The promise, as at the week ending 30 October, is clearly not where we want it to be. Covid continues to impact on the delivery and performance of services, and pandemic backlogs, Brexit-driven staff shortages and inflation costs are all contributing to making this winter possibly the most challenging that the national health service has ever faced.
Delayed discharges continue to be the single biggest factor driving up accident and emergency waits. That is why the relentless focus of our £600 million winter plan is on social care and actions to encourage integration authorities to help to alleviate delays.
In addition, we are working with NHS boards through our £50 million collaborative improvement programme, which looks to drive down A and E waits by offering alternatives to hospital, such as hospital at home, directing people to more appropriate urgent care settings and, where possible, scheduling urgent appointments.
That is not the fault of clinicians or emergency care workers. They are working their hearts out.
When the Cabinet Secretary for Health and Social Care took office in May 2021, A and E departments were able to see 87 per cent of patients within four hours. Today, the figure stands at just 63.1 per cent. That is the worst figure on record.
Things get worse when we look at the longest waits. The number of patients who wait for over eight hours has gone up by 717 per cent, and waits of over 12 hours have gone up by more than 1,000 per cent. All of that is happening on the health secretary’s watch.
Does the health secretary think that he is the best person to resolve the crisis? Is he saying that there is nobody at all who could do the job better than him?
When I took office, we still had legal restrictions because of Covid, of course. We no longer have those legal restrictions, so people are able to interact, and our services in the NHS are able to recover. We did not have elective care—in effect, we had paused it—at the time when I took office.
Since I took office, we have had not one, not two, not three, but four waves of Covid. That is the point that Alex Cole-Hamilton forgot to mention in his tirade. We are still in the midst of a global pandemic.
The Opposition might want to concentrate on personalities; it can do that. However, my relentless focus is on the people who are working on the front line of our NHS. They do not deserve a game of personality politics and the NHS being used a political football; they deserve the Government and every single person in the Opposition ensuring that we come forward with constructive solutions that will help our NHS at the most difficult time. That is why my relentless focus is on the NHS and those who work on the front line. I am very grateful for all their efforts every day, day in and day out.
I listened to that answer. I am sorry, but how dare the cabinet secretary dodge and deflect the Government’s negligence and inadequacies once again by constantly hiding behind the Covid pandemic? That is an insult to doctors, nurses and patients who are waiting in vain.
Nicola Sturgeon’s NHS chief executive of five years, Paul Gray, said that the crisis was coming down the tracks long before anyone had heard of Covid. Pandemic or no pandemic, the cabinet secretary should stop abdicating responsibility.
Everyone knows someone who is on a waiting list. When we drill down into the detail around emergency care, things get far worse. In the Royal infirmary of Edinburgh, only 45 per cent of patients are seen within four hours. At the Queen Elizabeth university hospital—the superhospital—in Glasgow, the figure is just 42 per cent. We have not had the first frost of winter, so things could get a lot worse.
What modelling has the cabinet secretary’s Government done for A and E waiting times this winter? Can he tell us with confidence that this is as bad as it gets?
I fully expect that there will be fluctuations throughout the course of the winter. I suspect that, in some weeks, we will see improvements, and that in others, unfortunately, a spike in Covid or flu cases might have an impact on A and E waiting times. I am not going to pretend otherwise, nor will I insult the intelligence of anybody in the chamber or anybody who is watching, by suggesting otherwise.
Alex Cole-Hamilton is wrong to suggest that there is no element of recovery in our NHS. Statistics that were published by Public Health Scotland show, for example, that in 75 per cent of out-patient specialties, fewer than 10 people wait for more than 2 years for elective surgery. In elective care, therefore, we are clearly seeing positive progress.
In relation to A and E, that is why the focus of the Government is on the front line and on investing in our staff. It is also why, as I said a few weeks ago when I spoke about our winter resilience plan, we are recruiting 750 nurses, midwives and allied health professionals from overseas, and why we are recruiting 250 support staff to help with acute primary care and mental health.
What I do not need from Alex Cole-Hamilton—I suspect that nobody needs it—is a tirade without any constructive solutions or suggestions. The Government will continue with our focus on solutions that will help our NHS over what will be the most challenging winter. My focus remains on that every day.
Will the cabinet secretary acknowledge the importance of recruiting and investing in NHS staff in Scotland on the basis of their skills, training, ability and commitment to do the job, and will he join me in commending the wonderful NHS staff of all nationalities—in particular, in the light of Keir Starmer’s troubling and short-sighted claims that the United Kingdom is recruiting too many foreigners into the NHS?
I could not agree more with Kaukab Stewart. Overseas workers in our NHS, whether they are doctors, nurses, admin staff, porters, caterers, domestic staff or anyone in between, are all part of our NHS family. Keir Starmer’s remarks were inflammatory and have no place in our discourse in Scotland. I hope that decent members of Scottish Labour will speak up against those remarks—Labour members seem to be shouting from sedentary positions—but, so far, all we have heard is a deafening silence. Although Labour’s concentration might well be on the front pages of certain right-wing newspapers, our focus is on the front line of our NHS.
Today, it was reported on the front page of
The Scotsman that patients presenting at the acute assessment unit at the QEUH are not included in the A and E statistics, despite the unit’s fulfilling that function. As many as 2,000 patients a month are being missed from our A and E waiting times stats because of how data is collected.
