National Health Service

– in the Scottish Parliament on 22nd November 2022.

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Photo of Alex Rowley Alex Rowley Labour

2. To ask the Scottish Government what its response is to reports that a discussion of a “two-tier” health service is recorded in draft minutes of a meeting of national health service board chief executives in September. (S6T-00981)

Photo of Humza Yousaf Humza Yousaf Scottish National Party

The meeting that the member references was an informal meeting of a small number of NHS directors, not a meeting of NHS chief executives, and the draft note of the discussion does not represent the view of NHS chief executives.

The founding principles of our national health service as a universal service, free at the point of use, publicly funded and publicly delivered for all, are not up for debate or discussion. From abolishing prescription charges to removing dental charges for young people, the Government has a laudable track record in dismantling any financial barriers that continue to exist in our national health service. Let me repeat: although reform is undoubtedly necessary in the face of a global pandemic, that reform will never ever be in contradiction of the founding principles of our NHS.

Photo of Alex Rowley Alex Rowley Labour

Back in February, I raised with the Deputy First Minister the concern that we were heading towards a two-tier health service. Since then, I have repeatedly raised the issue, both in and out of Parliament. I heard Humza Yousaf say yesterday—and confirm today—that it will never happen, and Nicola Sturgeon has stated that the Scottish Government will not “rip up” the founding principles of the NHS.

It is happening, however, and it is happening right now. Someone who needs a knee or hip operation and can afford it will get it. If they have savings and can pay for it, they will get an operation. If they are able to borrow the money to pay for it, they will get an operation. Those who can do none of those things suffer in pain on long waiting lists. I reiterate: we are already falling into a two-tier health system.

Does the cabinet secretary understand the enormity of the situation and of the crisis that our NHS is in here in Scotland? We have had the Covid recovery plan, a winter plan, a workforce plan and a delayed discharge plan. Despite all of them, things are getting worse. No wonder NHS chiefs are thinking the way that I have referred to—the plans are not working. What is next? What is the challenge, and what is the answer?

Photo of Humza Yousaf Humza Yousaf Scottish National Party

Alex Rowley touches on some important points, but we cannot underestimate the impact not only of the global pandemic and Brexit on our social care workforce—which I know he recognises—but of high inflation and energy costs on our health service. Any one of those factors would be enough to cause significant challenges for our health and social care systems. The fact that we have not just been hit by all three in quick succession but been hit concurrently by some of them is having huge impacts on our health service not just in Scotland but throughout the United Kingdom.

The simple answer to Alex Rowley’s question is that we are working on—and investing in—measures, such as reducing the long waits for elective care. In fact, Public Health Scotland’s most recent published data shows that we are making progress for in-patients and out-patients who are waiting the longest—that is, two years or longer. There is still a way to go, however.

We are also making progress in our investment in social care, which is what lies at the heart of the matter. Having capacity is really important if we are to improve accident and emergency performance and waiting times for elective care, so we are investing in improving the flow within our hospitals. That is our focus—indeed, my unrelenting focus.

Our focus will be on investing in social care so that we get people out the back door and prevent them from coming in the front door. Reform is necessary, but I repeat to Alex Rowley that that reform will always take place within the parameters of the founding principles of our national health service.

The Presiding Officer:

I must ask members for concise questions and answers. That way, more members will have an opportunity to take part.

Photo of Alex Rowley Alex Rowley Labour

We are already slipping into a two-tier health service. If someone can afford to pay or can borrow the money, they will get the care that they need, but if they cannot afford to pay, they will suffer in pain for years upon years on a waiting list. I suggest to the cabinet secretary that we need to prioritise getting a fair pay agreement for the workforce, pause the introduction of the ill-considered so-called national care service and focus on tackling the immediate underlying causes of the workforce crisis in social care, which he is failing to do. I also suggest that the Government be more open with the public about the current use of—and the cost of using—the private sector in Scotland’s NHS.

Does the cabinet secretary not see that, in truth, we need a non-partisan approach to reviewing all aspects of the NHS in Scotland—both hospitals and community provision—so that we can build a sustainable NHS that is free at the point of need? Does he agree that, if he fails to do that, he is in danger of running Scotland’s NHS into the ground?

Photo of Humza Yousaf Humza Yousaf Scottish National Party

On fair pay, in about 38 minutes’ time, I will be sitting round the table with trade unions to try to hammer out a deal. It is to their credit and, I hope, the credit of all the parties involved that we continue to be prepared to sit down and get a deal to avert strike action. None of us wants to see industrial action at any time, let alone during the winter. I look forward to those discussions. I will not give any details here, because it is important that we do that work in a confidential negotiating space, but if there are any breakthroughs, I will, of course, ensure that members are updated.

