Meeting of the Parliament [Draft]
Meeting date: Wednesday, March 13, 2024
Official Report 1124KB pdf
Contents
- Portfolio Question Time
- National Health Service Waiting Lists
- Scotland’s Economy
- Business Motions
- Parliamentary Bureau Motions
- Decision Time
- International Long Covid Awareness Day
Portfolio Question Time
Rural Affairs, Land Reform and Islands
Good afternoon. The first item of business is portfolio questions, and the first portfolio is rural affairs, land reform and islands. Members seeking to ask a supplementary question should press their request-to-speak button or enter the letters RTS in the chat function during the relevant question.
Agriculture Budget
To ask the Scottish Government when the remaining £46 million of deferred funding from the agriculture budget will be returned. (S6O-03182)
The 2024-25 budget returns £15 million in capital to provide important support to our rural communities, and the Deputy First Minister has committed to returning the remaining £46 million in full in future years. The remaining ring-fenced funds will be returned in full at the right time for specific measures that will help the transformation of Scotland’s farming and food production industry. That does not impact on the existing commitments or schemes, and the appropriate profile for returning the remaining £46 million of ring-fenced funding will be considered as part of a future budget process.
The minister’s response of “At some time” gives no comfort to all our farmers.
At the National Farmers Union Scotland conference, the First Minister could not say when the £46 million would be returned to the agriculture budget. Since then, the Scottish Government has had an extra £295 million in Barnett consequentials from Westminster. Can the minister tell us how much of that extra money will go to repay the £46 million taken from our farmers?
It never ceases to amaze me that the Tory party can come here and make comments about the £293 million, which is almost a couple of hundred million pounds less than what the figure should have been for the national health service consequentials. Some £230 million of that money will go to the NHS to counter the cuts that we have already faced.
What about the ring-fenced money?
Let the minister respond, please.
The ring-fenced money has already been allocated or will be allocated in the future. While £15 million has been returned to the budget, the other £46 million will be coming in future budgets, once the Scottish Government can work out its priorities after the savage cuts that have been made by the Tory United Kingdom Government.
Does the minister agree that capital investment is vital if we are to transform how we support farming and food production in Scotland, so that we help farmers and crofters invest in improved slurry storage and take action to tackle climate-related issues such as water scarcity and flooding? How does the failure of the Westminster Tory Government to provide any additional capital for Scotland in the budget affect our plans to become a global leader in sustainable and regenerative agriculture?
The UK Government failed to provide any additional capital funding for Scotland or our rural communities. Indeed, our capital budget is expected to fall by nearly 9 per cent in real terms, which is a cumulative loss of more than £1.3 billion to 2027-28.
In contrast, the European Union’s common agricultural policy provided a multi-annual programme budget over a seven-year period, with flexibility to use capital or resource spend. The UK Government offers only yearly allocations that fail to provide adequate EU replacement funding or a commitment on future spend on agricultural support, which requires long-term certainty. We need clarity and certainty from the UK Government right now about future rural funding after 2025, because we have no idea right now whether it will be the Tories or Labour in government, and neither of them is committing to supporting rural Scotland.
The minister will be well aware how appalled those in the farming industry will be at the fact that he is unable to say when the money will be returned to the budget. Is the minister aware of any other budget within the Government’s budget that is being raided in that way?
Liam McArthur is well aware that every budget has been under pressure because of the savage cuts that have come from the UK Government. Cabinet secretaries across the Government are all trying to find ways of pulling in their horns to ensure that we can deliver a balanced budget, as has been done every year since the Scottish National Party came into government; indeed, the Scottish Government has balanced its budget every single year. Everybody’s budget is under strain.
Before I call the next question, I remind members that this is a question-and-answer session so, after the question is asked, we listen to the answer.
Local Rural Economies (Housing)
To ask the Scottish Government, in relation to its rural delivery plan, what discussions the rural affairs secretary has had with ministerial colleagues regarding the impact of its housing strategies, including the rural housing action plan, on local rural economies. (S6O-03183)
The Scottish Government’s rural delivery plan will set out how all parts of the Scottish Government will deliver for Scotland’s rural and island communities. The Cabinet Secretary for Rural Affairs, Land Reform and Islands co-chairs the ministerial working group for the plan; the group has been established to drive activity and ensure cohesive delivery, and I am a member of it.
I am not sure that the action plan is in fact delivering for local communities across Scotland. I want to raise the issue of hotspot areas in the Highlands that are experiencing extreme pressure, due to the number of second homes. In some areas, the proportion of second homes is approaching 60 per cent, which is creating a number of difficulties, as I am sure members in the chamber understand. There is difficulty in recruiting people into public services such as teaching and the national health service, because there is quite literally no accommodation for those people. As the current policies are not working, perhaps it is time for the Government to consider giving communities the power to decide when the level of second homes is getting too high.
A number of initiatives are under way. The member will be aware of the recent legislation that gave local authorities the ability to double council tax for second homes. Short-term lets control areas are also an option for local authorities, and they can be specific about what they do with them. The £25 million key workers fund is available, too. I should say that Richard Lochhead and I had a round-table discussion with various local authorities and employers a few months ago, and we have a follow-up meeting coming up to talk about support in that area.
