One year ago, on 22 September, we debated a motion on taking action on a crisis in the Scottish Ambulance Service and the worst accident and emergency waiting times on record. Given the reality of staffing levels on the ground, I implored the cabinet secretary back then to let our hard-working national health service staff and the Scottish people know what to expect as winter approached.
Here we are again, still spiralling out of control. In the week ending 19 September 2021, 74.4 per cent of patients at A and E were seen within four hours; a year later, last week, that figure had dropped to 63.5 per cent—the worst on record.
Elsewhere in the system, cancer waiting times are also at their worst on record, with the number of people meeting the target going from 84 per cent in June last year to 76 per cent now. So much under the Scottish National Party Government’s control is going from bad to worse. Vulnerable children are unable to access mental health services, with over a quarter not being seen by a specialist within 18 weeks. Waiting times for routine treatment are mounting—over 10,000 Scots have been waiting for two years for treatment, which is an eight-fold increase on last year. Hospital delayed discharges are at a record high. Ambulance waiting times of over two hours have increased nine-fold in four years and yet the cabinet secretary was patting himself on the back just yesterday.
We understand that the pandemic has had a significant impact on the delivery of health services, but the fact is that the situation has been getting worse in 2022, not better, despite the pandemic receding. Many issues also predate the pandemic, such as staff shortages which are the result of successive years of poor SNP workforce planning.
One year on from our September 2021 debate, our amazing nurses, doctors, allied healthcare professionals and paramedics remain overworked and undervalued, and are at breaking point. Yet, one year on, the same SNP minister remains in charge, clinging on to his flimsy NHS recovery plan. The stats do not lie. This is a record-breaking cabinet secretary—SNP delivery personified. However, what does the cabinet secretary do when faced with hard facts? He might selectively compare stats from health services elsewhere to provide what the First Minister calls “context” or he might pass the buck and imply that shattered front-line workers are to blame for A and E waiting times, seriously undermining staff morale. I am afraid that any backtracking statement that is sent out later is akin to sticking a Band-aid on an unwashed, gaping wound. Patients who need treatment in Scotland do not want context; they want competence. However, if the SNP Government insists on context, how about this: nearly 70 per cent of nurses in Scotland feel that patient care was compromised on their last shift due to staffing levels.
Yesterday evening, I spoke to Norrie. Norrie’s mother is 96 and has pneumonia. Norrie’s mum was taken to an A and E department in an Ayrshire hospital last Thursday at 8 o’clock. The department was incredibly busy—too busy. Still, Norrie’s mum was triaged within 90 minutes. The staff were clearly doing their very best but, let us face it, they cannot conjure up more nurses or hospital beds, and there were no spare beds—none at all. Norrie’s mum spent 40 hours on a trolley in a busy corridor. She was cold and was beside automatic doors that opened and closed every couple of minutes. She was frightened and crying. She was breathless and disorientated, and all alone, because her family were not allowed to be with her. On Saturday afternoon, 40 hours after she first presented, she was moved to the clinical assessment unit where she is now. She is beginning to feel a bit better.
Can any of us imagine how we would feel if that had happened to our own granny or mum? Norrie really knows about healthcare. He has been a general practitioner for 40 years, and he cannot accept that that is what awaits his patients and his family. However, Norrie says that, sadly, his mum’s experience is not an exception. He says that it is not the fault of front-line staff, who go above and beyond.
Health is a devolved matter. The SNP has been in government for 15 years. The people of Scotland deserve to have dignity and respect while they are vulnerable. Mindful of last Thursday’s First Minister’s questions, I asked Norrie whether it gave him a measure of comfort to know that Scotland’s waiting times were better than elsewhere. His response—well, I cannot repeat the word, so let us just say that comparisons like that are meaningless and unhelpful for the people of Scotland who are suffering.
Norrie has a question for the cabinet secretary and the First Minister. He asks: do they agree that in Scotland today it is morally abhorrent for his 96-year-old mother to lie on a trolley in a cold corridor for 40 hours?
The SNP is patting itself on the back because there has been a 2.5 per cent improvement—2.5 per cent was the improvement in A and E waiting times. That is what the member wants to stand up and proudly declare, when the figure has come down from 74 per cent. The target is 95 per cent. My word! That is disgraceful.
Our cabinet secretary is the fifth SNP minister to be in charge of health. There has been a straight line of SNP MSPs since Nicola Sturgeon held the position from May 2007. After years of SNP mismanagement, dedicated NHS staff are burning out. Workforce planning is so poor that nursing vacancies are up by 25 per cent in a year, and they now stand at over 6,000. In the past year, around 15,000 workers left the NHS, which is the highest number in a decade. The root cause of many of the issues with A and E and routine treatment lies in the lack of flow of patients through hospitals.
There is a lack of beds in NHS Scotland. There are 716 fewer than there were at the peak in 2014-15. Urgent action is required. The NHS recovery plan is failing to have a demonstrably positive effect on waiting times. It is not working. Let us admit that and rewrite the plan ahead of this winter.
I declare my entry in the register of members’ interests, as I am a practising NHS doctor.
That the Parliament is concerned by the length and scale of NHS waiting times; notes that A&E, Child and Adolescent Mental Health Services (CAMHS), cancer and routine treatment waiting times are well short of where they need to be; recognises that the root cause of this problem is a lack of beds in NHS hospitals; regrets, therefore, that the Scottish Government is focussed more on structural reform than building greater capacity into the social care system; notes that the NHS Recovery Plan is failing to have a demonstrably positive impact on waiting times, and calls, therefore, on the Scottish Government to rewrite its NHS Recovery Plan ahead of this winter.
I welcome the opportunity to discuss the challenges that our health service continues to face and to speak to elements of the recovery that we are seeing across health and social care.
Before getting into the detail, I want to thank our NHS front-line staff and other social care staff for the incredible efforts that they make day in and day out. I see them on a more than weekly basis in the job that I am in and am able to thank many of them personally, but I take this opportunity to say to those who I do not get to see that the Government and I are eternally grateful for their efforts.
From the outset, I say that this debate can hope to be constructive only if the Opposition does not deny the reality of the context in which we operate. Looking at Sandesh Gulhane’s motion, I see that there is not one mention of the pandemic or Covid—not one mention of the biggest shock that our NHS has ever faced in its 74-year existence. To deny the severe impacts that the pandemic has had and continues to have on our health systems is, frankly, to deny reality.
