The next item of business is a debate on motion S6M-01302, in the name of Jackie Baillie, on taking action on the national health service and ambulance crisis. I invite members who want to participate in the debate to press their request-to-speak buttons as soon as possible, and those who are joining us online to put an R in the chat function.
I say to people: do not get sick, do not need an ambulance and do not need accident and emergency services in Scottish National Party-run Scotland, because in each of those areas the Government is letting them down. National health service staff, including nurses, doctors, and paramedics, are all doing their very best, and they absolutely deserve our thanks. However, they need more than warm words—they need action, and the SNP is not listening to their real and genuine concerns.
For months, the cabinet secretary has done nothing. Ambulance delays were raised as an issue in the press in June, July and August. Where was the cabinet secretary all that time? He was posted missing, clearly hoping that the problems would go away by themselves. However, that is not new. Susan Donald from Aberdeenshire got in touch with me. Her father died on 1 January 2021, aged 81. He fell and broke his hip three days earlier. She called the general practitioner at 6 pm, then she called 111, and she was finally put through to the Ambulance Service call centre at 9 pm. Despite it being an emergency, the ambulance did not arrive until almost 1 am the following day—seven hours after he fell.
The problem is not recent; it was happening nine months ago. Ms Donald, quite rightly, raised issues about co-ordination and governance, but she wonders why performance data that is available to senior management in health boards, the Ambulance Service and the Scottish Government did not flag the problems months ago. Patients raised concerns, health professionals raised concerns, and Unite the union raised significant issues of concern, as did the GMB. A doctor described the service as “third world”. There were almost daily reports of problems. Where was the cabinet secretary? People had to die, and it had to be on the front pages of national newspapers, to shock the Government into action. That is shameful.
Ambulance delays are the worst on record, but the delays have an underlying cause. The problem is patient flow through A and E and admissions to hospital. If we want to fix problems with the Ambulance Service, we need to fix the blockage at A and E and create more beds.
A and E waiting times are also the worst on record. The A and E waiting time target of four hours has not been met since it was introduced, in 2012—nine years ago. In the country’s flagship hospital, the Queen Elizabeth—which is in the cabinet secretary’s constituency, I believe—only 44 per cent of people were treated within that four-hour target time. Ambulances are queued round the block and the Red Cross has had to provide humanitarian aid to the paramedics and their patients because they are waiting so long. Unite has suggested that there should be a turnaround time of 30 minutes for an ambulance to transfer a patient to A and E. We agree. The cabinet secretary really must consider that seriously.
It is not just Glasgow that has a problem. Edinburgh has a problem, too, with only 52 per cent of people being seen within four hours. It is so bad at the Royal infirmary of Edinburgh that a doctor there described the hospital to me as a “war zone”, with elderly patients having intimate examinations carried out on trolleys in corridors, without any privacy.
Delayed discharge is also up by almost 50 per cent, and, with a significant number of Covid patients in hospital, there are simply not enough beds. In addition, there is a growing crisis in social care, which means that care packages for people leaving hospital are just not available.
Virtually every health board has cancelled elective surgery, which means that hundreds more people have been added to the almost 100,000 patients who are waiting for operations. A consultant confirmed to me this morning that even cancer surgery has been cancelled at the Glasgow Royal infirmary. And all of that is before winter pressures have even started.
John Thomson of the Royal College of Emergency Medicine said that the NHS needed another 1,000 beds to cope with the crisis. Jamie McNamee, the Unite convener at the Scottish Ambulance Service, agrees. He went on to say that, if things are to improve, the plans must include field hospitals and other temporary admission units. However, that aspect was entirely missing from the health secretary’s statement yesterday. I urge him to urgently consider the use of temporary wards and to please consider field hospitals. We need the extra capacity. We also need to ask staff who have recently retired from the service to come back to help out.
Dr Sue Robertson of the British Medical Association Scotland told the Health, Social Care and Sport Committee that, without any realistic plans to increase the workforce in the short term, we face a “perfect storm.” What urgent action is the Government taking to deal with the crisis in the short term?
I know that the Government wants to blame all the problems on the pandemic. I agree that the pandemic has been really challenging for the NHS and for social care, but that is, at best, a partial excuse. In this morning’s
, a paramedic said:
“I am fed up reading and hearing in the news that the pandemic is causing the problems with delays. It’s true that it’s a contributing factor but this has been a disaster in the making for years.”
He is absolutely right.
Since 2010, the SNP has cut 1,200 beds from the NHS—in fact, the Government started cutting beds in 2007, the moment that Nicola Sturgeon became health minister. From 2007 to 2010, the SNP failed to pass on the money for health that was given to it by the United Kingdom Government. That would have resulted in £1 billion more in spending today on the NHS. I remind members that Nicola Sturgeon was the health secretary for that entire period. Yes, it was Nicola Sturgeon, too, who cut the number of training places for nurses and doctors, despite being warned about the problems with staffing. This disaster has been in the making for the past 14 years.
The NHS in Scotland is entirely devolved—it is not the responsibility of Westminster—and it is run by the Scottish Government. There is no grievance to be manufactured; there is nowhere for the SNP to hide. This is a problem of its own making. It needs to listen to patients and staff, and it needs to sort out the issue now, before it gets worse over the winter.
That the Parliament thanks the Scottish Ambulance Service paramedics, technicians, call handlers and other frontline workers who are under significant stress as they cope with the current pressures on the health service; regrets the failure of the Scottish Government to address the underlying and systematic problems facing both the ambulance service and the wider health and social care service that predate the COVID-19 pandemic; welcomes the support of the British Army in helping alleviate the current pressures on NHS workers and patients; recommends that the Scottish Government adopt a 30-minute maximum turnaround time for ambulances from arrival at hospital, which will release paramedics to answer other calls, and protect staff welfare and wellbeing by reducing shift over-runs and guarding rest periods, and further calls on the Scottish Government to increase capacity in the health service ahead of winter by calling on recently retired staff to return temporarily and establishing temporary wards and field hospitals to ease the pressure on Accident and Emergency departments and manage the clinical backlog.
Our national health service is under more pressure than it has ever been in its entire 73-year history—there is simply no denying that or getting away from it. The global pandemic is a crisis the like of which none of us have ever witnessed, and I suspect that none of us will ever witness such a crisis again in our lives. Of course, it took Ms Baillie about six minutes to even mention what has been the biggest shock to the NHS in its 73-year history.