There are also economic development opportunities around renewables hubs, and we have had discussions with Scottish and Southern Electricity Networks and SP Energy Networks about, first of all, temporary accommodation units and how we can provide legacy units beyond that. A lot of work is going on. We are also working very closely with Highlands and Islands Enterprise and South of Scotland Enterprise on combining economic development and growth with housing opportunities.
As I have said, considering short-term lets control areas is key, and each local authority has the ability to bring those things forward and apply them specifically.
I have requests for supplementary questions from three members. I hope to take all three, if we can have reasonably brief questions and answers.
That is all talk from Minister McLennan. The house-building record of this Scottish National Party Government has been dreadful, with rural areas away from the central belt bearing the brunt of its failures. Over the course of the 2016 parliamentary session, the Scottish Government promised to spend £25 million on rural house building but failed to do so. Will the minister confirm whether the SNP Government has finally met that pledge eight years later? What further steps will he take to scale up rural house building?
That is bare-faced cheek from the Conservatives. It comes back to the capital budget being cut—[Interruption.]
Members, we must hear the minister who has the floor. Minister, please resume.
I will, if they will let me answer. First, I will provide a bit of context. [Interruption.]
Minister, please resume your seat. We are not going to make much progress and the net result will be that I will be able to call fewer members to ask supplementary questions, and indeed might not even get to all the questions on the Business Bulletin.
Minister, please resume.
There are a couple of things to say. The capital budget has been cut by 10 per cent, as the member will know, and there has been a financial transactions cut of 62 per cent in one year. I point out that 40 per cent more homes are being delivered per head of population than in England, and 70 per cent more than in Wales, and the Scottish Government has delivered 10,000 houses in rural areas over a number of years.
I have already touched on areas that we are looking at, including short-term accommodation for key workers and economic development opportunities with SSEN and SPEN, and how we develop them. Scotland has a proud record—indeed, its delivery record compared with England and Wales is outstanding—but the easiest and quickest way to build more houses would be for the UK Government to reverse that capital budget cut.
The Scottish Government has announced a £205 million cut in real terms to the affordable housing supply budget, despite the lack of affordable housing being consistently raised as a top concern in rural areas and consistently considered a cause of depopulation. The minister knows that it is more expensive to build in rural areas, so can he reassure me and the Parliament that the promise outlined in the rural housing action plan to deliver 11,000 affordable homes by 2032 will truly be delivered in rural areas?
That is a very important point. The target is to deliver roughly 20 per cent more homes in rural areas. I point out that there has been construction inflation of 20 per cent over the last year or so. In previous debates, we have talked about 10 per cent more homes equating to about 11,000 homes; that is the important part of this, as is the fact that 10 per cent is the minimum amount.
Actions were set out in the rural housing action plan last year. The short-term actions are to take place over about nine months, and then we go beyond that to the actions that will take place in medium and longer term. We are still working on those objectives.
We are working very closely with SSEN on renewable development opportunities. We will also come back to look at short-term accommodation requirements and the longer-term legacy of that housing, and work is going on with Highlands and Islands Enterprise on that. The rural delivery plan plays an important part, too; after all, housing drives economic development and economic development drives housing, so the plans have to work closely together. I am happy to meet the member to discuss that and other specific related issues.
I agree with Ash Regan on the importance of community groups in resolving the housing crisis; indeed, the fact that so many communities have delivered excellent housing developments across the Highlands proves that. A number of communities have approached me in recent days, not least Elgol. Is the minister open to engaging with those community groups about progressing such developments?
The member has raised a very important point. The Communities Housing Trust was awarded nearly £1 million to deliver capacity for local communities. I have already met people from a number of communities in Kate Forbes’s constituency area, and will continue to do so, and I am very happy to take the issue up with the member and meet people from the community that she has mentioned.
Wildlife Crime
To ask the Scottish Government what its response is to reports of rising wildlife crime across Scotland. (S6O-03184)
The Scottish Government has always been clear that wildlife crime is unacceptable. We have implemented a number of important changes in recent years to tackle wildlife crime, including increasing the maximum penalties for the most serious wildlife crimes and strengthening the laws around hunting with dogs.
The Wildlife Management and Muirburn (Scotland) Bill contains a number of key changes to help tackle instances of wildlife crime, including the persecution of raptors occurring on some grouse moors. I encourage anyone with information relating to any wildlife crime to report it to Police Scotland.
The Scottish Government is set, in the bill that was referenced, to grant additional powers to the Scottish Society for Prevention of Cruelty to Animals to investigate wildlife crime, but rural communities nevertheless expect Police Scotland to play a role, too. What research has the Scottish Government done on the impact of outsourcing policing on evidence and convictions, and what impact is having those powers projected to have on the SSPCA’s other duties and purposes?
The member is talking about a part of the bill that will be decided on next Tuesday, and I am delighted that he has taken such an interest in it, given that there has been a lot of discussion and debate about the bill across the chamber. We are getting to the heart of where the bill will be, which is right in the proper place, and I welcome and look forward to the Conservatives voting for it.