I will not, if the member does not mind.
In his opening speech, Sandesh Gulhane referenced where we were a year ago. He forgot to mention that there have been three waves of the pandemic in the subsequent year: the omicron wave; the BA.2 wave; and the BA.45 wave, which we have just exited.
We should, of course, challenge ourselves to do better and I fully accept that the A and E waiting times statistics for the week ending 11 September were simply not acceptable. I have said as much, as has the First Minister. That is why I am pleased that we have seen an immediate improvement. I accept that we are far away from where we want to be, but there was an immediate improvement, which included a 20 per cent reduction in eight-hour and 12-hour waits.
Of course, context is important. I accept that it is cold comfort for people who are waiting excessively long times for A and E treatment, but this is not a uniquely Scottish problem: health services across the world are facing this challenge. Scotland’s A and E performance continues to be the best in the United Kingdom not by a small margin but by quite a margin. However, again, I accept that more has to be done. That is why Kevin Stewart, who will close the debate for the Government, and I are working hard with health and social care partnerships up and down the country to reduce those delayed discharges. If we can do that and get some movement in the right direction, which I accept is not happening at the moment, that will free up capacity in our acute sites, which currently face an extreme challenge.
I do not accept that simply creating more beds in the system is a panacea. I think that preventing people from having to come to the front doors of our hospitals will dramatically help.
Last night, I spoke to a deep-end general practitioner who said that the health service is designed on a demand basis, not a need basis. With regard to the cabinet secretary’s point about prevention, does he agree that it is time that we took an approach to healthcare that involves preventing people’s health problems becoming acute in the first place, which is what adds to our A and E times?
I agree with that point in its entirety. The more we can prevent admission and ease demand on the system, the better. Our hospital-at-home model is a great example of how we can do that. Similarly, out-patient parenteral antimicrobial therapy—OPAT—which involves delivering antiviral treatment to patients at home or close to home and has saved 45,000 hospital bed days this year, is a key plank in our efforts to reduce that demand.
On planned care, there have been elements of a recovery. There has not been a full recovery—I am not going to suggest that, because our recovery plan covers the course of the parliamentary term—but statistics that were published last week, which Sandesh Gulhane and the Conservatives have not yet commented on, show that, for most of our out-patient specialisms, two-year waits either have been eradicated or are experienced by fewer than 10 people in those specialisms where those waits exist.
The cost of living crisis, which was created by—and is now being worsened by—the incompetent Conservative Government, is a public health crisis. If people have to choose between heating and eating, that will have a direct impact on their health.
We will continue to try to expand our workforce, and I will give more details on that next week. However, it is the case that NHS staffing in Scotland is higher per head of the population than it is in any other part of the UK.
Next week, I will give more details of how we are matching up against that recovery plan and what our winter contingency plans will be. Although I absolutely accept that we still face challenges due to the effects of the pandemic, I praise our NHS and social care staff for the incredible and compassionate care that they provide the people of Scotland with day in and day out.
I move amendment S6M-06073.3, to leave out from “is concerned” to end and insert:
“recognises the ongoing impact of the COVID-19 pandemic on health services and thanks Scotland’s frontline health and care staff for continuing to deliver high-quality care in spite of pressures associated with the ongoing pandemic; understands that these pressures are being experienced in health services across the UK and beyond; notes that, in 60 days, the number of people waiting longer than two years for an outpatient appointment was reduced by almost a quarter and that most specialisms have no waits of this length; welcomes that, since the start of the pandemic, NHS staffing is up by almost 9%; notes that child and adolescent mental health services began treatment of 5,200 children in the most recent quarter, the highest number ever recorded for the second quarter in a row; commends the dedication of Hospital at Home staff, whose work has avoided or saved bed days equivalent to that of a large district general hospital, including increased capacity for Outpatient Intravenous Antimicrobial Treatments, remote monitoring for COVID, and Respiratory Rapid Response services, which has already saved 45,000 hospital bed days in 2022; regrets the impact that Brexit and the UK Government’s anti-immigration rhetoric have had on recruitment in care services, and welcomes that over £1.6 billion of Scottish Government investment is being provided for social care and integration in 2022, and that, by the end of this parliamentary session, investment will increase by at least £840 million to improve services through the creation of the National Care Service.”
It is almost 500 days since the cabinet secretary took office. Unfortunately, in that time, his performance has been woeful, and the consequences have been devastating for our NHS, the hard-working staff and its patients. Our NHS is literally on life support, and I fear that the SNP Government is shamefully complacent and not up to the task of fixing that. Of course, Covid exposed the weaknesses in the NHS, but we know that the problems predate the pandemic. There were already 420,000 people on waiting lists before the pandemic. That number now sits at 750,000, which is one in seven Scots.
What has the cabinet secretary been doing? I will hand it to him—he has been a record breaker. Last week, A and E waiting times were at a record high, as were delayed discharge numbers and delays to elective surgery. The list goes on and on, but the consequences are devastating: 7,174 excess deaths, most of which were not due to Covid. Using the same estimates as the Royal College of Emergency Medicine, potentially, 1,400 people lost their lives or had much worse outcomes because of delays at A and E.
I am struggling to find anything substantial that has got better under his watch.
I accept that all that work takes time and that it will not happen, to quote him, “in a matter of weeks” or, indeed, “months”, but the cabinet secretary has had almost 500 days in which to make a difference.
No, I will not.
In May 2021, when he took over, pandemic restrictions were still commonplace, but 86 per cent of people were treated within four hours of waiting in A and E. That figure is now 63 per cent, so the number of people who wait more than 12 hours has risen by a stunning 1,012 per cent under his watch.
No, I do not. I would rather that the cabinet secretary listened.
