The next item of business is a debate on motion S6M-06899, in the name of Jackie Baillie, on protecting primary care. I invite members who wish to participate in the debate to press their request-to-speak buttons, or to place “RTS” in the chat function if they are joining us online, as soon as possible.
For most people across Scotland, the first point of call when it comes to their health is their general practitioner. GPs are very much at the front line of our national health service. Without functioning GP services, our health system would collapse.
In some areas of Scotland, however, GPs are closing their doors and handing back their contracts, and thousands of patients are being left without a GP. In other areas, lists are closed to new patients, and practices are simply unable to cope with the volume of patients that they have and to fill vacancies as GPs retire. I have letters from GPs in Lothian and Aberdeenshire and from a medical practice in Falkirk that is struggling to survive.
The Scottish Government must act to address the looming crisis in primary care, or more patients will struggle to get the help that they need. I will illustrate that point with some of the facts. GPs are seeing 500,000 people a week, which is a lot more than they were seeing before the pandemic. Most of them are working additional hours to try to meet the demand, and many can provide emergency appointments only due to short staffing as a result of vacancies or illness.
In a recent British Medical Association survey, 81 per cent of GP practices said that demand exceeded capacity, 34 per cent reported GP vacancies, and practices estimated that they are about 1,000 GPs short at present. The Royal College of General Practitioners says that there will be a need for even more GPs by 2027. Despite that, there is a lack of clarity about GP numbers. The Government bases its numbers on head count, but the truth is that many GPs work part time, and the flagship target of 800 GPs is well short of what is actually required. I ask the cabinet secretary to outline the urgent action that he intends to take to improve practice staffing and to say whether he will be transparent about GP numbers.
The SNP makes claims about the increase in multidisciplinary teams, but they are contradicted by GPs. Despite the recruitment activity, the Royal College of Nursing reports that 12 per cent of district nurse posts are unfilled. When we consider the numbers of allied health professionals, we see that there are 346 physiotherapy vacancies.
Faced with those challenges, it is extraordinary that the SNP has cut the health and social care budget by £400 million. Some £65 million has been cut from the primary care development fund alone, and £5 million has been cut from the GP sustainability fund. Our tone deaf health minister, Humza Yousaf, announced that at the same time as he is telling people to stay away from accident and emergency departments and to go to their GP instead.
That is just about the most wrong-headed decision that I have seen: cutting resources for GPs when they most need them, during a winter crisis. It represents breathtaking incompetence on the part of this SNP health minister. GPs are on their knees, and if the Scottish Government fails to address their serious concerns, more people will end up in already overwhelmed acute services when they could have been dealt with locally in primary care.
I urge the cabinet secretary to reverse the cuts and listen to the British Medical Association and the Royal College of General Practitioners. They are telling him that there is a crisis, so I say to him, “For goodness’ sake, please act.” Perhaps he could use for that purpose the £20 million that has been earmarked for a referendum. It never fails to astonish me that, when the nation is focused on a crisis such as the one that our NHS faces this winter, the SNP is focused on the constitution.
At the start of the week, there were extraordinary revelations that senior NHS executives were discussing the privatisation of our NHS. The discussion was green lit by Caroline Lamb, the most senior civil servant in charge of health for the SNP Government. Either the cabinet secretary knew about that and is complicit or he did not know about it, in which case he really cannot be trusted to be in charge. Either way, we can usually judge how close to the mark we are by the volume of abuse and aggression from SNP members and supporters, not just on social media but in the chamber.
This is a damaging story for the SNP, because it tells us that the NHS in not safe in SNP hands. Inside or outside the United Kingdom, the SNP—
I will not. The member should listen to this.
Inside or outside the UK, the SNP would contemplate a two-tier NHS where those who can afford to pay would get faster and better treatment and those who are not wealthy would receive a poorer service from a residualised NHS. However, the SNP is already presiding over a two-tier system. More and more people are paying for private consultations, diagnostics and operations. Those are some of the 700,000 people on waiting lists— the one in seven Scots who are being failed by the SNP and by Humza Yousaf.
The minutes of the discussion are also interesting as they confirm something that we already know—that the cabinet secretary does not listen. He does not listen to clinicians or to civil servants. He is paralysed and he does not make decisions. People across the NHS have lost confidence in him.
A s for the £1 billion black hole in the NHS budget, we should look no further than Nicola Sturgeon. When she was the health minister, she failed to pass on funding from the Labour UK Government to the health budget.
I will finish with two quotations. The first is from the
Scotsman leader yesterday, which said:
“Whether or not this was part of a brainstorming exercise, it is deeply concerning that it has come to this.”
That is right. Secondly, Neil Mackay wrote in
“If the NHS is a benchmark, then the SNP is unfit for government.”
Those are damning words indeed. This cabinet secretary is unfit for office, the SNP is unfit for Government, and Humza Yousaf should do the right thing and resign.
That the Parliament notes the recent warnings by BMA Scotland about the pressures on general practice, with 81% of practices surveyed reporting that demand was exceeding capacity and it estimating that an extra 1,000 whole time equivalent (WTE) GPs are needed now; understands that not all practices have access to full multi-disciplinary teams, limiting GPs’ ability to focus on the patients that need them most, and therefore regrets the Scottish Government’s decision to cut £65 million from primary care services and £5 million from the Sustainability Payment to practices; considers that this diminishes the ability of GPs to respond to winter pressures and will exacerbate the crisis in primary care, with serious consequences for staff and patients and the wider NHS this winter; is alarmed by reports that NHS board chief executives are considering the implementation of a two-tier system of access within the NHS, and considers this to be privatisation through the back door; remains committed to the founding principle of the NHS of being freely available at the point of need; calls on the Scottish Government to reconsider the cuts to primary care and to give an urgent update on where the 800 additional GPs it pledged in 2017 will be located, and regrets that the Scottish National Party administration is considering the privatisation of the NHS in Scotland.
It was a meeting of five people with one chief executive present. Believe it or not, with the more than 160,000 healthcare workers that we have, I do not know about every meeting that takes place. [
When I have met chief executives and the chairs of health boards, not one of them has ever floated the idea of charging patients. If they did that, I would, to be frank, tell them that that is not up for discussion under this Government.