The SSPCA’s powers are very limited and will be carried out in a concordat with the police. The organisations will work together to ensure that crimes that are reported can be progressed slightly beyond the point at which the SSPCA has been able to in the past, but the police will still carry out the final investigation.
Island Connectivity
To ask the Scottish Government what cross-Government action it is taking to improve island connectivity, in order to support measures to increase the population of Scotland’s islands. (S6O-03185)
The very first strategic objective in the national islands plan commits the Scottish Government to addressing population decline to ensure a balanced population profile for our islands, and the recent addressing depopulation action plan sets out how we will work with regional, local and community partners to deliver a sustainable solution to those challenges.
Our recently published draft “Islands Connectivity Plan—Strategic Approach” paper proposes a vision that Scotland’s ferry services—supported by other transport modes—should be safe, reliable, affordable and inclusive for residents, businesses and visitors, enabling transport connectivity, sustainability and growth of island and peninsula communities and populations. The draft strategic approach paper is open for public consultation until 3 May, and I encourage responses.
Would the minister agree that the population of Scotland’s islands is not only a challenge for the people on the islands, but a challenge for the whole country, even for those in cities, such as myself? Would he encourage young people, as they think about their career, to at least consider spending some of their time working and living on the islands?
I absolutely agree with that sentiment. The islands are profoundly important and contribute positively to our cultural heritage, environment, economy and national identity. Despite the challenges, islands are great places to live for our young people. That is why encouraging young people to stay within our rural and island communities or to move there is a priority in the addressing depopulation action plan.
As someone who has lived in a rural community, I know that such communities have a different sense and a different feel. Living in them is different from the way in which people normally live in a town, but there is a fantastic community feel in islands and rural communities that I encourage people to look at. That is why we are working with Youth Scotland and the young islanders network to consider how to best address population decline through co-developing ideas and actions to support and encourage young people to remain on, move to or return to the islands. We will also work to increase young people’s participation in community councils, which could empower young people to inform improvements to services in their area, making rural communities far more attractive places for them to live and work.
The exciting development of SaxaVord spaceport will play a vital role in the country’s space industry. However, to get to the spaceport in Unst, people have to take two ferries from Shetland’s mainland. Does the minister agree that cross-Government action on short subsea tunnels between Shetland’s islands would improve connectivity and reverse depopulation, as our Nordic neighbours have found with their tunnel projects?
I have to say to Beatrice Wishart that that is not something that I have heard about, but I would be keen to engage with her about it, and I am more than happy to meet and talk to her after this session.
Crop Damage (Beavers)
To ask the Scottish Government what support is available to farmers who have experienced damage to crops as a result of the activities of beavers. (S6O-03186)
Beavers burrowing into flood banks can exacerbate flooding in some areas, but in other circumstances beavers can reduce flood risks. I will be visiting a farm in Perthshire next week with NFU Scotland to discuss the flood damage and how that may have been exacerbated by beaver activity.
Farm viability and livelihoods can go hand in hand with delivering for nature and climate. However, that cannot be at the expense of farm incomes. NatureScot has mitigation measures available and we are exploring long-term solutions to key issues, such as increasing the resilience of river banks to flooding events.
When the minister visits farmers in Perthshire, she will be aware, as the minister beside her, Jim Fairlie, is well aware, that there are also farmers alongside rivers such as the Tay, the Arran, the Ericht and the Isla who have suffered significant loss due to flooding and damage to crops due to beavers eroding traditional flood banks.
It was the Scottish Government that decided, against the wishes of many in the farming community, to reintroduce beavers and to give them protected status. Does the minister accept that that puts a moral obligation on the Government to fully compensate affected farmers for the losses that they suffer?
Beavers are native to Scotland, and their re-establishment will play an important role in restoring Scotland’s natural environment. We are looking at how the Scottish Government and NatureScot can further support farmers to host beavers. There are opportunities to do that through the upcoming changes to agricultural support.
In my visit to Perthshire next week, we will be talking about mitigation plans and about what is available for farmers. Beaver licences will continue to be available to deal with serious risks where there are no feasible alternatives for beaver management. Of course, we also need long-term flood management, which would include things such as natural flood management and the realignment of flood banks, to help mitigate beaver issues.
I welcome the recent reintroduction of beavers in the Cairngorms national park, which has the dual benefit of facilitating translocation into a suitable habitat and providing an alternative to lethal control. What measures are being taken by the Cairngorms National Park Authority to support farmers to mitigate any impacts to their businesses?
The release of beavers in the Cairngorms national park represents a key milestone in ensuring that beavers, as an iconic species and as ecosystem engineers, can once again thrive across Scotland. The Cairngorms National Park Authority has produced a management and mitigation plan that reflects land managers’ primary concerns. The park authority’s commitment to fund small-scale mitigation activities and remedial works adds significant extra resource on top of the national mitigation scheme that is operated by NatureScot. That approach has been commended outside the farming sector.