In May 2021, more than 94,000 people were waiting for elective surgery; the number is now almost 140,000, which is a 27 per cent increase. More than 35,300 bed days were lost to delayed discharge; that figure is now almost 56,000, which is a staggering 58 per cent increase. A shocking 685,000 bed days have been lost since the cabinet secretary came to office. None of those measured figures are getting better—they are getting worse. New figures, which were published just this week, show that performance against the 62-day cancer waiting times target has plummeted to the lowest point since records began. More people will die of cancer because of that. That is dangerous incompetence on the part of the SNP Government, which has been in charge during years of poor workforce planning, the cutting of the number of hospital beds and training places for nurses and the underfunding of the NHS and social care. It is all coming home to roost
An array of experts in their field—including those from the Royal College of Nursing, the British Medical Association, the Royal College of Emergency Medicine, the Royal College of General Practitioners and the Royal College of Physicians and Surgeons—have tried to offer advice, but the cabinet secretary is not listening. Instead, he is presiding over an exhausted and demoralised workforce. Our NHS staff are going the extra mile to care for us, so they deserve our undying gratitude, but they need more than warm words from the cabinet secretary. They need a recruitment policy worth its name, action to retain staff who are leaving the service early because they have had enough, and decent pay for the whole workforce. Staff are the beating heart of our NHS so, if we are to recover, we need to support them and, with a winter crisis looming, there is no time to waste.
When a health board is failing, it is put in special measures. The NHS cannot wait any longer; it needs urgent help and, if the cabinet secretary is incapable of delivering, it is high time that he is put in special measures.
amendment S6M-06073.1, to insert at end:
“, deliver a real cancer catch-up plan, and invest in social care to tackle delayed discharge.”
It is my pleasure to rise to speak for my party in this important debate, which I thank Sandesh Gulhane for securing.
Before I move on to my substantive remarks, I must reflect on the cabinet secretary’s speech. Had he taken my intervention, I would have reminded him that every time he leans into saying that the pandemic is the cause of all this, a fairy dies. It happens all the time, and he is making not only Opposition parties in the chamber but hard-working NHS staff angry. He is revealing the blinkered nature of his Government’s attitude to the alarm bells that NHS staff have been sounding for years, some of which the Government has attempted to address through legislation and other ill-fated strategies. He cannot keep leaning on the fact that we had a two-year pandemic when things were demonstrably bad—as they still are—before that pandemic. He needs to reflect on that.
It is plain to see that our NHS is being stretched beyond breaking point. Patients are being abandoned in waiting rooms.
I apologise for not speaking through the chair on this occasion, Presiding Officer. SNP members know exactly who has abandoned our patients: this Government and not our hard-working clinicians, who are crying out for help and looking to members in the chamber for answers.
It is estimated that one in seven Scots is on a waiting list for some kind of treatment. That is a shocking statistic. Everywhere we look, the situation is getting out of control. That is even before we get into the teeth of what will possibly be the hardest winter that our NHS has ever faced. We see backbench MSPs celebrating tiny improvements in hospital waiting times while we still have people waiting for hours in pain and desperation.
Over one weekend in September, only 63 patients were dealt with within the four-hour target period. The availability of child and adolescent mental health services continues to be dire, as well. The need for services was illustrated starkly and tragically by a recent study that told us that a quarter of all deaths among five to 24-year-olds are from suicide. That is a shocking statistic.
This week, we saw the worst cancer waiting times on record for the third quarter in a row, with just one health board meeting the Government’s target. We know that early diagnosis and treatment are vital to survival in cancer care.
The Royal College of Emergency Medicine has said that waiting time delays have contributed to hundreds of avoidable deaths each year. Those people could still have been alive today. With things that bad, it is frightening to think what it might take for the Government to finally get to grips with the crisis. The stakes are incredibly high, and continued failure is simply not an option.
We must not forget the issues at GP surgeries, as well. Patients have got used to having to wait weeks for an appointment. To illustrate just how bad things are, I will tell members about a case that I heard about last week. A Ukrainian refugee had waited so long for a GP appointment that she was forced to travel back to Ukraine to get the medicine that she needed. How shocking is that?
It is not only patients who are suffering; NHS staff are reaching breaking point. Inadequate pay and poor conditions are affecting staff recruitment and retention, while there are currently more than 6,000 vacancies in nursing and midwifery alone. That puts a huge strain on the staff who are already there.
With the very short time that I have left, I will make three suggestions to the Government: it must take immediate action to address NHS staff recruitment and pay; it must adopt the Scottish Liberal Democrat plans for a burn-out prevention strategy; and it must carry out our proposals for more counsellors in schools and a single point of contact for CAMHS waiting lists. We cannot wait for that; we have been round the houses with this debate time and time again. It is time that the Government listened.
I move amendment S6M-06073.2, to insert at end:
“; notes that the increasing problems with NHS staff and recruitment, with 6,010 nursing and midwifery vacancies alone, will have a direct impact on waiting times; believes that staff should not face unsafe staffing levels on any shift; deeply regrets the impact of waiting times on both patients and staff, and calls on the Scottish Government to set up an urgent inquiry into avoidable deaths linked to the emergency care crisis, following estimates from the Royal College of Emergency Medicine that long waits have contributed to hundreds of avoidable deaths in 2022.”
For months, the Scottish Conservatives have said that people are paying the price of Humza Yousaf’s mismanagement of Scotland’s NHS. Earlier this month, A and E waiting times hit their worst level on record. The figures that were released yesterday are only fractionally better.
The sobering reality, which the vice-chair of the Royal College of Emergency Medicine emphasised last week, is that emergency department delays are associated not just with patient harm but with increased mortality.
I will put that into perspective. For the 3,400 patients across Scotland who spent more than eight hours in A and E a couple of weeks ago, 40 additional lives could be lost in a single month. That is why those statistics really matter.
Let me be clear: the buck stops at Bute house. NHS staff the length and breadth of Scotland have worked tirelessly to treat their patients in recent years, often at the expense of their own wellbeing.
In July 2022—almost a year after the NHS recovery plan was unveiled—one in every 25 patients waited more than 12 hours to be seen in A and E departments across Scotland. That was the worst month since records began.
What were Nicola Sturgeon and her SNP colleagues doing in July? They were refreshing the case for separation, with the launch of the SNP’s second independence paper. That is a massive distraction from our NHS’s recovery and hardly the “sharp focus” that the First Minister pointed to during First Minister’s question time last week.
In August, the Royal Infirmary of Edinburgh’s A and E department was over capacity every day—not just by a handful of patients but by dozens of them. That has implications for the safety of patients and staff. However, in August, Nicola Sturgeon appeared not once or twice but five times at Edinburgh’s fringe to hobnob with Hollywood actors and polish her public relations. That tells us exactly where the First Minister’s priorities lie.