I say to Jackie Baillie and Scottish Labour, who have brought to the chamber this serious debate on a serious issue—which was not given any serious consideration by Jackie Baillie in a speech that was, to be frank, ludicrous—that we should start by thanking all our primary care teams: not just our general practitioners, those who work in reception and our multidisciplinary staff, but primary care staff across the piece. I thank every one of them.
On Jackie Baillie’s concerns about the founding principles of the NHS and thanking our healthcare workforce, I give a categorical assurance that our Scottish NHS will never be sold off into private hands under this Administration.
The Government holds true to the founding principles of the NHS and Nye Bevan’s vision of patient care that is free at the point of need. We should be judged on our track record on that, which is, of course, one of abolishing prescription charges, removing dental charges for young people and continuing to fund free eye tests. Let us have it recorded that this Government will keep the NHS in Scotland publicly owned, publicly operated and free at the point of use.
Jackie Baillie decries the Government having to reprofile health spending to combat sky-high inflation due to Conservative mismanagement of the economy or to afford record high pay deals. There is one place that I would love to be able to save money: in the £250 million that Scottish people are still paying for Labour’s disastrous private finance initiative and public-private partnership projects to build hospitals in Scotland. Jackie Baillie was only ever trusted in government for the briefest of periods, but she should take the opportunity to apologise to every person in Scotland that they are still paying the price for Labour’s privatisation of our NHS.
Our general practice and primary care services have been impacted by Brexit, the pandemic and the cost of living crisis, but we will continue to invest in our multidisciplinary teams. Jackie Baillie seemed to talk them down, but 3,220 multidisciplinary staff and professionals have been recruited since 2018. Therefore, when people walk into their general practice, not only are they likely to be able to see general practitioners who do a phenomenal job, but they may well be able to see physiotherapists, advanced nurse practitioners and a multitude of multidisciplinary staff across the piece. Those individuals are there not only to give the best possible service to the public that they see, but to ensure that the incredible workload in general practices is spread more evenly.
I have previously raised with the cabinet secretary my constituents’ concerns about the declining quality of patient care at some general practices in Aberdeen. He has given a commitment that his officials will determine improvement plans for practices to put in place, but I am yet to receive an update from him. I seek confirmation that that will be forthcoming.
I will give that update. Mercedes Villalba is absolutely right. She has raised the issue with me on several occasions. It is, of course, an issue for the local health and social care partnership, but I will endeavour to get her an update.
Several initiatives are under way to address GP recruitment challenges. We have recruited 277 GPs as part of the target of 800, and figures will be published soon that will provide an update to that. There is no single silver bullet when it comes to GP recruitment and retention, and a number of interventions are under way. I make no apology whatsoever for doing what I can to ensure that timely access to GP services for patients up and down the country is a top priority for this Government.
I move amendment S6M-06899.2, to leave out from “notes” to end and insert:
“recognises the pressures on primary care and right across the NHS and social care due to the effects of Brexit, the global pandemic and the cost of living crisis; notes that the overriding priority for the delivery of healthcare must be to deliver the best outcomes for patients; supports the actions of the Scottish Government to abolish prescription charges and recognises that, under the current administration, they will remain free for all; believes that prescription charges are a tax on illness and that healthcare must be based on the clinical needs of patients and not their ability to pay; recognises that primary care provision extends beyond the work of general practice and welcomes that free eye care tests continue to be protected, that dental charges have been abolished for young people, and that, through NHS Pharmacy First, more first-line care is being provided for free through community pharmacies; recognises, in general practice, that Scotland currently has a record high level of GPs and that Scotland has proportionately more GPs than any other nation in the UK; welcomes that efforts to recruit 800 additional GPs by 2027 are on track, with 277 already in post by 2021; understands that, to support GP practices, over 3,220 multidisciplinary healthcare professionals have been recruited since 2018; acknowledges that primary care funding has increased again in the current financial year and understands that integration joint board reserves provided for primary care are to be utilised for primary care; recalls that it was the current administration that took the legislative steps necessary to stop the privatisation and commercialisation of GP services that was permitted by the previous Labour-led administration; further recalls that it was the current administration that brought Stracathro back into the NHS after its work was put into private hands by the previous Labour-led administration, and shares the Scottish Government’s unswerving commitment to the founding principles of the NHS to be publicly owned, publicly operated and free at the point of need.”
Jackie Baillie’s debate today is timely, because this week we learned about damning minutes of meetings of senior management of Scotland’s health boards, which, ultimately, are under the control of the Scottish Government’s health secretary. The minutes tell us that the health secretary’s NHS bosses have been weighing up charging wealthier patients to access NHS services.
After 500 days of failure in charge of Scotland’s NHS, that is a new low. The cabinet secretary is on record as saying that he would never consider charging anyone to use the NHS and that he finds the idea “abhorrent”. I wonder whether he also finds his record in office abhorrent. Here is a snapshot: the worst cancer waiting times on record—
— and the worst delayed discharge record, with an average of 1,832 beds occupied each day due to delayed discharge. I heard the cabinet secretary say “better than England” from a sedentary position—we live in Scotland.
We have the worst NHS backlogs. Almost 700,000 patients are waiting for NHS treatment, according to the latest figures. That is the highest number since those stats were recorded in their current form.
Sandesh Gulhane said that “we live in Scotland.” Yes, we live in Scotland, but the Tories are presiding over the English NHS. Is it not right that we criticise your policies in England, where you are privatising by stealth, day in and day out? People will not want you in government in Scotland, because you will do the same here.
The member should be representing her constituents here.
The second thing to say is that we cannot trust SNP statistics, as we have found when it comes to energy, because the SNP does not make a proper comparison with England. If we look at the stats, it is clear that the SNP stats are false.
Let us be clear. The situation is not in any way the fault of hard-working front-line NHS staff. Perhaps the cabinet secretary, instead of offering platitudes, should fund us properly.
Such is the seriousness of this week’s revelations that the First Minister weighed in to say emphatically that the founding principles of the NHS are not up for discussion. Well, they are being discussed on the SNP’s watch. What else could be being discussed?