Proposed Land Reform Bill
To ask the Scottish Government whether it will provide an update on its progress towards introducing its proposed land reform bill. (S6O-03187)
As outlined by the First Minister in September, the current programme for government includes a commitment to introduce a new land reform bill. Although I cannot comment on the contents of the bill ahead of its introduction to the Parliament, it will further improve transparency of land ownership, help to ensure that large-scale landholdings deliver in the public interest and empower communities by providing them with more opportunities to own land and have more say in how land in their area is used.
I recognise that many think that land reform is a rural matter. Could the minister give us an outline of how the contents of the bill will benefit people who are in urban settings who want to bring land and buildings into community ownership?
We strongly support community ownership for all communities, which is why, in 2015, the Scottish Government extended the right to buy to urban areas through the Community Empowerment (Scotland) Act 2015. We have also extended eligibility for the Scottish land fund to groups in urban areas. Since then, there has been a steady increase in successful applications from community groups in towns and cities across Scotland. A review of the provisions in legislation for the community right to buy will begin this summer, following the introduction of the land reform bill. It will cover the legislative and procedural aspects of the community right to buy and will report at the end of 2025.
Good Food Nation (Scotland) Act 2022
To ask the Scottish Government what discussions the rural affairs secretary has had with the health secretary regarding implementing the commitments contained within the Good Food Nation (Scotland) Act 2022. (S6O-03188)
The ministerial working group on food is the mechanism for cross-portfolio discussions and decision making on food-related policy at a ministerial level. Health interests are represented on that group by the Minister for Public Health and Women’s Health. The good food nation plan has been discussed at all the in-person meetings of that group. The group has also worked by correspondence to review and approve the consultation draft.
The Good Food Nation (Scotland) Act 2022 sets out a vision for Scotland to be a nation
“where people ... take pride and pleasure in, and benefit from, the food they produce”,
purchase and prepare. In order to achieve that aim, it is vital for the rural affairs secretary and the health secretary to work together to support high-quality producers and address ultra-processed foods and foods that are high in fat, sugar and salt, which are detrimental to health. Can the minister reaffirm that cross-portfolio working will continue to take place? Will she comment on whether the good food nation commitments will be enacted?
The good food nation plan reflects the importance of cross-portfolio working in order to achieve our vision of Scotland as a good food nation. The plan describes the key focus to achieve our vision of Scotland as a good food nation and details the working mechanisms that are in place to support that. The final version of the plan is due to be published in 2025. However, there is on-going work on the outcomes. For example, there is an open consultation on proposed regulations to restrict promotions of food and drink that is high in fat, sugar and salt, in line with our public health priority to create a Scotland in which everyone eats well.
Fishing Industry (Support)
To ask the Scottish Government whether it will provide an update on what steps it is taking to support the fishing industry. (S6O-03189)
As set out in the answers to previous questions on the subject, the Scottish Government continues to support and manage Scotland’s vital fishing industry in a number of ways. We continue to deliver the actions in our 10-year fisheries management strategy, with an update to the strategy’s delivery plan due for publication later this year. The strategy is underpinned by the funding that we continue to provide through marine fund Scotland and the various functions that we deliver to ensure that our fishing industry can operate sustainably and effectively.
Last year, the fishing sector asked the Scottish Government to consider a derogation to the North Sea cod avoidance plan in order to allow fishing for squid inside 12 nautical miles. As the Scottish Government officials recognised in their correspondence with the fisheries management and conservation group on 5 July last year, it is a lucrative fishery that can take pressure off nephrops grounds. However, no derogation was granted last year and the industry still has not been advised whether a derogation will be granted this year—something that the industry ideally needs to know by the end of this month. Can the minister confirm that a derogation is being considered? When will a decision on that derogation be made?
The Scottish Government wants to restore marine habitats in Scotland’s inshore waters and provide a higher chance of stock recovery and sustainable fisheries in the future. However, I understand that the issue is complex and there are strong views on both sides, and the decision to remove exemptions was not taken lightly.
The answer to the member’s specific question will have to come from the Cabinet Secretary for Rural Affairs, Land Reform and Islands, and I will ask her to respond to the member directly.
Does the minister agree that we would be far better able to support all of Scotland’s fishing industry had the Westminster Tory Government kept its much-repeated Brexit promise to fully replace all European Union marine funding?
I absolutely agree with that sentiment. I do not have the figures in front of me just now, but I know that the EU funding has been grossly cut by the United Kingdom Government and the Scottish fishers were far better off when we were part of the EU.
That concludes portfolio questions on rural affairs, land reform and islands.
NHS Recovery, Health and Social Care
The next portfolio is national health service recovery, health and social care. I remind all members that if they wish to ask a supplementary question, they should press their request-to-speak button, or enter the letters RTS in the chat function, during the relevant question.
Belford Hospital (Replacement)
To ask the Scottish Government what discussions it has had with NHS Highland about progressing planning and design work for the new Belford hospital in Fort William. (S6O-03190)
Officials met with NHS Highland in January to discuss the development of new projects, including the new Belford hospital. As colleagues will be aware, the Chancellor of the Exchequer ignored the Deputy First Minister’s call to increase capital funding for our national health service, so we are still facing a real-terms cut of nearly 8.7 per cent in capital funding over the medium term, until 2027-28. We will continue to work with NHS Highland to make progress where we can, in the face of that lack of capital from the United Kingdom Government budget, but Kate Forbes will understand the challenge that is before us.