If the cabinet secretary is so confident that the crisis in our ambulances and our A and E departments is entirely down to the pandemic, will he commit to a Government-led review of all deaths pertaining to the ambulance crisis? Will he then publish that review so that the Parliament can see it?
I will consider any good suggestion that comes from anywhere in this chamber, but I have never said that this is “entirely down to the pandemic”. In fact, yesterday, I said very clearly that, of course, there were challenges in our NHS and our Ambulance Service beforehand. However, it would be churlish and inaccurate not to recognise the severe shock of the pandemic on our NHS.
Also, it is not just about Covid patients. Covid patients are now taking up about 1,100 beds, but it is about the cumulative impact, as Dr Beckett explained well on “Good Morning Scotland” today. Patients with chronic conditions who have not been able to be seen in the past 18 months are now presenting with more complex issues and problems.
I will provide some context to the debate. Yesterday, the Scottish Ambulance Service received 2,226 emergency calls, of which 1,580 required a response from an ambulance. Over 19 per cent of those incidents were triaged as being immediately life threatening. Everyone at SAS is performing their duties under unprecedented pressure, and I thank them once again for their continued efforts. I have set out a number of proposals to support and improve staff wellbeing.
As many members will know, the SAS website includes published board papers, and performance statistics are included in those papers. However, I know that there are calls from across the Parliament for more information to be provided. Now seems to be an appropriate time to announce that the Scottish Ambulance Service will begin work on publishing performance data, by health board, on a more accessible part of its website. That information will be available soon, and I will make sure that members are updated on it.
Today’s debate comes on the heels of yesterday’s announcement, and I want to set the record straight in relation to some of the amendments that have been lodged. Not a single penny will be cut from the Scottish Ambulance Service’s budget. In fact, we are increasing its budget by over 16 per cent in this year alone—a £44 million increase on last year.
I will focus on just two of the commitments that I made yesterday, in order to give an update to Parliament. I can now confirm that deployment of Army personnel to support the Scottish Ambulance Service will begin from Sunday, with training commencing from Friday, and it will, in fact, total 114 personnel for ambulance driver support. That increase was agreed yesterday afternoon by the Ministry of Defence, which makes the decision on final numbers to support operational deployment. The deployment will come in three tranches, the first of which will be 27 drivers and seven support staff. There will be further deployments on Monday and Wednesday, and all additional boots will be on the ground by the end of the month. I formally place on record my thanks to our armed forces, who, in typical fashion, have responded to our call with extreme urgency and pace.
Yesterday, I also announced an additional £20 million of funding for the Scottish Ambulance Service. I can confirm that that money will be spent on a number of areas, including supporting the armed forces involvement that I have just set out; supporting increased senior clinical decision making; facilitating additional community support, where appropriate, including from the Red Cross; and facilitating additional student capacity to support services.
All of that will be done when it is clinically safe to do so. This is where I want to address one or two of the points that Ms Baillie has raised. I will take suggestions from wherever in Parliament they come, and I do not dismiss entirely or out of hand the suggestion for a field hospital. However, it will be important, first of all, that options are clinically safe and, secondly, that we have the workforce to staff any such beds. That option has been—
At the beginning of the pandemic, the NHS was not fully remobilised. In fact, we had stopped everything except urgent care and cancer care, so there was a—[
.]—No, not everything has stopped; that is an inaccurate suggestion from Ms Baillie from a sedentary position. We do not have that workforce. As she has rightly said, health boards are under pressure to take them out of core sites and put them into, for example, a temporary structure, but that would have an impact. I should say to Ms Baillie that I am not ruling it out; I am just saying that there would be implications, and it is perhaps not as simple as she suggests.
In terms of the wider system pressures, I have spoken a lot about the Scottish Ambulance Service.
Given that I am in my last minute, I will return to the issue of the wider pressures on the NHS. Jackie Baillie is correct in saying, as her motion does, that it is not just the Ambulance Service that is facing an extreme challenge. We must take a whole-system approach, and we will do so. Our forthcoming winter plan will set out the measures that we and our partners will take to ensure that we can deliver high-quality, safe care in a sustainable way. It will look at increasing capacity, and we will do that through the urgent discussions that we are already having with social care providers and local authorities. I will consider how we can increase our capacity in relation to the workforce immediately, as best we possibly can. Further, as Jackie Baillie asked us to do in her opening speech, we will look at how we can create temporary wards—for example, by repurposing some hospital space.
As I said yesterday, our Ambulance Service and NHS have been there for us when we have needed them the most, and, in turn, this Government will support our NHS during its hour of greatest need. I look forward to the debate.
I move amendment S6M-01302.3, to leave out from “regrets” to end and insert:
“recognises that excessively long waits for an ambulance can lead to worse outcomes for patients, and that the Scottish Government and Scottish Ambulance Service have apologised to people who have experienced long waits; notes that the Scottish Government has previously invested an additional £20 million to increase staff capacity in the ambulance service by almost 300; welcomes that an extra £20 million is now being invested to increase capacity further, including funding military personnel, recruiting additional Hospital Ambulance Liaison Officers, working with NHS boards to create Temporary Admission Wards and aiming to recruit 100 paramedic students to help alleviate the current pressures on ambulance staff, NHS workers and patients; further notes that the steps outlined by the health secretary will help alleviate pressure on the service in the immediate term and looking ahead to the winter; commends military personnel and the Scottish Fire and Rescue Service, which are providing driving support to the ambulance service in order to free up paramedic and technician time; supports the additional investment of £500,000 to improve ambulance service staff welfare, and the ongoing discussions between the board and trade unions to develop a rest break action plan and put it in place as quickly as possible.”
We all know the statistics by now. We have the worst A and E waiting times on record; we are 1,000 acute beds short ahead of winter; the fire brigade, taxi drivers and our British Army have been called in to help; and the NHS Louisa Jordan field hospital has been closed. All that is happening as our NHS faces its hardest winter in living memory.
Yesterday, the SNP-Green Government announced, finally, that it accepts that our NHS and Scottish Ambulance Service are in crisis. Today, we call for concerted and well thought out action. I say to the cabinet secretary that the days of knee-jerk responses must be over. Of course, at this late stage, the challenge is huge, so today I want to help the cabinet secretary by providing some advice. I also want to ask some of the key questions that I will expect answers to when I read his forthcoming winter action plan. I am not patronising him when I say that; it is simply that our NHS and Ambulance Service are in crisis on the SNP’s watch
Let us start with data. I welcome the cabinet secretary’s announcement a moment ago about ambulance response times, but I ask for the data to be published weekly. If it is, we will be able to keep track of what is happening on the ground and to fine tune the plans, where necessary.