I wonder whether Sandesh Gulhane will recognise and apologise for his party’s economic mismanagement, which has meant that my health budget is worth £650 million less? If he thinks that there are other places where we should reprofile the health and social care budget, he should name them. At the very least, he should stand up and apologise for his party’s economic mismanagement.
First, when errors were made by Liz Truss and Kwasi Kwarteng, they resigned, unlike SNP ministers, who never take responsibility for anything. Secondly, I am not sure whether the health secretary looks around the world and sees that inflation is a global issue. Finally on the question that the cabinet secretary asked—[
The cabinet secretary should listen to his own questions. He is spending £1.5 billion on setting up a bureaucratic national care service. There we go—I have found his money.
We hear that senior management are concerned about a disconnect between political decision makers and clinicians. They speak of siloed conversations behind the Government’s closed doors, without the chief medical officer and chief nursing officer. The language is stark: senior management appear to have little confidence and little trust in this health secretary and think that his input and suggestions are
“divorced from reality of life and purpose of service.”
Members should let that sink in.
Primary care is the backbone of our health service and the NHS is at breaking point. There are increasing, unsustainable demands, there is limited capacity, and GPs are experiencing burnout and demoralisation. More and more doctors are at the end of their tether and are choosing to leave the profession.
Last year, the Scottish Government pledged a £30 million sustainability support package, but we instead saw a cut of £5 million to this year’s budget. Instead of grandstanding and talking about money that it does not have, or using money on its pet projects, the Scottish Government should fund the NHS properly.
Let me reiterate: every additional day that the cabinet secretary remains in office makes him and the SNP-Green Government that he serves even further divorced from reality. The SNP cannot be trusted on health. NHS staff and patients do not trust this cabinet secretary, and it seems that neither do senior NHS managers—he should do the right thing and step down.
I refer members to my entry in the register of members’ interests, as I am a practising NHS doctor.
I move amendment S6M-06899.1, to insert at end:
“, and finds it extremely concerning that there are siloed conversations within the Scottish Government occurring without the Chief Medical Officer or Chief Nursing Officer, and that there is a lack of clinical input into political decision-making, leading to Scottish Government announcements being divorced from the reality of life and purpose of the service.”
Presiding Officer, if you will permit me, I would like, as many of the contributions that we have heard so far have done, to focus my remarks on the crisis that general practitioners currently face. I was recently contacted by a group of GPs who work at a practice in my constituency, and I know that others have had similar approaches. One told me:
“Things in primary care are bleak. Everyone is simply exhausted, and working harder is not possible.”
Last month, that same practice received a letter from the SNP-Green Administration confirming a cut of £5 million in promised funding to Scottish GPs in this financial year. The Government has blamed that broken commitment on budget pressures that have been caused by inflation. That is also a slap in the face to our GP practices, as it completely ignores the fact that those practices are under the same inflationary pressures—they are getting it from both sides.
It is also another grim case of the Government playing games when it comes to announcing funding. The new figure was announced as part of the winter resilience package, giving the appearance that it was somehow new funding, when it is plainly a funding cut. This week, we saw the first frosts of winter, and cuts at this juncture will have a direct negative impact on practices’ ability to meet the inevitable increase in demand that the cold weather will present. Those cuts will make it even harder for heroic healthcare staff to provide the timely high-quality care that they desperately want to provide.
There has long been a workforce crisis in general practice, with a lack of GPs, practice nurses and other clinical staff, and, as we have already heard, 81 per cent of practices have reported that demand is exceeding capacity, with 1,000 GPs needed to plug the gap. In 2017, the SNP promised to increase the number of GPs in Scotland by at least 800 over the next decade, but five years on, the improvement in numbers has been glacial. GPs are forced to pay the price for yet more ministerial disinterest in that regard.
Levels of burnout are among the highest in the health service, and Lib Dem research has found that almost every GP who is leaving the profession is retiring before their planned retirement date. Many others are leaving for other reasons at a time that we need them most, and who can blame them?
Our health service is being overwhelmed. No matter how many times the cabinet secretary denies it, SNP mismanagement set us on this course long before anyone had heard the word “Covid”. I mention again that Paul Gray, the former head of NHS Scotland, said that this crisis was inevitable and that Covid only hastened its arrival. The SNP and the cabinet secretary need to cut out the excuses, stop abdicating responsibility and get on with the day job. It is a damning verdict on the SNP’s handling of the NHS that senior health bosses have been discussing extreme proposals such as charging for treatment. It is clear that they are alarmed at just how bad things have become.
However, I feel duty bound to highlight the intense hypocrisy of Conservative members raising the alarm on threats to the NHS when Rishi Sunak is registered with a private GP practice that guarantees same-day appointments. Let us not forget that a Tory Government failed to take the NHS off the table during Brexit negotiations. It seems that Scots currently have the worst of both worlds when it comes to protecting our most precious national treasure.
It goes without saying that my party is utterly committed to the core principles of our healthcare system—that it is available to everyone and free at the point of need. It was, after all, Liberal Democrats who brought free eye and dental checks and free personal care to Scotland. We are also committed to supporting—
I am in my final minute. We are also committed to supporting all those on the front lines of our NHS; they have been asked to go beyond the call of duty for far too long. Their service warrants far better treatment than this.
Primary care is the front door of our national health service. It is the cornerstone that allows intervention as early as possible to ensure that people can be successfully treated in the community. It refers people to the support that they need in the right place, and it should be able to do that at the right time. It is that early intervention that keeps people out of hospital by diagnosing, referring or treating them before their condition deteriorates. It is a vital service that people have trusted over many years.
Our relationship with our GP is crucial in all of our lives, and supporting general practice is crucial to reducing pressure on acute and emergency services. However, a survey from the British Medical Association has revealed that four in every five—more than 80 per cent—of GP practices in Scotland have reported that demand for their service is exceeding their capacity and almost half have reported that the level of demand for their service is substantially exceeding capacity.