I absolutely understand the challenge that the health secretary and indeed the whole Government are dealing with. He will be aware that, at a time of constrained public finances, it is all the more important to use funding that progresses work as far as possible and not waste the previous funding and effort that have gone into bringing the project to the current point. To that end, how much money has the health board asked the Scottish Government for to continue the design work on the new Belford hospital?
Discussions are on-going, and it is essential that NHS boards continue to plan for how they will improve and reform services. We remain committed to supporting them in that process by exploring all funding options that are available to progress projects, as capital projects such as the Belford will clearly assist with patient outcomes and productivity and will thereby assist our NHS recovery.
The UK Government cuts to our capital budget have resulted in new health capital projects being paused. We know that the situation remains challenging, as Kate Forbes highlighted, as many projects around the country are under review. Both the Deputy First Minister and I are working through that challenge, but colleagues will appreciate that that may take some time, as we look at all options. I will do what I can to keep Kate Forbes updated, given her understandable interest and concern.
Fort William is the outdoor capital of the UK, and yet a helicopter taking a casualty from the hills cannot land at its hospital. The people of Lochaber have been promised a new hospital for more than two decades. Will the Scottish Government make good on that promise?
I thank Rhoda Grant for that question, and I understand the concern that she expressed. The need for a new hospital there has been set out, as Kate Forbes articulated. The issue that we have is the financial reality that we face. The costs of these projects have risen, with spiralling UK inflation—which is not the fault of NHS boards or the Scottish Government—and a constrained capital budget, in which £1.3 billion is being removed up until 2027-28. The financial reality is, therefore, that these projects must be reviewed, through the process that is currently being undertaken by the Deputy First Minister and me, in order that we can take forward as many as possible.
ADHD Medication Supplies
To ask the Scottish Government whether it will provide an update on the availability of attention deficit hyperactivity disorder medication supplies in Scotland. (S6O-03191)
Various attention deficit hyperactivity disorder medicines, a number of which are manufactured by Takeda Pharmaceuticals, continue to experience limited and intermittent supplies, with market data indicating that supplies will stabilise between March and the end of May 2024. The shortages are caused by a combination of manufacturing issues and increase in demand. The pricing and supply of medicines is reserved to the United Kingdom Government, and we continue to engage with it on the issue.
The Scottish Government recognises the impact of the global shortages on people who are living with ADHD and their families. NHS Scotland has robust systems in place to manage medicine shortages when they arise. Anyone who is affected by the issue should speak to their clinical team.
During a recent event that I sponsored in the Scottish Parliament, I had the opportunity to meet a young girl with ADHD who expressed concerns about her medication. She shared her experience of having to skip medication days. Can the minister advise on measures to ensure that no child with ADHD needs to skip their medication days?
I thank Rona Mackay for raising the issue in the chamber. I am sorry to hear about the situation in which the young girl to whom she spoke finds herself.
A UK-wide national patient safety alert is in place for medicines that are used for the treatment of ADHD. It advises healthcare professionals of the shortage and provides information on alternative suitable medication where appropriate. Restrictions have been introduced that prohibit a number of medicines for the treatment of ADHD from being exported from the UK or stockpiled, to protect supplies. The chief pharmaceutical officer for Scotland is a member of a UK-wide medicine shortage response group, which has been set up to identify and co-ordinate responses to medicine shortages and provide advice to clinicians on alternative therapeutic options.
The shortage of ADHD medication supplies is causing distress for people who advocated tirelessly to get a diagnosis in the first place. One constituent of mine first sought a diagnosis in 2008 and was finally diagnosed privately with ADHD in 2023, but she will shortly run out of the medication that she needs. What consideration has the Scottish Government given to exploring new procurement options for drugs such as lisdexamphetamine, given the production issues that the current supplier faces?
As I said in my response to the original question, the UK Government remains responsible for medicine supply. However, the Scottish Government is in close dialogue with all health boards to manage the shortage and provide support where necessary.
Health Budget
To ask the Scottish Government what its response is to a recent report from the Institute for Fiscal Studies, which states that the 2024-25 budget implied a real-terms reduction to health spending. (S6O-03192)
The Scottish budget shows year-on-year real-terms growth in health funding when we compare the opening position. The budget document states the opening budget position for each financial year and allows direct comparison with the previous two years, which provides a consistent point of reference for the Parliament and stakeholders.
In fact, the IFS report also notes the-real terms increase when comparing on a budget-to-budget basis. The report clearly underlines how important additional in-year funding is to maintaining real-terms growth. That funding is directly dependent on the United Kingdom Government prioritising additional health investment over the year, but we did not see it prioritised in the budget.
I recognise that comparisons can be made with previous years, but the Institute for Fiscal Studies made the point that the Scottish Government’s claim that health spending had increased by 1.3 per cent for 2024-25 did not include the top-up figures for the previous health budget in 2023-24. Does the cabinet secretary recognise that there is some inconsistency in that, and that that makes it more difficult to scrutinise budgets?