Those appalling waits occurred during the summer months, well before the pressures of winter and colder weather pile on to our NHS. In my region, the medical director for acute services at Aberdeen royal infirmary said in August that
“the system is not working because it’s not fit for purpose.”
Ambulances are already stacking outside ARI because the hospital simply does not have the capacity. Paramedics and their patients are waiting hours outside A and E, meaning that ambulances cannot be deployed elsewhere. People in the north-east are being told to present to ARI only if their condition is life threatening.
Figures that were published yesterday show that, for the quarter ending in June 2022, NHS Grampian failed to meet the 62-day standard and the 31-day standard for cancer waiting times. In addition, there are long waits for magnetic resonance imaging scans, colonoscopies and access to psychological therapies.
Meanwhile, Montrose minor injury unit has closed in Angus; Aboyne community hospital has been shut because of staffing shortages; Friockheim health centre has closed its doors because of lack of doctors; and primary care across the north-east is under impossible pressure. Many NHS services are being centralised by stealth with NHS 24 acting as the gatekeeper, with lengthy waits to speak to an operator.
Quite simply, Presiding Officer—
I am nearly finished. I wish that Humza Yousaf would listen to what people are telling him. His
NHS recovery plan has not worked. Things have gone from bad to worse. That is no wonder, given that Audit Scotland has said:
“There is not enough detail in the plan to determine whether ambitions can be achieved in the timescales set out.”
The health secretary will be appearing before MSPs in the chamber next week to address those issues. I know that he wants to mention them now, but I ask him to please listen—I am nearly finished. I sincerely hope that he will address the issues. After months of excuses, this is an opportunity to rethink his failing recovery plan and to tell front-line staff and the public what action he will take to reduce delayed discharge, increase the number of beds, improve workforce planning and focus on staff retention.
Everyone has had enough of SNP soundbites. Humza Yousaf and his colleagues need to step up—[
.]—and get a grip. Too much is at stake.
This is a timely debate, and I am glad that we are having it. The fallout from the Chancellor of the Exchequer’s statement last Friday is reaching into every aspect of our lives—not least, into devolved areas including health services.
I will not have been alone in being completely stunned by some of the public comments that we are seeing from the sort of respected people who normally keep their own counsel.
Not least, last night, as I was preparing for this debate, I read the words of former deputy governor of the Bank of England Sir Charlie Bean. He said that Kwasi Kwarteng’s measures “could finish”—I repeat, “finish”—“the NHS”. Wow! That warning should strike fear into every single one of us across England, Scotland, Northern Ireland and Wales. We all have our own national health services, but they are all at the mercy of decisions that are being made by a reckless UK Government, which today we know has ignored the warnings of its own officials.
This is not a good week to be a Tory. It is even harder to be a Scottish Tory in this Parliament, leading a debate on the security of the NHS in Scotland, the importance of investment in clinical and social care staff, and measures to bring down waiting times and secure patient safety. Before I heard his speech, I felt sorry for Sandesh Gulhane. However, he ignored the impact that his party’s reckless decisions are having on the funding and operation of the national service, which I know he cares about.
The motion rightly asks questions about actions that we took to protect patient safety, improve patient flow through hospitals and make our care sector sustainable. All those areas require scrutiny, our attention and sustaining of the highest levels of funding that the Scottish Government can manage within the grant that it has. However, although I really do try to temper my emotions when I talk in the chamber, I cannot hide my utter distress and, to be frank, my anger. I cannot hide my anger at the Conservatives, whose actions last week have caused immediate financial pain to our NHS—[
.]—and are set to make the mental and physical health of our citizens even worse. Week after week—[
.]—the Tories are on their feet telling patients’ stories—
Week after week, the Tories are on their feet, telling patients’ stories—we have heard one today—and some of them are very distressing. How will we make sure that every patient gets the health service that they deserve and a long and healthy life? Is it by crashing the pound? Is it by giving more money to the super-rich, while asking the poorest people either to heat or eat? Is it by letting inflation run wild and decimating budgets, from household budgets to Government budgets? No, it is not.
The Tories are demanding that we give the richest Scots in our society the same tax breaks as have been roundly condemned by the International Monetary Fund. A range of financial experts, and many people in their party, disagree with them. Those tax cuts would leave the Scottish Government with less money to fund health and social care, in addition to all the other assaults on those areas. The rising costs of heating our care homes and hospitals and the impact of the cost of living on mental health have an impact on the mental health of our own NHS staff, which is another important aspect.
On the other hand, here are the Tories in this chamber, making all the demands that we heard in the opening speech. A child of 10 could point out the hypocrisy. They complain about our publicly funded NHS, when their mismanagement of the economy takes money away from the NHS in real terms and increases the causes of ill-health in our population.
I come back to Charlie Bean’s comment. Is our NHS finished? No—here in Scotland it is not, because the majority in this Parliament know that the way to protect the NHS in Scotland is to never have Tories anywhere near the decisions that affect it, whether here or at Westminster. I say to Tess White that only in an independent Scotland could we ensure that the reckless incompetence of Liz Truss and all her far-right hedge-fund lobbying pals—
As we can see from the contributions so far, the topic of the debate is very important to the public. It is at the forefront of the public’s concerns month after month, year after year. There is a reason for that, which is that people truly value our NHS and want it to succeed. They understand that it is our most valuable asset, as a country, and that if the NHS is running well, the country is on the right track.
That is why my party, and I am sure many members in the chamber and people in our communities, cannot understand why, when we are going into a winter that will undoubtedly see a significant increase in fuel poverty and malnutrition, as well as increased concerns about spiralling mental health due to the state of the economy, we are not having a serious rethink of the NHS recovery plan here in Scotland.
The fact is, that the SNP-Green Government has shown itself to be wholly incapable of taking responsibility for the scale of the crisis that is engulfing our health and social care service. I want to speak to SNP back benchers as well. It is our responsibility to scrutinise what is being done here in Scotland by the Scottish Government. We are discussing a serious point that has to be taken on board. No matter what the problem is, there is always an excuse from the Government. All the while, patients and staff want solutions and a sense of on-going progress.
I will tell the member how that can be mitigated: it can be done by voting Labour at the next general election.