I am more than happy to sit down with Alex Rowley or any of his colleagues to discuss the national care service. Nobody is waiting for its establishment to make improvements to social care. Indeed, that is why we have invested in interim care, in step-down care and in increasing the pay of adult social care workers.

As for taking a non-partisan approach, I am happy to have discussions with the Opposition, as I do regularly. Like Alex Rowley, I do not want people to have to think that the only option for them is to go private. However, according to the data that has been published by the Private Healthcare Information Network, our rates in Scotland are lower than those in other parts of the UK. The way in which we tackle the matter is to ensure that we get our social care and healthcare systems working across the piece so that we have capacity within our hospitals to bring down waiting times.

The Presiding Officer:

I must ask members again for brief questions and responses.

Photo of Sandesh Gulhane Sandesh Gulhane Conservative

I commend the BBC for reporting the meeting, despite the online abuse that its reporters have been receiving for daring to be free journalists.

In addition to the proposal for a two-tier health service, the minutes of that meeting of NHS bosses describe concerns about a lack of clinical input into political decision making, a disconnect between the messaging from the Scottish Government and the reality that the boards are facing, and siloed discussions within the Scottish Government itself. Will the cabinet secretary commit to asking Audit Scotland to investigate the controversy and the details surrounding the meeting?

Photo of Humza Yousaf Humza Yousaf Scottish National Party

I find it genuinely laughable that Dr Gulhane thinks it a really good use of Audit Scotland’s time to investigate an informal meeting that included one NHS chief executive and in which the view that was expressed does not, as I have said, represent the view of the NHS’s chief executives, its chairs or its chief operating officer—and most important, might I say, anyone in the Government. After all, we are the ones who decide the policy of the national health service. Therefore, I will not ask Audit Scotland to carry out such an investigation. Dr Gulhane can ask Audit Scotland himself whether it thinks that would be a good use of its time.

I say to Dr Gulhane that we in the Scottish Government should be judged on our deeds. We abolished prescription charges, removed dental charges for young people, continue to fund free eye tests and have scrapped charges in our hospital car parks. When the Conservatives at Westminster were presented with a Lords amendment to take the NHS off future trade deals, they were whipped to vote against it. Of course, one of those individuals, who is not present in the chamber today, was one Douglas Ross MP. The threat of privatisation, therefore, comes not from the SNP Government but from the Conservatives refusing to rule the NHS out in any future trade deal.

Photo of Emma Harper Emma Harper Scottish National Party

I thank the cabinet secretary f or his unequivocal statement that, under a Scottish National Party Government, the NHS in Scotland will always be a public service that is free at the point of need. Ensuring that the NHS has the right staff is vital. Does the cabinet secretary agree that, as well as investing in training and recruitment, we must seek to attract staff from overseas to make Scotland and the NHS their home? Does he share my disappointment that Sir Keir Starmer seems content to use anti-immigration rhetoric that is on a par with that of Nigel Farage?

The Presiding Officer:

I regret that that question is largely not relevant to the substantive question. I call Alex Cole-Hamilton.

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

I make a commitment to the cabinet secretary that, every time he seeks to deflect his Government’s role in the NHS crisis by referencing the pandemic, I will remind him of the words of the former chief executive of NHS Scotland, Paul Gray, who said that this crisis was always coming because of the SNP’s mismanagement “regardless of Covid”.

Today, a new Public Health Scotland report says that the burden of disease in this country and, by extension, on our NHS is set to rise by 21 per cent over the next 20 years. The pressure on our NHS is nowhere near its peak yet. I suggest to the cabinet secretary that that is a damning verdict on the SNP’s handling of the health service. Indeed, the fact that senior bosses are even discussing such extreme proposals is a reflection of how bad things have got on his watch.

Photo of Humza Yousaf Humza Yousaf Scottish National Party

For someone who, in the past couple of weeks, has made a lot of ensuring the accuracy of the parliamentary record, Mr Cole-Hamilton might want to reflect on what he has said about directly quoting Paul Gray. I am sure that people will be poring over that quote to ensure that Mr Gray has not been misquoted.

I say to Mr Cole-Hamilton once again that if he thinks that he can put his head in the sand and deny the impact of Brexit, the global pandemic, the high rate of inflation and the cost crisis inflicted upon us by the Conservative Government, I genuinely do not know what planet he is living on. No one is arguing with him that reform of the NHS is necessary. We have regular discussions about such reform, but always within the parameters of the founding principles of the national health service.

As for where the public are on this issue and who can best judge the performance of the NHS, the public have their say at every election about who they believe should be trusted with the stewardship of the NHS. I ask Mr Cole-Hamilton to reflect on why he is leading a party that has four MSPs in the Parliament while, time and time again, the people of Scotland trust the SNP with that stewardship.