As colleagues have said, I am not alone in looking at my mailbox and seeing that it is full of people who are struggling to see their GP and full of GPs who feel at their wits’ end trying to do the job that they love fully. Indeed, Dr Andrew Buist, chair of the BMA Scottish GPs committee, issued a stark warning by saying that the situation in primary care is at a “tipping point” because of the Government’s decision to slash funding for GP practices by £65 million.
The target to recruit 800 GPs by 2027 is short of what is required, and it kicks the issue down the road. The SNP has had 15 years to get NHS workforce planning right, but it has failed miserably year after year.
Will the member accept that the ScotGEM—Scottish graduate entry medicine—programme, which is unique to Scotland and was introduced by the SNP, is welcome and is specifically looking to address GP vacancies in rural areas?
Of course, it is important that we look at the needs of every community in Scotland, but it is clear that the issues go far beyond that and that we need sustained investment.
For 15 years, there has been a lack of a strategic plan on NHS staffing not only for GPs but across acute settings and all other healthcare settings.
I would like to make some progress, if the cabinet secretary does not mind, because I am conscious of time.
The NHS is the Labour Party’s proudest achievement. It has transformed the health of our nation and is envied across the world for its defining principle of providing healthcare that is free at the point of use. However, this week, it has been revealed that the possibility of creating a two-tier healthcare system through privatisation has been explored under the watch of the cabinet secretary. This week, the First Minister and the cabinet secretary scrambled to state that they do not support any shift toward privatising the NHS, and SNP back benchers and members were scrambling to add BBC journalists to the list of things that are to blame for the current state of the NHS in Scotland. However, perhaps we should not be surprised by what we heard this week, because the SNP has form on this. Indeed, in his book “
Grasping the Thistle
“We would encourage the private sector to compete with established NHS, hospitals, clinics and other services. We would encourage NHS management and staff to buy out existing NHS facilities and services under favourable financial terms and join the private sector.”
The cabinet secretary did not want to hear that from his colleague.
Our NHS is on its knees and its front-line staff are suffering. They have had enough of the failing health secretary not listening to what they need. That is why the RCN is striking for the first time in its history and why Scottish Ambulance Service staff, including paramedics, are striking for the first time in over 30 years. The cabinet secretary should deliver
“A decent and acceptable pay rise for NHS and social care staff”, which
“is essential, not just to avoid strikes but to retain and recruit the staff we need to make essential improvements to our health service”
Those are not my words; they are the words of another former SNP cabinet secretary, Alex Neil. Perhaps the health secretary should heed the advice of his former colleague and get back round the table and listen to what staff are telling him, because it is clear that the health secretary had lost the confidence of front-line staff, patients and their families. His record speaks for itself in comparison to those of his predecessors, and he has no idea, plan or support to offer.
Patients and staff deserve so much better than this Government and this cabinet secretary.
I am not sure about grasping the thistle—I think that the Labour Party is clutching at straws, with this debate.
The challenges that face Scotland’s NHS are plain for us all to see, but so is the clear, focused and considered action of the Scottish Government in seeking to address those challenges—some of which I will return to later in this short debate. It is, of course, right that our Scottish Government’s NHS recovery plan be properly scrutinised. In that context, this debate could serve Parliament well.
However, what does not serve our Parliament well is the Labour Party presenting, in a motion on the Scottish NHS, false accusations as though they are factual, when they are patently and demonstrably untrue. It is an exercise of significant deceit and, indeed, hypocrisy to suggest that the Scottish Government is considering privatising the NHS. With regard to Scotland’s NHS being free at the point of use, it was our SNP Government that abolished prescription charges, which were in place when Labour was last in control of this Parliament. It is our SNP Scottish Government that has maintained free eye tests in this country; it costs over £20 for an eye test in Labour-controlled Wales.
It was, of course, the Labour Party that brought private finance initiatives to our NHS in Scotland, and PFI and public-private partnership contracts still cost the Scottish Government £250 million every single year—liabilities that were run up under the Labour Party. It was the Scottish Government, however, that sought to unpick Labour’s PFIs. Indeed, in my city of Glasgow, that was done at a cost of £26.3 million to abolish at Glasgow royal infirmary parking charges that were put in place by the Labour Party. Therefore, there will be no NHS privatisation on our watch. Thank heavens that the Labour Party is not in charge of the NHS, here, in Scotland.
I agree with Jackie Baillie in relation to the pressures on GP services. That is why I am pleased to see that efforts to recruit 800 additional GPs by 2027 are on track, with 277 already being in post by 2021. Of course we need to strive to go further; we must do more.
However, I will tell members what does not help. It does not help that, when we, in Scotland, look to attract additional GPs or to fill vacancies elsewhere in health and social care, we have a Labour Party and a Labour Party leader, in Keir Starmer, that are doubling down against freedom of movement of people and are talking about there being too many immigrants in the NHS, then deploying cheap, gutter-level right-wing rhetoric about immigration dependency. That is just shameful, Presiding Officer. It is shameful.
On the contributions that overseas workers make to our healthcare system, we need to ensure that overseas-trained GPs in Scotland do not leave because of UK visa problems. I mention that because I noted, in my preparation for today’s debate, that the chair of the BMA Scottish GP committee, Dr Andrew Buist, said:
“We are desperately short of GPs as it is, so the last thing we need is to be in a position where fully qualified clinicians are being left with no choice but to leave Scotland because of an issue with the terms and conditions of their visa.”
Labour also made another important point in relation to multidisciplinary teams. Yes—we want more workers and so on, but denying the fact that since 2018, there are 3,120 more of them in our NHS just does not cut it. Yes—we need more people, but look at the progress that we have made. The year 2018 is very important because it predates the pandemic. What has happened shows that the Scottish Government was well aware of the demographic challenges in Scotland’s healthcare and social care system and was taking steps pre-Covid-19 to address them. It is a work in progress.
This year, the budget for primary care in Scotland is actually on the increase; and I note that, according to the cabinet secretary’s amendment, integration joint boards are also going to use their reserves to invest in primary care. It would be helpful to get more information from the cabinet secretary on that proposed change.
