up cross-portfolio thinking. Ministerial statement after ministerial statement cannot cover up the lack of progress. One would think that the SNP’s priorities might lie elsewhere.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I start with at least one correction—I do not have time to correct all the misspeaking in the debate. Miles Briggs quoted the Royal College of Paediatrics and Child Health as saying that it would take five years before the children’s ward in St John’s would be open. He failed to mention that that information was from a 2016 report that referred to a timescale of three to five years. We have already corrected the Conservative news release, but they keep on saying it.

I gently suggest that Mr Mountain and Mr Briggs get together on their position on escalation. Mr Mountain despairs at escalation, but only a few short hours ago, Mr Briggs was demanding that I do precisely that for NHS Greater Glasgow and Clyde.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I do not have time. There have been record levels of investment in the NHS since this Government took office in 2007. Despite UK Government actions that have short-changed us by £90 million this year, we have made the right political choice to invest more than £14 billion in our health and social care services this year.

Although improvement is about much more than money, let me just say that if we had followed Tory tax plans for well-off people, we would have had £500 million less for our public services. I have to go back to 2016 for Labour health plans, because Labour has not come forward with anything else—at least not officially, although Mr Rowley made a stalwart attempt. If we had followed Labour’s plans, the NHS would this year be worse off by £750 million.

The challenges that our health service faces are faced across the UK and more widely. They include changing demographics, rising demand and citizens rightly wanting more care closer to their homes. That is why we have a waiting times plan. It is why we have increased training places across a number of professions, including medicine, nursing, allied health professionals and more, and it is why we have the major transformational plan for health and social care integration, to which Mr Coffey rightly referred.

We are seeing improvement. I have to say again that our A and E service has continued to be the best performing A and E in the UK for four years. Vacancy rates in nursing are half those in England. In cancer, we are meeting the 31-day waiting time target. I ask members, please, to get that right. It is wrong and unfair, on those who work so hard to deliver that, to ignore it in order to make a political point. We are seeing improvement in performance against the 62-day target, too, and the specialist training places fill rate is at its highest so far.

All those numbers matter, because they all reflect the hard work of our staff. If we really want to thank them, let us paint a fair picture of what they are achieving.

The Conservative amendment wants 11 per cent investment in general practice services. We call that service primary care. We agree—that level of investment in general practice is what we are working towards, through investment in allied health professionals in pharmacy and optometry, which is exactly what our patients want.

However, if we care about services and our support for the NHS now and in the future, let us not pretend that Brexit in any form is anything other than a threat. There is no Brexit that will work for the NHS. It threatens more than staff recruitment, access to medicines and vital health research: it threatens the NHS as a public service that is free at the point of need.

The SNP has no intention of allowing bits of Scotland’s NHS to be sold off to the private sector, as we see happening in England, or in allowing any part of our NHS to produce charge lists for new hips, new knees and cataract operations, which is what Mr Briggs’s party presides over south of the border. Nor will we see any part of our NHS being traded away in a deal. That is why we need NHS protection legislation—

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I say to Mr Whittle that we need protection against the UK Government, because what I have said is precisely what it is trying to do.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

We are not in charge of trade, and we are not in charge of immigration. Mr Whittle’s party is in charge of those things south of the border. He can shout at me as much as he likes, but he cannot deny his party’s culpability and responsibility. It should take ownership of that.

There should be not a single party in the chamber that claims to represent the people of Scotland that does not support our demand for NHS protection legislation. Let us see, when the vote comes, how many of them really believe that our NHS should be a public service free at the point of need and that we should truly thank and applaud the staff of the NHS and paint a fair picture of everything that they are achieving.

Photo of David Stewart David Stewart Labour

This has been an excellent debate on the most important subject for the people of Scotland: investment in our NHS. Understandably, it has been a passionate and occasionally boisterous debate—I am looking at the Cabinet Secretary for Health and Sport—but contributions were mostly insightful, knowledgeable and strongly held.

Waiting times are always a difficult matter. When a patient is suffering from an illness or an injury—I am sure that the cabinet secretary will want to listen to this—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.

Of course, the debate is not about numbers on a spreadsheet; it is about the conditions that are faced by staff. Let us, across the chamber, thank our NHS staff for all the hard work that they are doing on the front line. [



The debate is also about patients in our hospitals and communities. As my colleagues Monica Lennon, Mary Fee and Neil Findlay have made clear in their excellent speeches, NHS staff in Scotland have been underpaid, undervalued and underresourced, and patients have been feeling the pain of that, with A and E targets being missed, planned operations being cancelled, bed days being lost to delayed discharge and seven out of eight key targets missed for two years, according to Audit Scotland.

Like every member in the Parliament, I am passionate about the NHS. It is not just another issue, another debate or another headline. Like many members, I have family and personal connections with the service. My brother-in-law is a Highland mental health nurse, my neighbour is a midwife and a close friend is a nurse at an Edinburgh general practice.

My political hero—and I am not embarrassed about this—is Nye Bevan, the architect of the NHS. More than three score and 10 years ago, the first NHS patient, Sylvia Beckingham, was admitted to hospital to be treated—successfully—for a liver condition. She was patient alpha—the first ever patient treated by the NHS. It was a new service, truly national and free at the point of use, where the staff checked your pulse, not your purse. Many members have illustrated that perfectly this afternoon, by quoting dissatisfied constituents who have felt let down by the system.

That system allowed Patient Rights (Scotland) Act 2011—a good piece of legislation—to be put in place, guaranteeing a 12-week treatment time. That allowed hospitals and boards to manage expectations, and it allowed patients to have a known timeframe. We cannot forget, however, that waiting times are not just simple facts and figures. Behind the delays in getting an operation, there is often a person with anxieties, pain and stress.

The theme of this timely Labour debate has been investment in our NHS, long-term planning and the transformational delivery of health and social care, but members should not just take my word for it. Professor Sir Harry Burns told the Health and Sport Committee—if members care to listen—that the NHS needed complete “system change”. Dr Peter Bennie, former chair of the BMA’s Scottish council, said that the NHS is “stretched ... to breaking point”. A Royal College of Nursing Scotland survey showed that nine out of 10 nurses say that their workload has got much worse.

I close by reminding members that Nye Bevan famously said:

“The NHS will last as long as there’s folk with faith left to fight for it.”

At decision time, let us vote to put our faith in the front-line NHS staff across Scotland.