No. As I said in my earlier answer, we provide budget-to-budget consistency so that there can be clear scrutiny. Given the pressures that we are currently under, I more than understand how important in-year consequentials are and I encourage the UK Government to continue to consider the call from international organisations to prioritise investment in public services instead of tax cuts, because that would allow us to further increase spending in our health service, which is much needed.
Liz Smith and the Conservatives seem to imply that, somehow, money could appear out of the magic money tree to fund the national health service in Scotland. Can the cabinet secretary clarify whether the NHS in England is much better funded?
Answer on matters within your responsibility, cabinet secretary.
The decisions that are taken in the UK Government for the NHS in England have a direct consequence for the budget that we have in Scotland. The UK Government’s figures show that the Department for Health and Social Care’s budget for 2024-25 is 0.2 per cent less in real terms than in 2023-24. Those figures stand. In contrast, our 2024-25 budget provides a real-terms increase of almost 3 per cent for the NHS in Scotland, as we continue to prioritise front-line public services.
Patients and staff have been promised state-of-the-art national treatment centres for many years now, specifically to increase capacity and tackle the waiting list backlog. As a result of the real-terms reduction in health spending in the forthcoming financial year, the cabinet secretary has instructed health boards to halt all project plans. Now that the NHS recovery plan is in tatters, how does the cabinet secretary intend to clear the waiting list backlog?
I do not accept the premise of Jackie Baillie’s question. She is suggesting that it is decisions that we are making around the capital investment in our NHS that are detrimental to the national treatment centres project, but that is not the case. The situation is a direct consequence of the decisions that have been taken elsewhere, as we have seen nothing about a capital increase to our budget in the spring statement or, indeed, the autumn statement.
The national treatment centres are absolutely critical to our continued recovery, and I want to see them happening. However, as I said in my answer to Rhoda Grant’s question, there is the financial reality of a diminishing budget from the UK Government and increased costs, which mean that we have to put those projects under review. Wishing it to be otherwise is not enough; we have to get on with looking at how we can fund those centres, which I am committed to considering as far as possible.
What assessment has the Scottish Government made of health spending and the impact on front-line services and patients in rural and island areas, given the higher costs of delivering services to those areas?
That is something that both I, as somebody who grew up in an island community, and the Government recognise. In negotiations with health boards, we will look at what we can do to provide on-going support around the disproportionate costs of delivery of their service. That remains under constant review on a budget-to-budget basis.
National Health Service Dentistry (Dunoon)
To ask the Scottish Government whether it will provide an update on the availability of NHS dentistry for residents of Dunoon and its surrounding communities. (S6O-03193)
NHS Highland has recently been successful in recruiting to posts within the public dental service in Dunoon, which is currently providing NHS dental care for priority groups as well as emergency dental care. I also understand that the board has procured funding to establish a peripatetic service, which is expected to be in operation around Argyll and Bute this summer. The board has a dedicated dental helpline for patients in Argyll and Bute, which can provide advice on which practices are accepting new NHS patients in Highland and surrounding health boards, as well as further advice and support.
I appreciate that work has been on-going. In response to a previous written question on the matter, the Government noted the opening of a new dental practice in Inverness. Although that might be welcome for residents there, it is hardly of comfort to residents in Dunoon, who are 174 miles, or four and a half hours, away—several deeply concerned residents have been contacting me about that. I appreciate that something has happened, but does the Scottish Government have other incentives to offer existing local practices to help increase their capacity and meet demand?
On Friday, I had conversations with a number of my constituents about dentistry in Dunoon and Cowal. I had hoped that a new dental practice would open in Dunoon, because there had been interest in one of the Government’s Scottish dental access initiative grants, which gives £100,000 for a new practice to be opened. Unfortunately, the dentist who had previously expressed an interest in purchasing the practice via the grant has advised that they are no longer progressing the matter.
I mentioned the peripatetic unit, which I think will make a difference, and the board has advised me that it continues to seek expressions of interest for the grant and continues to engage regularly with local dental practice owners and dental corporate bodies regarding the provision of NHS dental services for communities in Dunoon and Cowal.
NHS Forth Valley Assurance and Improvement Plan
To ask the Scottish Government when it last received an update on NHS Forth Valley’s assurance and improvement plan. (S6O-03194)
The Scottish Government receives regular updates on NHS Forth Valley’s assurance and improvement plan through the NHS Forth Valley assurance board, which last met on Friday 8 March 2024. Good progress is being made across all areas of leadership, culture and governance, and, given the strong focus on evidencing the improvements that are being made, I am hopeful—I am confident—that that will lead to de-escalation.
Minutes from the NHS Forth Valley assurance board meetings are published and can be viewed on the Scottish Government’s website, www.gov.scot. A copy of the improvement plan is available on NHS Forth Valley’s website.
I acknowledge that progress is being made and that Forth Valley royal hospital performs well in, for example, elective care. As the local MSP, I continue to get a steady stream of very positive messages about the care that people are receiving, and we should acknowledge the work of the staff in that regard.