Let us try to work collegiately to improve Scotland’s NHS, but let us base the demands of the challenges that the doughty NHS faces here, in Scotland, on the facts and not on Labour fantasy.
I thank Labour for bringing the debate to the chamber. The only time that we get to hold the Government to account on health is during Opposition time. Even then, we know that we and Labour will lose the vote, because the SNP and the Greens will band together to defiantly say that we have somehow got this all wrong
Humza Yousaf often talks about challenges and recovery from the pandemic while forgetting that, under the SNP, the NHS was creaking before the pandemic.
Of course, as we have already heard, the background to the debate is the leaked discussion among health chiefs at which various ideas were floated, including charging people who can afford to pay. We already have a two-tier health service under the SNP. Constituents who cannot even get to speak to a GP have contacted me to say that they have gone private. One case, in particular, stands out: it is of a person who ended up paying thousands to see a GP privately, then paid for a minor procedure. That is just not acceptable. Quite apart from the “Thinking the unthinkable” leaked discussion, we already have a health service in which people who can pay get health treatment and those who cannot, or will not, do not.
We are all proud of our national health service, but, under the SNP, it is becoming the national have-not service. That is the reality on the ground. What happens in general practice affects what happens elsewhere in the health service. If people cannot see a doctor, they might well end up at an A and E department instead, or get sicker and go to hospital when that could have been avoided.
We need to know what is happening on the ground. However, we currently have no idea which GP practices are offering phone calls, no calls or face-to-face appointments. That would not be acceptable at the best of times, because data is needed in order to plan, and it is certainly not acceptable now.
In my area of Lanarkshire, things are particularly bad.
I tried to intervene on the cabinet secretary, but perhaps he did not hear me. In NHS Lanarkshire the situation is especially bad. Since October last year, it has spent 315 days at code black, and we are facing a second Christmas at that status. Graham Simpson knows that that is frightening stuff for patients and staff in our area. Does he agree that we need an urgent plan from ministers to get NHS Lanarkshire out of code black? The cabinet secretary is right to say that we should thank the staff—
I thank Monica Lennon for her intervention. She is absolutely right that NHS Lanarkshire is in a state of crisis, as it has been for too long. We need to see an action plan to get our area out of that completely unacceptable situation.
We have all been inundated with constituents who are desperate for help. I have a couple of personal testimonies. One is from an East Kilbride resident who said that they found themselves requiring support from a GP. They went to their medical practice and requested an appointment for a painful foot. They were told that there were no appointments available that day and that there were no pre-booked appointments available. That kind of thing is commonplace.
I have other examples, but I will not go through them because I am aware of the time. The situation that we face is not good enough—not just in Lanarkshire, but across Scotland. Frankly, the buck stops with the cabinet secretary and no one else. He should do something about it, or fall on his sword.
I told Mr Kidd that that would be the case before I got up to speak.
Members might not be surprised if I start from a financial angle. Whether we are independent or not, and whether we have borrowing powers or not, we still need to set budgets and live within our means, and we will never have as much money as we would like.
Labour and others have complained in recent years that local government has not had the funding that it deserves. One of the reasons for that is that we have prioritised health and the NHS. If the Labour Party was in power, it could do things differently. However, it could not give more to local government and also give more to health services and the NHS.
First, we could agree that the NHS will always have a budget and that that budget will never be able to meet all the demands that every person in Scotland wants it to meet.
Secondly, once we have decided on a figure for the NHS and health, we need to decide how to split it up. How much should go to GPs and other primary care, and how much should go to hospitals, A and E and so on?
I think that most of us here would agree that we should focus more on preventative care and less on reactive care. However, what we have not agreed on so far is how to make that switch. If we cut funding to hospitals, including A and E, in order to invest more in primary care, including GPs, waiting times for hospitals will probably increase more. I wonder whether the Opposition parties would be willing to support that, or would still turn up at First Minister’s question time every Thursday to complain about hospital waiting times. Let us be honest: every time there are demands to reduce hospital waiting times, it discourages investment in preventative services, including GPs.
Even within GP funding, there are choices to be made. The 100 or so deep-end practices, which work in our most deprived 15 per cent of areas, would argue that funding should be more skewed to the poorer areas. I wonder whether Jackie Baillie would support a reduction in GP services in a better-off area such as Helensburgh in order to increase funding for GPs in a needier area such as Dumbarton. Like it or not, those are the kinds of choices that we have to make.
We can all talk about ambition, and I am happy to do so, but the angle that I am taking today is that we have a fixed budget that has to be split up one way or another.
Although parts of the NHS are under severe pressure, much of it is providing excellent services. I certainly hear good reports directly from constituents and in Care Opinion emails. I will quote a recent example. It says:
“At my 34-week midwife appointment my midwife noticed a stop in” the baby’s
I was sent to either maternity assessment or day care every day for monitoring and every single member of staff was amazing. I was admitted one night into Ward 72 and again the staff were amazing. It was decided I would be induced at 37 weeks, throughout this long and scary process again the staff on Ward 72 plus the doctors were so reassuring and kind.
I was took to the Labour Ward after 2 days in Ward 72 and had Hannah as my midwife, a real asset. I had a problem at the end of my labour and had to have doctor intervention, again the doctor was amazing.
After birth I was took to Ward 63 where again the staff were all so nice and caring. After getting home my community midwife noticed my little one had some jaundice so back up we went, we were readmitted for 2 days back into Ward 63. This was very upsetting for me at the time and the compassion I received from all the staff was just amazing.
Throughout our whole journey every single person we met—healthcare workers, cleaning staff, midwives, doctors—were all second to none. I know the NHS is having a hard time and you can tell these people are overworked and understaffed, but that doesn’t take away anything from the care they give. I would like to thank every one of them.”
There is no doubt that primary care is under immense strain. Survey results from the BMA warn that 81 per cent of practices said that demand for their services was exceeding capacity. We know that, as a result of the pandemic, people are presenting later, often with more complex conditions and sometimes with more than one complex condition. Receptionists, who are often simply trying to get patients the treatment that they need in the quickest way possible, bear the brunt of the responsibility for telling patients about alternative pathways.