Data also provides us with lessons that enable us to avoid making planning and resourcing mistakes in the future. If we do not measure, we cannot improve. I am calling for that because I want to help; I want to advise. I do not want to see problems spinning out of control. Speaking as a doctor, I can say that we know that early intervention is key to treating disease. The same goes for managing policy in a crisis.
Our Ambulance Service is under enormous pressure. With regard to the valuable assistance of the police, the fire service, taxi firms and our British Army, we also need transparency around the scale of crisis support. From week to week, we need to evaluate how much we depend on that support, how long we will need it and what lessons we can learn and take forward for NHS planning.
Processes and procedures are also important. What exactly is it that the Government is asking the fire service and taxi firms to do? Are the processes and pathways in place for that external support? Can we see them? How is the Scottish Government going to evaluate the work of the fire service, taxi firms, our British Army and police support? What are the Government’s target response times for ambulances and taxis? How can the cabinet secretary ensure the safety of taxi drivers and their passenger patients? There is still a lot of Covid out there. Also, has the Scottish Government started the Disclosure Scotland process for those drivers yet?
The action plan for the NHS and Ambulance Service will not be a credible plan without joined-up thinking across services and departments regarding workforce planning. In order for planning to help, we need that. In a crisis, plans might need to be adapted as the data informs us of the reality on the ground, but we need a well thought out blueprint in the first place. That requires details of clinical pathways.
NHS staff and, indeed, the Scottish people need to know the patient journey, given the reality on the ground of staffing levels, patient waiting times, cancelled operations and the rapid approach of winter. What can patients expect? How will the patient journey evolve? What will need to be changed? We need clarity on those issues and we need to communicate clearly with staff and patients.
Finally, let us consider pop-up wards. Just as the failure over years to plan for and maintain stocks of personal protective equipment exposed clinical staff and patients to danger during the pandemic, the decision to close the NHS Louisa Jordan field hospital is coming back to haunt us. What an example of poor planning and waste that is. We need to act now to establish pop-up wards at hospitals, but I give a word of warning: such wards should not be used to fudge A and E waiting time stats. If patients are waiting in a ward to be seen, that is what is happening: they are waiting.
Will the cabinet secretary commit to maintaining the four-hour A and E treatment target, regardless of the emergency care setting? Will he provide details on workforce planning, clinical pathways and temporary facilities? Will he provide weekly reports on the external support that is being provided to the NHS and the Ambulance Service?
There have been five SNP ministers in charge of health—a straight line of cabinet secretaries since Nicola Sturgeon held the position from 2007 until 2012. We are in a crisis. Please act.
I declare an interest as a practising doctor.
I move amendment S6M-01302.2, to insert at end:
“; recognises that A&E waiting times have reached record highs, and believes that the four-hour A&E treatment target should be followed regardless of the emergency care setting; calls for the publication of weekly ambulance response time data so that progress can be measured in every region, and further calls for this year's planned efficiency savings for the Scottish Ambulance Service to be halted.”
I thank the Labour Party for choosing to devote some of its parliamentary time to this issue. The Labour Party is correct to say that the Government has failed, because it has. It has failed Gerard Brown, Catherine White, Lilian Briggs and many others who have been forced to wait hours for help while in agonising pain, often being unable to access food and water or even to go to the toilet. For those who are not as directly involved in politics as we in the chamber are, the stories that broke last week in the
Daily Record will have come as a great shock. Sadly, however, the crisis has been on the cards for a long time.
In the summer of 2016, a Scottish Liberal Democrat freedom of information request revealed figures that showed how much pressure the Ambulance Service was under. In 2015-16, the Scottish Government’s target to respond to serious incidents in less than eight minutes was missed more than 51,000 times. In Glasgow, the number of patients who faced waits of 20 minutes or more almost trebled from 80 to 233. In Aberdeen, the number rose from 16 to 40. The warning lights have been on for years, but the Government still has the audacity to blame the pandemic, in large part, for its own failures.
Two weeks ago, after I lodged an urgent question on A and E waiting times, the health secretary told me that I needed to ground myself in reality, so let me take the opportunity to lay out for him what the reality looks like. The reality is that one in 20 patients who are in pain is waiting more than a year for treatment; that nearly 8,000 patients are waiting more than four hours to be seen in our A and E departments; that 8,356 ambulance staff working days were lost due to mental ill health in 2020 alone; and that Gerard Brown lost his life because he waited 40 hours for an ambulance. While the health secretary dances around scrutiny, berating anyone who dares to hold him and his Government to account, people are hurting and people are dying.
Granular improvements are not good enough. The delays are not the result of the pandemic alone, and they are certainly not the fault of members of the public who call in desperation for emergency care. They are a symptom of an overrun and understaffed healthcare service that has been ignored for too long by a Government whose priorities have been elsewhere.
If resources are not offered soon, staff will leave and the NHS will be in even more trouble. Last year, my colleague Liam McArthur led the campaign to pay student paramedics. In October 2020, the former Minister for Public Health, Sport and Wellbeing, Joe FitzPatrick, said that he agreed with the principle but could not agree to a bursary—that is, until the election campaign, when the polls indicated that the SNP had to do something. It is too little, too late.
The ambulance waiting times crisis did not come out of nowhere. It is the result of failure after failure at the hands of the Government. The unimaginable pressure that our health service is under is scarring a generation of healthcare professionals. Staff are struggling and are fighting against impossible workloads.
The health secretary failed to provide any light at the end of the tunnel with his NHS recovery plan. It was a bundle of repackaged announcements, most of which will not take effect until years down the line. Nothing in his statement yesterday reassured the public or Parliament that things will get better. Staff, patients and their families not only deserve more from the Government; their health actively depends on it.
I reiterate my call to the Government. If the health secretary is content and confident that the problem is purely an aberration that has been caused by the pandemic, let him conduct a review into waiting times and into why deaths, such as that of Gerard Brown, happened. If the cabinet secretary is confident about the statistics and results, let him publish them for Parliament and the public, who are watching the ambulance waiting times crisis.
We are happy to support the Labour Party motion.