The Scottish National Party often states that Scotland’s emergency departments are outperforming England’s on the targets for patients to be seen within four hours, but that has been challenged by senior medics. Statistics from Public Health Scotland refer to only 30 of the 91 A and E services in Scotland, yet the Scottish Government measures the performance of those units against 170 of England’s type 1 major A and E services, which deal with the most severe situations, including shootings, stabbings and extreme road traffic accidents.
Will the Scottish Government admit that it is using statistics to cover up the true scale of the humanitarian crisis in our NHS?
No—I do not agree with that at all. It is well recognised that, in respect of comparisons across the UK, when NHS England’s agency NHS Digital compares A and E performances across the four nations, it uses the terms “core” for Scotland, “major” for Wales and “type 1” for England. All those services are consultant-led A and Es that offer 24-hour services with full resuscitation facilities and designated accommodation for A and E patients.
In my response to Alex Cole-Hamilton, I said that the figures for the week ending 30 October were nowhere near where I want them to be. I will not pretend otherwise. However, we are in a global pandemic, of course, which is affecting health services across the UK and—dare I say it?—right across the world.
I am pleased that, even with those challenges, Scotland continues to have the best-performing A and E service in the entire UK. It is 8.7 percentage points better than England and 8.1 percentage points better than Wales. In fact, analysis by Sky News has found that half of 1 per cent of Scottish patients waited longer than 12 hours in A and E. That is half of 1 per cent more than I would like it to be, but it compares with 3.1 per cent in England and 6.1 per cent in Wales.
The point of my raising that is not to say that our performance is where we want it to be—I am saying that it is not. It is to show the context of a global pandemic that is clearly affecting health services across the United Kingdom and the world.
It is another record-breaking day for the cabinet secretary. We know that the situation in A and E is emblematic of the wider crisis that is engulfing our NHS. Delays to discharge are at their highest-ever levels, social care is in crisis and the Royal College of Nursing is balloting nurses on strike action for the first time in its 106-year history.
I have a constituent who has been waiting for nine months for a colposcopy after her smear test reported high-risk human papillomavirus and abnormal cells in her cervix. That is four months longer than is set out in national guidelines.
Excessive waits are the difference between good outcomes and bad outcomes. Once again, I ask: when will the cabinet secretary set out a clear and meaningful plan, ahead of winter, to deal with the shocking waiting times? If he cannot, or if he will not, will he resign?
I am happy to look at the details of Paul O’Kane’s constituency case. On the face of it, from what he has reported, that sounds like a long wait, indeed. If he wants to furnish me with the details, I will be happy to look at that.
We have a plan. I stood here and referenced our £600 million investment over the winter. What will that do? We will recruit 750 nurses, midwives and allied health professionals from overseas. We will recruit 250 support staff during this winter across acute care, primary care and mental health services. We will give £45 million to the Scottish Ambulance Service so that it continues with the recruitment of paramedics. We will invest in hospital at home, and we will allow health boards to introduce schemes in which employer contributions can be recycled. We are taking action.
In addition to that, I will convene a further meeting with local authorities and care providers tomorrow. We are investing in social care because the number 1 factor in A and E delays is social care. The responsibility for providing care packages remains at the local authority level, and we will work collaboratively with our local authorities.
In relation to all that Paul O’Kane has said, and in relation to all the questions from Labour so far, not a single constructive solution has been offered. That is symptomatic of why he is sitting there and why the SNP Government is in charge of the NHS in Scotland.
Long waits for A and E mean that more ambulances are clogged up with patients waiting to get into A and E. At the moment, the protocol is that doctors in emergency departments cannot treat patients in ambulances. If the cabinet secretary cannot solve the delays at A and E, will he look at allowing doctors to treat patients in ambulances, while they wait for the problem to be resolved?
We will look at any suggestion that comes from the Opposition, so I will take a look at what Edward Mountain has proposed. However, the source of the problem is the issue of delayed discharge and the solution is to deal with that issue. Social care is at the very source of that.
At tomorrow’s ministerial assurance group meeting with local authorities and our colleagues from the care sector, we will see what more can be done to get those 1,800 people who are in our hospitals but who are clinically safe to be discharged home or as close to home as possible—for their benefit, let alone for the benefit of the NHS. That is where the source of the challenge lies, and that is where our energy and efforts will go. Notwithstanding that, I will, of course, look at Edward Mountain’s suggestion.
Long waiting times are contributing to hundreds of avoidable deaths. That is not acceptable in any part of the country, whether that is in England, Wales or Scotland.
Lanarkshire remains in code black status. The cabinet secretary knows that colleagues in Lanarkshire have worked constructively on a cross-party basis. We appreciate the time that he gave in coming to a recent meeting with the NHS board. However, today, NHS Lanarkshire has recorded its worst-ever A and E performance times. Things continue to get worse, not better. Will the cabinet secretary provide an update on the situation in Lanarkshire? What more is the Government doing to address the dangerous and unsafe situation for staff and patients?
Monica Lennon is absolutely right to make two important points. The first is about the need to put patients at the centre of this. We know that excessively long waits do patients harm; I will certainly not argue with that point. The Government is, of course, focused on trying to avoid excessively long waits, because any such wait is one too many.
We know that there is a job to do. I will not rehearse everything that I have said in my previous answers.
On Monica Lennon’s second point, which she made well, there has been very good cross-party consideration and challenge on the issue in Lanarkshire. She has challenged me quite frequently on it, and she is right to do so. I will be in Lanarkshire tomorrow and will, of course, raise the issue relating to the code black status and the continued challenges that NHS Lanarkshire faces. On the back of that, I will write to Monica Lennon with further details and an update.