The Health and Social Care Committee’s report on alternative pathways highlighted that those need to be better communicated and that we need to move away from the expectation that every primary care appointment needs to be with a GP.
We need to diversify appointment types and ways of booking to make it easier for people to access an appointment at a convenient time. Many practices do late nights in order to facilitate appointments for people who are working, but, by facilitating phone or video appointments, we might be able to make better use of appointments and reduce the constant pressure to work longer hours.
The Royal College of General Practitioners has said:
“We urgently need a national conversation to manage public expectations of what people can reasonably expect from the health service in these conditions. Better public understanding of how to use our public services is needed, including the new ways of working in general practice.”
We need to make sure that GPs have the technology to be able to facilitate those appointments. We also need electronic prescribing, because GPs’ valuable time being taken up with signing individual prescriptions should be a thing of the past. Information technology systems can take time to roll out, but, if the cabinet secretary could look at a solution to reduce the number of repeat prescriptions that need to be physically signed, that would go some way to reducing the workload. Many people will be on medication for the rest of their lives and, aside from medication reviews, many of those prescriptions are just signed monthly with no contact with the patient. We seriously need to consider whether that is a good use of GP time and how we can make the process less cumbersome.
In its briefing, the Royal College of Nursing highlighted the vital work that district nurses and other nursing staff, as part of multidisciplinary teams, do to keep patients as well as possible, often visiting them in their homes and in community settings. The contribution that they make to the primary care teams should never be underestimated.
The RCGP highlighted that, as well as talking about resilience, we need to have a conversation about why GPs and other primary care staff become overwhelmed in the first place, and we must fix or mitigate those issues. The college also said that
“Short-term fixes to the health system must be paired with long-term strategic planning” to address workforce and workload issues. We must aim towards a point where GPs do not feel overwhelmed through working for their patients.
I have previously mentioned in the chamber the need to support out-of-hours services, which are a key part of primary care. They also help to relieve pressure on A and E by providing an alternative route, but we are relying on dedicated staff to provide those services in addition to other roles, and we need to make that more sustainable.
We need to tackle the acute problems this winter and make sure that the situation does not worsen for staff and patients. At the same time, we need to work to make general practice more sustainable and put it on a good footing to be able to promote and support good health rather than the current cycle of constantly being a national sick service.
I thank all the organisations that sent briefings and every one of the people who work in health and social care. They are doing their utmost to support those who need it through the winter and the rest of the year.
We rightly take pride in our NHS and its founding principles of universality of care, respect and dignity. The last thing that we need is a two-tier service, but that is already happening in Scotland.
Today’s amendment from the SNP Government is appalling. It does not acknowledge the massive pressures that our NHS is facing, which are increasingly impacting on people’s health. Our hard-working NHS staff are under huge pressures, not just because of Covid, but because of long-term systemic understaffing and a lack of action to recruit, support and retain staff.
I will bring to the chamber’s attention the experience of my constituents in the Lothians. We see pressures right across our NHS, including in A and E, among GPs, and in dentistry and care services. Waiting times for accident and emergency services in NHS Lothian are damning. Since May this year and up until November, there was only one week during which the percentage of people who were seen within the Government’s four-hour target was more than 70 per cent. Last week, more than 1,700 people were stuck in A and E for more than four hours. Only 63 per cent of those attending NHS Lothian’s emergency departments were seen within four hours. In the same week, more than 200 people were stuck in A and E for more than 12 hours. Members should imagine for a moment what it is like for someone to wait for 12 hours when they have gone to accident and emergency.
Jackie Baillie’s focus on GPs was absolutely right—people are going to A and E because they cannot access their GPs. For the first time, GP surgeries have started contacting my office to talk about the real pressures that they are experiencing, which are exacerbated by the reduction in funding. I am told that, in NHS Lothian, we lost £9 million because GP services in Lothian were unable to recruit the GPs that we had lost. That money is not coming back.
Constituents have reached out: one had to wait a month to see his GP; another one said that he finds it extremely difficult to register with a GP, because there is a queue outside the practice every week; and, in Musselburgh, people have been experiencing issues with access to a GP for years, to such an extent that an independent review had to be set up.
Our front-line services are under massive pressures, with our GPs being
“depleted and demoralised”.
Those are not my words but those of the Royal College of General Practitioners.
It is not only GPs—the pressures on our NHS dentists in Lothian are shocking. A Labour freedom of information request revealed that, between 2021 and 2022, 92 dentists withdrew from NHS Lothian’s dental list. At the beginning of this year, out of 163 general dental practices in Lothian, only 51 confirmed that they are accepting new patients, with some only accepting children. That creates the two-tier system that I talked about at the start of my speech. Those who can afford it go private while the rest are forced to wait months, borrow money from friends or family to get private treatment, be in pain or lose teeth. That is not acceptable.
It was the Scottish Labour Party that launched the call for a national care service, so we welcome the proposals from the SNP to deliver it. However, the reality is that, rather than focusing on the experiences of our carers and providing decent terms and conditions across the country and career development opportunities, we are seeing SNP centralisation—
The national health service is an institution of which the United Kingdom can be immensely proud. The provision of medical care that is free at the point of need fundamentally demonstrates our commitment to the idea that means should not determine access to healthcare.
On numerous occasions, I have spoken about my personal experience of that life-saving service.
Throughout all of our debates on the issue, we should remember that that is our goal, and it is our hard-working healthcare professionals on the front lines who should be supported in any way possible.
It is evident that the NHS in Scotland is going through a difficult time. My older brother has just retired as a GP, and his generation is walking away due to practices that are going on now. The number of GPs in Lothian is falling. I know of numerous practices here, in Edinburgh, where, if a patient does not phone between 8 and 5 past 8, they will not get an appointment on that day or in the week ahead.
As Sarah Boyack pointed out, dental treatment in the Lothians for NHS patients is collapsing. My dentist has decided to go private, and my family and I are still waiting to find a dental practice that we can register with, because no dentists are taking on that work.
We already have a two-tier system in Lothian. I ask the health secretary to visit places in my region rather than sit in his office, thinking that everything is fine.