When visiting hospitals in my region, I have seen hard-working people struggling to do an impossible task with too few staff, fewer resources and constant pressure. With that, and the worst cancer waiting times on record, how can we in this Parliament, and as a people, say that what we are achieving is good enough? It is time to take responsibility. I ask the Government, please, to take responsibility, and I ask the Government back benchers to put some pressure on the front bench to take responsibility. When we take responsibility, we can have a serious discussion about how we help to take away the pressures on the NHS. I am one of the first in this chamber to take on the Tories and debate what we need to do about the Tory Government.
In the short time that I have, I would like to highlight the unacceptable length of waiting times in women’s health services. Women are being forced to wait for dangerously long periods for gynaecological treatment. The data for April to June this year, which was published yesterday, highlights that only just over half of eligible referrals for cervical cancer started treatment within 62 days. That means that nearly half of those who were eligible did not start cancer treatment within two months. That is a shocking statistic and is a key breach of the Government’s pledges.
Those are serious issues that cannot be left for so long without serious risk to life and long-term health, yet it sometimes seems that, because the issues relate to women’s health, they are more likely to take a back seat. What makes me say that? After repeated promises in the chamber to have a women’s health champion, and despite being told more than once in the chamber that an appointment would be made in the summer, we are now approaching October and we still have no women’s health champion.
I recently stood in the chamber and said that I was “fed up” with mitigating Tory policies from Westminster. The term “fed up” does not do justice to the anger that I and so many others feel at the absolute chaos that the Westminster Government has brought to our communities. We should remember the phrase on the side of a bus about £350 million a week going to Europe and the words
“let’s fund our NHS instead”.
As Ms Martin pointed out, Sir Charlie Bean has said that a failure to reverse the tax cuts for the wealthy could result in the end of the national health service. We should let that sink in: it is about the end of the national health service. That is how far the obsession with Brexit ideology has taken us in just a few short years.
On reading the Conservatives’ motion, people would think that they are in favour of investment in public services, but a party that demands that the Scottish Government follow the Chancellor of the Exchequer’s new fiscal measures cannot credibly claim to care about our public institutions or, indeed, the public whom they serve.
Our NHS faces unprecedented pressures that have been caused by the global pandemic. NHS workers are exhausted, but they continue to work on the front line in the most challenging circumstances to deliver the Government’s recovery plan. They should have our support, our respect and our thanks.
The Tory motion mentions hospital beds, but not the fact that out-patient antimicrobial therapy services allow patients to be seen at home, which will save 45,000 hospital bed days this year alone. That is one example of how service restructure is working.
Tory members never say, “Yes, we’ve rolled it out. It’s working. It’s good.” They always say, “Why did it take so long?” Why can they not just get behind the NHS as it makes improvements?
Our NHS continues to outperform services in the other UK nations. Our A and E department waiting times are not acceptable, and there is much more to be done to get waiting times down for key services, but the NHS and the Scottish Government are addressing that issue.
Brexit has exacerbated recruitment challenges and has had an impact on health and social care recruitment. That has led directly to increased times in hospital for patients, which has put further pressure on our hospitals.
Undoubtedly, we need to continue to invest in front-line health and social care. The Scottish Government is already acting by backing such investment with a £1 billion NHS recovery plan, £500 million in urgent and unscheduled care collaborative funding and £40 million in additional CAMHS revenue. The Scottish Government cannot borrow money to give away to its wealthy friends. It is working with a fixed budget and is doing the best that it can, working with NHS colleagues, to improve the situation.
I am angry today. My staff had to intervene to get help for a young family that was left with no food over the holiday weekend as a result of failure in the universal credit system and failure by the Labour-Tory administration in the local council to administer a crisis grant in a timely manner. People, including children, are at risk of malnutrition now and will be at risk of hypothermia as the days shorten. Health inequalities, including those relating to mental health, are exacerbated by poverty and stress. The UK Government is inflicting poverty on many more people, including hard-pressed families, pensioners and those who are most vulnerable, yet it says that we are obsessed with the constitution and independence.
While trashing the economy and causing the pound to crash, the Westminster Government is reviewing all retained European Union law on the statute book. That law relates to clean beaches, product safety and food standards.
The UK Government also seems to be obsessed with bringing back imperial measurements. Maybe the Scottish Conservatives will understand that they do not have an ounce of credibility, an ounce of empathy or an ounce of shame in bringing their motion to the chamber.
This remains an extremely difficult and demanding time for our health and social care systems, which is why the impact and legacy of Covid should never be underestimated. Months of delayed appointments, cancelled procedures and the frustrations, worries and problems that they bring cannot be fixed overnight. We should not forget that, for many, the pandemic is not over. It is likely that Covid will have an impact on all manner of care this winter, which is why we need preventative action.
Those who are eligible for vaccination must be encouraged to come forward, and people need to know their rights and what they should expect. We must ensure that there are long-term, sustainable improvements to waiting times. Tackling waiting times requires action to keep the population well and prevent people from having to attend hospital in the first place. We must also ensure that we minimise other factors that disrupt hospital capacity.
Normality seems very far away for our wonderful health and social care staff, whom we must keep well to ensure that we minimise disruption this winter. While the rest of society has been able to take a breath, our NHS and social care staff simply have not had that chance. For that alone, we should be endlessly grateful for their fortitude. Behind every waiting time statistic is a team of clinicians, support staff and social care workers who are trying their best. We must listen to what they need and support them when they ask. Without their hard work, determination and expertise, there is no NHS. Keeping them well is not simply about mitigating and protecting against Covid; it is also about taking other measures and making changes to terms and conditions.
The cabinet secretary, Jackie Baillie, Alex Cole-Hamilton and I attended a meeting earlier this year with the RCN to hear from nurses. One thing that came out clearly was the impact of the lack of flexible working patterns on nurses, who then leave NHS employment. In many instances, the situation results in nurses taking retirement only to return to work in better shifts as bank cover, often in similar roles to the ones that they have just left. At the Health, Social Care and Sport Committee yesterday, I was pleased to hear from Alex McMahon that work on the matter was in progress, and I would be grateful for any update that the minister has on the issue in his closing speech.
Although such steps are welcome, we need to hear from other health professionals about what they need, and to address how to prevent others from being in the same position as the nurses from whom we heard at our meeting with the RCN. We need to ensure that the safe staffing legislation is implemented.