We debate many motions that thank various workers and groups for their efforts. Although such motions have a place in the work that we do here, the weight of the crisis that affects ambulance availability and the subsequent stress that is caused to patients and front-line workers should hold greater sway than usual.
Although I applaud all of our dedicated staff, I will use my time better in trying to find out why the Government keeps letting them down. My standing here telling paramedics, call responders and technicians how thankful we are for their work will have made no difference if I am back here in a year doing exactly the same, while an unresponsive Government continues to make excuses for the problems.
We cannot change processes, adjust targets and rebrand services and call that reform. It is not. It is a branding exercise, not responsible governance. The key to the whole situation is simple. The Ambulance Service is underfunded, understaffed and lacking in resources: fix that, and we fix the problem.
I cannot stress enough to the Government that chasing targets and small headline improvements over proactive structural reform is not the way to run a health service. It is disappointing that the health secretary wasted his time this week briefing the
Daily Record on his statement before informing Parliament, because doing so only further ingrains the image that this is all about expectation management and public presentation.
I do not want to manage the expectations of the woman who was left lying in Ayr town centre for four hours last month as she waited for an ambulance; I want her to be treated and back home with her family. That example is not even one of the extreme ones. Reports of patients waiting more than 40 hours for an ambulance create anxiety and stress throughout many communities, which are well aware that a delay in making it to hospital could, as we know, be the difference between life and death.
At least there is some positive news this week, as Covid rates seem to be declining across Scotland. I believe that we should use any breathing space that that allows us to focus all our efforts on preparing the NHS for the coming winter, and on alleviating pressure on the worst-impacted parts of our hospitals. Instead of doing that work, however, we might have to pick up the pieces from the missteps that have been taken over the past couple of years.
As my party colleagues and other members have mentioned, a concerning clinical backlog needs to be addressed right now that requires new field hospitals to tackle it. That is exactly what we should be doing. I understand that the health secretary has not ruled that out; I would support any steps to achieve that goal. Regardless of how it is reported, it is important for patients and the communities.
Before I close, I reiterate that all the problems—queues of ambulances, lack of beds, overworked staff—are deeply interconnected. We cannot tackle them without addressing the problem of underfunding. The Government has committed £1 billion of investment in the NHS over the next five years. Although some of that investment has gone towards training and recruiting new staff, that process will take almost a decade to bear fruit. In fact, nearly all the funding was already earmarked before May, with a fair amount of previous commitments already having been shelved.
That investment will not be enough. The NHS needs emergency measures to cope now. We see from feelings in the chamber that reports from our constituents suggest that the public wants action, too. After emergency measures, we need to address the problem of long-term planning and the failure to bring in well ahead of time the resources that the NHS requires.
The chamber should deal with the difficult issues, and we should pursue whatever works for the NHS. The strength of Scottish Labour’s motion reflects that intention, so I hope that it will be supported in that spirit.
I start by reiterating what other members have said: the Scottish Ambulance Service is the heartbeat of our NHS. There is no service like it. Providing emergency care for the public 24 hours a day, every day of the year, our Ambulance Service has a unique and challenging job. I place on record my thanks to the paramedics and others who make sure that the service is available to those who need it, not just during this dreadful pandemic, but always.
As the cabinet secretary said, there is no ignoring the strain that the pandemic has put on our services. We are in a crisis and, despite the lifting of restrictions and some aspects of daily life feeling a little more normal for many of us, that strain on the NHS is still very much there. Covid has not gone away, and there is no denying that the Ambulance Service is under immense pressure from unusually high demand. Our emergency departments are busier than ever with complex cases. Just last month, more than 10,000 life-threatening incidents were responded to, which is double the figure in 2018. As members of other parties have said, we also have to accept that the pressure on the Ambulance Service predates the pandemic.
The fact that anyone is having to wait the reported times for an ambulance is completely unacceptable. I, too, have been contacted by constituents who faced unacceptable waits, and I have taken up their cases where appropriate, as MSPs of all parties—governing parties as well as Opposition parties—would be expected to do. I welcome the cabinet secretary’s announcement yesterday. I am glad that we have recognised the unacceptable place that we are in and that we are now taking swift and appropriate action to ease the pressure.
That pressure needs to be looked at in the round. A lot of the debate today has been about criticising the Government—and only the Government. However, I think back to a pre-pandemic case of individual in my constituency who waited for an ambulance for a long time—I cannot remember the number of hours, but it was certainly hours—after she slipped on ice as a result of cuts to gritting. We need to look at everything in the round: how not only the Government but local authorities can improve the situation. The public expect us to speak constructively about that.
The member acknowledges, I think, the scale of the crisis and the issues that existed before the pandemic. He made a point about ice, but would he accept that cutting local government funding and budgets contributes to our wider problems in the health service, and that it has a knock-on effect? We have to fund local government properly if it is to deliver services.
I do not accept that characterisation. Local authorities have their own decisions to make and, as Mr O’Kane might be aware, the local authority in North Lanarkshire is made up of a Labour and Conservative coalition.
However, I was not trying to get into a political bun fight about what Labour might be doing in North Lanarkshire and what the SNP is doing at Holyrood; I was trying to say that things need to be looked at in the round. We need to take a whole-systems approach where everything interacts with everything else. I hope that the member agrees with that.
I whole-heartedly welcome the announcement yesterday of the additional £20 million that will be invested in the Ambulance Service. That will allow for extra personnel to ensure that services can continue to operate and, ultimately, that sick patients can be helped timeously. It is good to hear that we are pulling in resources from the military, paramedic students, the Scottish Fire and Rescue Service and the British Red Cross, among others.
In relation to student paramedics, as Alex Cole-Hamilton said, the Scottish Government recently implemented the £10,000 bursary scheme. A lot of the credit for that goes to Liam McArthur, but I also want to give some credit to Hollie Carragher from my constituency, who lobbied me and the First Minister. I want Alex Cole-Hamilton to know that people from wider society successfully lobbied on that issue.
Yesterday, the First Minister finally admitted that our NHS is in crisis, but only after growing pressure from NHS boards, healthcare professionals, unions and MSPs, who warned the Government that if it did not act, it would push our NHS beyond breaking point.
The Scottish Conservatives repeatedly warned the Government that our NHS was at breaking point long before the First Minister’s admission. A and E waiting times, ambulance waiting times, the cervical cancer screening scandal, waiting lists for vital diagnostic tests and waiting lists for child and adolescent mental health services are just some of the issues that have been raised in the chamber. It is clear that, after 13 years in government, the SNP does not have the willingness or the ability to fix the problems that it has created.