The situation is bleak—that is the only word for it. We are proceeding through this most difficult of winters without a properly functioning primary care service. It is true that we are recovering from the pandemic, but to claim that all the problems in our health services began in March 2020 is fanciful. For too long, the SNP Government has hidden behind the pandemic as an excuse for its failings when, in reality, the situation in which we find ourselves has been years in the making. We need action.
The cabinet secretary will say that he has not got the money to do that. I will suggest a way that at least three or four committees in this Parliament that took evidence last week can also suggest: the Government can save £1.3 billion by getting rid of its fanciful plan for a national care service. That plan simply will not work. The trade unions are telling us that the Government plan will not work, the professionals on the front line are telling us that it will not work and the third sector is telling us that it will not work. The Government should put that idea to one side and put the money into primary care and hospital care. That would do so much more for the patients of Scotland.
Front-line services such as A and E and GP practices rely on other services to run smoothly. The deep-running problems in our health and care services date back long before the pandemic and are deeply rooted in the mismanagement by this SNP Government.
I do not have time.
That is not an abstract problem; it is not just numbers on a page or debating points for this chamber. The health secretary is putting at risk people’s lives and their wellbeing. The Government must act now to stop the stress on the system. Perhaps a good place to start would be for the health secretary to take some responsibility and for the First Minister to replace the man at the top.
First of all, it says something about Labour that it has lodged a motion that is factually inaccurate and is based on a
Daily Mail headline. It appears to me that Labour’s journey to becoming red Tories is well under way.
I know that it has been a while since Labour was last in power here and in London, but it is certainly worth reminding it of its record on privatisation in the NHS. In 1999, it transitioned the NHS from a public sector provider to one that included the private sector under the disguise of choice and competition. We also have Labour’s costly PFI contracts, which my colleague Bob Doris mentioned earlier. Those have taken hundreds of millions of pounds out of the health budget in profit payments every single year. That money could and should be going to patients. When Labour comes to the chamber making a claim that it knows is false, it needs to be reminded of its distant but not yet forgotten past.
As for the blue Tories, their amendment states that
“Scottish Government announcements” are
“divorced from the reality of life and purpose of the service.”
It takes a huge amount of brass neck to come to this chamber to make such a claim.
I have only four minutes, Mr Balfour.
Thankfully, this SNP-led Government does not agree with either of those parties. I am pleased that the health secretary announced—although he did not need to—that the founding principles of the NHS are not up for discussion and that the service will remain free at the point of need.
I welcome the Scottish Government’s investment in recruiting more than 3,220 healthcare professionals since 2018. The Government is committed to investing at least £179 million a year on growing primary care multidisciplinary teams.
However, we have heard from the Opposition today about costs, finances and cuts. I am not sure whether they understand a few simple economic facts. Brexit has been a disaster. As I stated in Christine Grahame’s members’ business debate last night—I mention this for the interest of Sandesh Gulhane—Adam Posen, who is a former member of the Bank of England monetary policy committee, suggested earlier this year that Brexit was responsible for up to 80 per cent of the increase in prices in the UK.
Currently, inflation is running at 11.1 per cent. That has largely been caused by Brexit. [
.] Added to that are the European Union nationals who have left their employment in Scotland, some of whom would have been working in Scotland’s NHS. Those are undeniable facts that the Opposition must listen to and accept.
On top of that is the current race to the bottom on immigration in which the Tories and Labour are competing. Do those two parties not realise that that might make it harder to encourage people to come to live and work in Scotland, whether in the NHS or for any other employer?
If those parties want more money to go into the NHS—we all do—they must indicate from which budgets that money would come, because of the limited financial situation that this Parliament, sadly, faces.
We have heard some members make comparisons with the NHS elsewhere. I mention, once again for the benefit of Sandesh Gulhane, that prescriptions are free in Scotland but they are £9.15 each in England.
Dental care is free in Scotland for under-26s, without an opt-in. NHS eye tests remain free in Scotland, in comparison with England and Wales, where they cost £21.31 a time. Also, Scotland has 95 GPs for every 100,000 people, compared with 70 in England, 80 in Wales and 75 in Northern Ireland.
In contrast to that positive progress, in June 2022 the Health Foundation criticised the UK Government’s lack of action and said that it was unlikely to meet the target of adding 6,000 GPs for 2023-24. I know that the NHS has its challenges—it always has and it always will—but I also know that this SNP-led Government is focused on making, and is determined to make, our NHS stronger for generations to come.
How many warnings from the front line of our NHS will it take for this health secretary not just to listen but to act? Primary care is at breaking point. Members have laid bare the fact that there simply is not the capacity to meet demand.
Sadly, Graham Simpson highlighted the fact that, under the SNP, we now have a national have-not service. Jeremy Balfour outlined the alarming stats and bleak picture. Dr Sandesh Gulhane highlighted the lack of trust in Humza Yousaf and shed light on conversations that are taking place behind closed Government doors. Jackie Baillie stated that GPs are on their knees while Humza Yousaf says, “Go to the GP rather than A and E”. What does Humza Yousaf do? He deflects and he blames Labour. He makes personal attacks on Jackie Baillie. He sneers at Dr Sandesh Gulhane. Alex Cole-Hamilton talked about a “slap in the face” to GP practices and the heroic healthcare staff. Paul O’Kane talked about GPs being at their wits’ end.
Research by the British Medical Association clearly shows that it is not just some practices that are struggling but the vast majority and that, if primary care buckles, it will be catastrophic not just for general practice and patients, but for the whole healthcare system.
There are two overriding issues affecting primary care: a lack of GPs and a lack of resources. Bob Doris referred to Humza Yousaf’s plan to recruit 800 additional GPs by 2027. However, the BMA says that we do not need 800 additional GPs—we need 1,000 and we do not need them by 2027; we need them now.
We need to stop the haemorrhaging of existing GPs in search of better conditions abroad or early retirement, and to stop those who are considering cutting the sessions that they currently work.
Mr Doris talks about blame, and he is blaming Brexit for these dire situations. We cannot plug the gaps when the system is a sieve. More than a third of practices report having at least one vacancy, which is a higher figure than at this time last year. It takes years to train a doctor.