We must also ensure that any patients who are impacted by cancellations are kept as fully informed as possible, and that they receive appropriate support and help to keep as well as possible while they wait for their operation—I raised that point yesterday at the committee. The cumulative effect of the pandemic and those factors, among others, cannot be ignored.
I want to end with a reflection on the impact that the cost of living crisis will have on our NHS and waiting times this winter. Over winter, we will see the acute reality in our hospitals of the absolute mess that the reckless UK Government has caused. We will see people presenting at A and E with malnutrition and conditions that are associated with it, and we will see people with chronic illnesses and disabilities facing massive debt for running the machinery that keeps them alive and facilitates their everyday lives. Despite all that, all the UK Government does is hand out tax cuts to the wealthiest and lift the cap on bankers’ bonuses.
I am just about finished—I am sorry.
We know the long-term impacts of wealth inequality. There are children today who will see their health impacted well into adulthood by the cruel Tory regime and the decisions that it is taking now. We know the impacts that Tory policies had in our communities during the 80s, and here we are again. UK Government ministers should be ashamed; instead, they are doubling down with lines in the media such as
“You won’t like this budget if you” support
We need to tackle waiting times, delayed discharge and other issues at the acute end as best we can but, with this UK Government, we are doing that with one hand tied behind our back. All the while, the UK Government continues to implement despicable policies that will impact families across Scotland for generations.
As a preliminary, let me record my huge admiration for all who work in whatever capacity in the health and care sectors. Nothing brought home to me how much theirs is a vocation than their commitment during that two-year-long pandemic. The pandemic is where I will start.
Throughout the UK in the devolved health services and beyond, to Europe, the pressures, the wearing of personal protective equipment and the restrictions dramatically disrupted the usual business of our GP surgeries and hospitals. The aftermath of that situation is seen in the delays and in our playing catch-up with treatment.
I recall Borders general hospital dividing itself into two treatment areas—one for people with Covid, and the other for emergency treatments. I recall how the chief executive, along with colleagues, had to learn to adapt to that fast-evolving, global virus.
Other health treatments were postponed of necessity. Access to GP services was, and remains to this day, limited. To this day, of necessity, our GP and ambulance staff and staff in our hospitals are still taking precautionary Covid protections, which all add to delays.
Those years caused a backlog in treatments. Of course, delays in individual cases are dreadful—I have heard about them myself—but we must put them in the extraordinary context of the pandemic. I had never known a pandemic previously but, apparently it is yesterday’s news for the Opposition. It is not, and that context is fundamental. I say to Ms Mochan that the pandemic is not an excuse, but an explanation—there is world of difference.
The Conservative motion does not mention that, yet the continuing impacts of the pandemic—the fact that protections are still required; that staff in the health and care sectors are still having to take sick leave because they contract Covid; that ambulance drivers not only require the Covid protections but must sanitise their ambulances after each patient journey; that wards require extra cleaning; that GPs are limiting face-to-face consultations; and that even dentistry is trying to catch up—are all for the same reason: Covid is still among us.
All of that is fundamental to where we are today. The root cause, as of now, is the necessary postponements when Covid was at its height, the catching up that needs to be done and the continuing protections. That is corroborated by the fact that the positions in the English NHS and the Welsh NHS are worse, although I take no pleasure in saying that, because each individual—rightly—is a priority for treatment, wherever they live.
However, the NHS is working through the situation and, as in “normal times”, certain treatments and certain emergencies must take priority. I say to Jackie Baillie that, today, NHS Borders confirmed that 100 per cent of patients in the Borders who are diagnosed with cancer receive their treatment within the Scottish Government’s target period of 31 days, and that almost 97 per cent of eligible patients who are given an urgent suspicion of cancer referral have received their first treatment within the Scottish Government’s 62-day target period.
I am in my final minute.
Therefore, I commend NHS Borders.
The motion does not even dip its toe into the waters of Brexit, as a consequence of which we lost staff in the health sector and especially the care sector. That brings me to the need for us to have some honesty in this debate. Let us have more light and less heat. All Governments have struggled with the pandemic in the health and care sectors, from the early lockdown days until now. The fact that vaccines have to be delivered on a mass scale places a huge demand on NHS services.
The problems of Covid and Brexit have now been compounded by reckless Truss economic policies, which will impact on the health, the wellbeing and the safety of people in Scotland. There has been not a whisper about any of that from the Tories; I wonder why.
How can I follow those intellectual gymnastics of Christine Grahame, who created a new thought experiment in dancing on the head of a pin by explaining to Carol Mochan that what we have heard from SNP members all afternoon has been explanations, not excuses? First, it was Covid. [
] Try explaining that to the nursing profession, which begged the Parliament to pass the safe staffing bill some 10 years ago because of a problem of the Scottish Government’s creation.
We were then told about the Tory tax cuts. I find them as horrifying as the next person, but they have not even happened yet. SNP members cannot use other people’s mistakes to excuse away the inadequacies of their Government after more than a decade of mismanagement, and shame on them for trying to do so.
I do not have time.
Last week, I met an intensivist in a major Scottish hospital who told me that, when he goes to work, it is unsafe on every shift, because his hospital is down to the tune of 80 nurses on every shift. That is astonishing. He spoke about the fact that, even though intensive care was short staffed, staff sometimes had to be slipped from intensive care to other wards where, if a member of staff was not slipped in that way, there would be no nurses on the ward at all. We are in a state of abject crisis and it is only the policies of the SNP Government that are to blame.
I do not have time; I have only four minutes and I must make progress.
That intensivist talked about the data incident reports that he had to do about adverse experiences on wards, such as injury or death. He used to do only 20 a month, but he now does 50 a month. That is the measure of the lack of safety in our wards and in our hospitals.
The situation that we are in is down not to the excuses that we have heard today, but to a range of things. It is down to active policy decisions, such as the decision to cut 300 places from nursing and midwifery training and the decision to create advanced nurse practitioners, which fixed one problem but created another. Although advanced nurse practitioners were needed, it was not recognised that lots of people who were in wards that were under pressure and understaffed would find the quickest way out, which was to take an advanced nurse practitioner role, so that they would not have to stay in an unsafe ward. Those are real problems that we are hearing about. Intensivists and other clinicians would not be coming us to complain if the Government was listening to them and acting on a day-to-day basis on the problems that they raise.