The cabinet secretary will be aware of the challenges that smaller health boards such as NHS Forth Valley face. Will he outline any further measures that the Scottish Government is taking to address that?
I thank Keith Brown for his interest and for the information that he has passed on about direct patient experience, which is incredibly important. This is a challenging time for us all. I, too, recognise the progress that has been made in elective care, as well as the continued difficulties in, for example, unscheduled care and the challenges that smaller boards are facing more widely.
The Government is continuing close dialogue with boards to maximise performance and delivery locally. That is supported by strategic collaboration on financial and workforce planning. Practical measures from an NHS Scotland perspective include mobilising tailored improvement support from the national Centre for Sustainable Delivery, creating additional capacity through the new national treatment centres and targeting regional and national approaches, where appropriate, to support pressured services.
I recognise that, in NHS Forth Valley’s case, improvements have been made. There is more to do, and I am committed to providing as much support as I can so that that continues.
It is unclear how the required improvements to urgent and unscheduled care at NHS Forth Valley will take place, and the picture on psychological therapies and children’s mental health is extremely challenging. What improvements have been made and what action can be taken to ensure that patients are given the care that they require?
I recognise Alexander Stewart’s points and reiterate my points in response to Keith Brown about our providing support and intervention in those areas. Alexander Stewart is right to point to unscheduled care as a particular concern, which has been the case for a long time. I hope that we will see some improvements to NHS Forth Valley’s figures in the weekly accident and emergency statistics. However, it is coming from a very low bar and we need there to be a much greater improvement. My commitment is to continue to support the board in the progress that is being made.
E-health Strategy
To ask the Scottish Government how it will develop its e-health strategy in the coming years. (S6O-03195)
I can confirm that the Scottish Government’s e-health strategy was replaced by a digital health and care strategy, which was published jointly with the Convention of Scottish Local Authorities in 2018 and updated in 2021. The strategy is accompanied by an annual delivery plan, with the 2024-25 delivery plan scheduled to be published in April 2024. There are no plans to develop the strategy further in the immediate future.
One of the few benefits of the Covid pandemic was that we were able to embrace digital technology much more, which came to the rescue in many fields, not least in telehealth. Does the cabinet secretary agree that we must continue to develop and exploit the power of digital technology in our health service to help us to improve things such as general practice appointment systems, e-health digital consultations and general telehealth services, which are not only crucial for people who live in rural parts of Scotland but are valuable as a means of improving general access to all our national health services?
Yes, I agree that further utilising innovation and technology will be a central element of reforming health and social care. I agree that we should be exploring more opportunities for greater use of digital solutions. Some of that is about maximising the capabilities of our existing investments. For example, the new GP information technology system, which we are in the process of rolling out, gives GPs the ability to offer online booking services. We have already rolled out the Near Me service for online consultations.
Some of this is about exploring the art of the possible. Through the Scottish Funding Council, we have recently confirmed 10-year funding for the Digital Health and Care Innovation Centre to continue to lead our efforts to explore where those opportunities are.
I am grateful to Willie Coffey for raising the issue, because digital is an area in which we will need to spend much greater time and resource.
As we attempt to tackle significant issues in our health service, I hear time and time again from our health boards that their outdated IT systems are a block to progress. A modern collaboration and communication platform is essential, to bring our health service back into a better state, especially in data gathering and the development of our e-health systems.
The Chancellor of the Exchequer committed in excess of £3 billion to develop healthcare tech. Will the cabinet secretary consider working with the United Kingdom Government to bring NHS Scotland’s IT systems up to scratch and create a UK-wide communication and collaboration system?
I agree fundamentally with the points that Brian Whittle raises about the need for that investment, though I gently point out to him that the investment that was announced by the chancellor is money that will arrive not this year but in years to come. I believe that we need that investment much earlier.
Of course, we will seek to collaborate, where it is possible, to ensure that there is effective communication between systems and, within Scotland, between GP services, acute settings and social care. That is exactly what the reform discussions that I am embarking on will be about trying to direct. With regard to where the capital comes from to invest in that work, I encourage Brian Whittle to encourage his colleagues to see to it that that investment is front-loaded, so that we can have it now.
The roll-out of e-health and digital technology is going at quite a slow pace. Recording of patient data still differs from one health board to another, which hinders progress, and some prescriptions are still being written by hand.
If we are to develop an e-health strategy that is fit for the future, we must see rapid advancement in the streamlining of recording practices across the country, and we must ensure that staff and patients alike are clear on what that progress looks like. Will the cabinet secretary outline in any future e-health strategies how we might address those concerns?
I agree with the premise of Carol Mochan’s question. She is absolutely right that, for us to have a productive health service that is responsive to patient need and that ensures that our clinicians are able to communicate effectively—between boards, where that is necessary, and between different settings, such as primary, acute and social care—cohesion and coherence are necessary.
We are already making investments, although I take the point that Carol Mochan makes about the pace of those. We want to go faster. We are looking with interest at the capital investment that is to come in future years from the UK Government, and we would want to see investment to come sooner. I will continue to collaborate with boards and colleagues on how we can make the digitisation of our health services a faster process.