It is also clear that the crisis was entirely preventable, but because of the length of time that it took the SNP to act, those long-standing pre-Covid issues have now been exacerbated by the impact of the pandemic.
Further to yesterday’s announcement by the cabinet secretary, more than 100 military personnel will be drafted in to provide much-needed assistance to our hard-working NHS staff. This morning, we heard that taxi drivers will be recruited to help to transport patients to hospital for appointments. Those are the same taxi drivers who were hung out to dry during lockdown by the SNP Government.
In my region, NHS Lanarkshire will benefit from the services that will be provided by the staff who are deployed by the British Army, the fire brigade and taxi services. That assistance will provide welcome relief to my constituents and NHS Lanarkshire’s front-line staff. However, we should never have ended up in this position in the first place.
Over the past few weeks, we have heard devastating news of people dying as a result of the length of time that they had to wait to receive urgent care. We have heard of elderly people who lay on the floor in agony, hoping that someone would come and help them. People have waited for hours on end at A and E, while others have turned up at hospitals because they could not see their GP face to face, as GPs are so overworked and overwhelmed. All those situations arose on the cabinet secretary’s watch, and it can never be allowed to happen again.
The Scottish Government had every opportunity to intervene to fix those issues but, instead, the health secretary told people to think twice before calling an ambulance. Will he finally apologise for that, or will he continue to dismiss the notion that what he said was reckless and irresponsible?
The SNP’s amendment does not even begin to address the immense issues that our heroic NHS staff have had to endure. Frankly, the SNP should be ashamed. The Scottish Conservatives will vote against the SNP’s amendment. Instead, we will vote for a position that will force the SNP Government to declare major incident status in our Ambulance Service, halt its planned efficiency savings, maintain the four-hour A and E treatment target and publish ambulance response time data on a weekly basis so that progress can be measured in every region.
I agree with the points that are raised in the Labour motion, especially the recognition that is given to the wonderful Scottish Ambulance Service paramedics, technicians, call handlers and other front-line workers who have been failed by the Government. It is only right that we continue to support our NHS heroes who are always on hand to respond to an emergency. I urge Labour to vote for our amendment to its motion, to recognise our hard-working NHS staff but also to ensure that the Scottish Government is held to account for the NHS crisis that it has created.
First, as everyone else has done, I pay tribute to the incredible hard-working staff of the Scottish Ambulance Service. They are undoubtedly at the sharp end of our health service provision, and they deal with some of the most serious situations that we will ever face in life in a professional and caring manner. They see things that would make most of us blanche, and they still save countless lives each and every day as part of their job.
However, I think that it is important that our admiration for the work that they do is not tarnished by the negative attention that they have received lately, including this afternoon, from media and politicians alike. The critics may prefix their attacks by telling them how much they admire them, but what the NHS worker hears when the part of the service that they work in is continually criticised is, “You’re hopeless.” We all know that that is unfair and untrue, and I am sure that that is not what the people concerned want them to think.
I understand that it is the job of politicians to raise the concerns of their constituents and oppose the Government, but last week’s Conservative debate on GPs and Labour’s debate today on the Scottish Ambulance Service are beginning to look like a co-ordinated political attack on our health service as it tries to deal with the effects of a pandemic that none of us saw coming and a Brexit that slashed the number of workers in health and social care.
Official Report will show that she mentioned the FM more often than she mentioned the pandemic.
We have had two debates from Labour on two very important issues—rail and ambulances. Labour’s solution to both appears to be to spend money that we simply do not have. There is no money tree out in the parliamentary garden. That is not real politics—that is student politics. There are real issues to be dealt with, and they must be dealt with. However, the unwillingness of any of our opponents to accept that the pandemic is a serious factor in all this does not serve anybody any good.
I was pleased by yesterday’s announcement from the Cabinet Secretary for Health and Social Care that volunteer drivers from the Scottish Fire and Rescue Service will be drafted in to assist the Ambulance Service, and that, from this weekend, the Army—or, as the Conservatives continue to call it, “the British Army”—will be helping to take some of the pressure off. That is very welcome news, which I hope will at least begin to address some of the problems that we are experiencing. In addition, 100 trainee paramedics will be tasked with call handling, which will help to alleviate some of the backlog caused by an increased level of calls.
It is a difficult situation that is obviously worrying to the public and not easily resolved. However, we should remember that it is a situation without precedent in Scotland or the UK and that we are not alone in dealing with these problems. For example, four out of 10 ambulance trusts in England are using Army personnel to help deal with the situation.
I echo and agree whole-heartedly with the appeals of the health secretary that members of the public should ask for an ambulance only if they believe that the situation is life threatening, particularly just now. In all other circumstances, they should phone NHS 24 on 111. If NHS 24 believes that an ambulance is necessary after someone has talked to it about the situation, an ambulance will still be dispatched, even though the member of the public did not call 999—I know that because it has happened in my house. That advice is being given all over the UK, as well as in Scotland. It is important that we adhere to it in order to reduce waiting times for the most serious cases.
I am not sure that there is a quick fix to the situation—I know that that is not for want of trying on the part of our dedicated health professionals across the Ambulance Service, the NHS and social care in Scotland. We should also remember that Brexit has prevented a lot of the workers who used to work in social care in Scotland from coming here, which is having a huge impact on our ability to get hospital beds emptied and people back into the community.
I appeal to my colleagues in all parties in the chamber to pull together and give all our support to the people who are working so hard to battle the pandemic and keep our citizens alive in the most demanding of circumstances, and to stop seeing them as a weapon to be used in a political battle. They deserve much more than that.
, too, thank our ambulance crews and all those working in emergency care and the wider NHS for continuing to work extremely hard in very difficult conditions. The stories of extremely long waiting times for ambulances make for distressing reading and I cannot imagine the distress felt by the people who have faced those agonising waits. I am grateful for the measures that the cabinet secretary set out yesterday, and I hope that they begin to make an impact quickly.
Ambulance crews are working incredibly hard to reach people who need help as quickly as possible, but demand is simply outstripping supply. The pandemic means that staff have been working flat out for 18 months with no respite, and I am extremely concerned about the impact on their mental and physical health. There have been disturbing reports of crews being unable to access food, water or rest for whole shifts. How can we expect them to care for us when they have no time to care for themselves?