We have heard a lot in the debate about waiting times in accident and emergency, our Ambulance Service and emergency care. However, those waits are not the fault of emergency care, and it is absolutely critical that we say that.
Ambulances cannot get to people in time because they cannot discharge their patients into A and E departments when they arrive. They are waiting in queues outside A and E. Why? Because A and E departments are entirely full. Why are A and E departments entirely full? It is not because they are not treating people. They are treating people, but they cannot discharge them into the wider hospital. Why is that? The hospitals are full. Why are the hospitals full? Patients cannot get a bed because of the more than a thousand people who, on any given night, are languishing in Scottish hospitals well enough to go home but too frail to do so without a social care package. This is a crisis that is causing an interruption in flow throughout the whole of our national health service.
The SNP should be focusing on that, not the ill-fated bureaucratic exercise of creating a national care service, which will strip power away from the people in social care who know how best to use it and deliver it into the hands of ministers who have shown nothing but disinterest in the problems that they have been told about, year after year.
This is a crisis of the SNP’s own creation. I have no skin in the game of protecting the Conservatives regarding what they are doing in terms of tax cuts, but it is an insult to everybody who is currently lying on a trolley in a hospital ward or an A and E department to say, “This isn’t on us. It’s on faceless bureaucrats at Westminster.” Of course it is on the SNP. It has been in charge for 15 years now—it should start acting like it.
Our NHS staff do an incredible job. They are always here for us. It is not the job of doctors and nurses to address the woeful mismanagement of this Government. That is the job of ministers, and they should start acting like it is.
In rising to close the debate for Scottish Labour, I want to genuinely recognise the outstanding work that is done by everyone working in our NHS: staff who go out every single day on to the front line to look after all of us—staff who we clapped for every week during the pandemic, who now feel dejected, burned out and undervalued by this SNP Government.
The NHS is this country’s greatest institution—realised by a Labour Government, which rebuilt this country from the ashes of war. Let me say to Gillian Martin and others that I share their anger over the Tories’ economic policies, which is why we need a Labour Government across the UK, with the plan outlined by Keir Starmer this week in Liverpool to reverse the economic disaster that has been created by the Tories.
In my lifetime, I have never seen the NHS in Scotland so unwell.
I have never seen the people who work in it so demoralised. I have never seen people languishing on waiting lists and in A and E departments in the current state that they are in. The cabinet secretary should be embarrassed by that.
Many of the people who work in our NHS are our friends, family and neighbours. They are people who love the bones of our NHS but are totally broken. That is what 15 years of SNP mismanagement and a record of failure has done, as outlined by my colleague Jackie Baillie in her opening remarks.
This is at the door of the cabinet secretary.
I would like to make some progress.
The cabinet secretary has been in post for almost 500 days. People say that he is missing in action, but he is not even missing in action—he is just missing.
I t is time for him to own his record. He must listen and engage with what staff are telling him.
In his speech, the cabinet secretary said that we should be grateful that two-year waits have been eradicated. Is that the sum total of his ambition for the NHS? Is that what he stands behind?
This week, it was revealed that hundreds of surge beds that were made available last winter to cope with additional patient numbers are still occupied.
Let us reflect on the views of doctors working in our NHS, as highlighted by Alex Cole-Hamilton and others. John-Paul Loughrey, the vice-president of the Royal College of Emergency Medicine Scotland, said that the latest delays could lead to 40 deaths in the following 30 days. He said:
“Every hospital in Scotland just now is under the cosh.”
As we have heard, just last week, 1,200 people spent more than 12 hours waiting in emergency departments in hospitals across Scotland. It is worth hearing that again, because we need to let it sink in. That is the reality in our hospitals right now.
W e know that part of the solution to getting people out of hospital requires well-supported and valued social care.
I appreciate the member giving way; my intervention is on that point.
The issues are complicated. The Health, Social Care and Sport Committee heard yesterday from the chief executive of NHS Dumfries and Galloway, who said that Brexit is part of the problem when it comes to recruitment. Does the member acknowledge that the chief exec of NHS D and G said that?
Of course I acknowledge that Brexit is part of it. However, what we hear from the Government is excuse after excuse. If it is not the pandemic, it is Brexit. If it is not Brexit, it is how we operate care homes. If it is not that, it is procurement. Excuse, excuse, excuse. Where are the solutions?
Actions speak louder than words. If this SNP-Green Government respected care workers, it would offer them more than the derisory pay rise that it has offered them. Our care workers deserve better. That is why Scottish Labour has consistently called for care workers to receive an immediate pay rise to £15 per hour.
NHS staff are working tirelessly to provide exceptional care, but they are being let down by the inaction of this Government and this cabinet secretary. The SNP cannot shirk responsibility for the current crisis. I noticed that many SNP back benchers did not even want to mention the NHS for which their party is responsible.
The crisis is the result of 15 years of sustained failure by this Government—a Government that is out of touch, out of ideas and unwilling to take responsibility. I challenge the cabinet secretary to step up, show leadership and do whatever is necessary to avert a coming humanitarian crisis in our hospitals this winter.
We have heard a lot today about pressures in the system, the impact on people who access health and care services and what we are doing to support improvements for winter and for the future.
As the health secretary said, none of this is easy, especially in times of financial austerity. However, we are confident that we are providing as much support as we can within our control. In Scotland, we have higher staffing per head than NHS England has; we have already delivered a record number of GPs working in Scotland, with more GPs per head than is the case in any other country in the UK; and front-line health spending is 4.6 per cent—or £143—higher per head in Scotland than it is in the UK as a whole. That level of commitment will help us to minimise the impact on people during this difficult time.
Like Gillian Martin, Clare Adamson, Gillian Mackay and Christine Grahame, I think that it is crucial that we frame today’s debate in terms of the cost of living crisis and the effects that that will be having on the mental and physical health of people across Scotland. We know that poverty is the single biggest driver of poor mental health. This crisis will not be affecting people equally, just as, during the pandemic, existing inequalities are being exacerbated.
There is no aspect of this crisis that is without implications for mental health. There are likely to be implications at all levels of need, from rising levels of worry and anxiety to increased levels of distress, increased demand for signposting and community support and a rise in demand for specialist mental health services.
