To ask the Scottish Government what action it is taking to address the reported growing concerns over the shortfall of psychiatrists employed by the national health service to deliver psychiatric care. (S6T-02138)

We are actively encouraging medical students to consider a long-term psychiatry career. We have created 42 additional posts in core psychiatry since 2014, and, with one exception, 100 per cent of entry-level posts have been filled for the fourth year.

The psychiatry recruitment and retention working group will report back to ministers in spring 2025. The Royal College of Psychiatrists in Scotland is a critical partner in this work, and the Cabinet Secretary for Health and Social Care is meeting with college representatives on Thursday. Ensuring the provision of high-quality and safe patient care remains our utmost priority.

That sounds like a lot of things in the future—but I thank the minister for the answer. I thank The Guardian and the BBC, which have done some investigation into the matter. They have found that health boards are paying up to £837 an hour for locum psychiatrists. Last year, total payments exceeded £35 million. Not only that, but there are serious concerns that some locums are being used in remote consultations from places outside the United Kingdom, such as India, meaning that they are not even members of the Royal College of Psychiatrists. Does the minister accept those concerns, and does she accept that mental health services in Scotland are at breaking point?

I certainly do accept those concerns. I am aware of the incident that Edward Mountain raises with me of a psychiatrist who was working outside the UK. I am assured that the arrangement happened only when there were no consultant psychiatrists available to work in that particular health board and that the practice has been stopped. It is not a common practice. I am absolutely aware of the challenges that exist across the workforce, which can be particularly marked in more remote and rural areas. It is helpful to see the latest statistics, which show an increase in full-time posts in the past year and, indeed, an increase since 2014. I have absolutely no doubt that there are concerns.

As I mentioned in response to a question last week, there are concerns in specific areas of the country—particularly remote and rural areas, where boards find it difficult to recruit and there are concerns about certain specialties. We are working closely with the royal college and others to improve the situation.

Well, there’s a surprise: emergency locums are being used because there is an emergency. When the minister and I were elected as regional Highlands and Islands MSPs, we both knew the problems that patients in the Highlands faced. New Craigs hospital was reducing bed numbers, there was a shortage of psychiatrists, and constituents were having to travel vast distances or were having online consultations via Near Me with different psychiatrists.

It is clear, minister, that you have no idea of the extent of the problem, and you had no idea of it before it was flagged up to you as a result of the investigation. Surely, if you did, the Scottish Government would have done some workforce planning years ago—and you have not. Do you think—

Always speak through the chair, please, Mr Mountain.

Thank you—[Interruption.]

Do continue, Mr Mountain.

Sorry, but I am hearing a lot of barracking from my right and it is difficult to ask the question. [Interruption.]

I would be grateful if members could resist any temptation to contribute.

Thank you, Presiding Officer.

I do not believe that the minister had any idea of the problems until they were flagged up as a result of the investigation. Otherwise, the Scottish Government would have done proper workforce planning to ensure that that did not happen. Trying to solve the problem now is like bolting the door after the horse has bolted. Minister, do you think that you really are in charge of what is going on?

Again, Mr Mountain, I would ask that you always speak through the chair.

The member is aware that, before I came into politics, I worked for 20 years as a mental health pharmacist in NHS Highland. The issue is very close to my heart, and it has been throughout my working life. Not only that, but it is important to my constituents.

Many of the issues that the member raises in the chamber today have been raised with me, and I, in turn, have raised them with NHS Highland. I am well aware of the challenges that exist right across the workforce. It is really helpful to see that the latest statistics for NHS Highland mental health nursing staff show an increase of 3.6 per cent in the latest 12 months to 30 September 2024, while the number of psychiatry staff increased by 10.5 per cent in that period. Despite that huge improvement, and in view of the on-going challenges that NHS Highland faces, my officials continue to offer enhanced monitoring and support to NHS Highland’s mental health services.

I will address what we are doing nationally to tackle those issues. The mental health and wellbeing workforce action plan is committed to the on-going work of the psychiatry recruitment and retention working group, which is considering how we can better support the recruitment and retention of psychiatrists. As I said in answer to the member’s first question, the psychiatry working group is actively exploring possible solutions to issues such as the use of locums. The group will meet in December 2024 and will report back to me in spring 2025. I look forward to seeing that report and taking forward the group’s recommendations.

It is welcome to hear the minister outline what is happening right now. Will she set out the changes that have happened in the psychiatry and mental health workforce over the past decade? What impact are the pension rules set by the UK Government having on the retention of psychiatrists?

The member asks really good questions. Although record numbers of staff are providing mental health support to a larger number of people than ever before, we acknowledge that it does not feel like that on the ground. That is why we have continued to invest heavily in our mental health workforce—that is, the broad, multidisciplinary health workforce.

I have already referenced the increase in mental health nursing and psychiatrists in Highland. In 2024-25, in order to support multidisciplinary teams, the Scottish Government provided national health service boards with approximately £2.7 million for mental health pharmacists and technicians, and we provided NHS Scotland with around £30 million for continuing education and training and for workforce expansion. [ Interruption .] Mr Mountain is now barracking me from a sedentary position, which I find profoundly unhelpful as I am trying to get on the record the work that we are doing, in response to the question that he asked.

We have exceeded our commitment to provide funding for 320 additional staff in child and adolescent mental health services by 2026. We have also funded more than 800 additional mental health workers in accident and emergency departments, general practices, police custody suites and prisons.

The issue of pension taxation is reserved. We have raised it with the UK Government, in recognition of the fact that we have limited ability to influence that space. We have taken the action that we can, by devolving powers to NHS boards to use local flexibilities within NHS pension arrangements and to offer pension recycling.

Despite that, Scotland’s mental health has worsened, according to all measures. The most recent Scottish mental health survey found that the CAMHS waiting time target has never been met and that a total of 28,000 Scots are waiting for mental health support. We have seen the Government’s response, which has taken the form of an extortionate sticking plaster through more than £130 million being spent on locum psychiatrists over the past five years. As we have heard, health boards have been paying up to £837 per hour to plug the gaps. Does the minister’s idea of a robust NHS workforce strategy involve anything resembling such a figure? Does she consider such expenditure to be an appropriate and good-value use of taxpayers’ money?

NHS Scotland’s staff pay bill is more than £10 billion a year, with spending on locum psychiatrists being a tiny fraction of that. As Paul Sweeney will be aware, spending on such locums is managed by local health boards. Boards should always seek to secure the best value when they enter into arrangements for the use of locum psychiatrists.

At a national level, as I mentioned in response to the question last week, we have established a medical locum task and finish group to review and improve the processes and practices that are adopted when locums are engaged locally.

In reference to the first part of the member’s question, I agree that there is undoubtedly a rise in demand. In some parts of the country, for example, we have seen a 1,500 per cent increase in requests for neurodevelopmental assessment. Those pressures could not have been predicted. That relates to the reduction in stigma associated with those causes, which is a really good thing, but it undoubtedly adds to the challenge in managing the current situation.