We need to protect Ambulance Service staff. As people become frustrated with long waits, staff will inevitably bear the brunt. I welcome the Scottish Government’s announcement of additional wellbeing support, but we also need strong messaging that abuse or intimidation of ambulance crews is not acceptable. There have been reports of call handlers receiving abuse due to long waits. I would therefore be grateful if the cabinet secretary could confirm whether the additional wellbeing support that is being put in place for ambulance crews will be extended to other staff.
Extra clinical capacity will no doubt relieve some of the pressure that is being placed on teams, and I am extremely grateful to the 100 second year students who will be working across the Ambulance Service while carrying out their studies. They should rightly be applauded. However, I have concerns about the impact that it will have on their studies and the potential risk of burnout. I therefore ask the cabinet secretary to confirm that no students will be academically disadvantaged and that they will receive wellbeing support.
The demand for ambulances will undoubtedly place pressure on other emergency and out-of-hours services, and I am concerned about the secondary impact of long waits on NHS 24 and out-of-hours general practice. We must ensure that they are properly supported to meet a potential surge in demand. Likewise, delayed discharge is placing pressure on hospital wards, A and E departments and the Ambulance Service as patients occupying hospital beds cannot be discharged without a care package.
We need to take a whole-system approach when looking at how we can relieve pressure. Dr Daniel Beckett, an acute care consultant, has spoken in the media today about the fact that, if we could meet patients’ social care needs, patients would be able to move out of hospitals, which would in turn reduce crowding in wards and emergency departments as well as reducing ambulance delays. A national care service is of course the Parliament’s long-term goal, but social care needs support now. I have previously spoken about the need for a social care recovery plan and I urge the Government to give serious consideration to that.
Although a whole-system approach is vital, we must also respond to acute pressure points in the system. NHS Forth Valley, in my region, is currently the worst-performing health board in terms of the four-hour A and E target. Nationally, 71.5 per cent of patients are being seen within four hours, whereas in Forth Valley it is just 53.4 per cent. That is a significant difference and I would be grateful to hear from the cabinet secretary whether he is considering targeted interventions for Forth Valley.
We must prioritise staff welfare. Our dedicated NHS workers continually go above and beyond, but that should never be taken for granted. Clapping on the doorsteps is not enough when paramedics cannot access food and water throughout a 12-hour shift.
As many members have done this afternoon, I thank those working in our health service and emergency services, including our Scottish Ambulance Service paramedics, technicians, call handlers and other front-line workers, who are under significant stress. We know what the pressures are at the moment.
I am somewhat disappointed to be returning to a debate that seems to be based on arbitrary requests and does not really look at the systemic issues or support the Government in what it is trying to do to tackle the issues. Last week, we had a call for GPs to resume “normal” and “face-to-face” services at a set date. [
.] No, thank you, I will not take an intervention.
It was an arbitrary request, and doing what was asked would do nothing to help the situation that we are in. Jackie Baillie talked very well about the systemic issues and all the points of pressure on our health service, including those regarding getting people into social care and out of hospital. However, the motion asks us to set
“a 30-minute maximum turnaround time for ambulances from arrival at hospital”, and, again, those words will not really address the problem at all. They are just arbitrary words for the debate.
No, thank you.
The tone of the debate is that everything to do with the management of the health service rests on this Government alone. [
.] No, thank you.
If we look to Wales, we see that the BBC reported today that morale in the Welsh Ambulance Service is “at rock bottom”. There was a 57 per cent increase in calls in July. Mark Drakeford is requesting support from the Army because of the pressures. Treatment times are under pressure, and there are pressures in areas outside hospitals as well.
On the health service, there is no denial of where we are or that there are problems. When anyone loses their life or has to wait for an unacceptable time, it is never said that that is acceptable—it is not. What I hear is that we have to work on the pinch points by, for example, investigating whether we can open up more admission wards in hospitals or whether we can use a pop-up solution—[
.] To say that the situation is just on this Government is to completely ignore the situation in the wider UK, where all Governments are under the same pressures. We have talked about the shortage of doctors—[
The Presiding Officer:
Ms Adamson, give me one minute, please. Colleagues, there are a lot of comments coming from sedentary positions across the chamber. I would be grateful if we could hear Ms Adamson.
Thank you, Presiding Officer. I have obviously touched a raw nerve. Members do not want to hear that this is a broader issue than just one for Scotland.
Hundreds of student paramedics will now receive a bursary, as Fulton MacGregor said. The
Daily Mail reported that there are 50,000 vacancies for doctors in the health service in England. We are all experiencing the pressures.
That is why I want to highlight what the Scottish Government is doing. We should all get behind the Government to help our health service. There is additional investment of £20 million for the Scottish Ambulance Service to improve response times, alleviate pressures and improve staff wellbeing. We need to get behind the service and we need to train more paramedics. I am glad that we have paid trainee paramedics and nurses double the bursary that is paid in England.
We need to get behind the work that the cabinet secretary is doing. We are listening to the Scottish Ambulance Service, we are listening to people’s calls and we are investigating where the pressures are. The Government has wellbeing at its heart, and we know that it will consider the wellbeing of the workforce.
My constituent Susannah Jackson, who has previously suffered a stroke, had a bad fall at home. An ambulance was called at 5.30 pm but did not arrive until 10.30 that evening. My constituent was worried and in pain. She was taken to Edinburgh’s royal infirmary, where she had to wait on a trolley in the corridor before finally being seen at 5.45 the next morning.
The staff said, “Monday nights are always bad.”
That was no isolated incident. An elderly constituent of mine, Helen Fraser, is a local community champion who recently led a street-to-street campaign against plans for a builders merchants yard in a residential area of Haddington. Against the odds, she won. Helen is a fighter. She is not one to complain, but last week she sent me an email about her husband’s treatment at the hands of the SNP Government. It opened:
“Dear Craig. As you know, Ian is terminally ill. Over the weekend he developed a further problem which caused great pain and our GP attended to him at home yesterday. The doctor said Ian needed an Xray and arranged for an ambulance to the Western General. The GP mentioned the current ongoing delays of hours, and said if things got worse to dial 999.”