The SNP Government must focus on retaining the talent that we have.
Humza Yousaf says, “Judge me by my record”. On resources, the cuts of £65 million from the primary care budget and £5 million in support payments mean that GP practices will have to try to meet patient demand with even fewer resources than before, and the kicker? The slashing of £65 million from primary care was announced on the same day that the Crown Office confirmed that almost £51 million of taxpayers’ money has been spent on a range of malicious prosecutions.
If the health secretary left his bunker and his spin doctors and listened to our doctors and nurses on the NHS front line, he would understand that establishing multidisciplinary teams in primary care is vital if we are to scale up our patient care. We know that there are problems with putting in place multidisciplinary teams that can help to spread the GP workload.
We have an NHS recovery plan that has seen things getting worse, not better. We have a winter resilience plan that tells the public to access urgent care only if the situation is life threatening, which piles even more pressure on primary care. Things are so dire that NHS leaders have considered introducing a two-tier system for treatment, which would charge the wealthy.
I am grateful to members for the many considered contributions on this absolutely vital subject. I believe that there is support across the chamber for the Government’s steadfast position on maintaining Scotland’s NHS as publicly owned, publicly operated and free at the point of need.
Far from denying the challenges that primary care faces, the first thing that our amendment does is recognise those pressures. Earlier this month, in the debate on alternative pathways to primary care, I was very open about the challenges that the NHS is facing. It will take time to recover from the Covid pandemic, and we have yet to see the worst of the cost of living crisis. However, I also believe that primary care is in a better place to respond to those challenges as a result of our investment and reforms.
Evaluation from local areas shows that our reforms are working. The expanded multidisciplinary team—the 3,220 whole-time equivalent healthcare professionals whom Tess White appears not to know about—support the effective use of time and expertise by reducing multiple appointments for the same issue and freeing up time for longer appointments where required, and are associated with high staff and patient satisfaction.
The reforms are also helping to cut GP workload and make general practice a more attractive career by allowing GPs to focus on complex rather than routine care and leadership, which in turn is improving patient outcomes, community health and practice sustainability.
I absolutely understand and acknowledge the pressures that are being faced in NHS Lanarkshire. We are in regular contact with NHS Lanarkshire, and we have increased the level of staffing right across the board there.
GPs are rightly passionate about their vocations, and they want to encourage new medical graduates into the profession. So do we all, and what we say to the world matters. In the public discourse, our support for the sterling work of general practice teams must be crystal clear and unequivocal if we are to attract new undergraduates to choose general practice as the worthwhile and rewarding career that we know it to be.
I will tell members a little more about some of the initiatives that we have under way. We are listening to what GPs tell us, and the Government is responding. In June, we launched a new recruitment drive to attract qualified GPs to move to Scotland. Initiatives such as rediscover the joy of general practice assist some of our most remote areas to bolster GP coverage. We are increasing medical school places by 100 each year during this session of Parliament. Recruitment into GP specialty training in 2022 has so far been better than in any other year on record, with a 98 per cent fill rate. In October, we announced 35 additional places for GP specialty training and, as of November 2021, there were 1,184 established GP training places in Scotland. As Emma Harper mentioned, ScotGEM, which is our four-year graduate entry medical degree with a focus on general practice, is proving successful, with the first cohort of 52 students graduating earlier this year.
It is perfectly valid to compare the SNP-run NHS in Scotland to the Tory-run NHS in England and the Labour-run NHS in Wales. It is perfectly valid to look beyond the Opposition rhetoric to see what those parties actually do when they are in power. I reiterate my immense gratitude to our dedicated workforce, who work day in, day out to deliver the care that our citizens need in general practice and elsewhere in our NHS.
In closing for Scottish Labour, I want to be clear that our motion has been brought to the chamber to ensure that the voices of patients, carers, GPs and all primary care staff are heard loud and clear—oh boy, has that been necessary.
It is obvious that the SNP Government and SNP back benchers are ignoring the pleas for help from all corners of our healthcare system.
“to the effects of Brexit, the global pandemic and the cost of living crisis”.
Granted, those issues contribute to the pressures that exist—of course they do—but there is a glaring omission, because those pressures are also due to his, the First Minister’s and the entire Government’s shocking mismanagement of the health service in Scotland, their lack of openness to scrutiny and their constant harking back to what happened many years ago. My colleague Paul O’Kane pointed out that the SNP has been in government for 15 years. Given the cabinet secretary’s closed approach, it is disappointing—although not surprising—that allies of the SNP are considering options such as privatisation of the NHS in Scotland.
It is old and tired rhetoric that the Government uses. The Government constantly ignores its own position in Scotland.
I actually wanted to say that I was heartened by the opposition in the chamber to the notion of privatisation of our much-loved NHS. I believe the Government in that regard, but I ask Stuart McMillan whether he actually believes that the BBC was lying to us about what happened. We should not understate how concerning the broadcast reports of creeping privatisation were; they truly sent a shockwave through the NHS and the public when the story broke.
Please resume your seat for a second, Ms Mochan. During the debate, I have made a number of pleas to members across the chamber for a degree of decorum and respect for the member who is speaking. It does not help if we get barracking from Government members and from Opposition members to the point at which the member who is speaking has to almost yell into the microphone. Can we have a bit more respect for the remainder of the debate?
Thank you, Presiding Officer.
The fact that so many people were sent out to trash the story made it more real to us, because the Government was obviously concerned. I have had a lot of respect for Bob Doris during my time in the Parliament, but I thought that his speech today was not a fair representation of what is going on.
I wonder whether the convener of the Health, Social Care and Sport Committee would like to add to the committee’s work programme; we should perhaps scrutinise the information that we have heard today.
I realise that I must come to a close. The people of Scotland, the workforce and the health service need the Scottish Government, the cabinet secretary and, if I am honest, back benchers to be much more open about what is actually happening in our health service. We need to look at the cuts that have been made and at what we can do to make a difference. We must ensure that the Government will put up with scrutiny from the Opposition, because good opposition makes good government, and I want the people of Scotland to have a good and fair public health service.