We are working across Government and with key partners to look at what we can do, within the limited powers of this Parliament, to support people through this crisis. Probably the only folk who will not be accessing such services will be the likes of the bankers, whose bonus cap has been removed, or the ultra rich, whose taxes have been cut—that is the Tory way.
I want to try again to talk about the inverse care law. A deep-end practice GP told me last night that about 20 per cent or so of the people who are furthest removed from society do not access NHS services, although they are the people in the most need. What will we do to stop the problem of demand outstripping need?
We stop the problem by investing in more outreach—something that we cannot do if our budgets constantly get cut because Tories cut taxes rather than invest in our public services.
Dr Gulhane’s motion mentions CAMHS waiting times. As mental wellbeing minister, I want to use some of my time today to focus on that area, which is just one area in which the Government is taking forward significant improvement work.
I whole-heartedly agree that it is crucial that the right mental health help is available in the right place and at the right time, and I will focus on what we need to do.
I know that waits for mental health services are unacceptable, and we are working to ensure that we meet the standard of 90 per cent of people starting treatment within 18 weeks. That is why the Government has heavily invested in CAMHS over the past year and past months, and we are now beginning to see the impact of our investments. [
.] The Tories do not like to hear this, Presiding Officer.
Our investments in CAMHS have meant that, according to the latest national performance data, more than 5,200 children and young people began treatment in the last quarter. That is a record, and it is the highest sustained level of activity. Boards and those on the front line are working hard to reduce backlogs and treat people, with those who have waited longest being treated first.
If anyone wanted to see the arrogance and complacency of the SNP Government, we saw it there.
The storm clouds that loom over the horizon are bringing a winter crisis that the SNP Government is ill prepared for. Even before those storm clouds arrive, our surgeries, hospitals and care homes are on life support. Routine operations are being cancelled, elderly people are being left in hospital beds unable to be discharged, cancer patients are waiting too long for diagnosis and treatment, ambulances containing the sick and dying are queuing outside hospitals and patients are waiting hours and sometimes days for life-saving treatment. Nursing and care shortages are undermining patient care. Hard-working and committed GPs are leaving the NHS in record numbers.
The picture is bleak, and earlier this month—
I will not give way at the moment.
The NHS needs a proper cancer plan, a proper workforce plan and a Government with the competence to deliver them. Yesterday, the minister congratulated himself on A and E waiting times, but what is there to celebrate? A third of people are still waiting for longer than four hours to be seen in our emergency departments, and any minor improvement on a record low is hardly something to be proud of.
Not at the moment.
The minister all too often pats himself on the back when he should be getting his finger out. If the SNP wants to remind patients of its record, here it is: the longest cancer waiting times ever; the longest ambulance waiting times ever; the longest diagnostic waiting times ever; and the highest number of beds occupied due to delayed discharge ever. But from Humza Yousaf, all we get are empty promises and hollow words, because he is an inaction man. This winter, his inaction will cost lives.
As Tess White warned, 40 additional lives could be lost in a single month as a result of A and E waiting times.
In my own health board area, Edinburgh royal infirmary’s A and E department was over capacity every hour of every day in August by an average of 80 people, but the Government’s failures extend way beyond our A and E units.
Mr Hoy has just talked about failures, but I wonder if he could talk about the failures south of the border, because Scotland’s core A and E waiting times were 9.5 percentage points better than those in England. Is that failure, Mr Hoy?
I remind the member that I stood for the Scottish Parliament to hold the Government to account, and that is what I intend to do.
Do not take my word for it.
Cancer Research UK warned that more than three quarters of patients who require an urgent cancer referral started treatment within 62 days during this quarter, which is well below the target and the worst since the start of the pandemic.
I will not.
Before the minister uses Covid as an excuse, let us not forget that the 62-day target has not been met since 2012, and it is not just our NHS that is in crisis—and perhaps Mr Stewart might want to listen to this, as he is the minister responsible—it is social care too. Make no mistake—the plan for a national care service in Scotland is a dangerous power grab. Many of the Government’s failures in our NHS are made worse by failures in social care.
The Presiding Officer:
Can we be serious for a moment, colleagues? I remind the chamber that we must all take the code of conduct seriously, at all times, and if we are addressing each other in terms that are not courteous or respectful then we need to question that, so please treat one another with courtesy and respect at all times. The debate will be all the better for it.
I understand why Mr Stewart did not want to hear this, but he will hear it.
Despite saying that it would eradicate delayed discharge, the SNP has made it worse. Care at home is in crisis; the workforce is demoralised, and rather than fixing the current crisis the SNP now proposes a wholesale restructuring of the entire social care system. The deck chairs are being rearranged on the Titanic. Minister, that move will waste scarce resources and it could cost lives. Those are not my conclusions; they are the conclusions of key stakeholders. West Lothian integration joint board said:
“The implementation of the Bill is likely to cause significant disruption and uncertainty to service delivery and staffing.”
The Scottish Ambulance Service said:
“There is genuine concern that this will have a negative impact on communication, continuity of care, duplication of effort and also the ability for staff within SAS to be able to communicate effectively” and COSLA warns that the plans risk
“repeating the cycle of successive reorganisations” and
“come with a significant opportunity cost and disruption – but fail to address the fundamental and deep-rooted changes needed to integrate services at the front line.”
Minister, this is a disaster waiting to happen.
Let us not lose sight of why some in the SNP Government have taken their eye off the ball—as we read in the
Herald on Sunday at the weekend. It is because the prize of independence is, in the SNP’s eyes, a bigger prize than fixing the crisis in our NHS. This is Government complacency on a scandalous scale.
The Government is failing patients across Scotland. It is failing on A and E waiting times. It is failing on cancer treatment targets. It is failing on ambulance waiting times. It is failing on routine waiting times for elective surgery. It is failing on NHS dentistry. It is failing on child and adolescent mental health. It is failing on delayed discharge. It is failing on workforce planning. When patients die this winter, it will be Humza Yousaf who must take responsibility for the stark result of those failures, because the problems that we see across health and social care are problems created—and ignored—by the SNP Government. It is a Government distracted by the wrong priorities. It is a Government that, sadly, and to its shame, cares more about dividing our nation than healing its people.