Helen reports that the Ambulance Service logged the instruction on Monday at 1.45 pm. Around 6 pm, she got a call to say that Ian was in the system and to apologise for the delay. The operator could not indicate when the ambulance might arrive. A further call came at 9 pm, with the same message. There were other calls on Tuesday morning, at 1.15, at 3.15 and at roughly 6 am. Helen says that the calls were all the same, apart from one with a nurse, who asked more questions. On the final call, Helen asked whether she could change to the 999 system. She was told that the wait for emergency vehicles was bad and would be hours; Ian would have to be triaged again, and there simply were not enough vehicles.
Helen said that it was impossible to sleep. Finally, she decided to use a taxi. She tried to cancel the ambulance by using the incoming number, but it did not accept incoming calls. She called the Western general hospital and asked for the message to be passed on that she and Ian were still coming in. She asked whether the ambulance could be cancelled, but the person to whom she spoke said that she was not able to do that.
When, at last, the receptionist at the hospital booked Ian in, she agreed to cancel the ambulance. However, Helen said that after she got home later that day, a neighbour told her that an ambulance had been at her door at 8.30 am, 19 hours after it had been ordered. Helen said:
“I really hope no one thinks we left home without consideration of the consequences.”
In her email, Helen Fraser speaks for many. She says that the NHS is in a “complete shambles”. She says:
“There is no blame whatsoever to be attached to the hardworking staff and our medics and nurses. The problem lies squarely with the incompetence of the Scottish Government—no amount of blaming Westminster, or Boris Johnston, or Covid, can cover up statistics”.
“Ours is just one case but how many other patients were caught up in this ongoing catastrophe.”
Ian Fraser deserved to be treated with dignity, but under this SNP Government his urgent needs were disregarded. For Helen and Ian Fraser’s sake, and the sake of the thousands of Scots who are caught up in this unfolding catastrophe, the minister must get a grip of the crisis.
I am sorry, Presiding Officer, but that caught me a bit and I welled up just there.
We have heard that our Ambulance Service is at breaking point. There can be no doubt that the Scottish NHS is in crisis and that the SNP is to blame, not the pandemic. The SNP has ignored the warning signs for years. As Jackie Baillie outlined earlier, all the concerns of stakeholders—unions, patients and healthcare professionals—have been ignored, resulting in unnecessary deaths. The failures are systemic—they are not pinch points, as Clare Adamson said. The SNP has dithered and taken far too long to respond to the crisis.
Action must be taken; the Scottish Conservatives are calling on the SNP to provide an emergency funding package and publish a detailed strategy to maximise the use of military staff to tackle the crisis. Every day, we read about cases of long waits for ambulances that sometimes lead to needless deaths and the kind of heartbreaking stories that we just heard from my colleague Craig Hoy.
The Scottish Government has requested the support of the British Army in tackling Scotland’s ambulance crisis. Although we welcome that request being made, it should have happened already; that just exposes the SNP’s shambolic handling of Scotland’s health service. In addition, firefighters and taxi services have now been drafted in to help the Scottish Ambulance Service. However, even after Humza Yousaf’s statement to the Parliament yesterday, Unite the union warned that drafting in the army and firefighters as drivers “will not be enough” to cope with the crisis. Further, my colleague Meghan Gallagher highlighted the cabinet secretary’s hypocrisy in announcing that taxi drivers will now be recruited to help transport patients to hospital for their appointments: those are the same taxi drivers who were hung out to dry during lockdown.
The pandemic has exposed the many deep-rooted weaknesses that existed in our health service long before we heard of Covid and that are due to the SNP’s mismanagement. The deep-rooted workforce crisis was mentioned by Mr Cole Hamilton in his speech. Our healthcare professionals have worked in those extreme conditions for years, juggling staff and equipment shortages, just to keep patient services going. Although there has rightly been a focus on tackling Covid in our health service, other illnesses and diseases cannot simply be forgotten about. The number of excess deaths in Scotland is tragic, and my thoughts are with those who have lost a loved one.
Yesterday, Nicola Sturgeon finally admitted that the NHS is in crisis, but Ms Sturgeon and Mr Yousaf would not confirm when an NHS winter plan would be published. It should have formed an integral part of any NHS Scotland remobilisation plan, but it has not. We are calling on the SNP-Green Government to shelve plans for £15 million in “efficiency savings”—that is not the same as cuts; they have been requested to make “efficiency savings”—in the Ambulance Service and instead announce a series of actions to tackle the crisis, including an emergency funding package that focuses on saving lives. The SNP needs to develop a real plan of action to fully remobilise our NHS, fund our Ambulance Service properly and bring waiting times back under control. Although that will be a challenge for the SNP, it is about time that we got some detail and not just soundbites.
The Scottish Conservatives will vote against the SNP amendment, and I urge Labour to vote for our amendment—laying out some of the questions that we need answers to from the Scottish Government—to strengthen Jackie Baillie’s motion.
There can often be more heat than light in these debates and I am pleased that there have been some helpful suggestions. I do not agree with everything that was said, but I will try to address as many comments and questions as possible.
There were calls during the debate to thank Scottish Ambulance Service staff, provide additional investment, get support from the armed services, protect staff welfare and increase the workforce by encouraging recently retired workers to temporarily return to the NHS. The Scottish Government has delivered on all those asks, as set out over the course of yesterday and today, which is why our amendment includes all the asks in the original Labour motion.
A number of members spoke passionately about constituency cases. Once again, as I did yesterday, I apologise unreservedly to anybody who has not received the standard of service that they should have
We heard about a number of other asks that the Government currently cannot support but will continue to consider. For example, we have concerns about the clinical safety, or the lack thereof, of pop-up tents to support A and E, which was something that was mentioned by the Royal College of Emergency Medicine in a statement that it put out. A lot has been said by Jackie Baillie and others about mandating a 30-minute maximum turnaround time at hospitals. I guarantee that we want turnaround times to be as short as possible, but we must monitor that as part of a wider drive towards system improvement. We all want turnaround times to be as short as possible, but simply mandating it does not make it so.
I know that that was an ask from Unite, as I spoke to Unite yesterday. It welcomed the statement that I made and pushed the Government to go further, and I accept that. I also accept that Ms Baillie is making the point out of sincerity. I give her a guarantee that we want turnaround times at our hospitals to be as short as possible.
A number of members mentioned flow at hospitals and rightly made the point, which I hope I reflected in my opening speech, that this issue is about not just the Ambulance Service but the whole system. I made an announcement yesterday about almost doubling the number of hospital ambulance liaison officers—HALOs—in our hospitals, particularly at our busiest sites, which goes back to the point that Gillian Mackay made about interventions at our worst performing sites. That will hopefully help with patients being discharged from ambulances and their flow through the hospital site.
Carol Mochan spoke passionately about staff. She was right: staff do not need warm words. I am sure that they would welcome warm words, but they need more than that, which is why I am pleased that the Government has recognised our staff by making sure that they are the best paid in the UK. The recently implemented 4 per cent pay rise is the largest single pay rise in the history of devolution.
It was remiss of me not to welcome Dr Gulhane to his front bench role, and I wish Annie Wells the very best for her recovery. From my private messaging to her, I know that she hopes to be recovered and back on the front bench soon, but in her absence, I am sure that Dr Gulhane will do a good job. He asked a number of questions on data; I think that I answered a lot of them but I will take back some of his suggestions. He asked for a commitment that we will not scrap the four-hour target in relation to A and E. I give him an absolute commitment and assurance that we will not do that. I should say that in May, the UK Government intended to scrap that target; I do not know whether it followed through with that. We will certainly not do that; we commit to that target regardless of whatever temporary admission wards and so on are created.
Gillian Mackay asked a number of questions about additional wellbeing support. Of the funding that was announced yesterday, £500,000 will be for targeted wellbeing. She made a good point about making sure that second-year paramedic students who are helping us, particularly in control centres, are not disadvantaged academically. That is the intention, but I will consider the issue further. She was right to make her point, as other members did, on social care.
Clare Adamson was also right—I am not sure why members were getting so anxious about her contribution—to say that these are shared challenges across the UK. That does not absolve the Scottish Government from responsibility here; not at all. That is our responsibility and my responsibility, but these are shared challenges. I accept the fact that our A and E record times are challenging, but we are still the best performing A and E in the entire UK.
We have set out an additional £20 million of investment for the Ambulance Service and I will update the Parliament on our forthcoming winter plan. The NHS will always have this Government’s full and entire support.
There can be no doubt that the Ambulance Service in Scotland—and, more widely, our NHS—is in crisis. Each member in the chamber today will have had correspondence from constituents about having to wait hours for help to come, and a number of members have spoken very powerfully of those cases today. We have seen ambulances queueing at our hospitals and we know that waiting times at A and E are at their worst levels since records began. Tragically, people have died. We heard today from Jackie Baillie about Susan Donald and her father from Aberdeenshire, and we have all heard about Gerard Brown from Glasgow, who passed away after waiting 40 hours for an ambulance.
Families are broken-hearted and they are asking why, because it did not have to happen. We have heard the calls from paramedics, doctors, nurses and other healthcare staff for immediate help to support a workforce that is “exhausted, undervalued and overwhelmed”. Those are the words of a whistleblowing paramedic, who does not want to be identified, because she fears for her job. She goes on to say:
“In all the years I have been a paramedic I have never seen the job as bad as I do now.”
Nobody denies that we are living through unprecedented times, but we know that things had been worsening for years before the pandemic. Services were struggling to keep up with demand and there was a growing backlog of care. The pandemic has exacerbated a bad situation.
Although we have heard it before, it is important to hear it again. Another paramedic whistleblower, who is based in Glasgow, said:
“I am fed up reading and hearing in the news that the pandemic is causing the problems with delays. It’s true that it’s a contributing factor but this has been a disaster in the making for years.”
That is not me, Jackie Baillie or any other politician saying that; it is a paramedic who is working on the front line, and the cabinet secretary and the Government cannot ignore those words. As much as James Dornan might want to make it about the hard-working staff versus Opposition politicians, those words cannot be ignored. [
] The cabinet secretary must listen to my point and explain to hard-working staff and bereaved families why he was missing in action—as my colleagues Jackie Baillie and Carol Mochan pointed out—until he went to the
Daily Record to give that interview.
The reality is that the crisis did not start 18 months ago with a global pandemic. It has been consistently building, and the warning signs have been there year after year. In 2019, compared with 2014, there was a shocking increase of 634.4 per cent in long turnarounds, which impact on the availability of ambulances to respond to emergency calls. Those trends continued into 2021. Last week, Unite the union claimed that lives
“are being put at risk”, as the average 999 ambulance waiting time across Scotland has increased to six hours.
In the debate today, other members have spoken about the problems with acute bed capacity, staffing and retention, as well as delayed discharge. The Scottish Government has been forced to take remedial action to alleviate the pressures that our Ambulance Service is facing, as has been evidenced in the debate, and the Government finds itself playing catch-up.
Scottish Labour’s priority is to give our Ambulance Service the urgent support that it needs in order to save lives. As such, we welcome the Government’s decision to request help from the Army, but the Government must go further and explore the potential of calling on recently retired ambulance staff to help during the crisis. We must acknowledge what the trade unions are saying to us about how much help the Army will be in practical, front-line roles.
Scottish Labour also supports the call from Unite for the introduction of a 30-minute maximum turnaround time for ambulances from arrival at hospital, which will release paramedics to answer other calls. As Jackie Baillie outlined, that is not a random request and we did not make it up; we spoke to Unite, which represents the staff on the ground, and they say that that would make a real difference.
In addition, temporary wards and field hospitals must be looked at. I appreciate what the cabinet secretary has said, but I ask him to work closely with the Royal College of Emergency Medicine and others to look at those options thoroughly.
We also recognise issues that Dr Sandesh Gulhane raised around reporting. We are in agreement that more regular reporting on response times has to happen, and I note what the cabinet secretary has said about improving the data that is available. We will therefore support Dr Gulhane’s amendment.
We have heard a lot of chat this afternoon about warm words and I want to point out some of the words that have been used by the Government in the past about the NHS. It has said that the NHS is
“Our most cherished public service”, that it will “protect” and “nurture” it, and that
“shorter waiting times and treatment that continues to improve” are the Government’s core priorities for it. Those are all quotes from SNP manifestos over the years. The reality is that patients and the hard-working staff of the Ambulance Service and the wider NHS are facing the consequences of 14 years of Government inaction on those issues.
Staff are upset, distressed and angry, and they fear for the winter ahead. That is why I want to speak about staff wellbeing, which is fundamentally important to supporting the workforce on the front line. I acknowledge what the cabinet secretary said about the wellbeing fund, but it needs to go further and deeper to make a difference. That is what the unions and the Royal College of Emergency Medicine are telling us, and the BMA told us that yesterday in committee.