NHS Lanarkshire (Recovery)
To ask the Scottish Government whether it will provide an update on NHS Lanarkshire’s recovery plans. (S6O-03196)
NHS Lanarkshire, like all health boards, produces annually updated delivery plans that set out how it is addressing the challenges that are set out in our national health service recovery plan. Boards are currently in the process of developing their updated plans for 2024-25. Once NHS Lanarkshire’s plans are finalised, they will be published via its website.
The plans will set out how the board continues to address significant on-going pressures as Covid backlogs, delayed discharge and Brexit-related staff shortages compound the pressures on its already stretched services. I offer my continued thanks to NHS Lanarkshire and its staff for their on-going and dedicated effort during these challenging times.
I also put my thanks to NHS Lanarkshire staff on the record. Can the cabinet secretary advise whether the downgrading of the neonatal intensive care unit at Wishaw will help or hinder NHS Lanarkshire’s performance? In his assessment, will that plan be good or bad for the babies, children and families of Lanarkshire?
To be clear, there is no downgrading of Wishaw general hospital’s neonatal unit. The changes are about ensuring that we provide, in a safe way, the specialist services that certain sick babies need.
My colleague Jenni Minto visited Wishaw general hospital recently and was able to see the progress that is being made there. We will continue to engage with staff and patients to ensure that there is understanding of why it is necessary to take forward the changes, which are led by clinical advice and evidence. I will ensure that Monica Lennon has that advice sent to her, by either me or Ms Minto.
General Practitioners (Training and Recruitment)
To ask the Scottish Government whether it will provide further details of the progress that it is making towards fulfilling its 2017 commitment to increase the number of GPs by 800 within a decade. (S6O-03197)
I remain fully committed to increasing the number of GPs in Scotland by 800 by 2027. I welcome the fact that the GP headcount has increased by 271 since 2017 and is now consistently over 5,000. Training new GPs is key to our approach. That takes time, but we have expanded GP specialty training, adding 35 places this academic year and a further 35 places next year. There are currently just over 1,200 trainee GPs in Scotland. We are also investing over £1 million each year in recruitment and retention initiatives, and I will set out my plans to further increase GP numbers in due course.
When I met a constituent who works part time as a GP, I was concerned to hear his view that, because GPs are not given financial support to have trainee doctors working with them, GPs are potentially missing out. The situation means that trainee doctors do not see the fantastic contribution that GPs make to our health service. My constituent wanted me to highlight directly to the Scottish Government that lack of funding, which does not apply to hospitals. Will the cabinet secretary review the issue and consider whether providing funding could make a big impact?
Sarah Boyack will be well aware of the financial pressures under which we are operating, but, in principle, yes, I am more than happy to look at that and to hear more from Sarah Boyack’s constituent about how we can increase the resource that is going into primary care. Part of the reform consideration is about prevention and ensuring that people use primary care much more effectively. I would be happy to meet Sarah Boyack and her constituent to hear about that directly.
GP shortages are particularly acute in Scotland’s Highland, island and rural areas, and doctors are quitting. Some rural practices are now wholly staffed by temporary locum doctors. That is worsening health inequalities and depopulation in those areas. The shortfall of GPs has been described as critical by the British Medical Association, and it has called for special measures to be put in place to reverse the crisis. Golden hellos clearly are not enough to address the issues, and current schemes are also not delivering enough GPs.
We need urgent action to properly tackle the root problems of the failure to recruit and retain GPs. What urgent action is the Scottish Government taking to address the crisis in rural and island communities now?
I have already set out in response to Sarah Boyack’s question the work that we are doing to invest in recruitment and retention—that is worth £1 million a year—and to provide increased numbers of GPs in training. We currently have 1,200 GPs in training. I look forward to meeting the BMA and hearing more about its suggestions for how we can continue to facilitate recruitment and retention, but we will do so in a financially constrained environment in which decisions that have been taken for us have had an impact. For example, Brexit has had an impact on our workforce, and the fact that the resources coming from the UK Government are diminishing is having a clear impact on our ability to invest in the reform that we need.
We know that training new GPs will play an important part in increasing the number of GPs in Scotland. Can the cabinet secretary provide an update on what further steps the Government is taking to support people to train, such as the unique ScotGEM—Scottish graduate entry medicine—programme, which has a focus on recruitment in rural areas?
That is a good point from Emma Harper—she is absolutely right. Recruitment into general practice specialty training programmes in Scotland has improved drastically in recent years. For example, of all the GPST posts that were advertised in 2022, 99 per cent were filled successfully, which was up from 64 per cent in 2016. A 100 per cent fill rate has been achieved for the first time in Scotland this year, based on data that was published in July 2023. End-year results will be published shortly, and we will confirm the final position for 2023.
We are funding on-going expansion in GPST, with 35 additional posts having been created last year and another 35 being added this year. In addition to increasing training numbers, we recently committed to investing £1 million in targeted enhanced recruitment scheme bursaries for GP trainees who agree to undertake training in traditionally hard-to-fill areas, including in remote and rural parts of Scotland.
On a point of order, Presiding Officer. I apologise that I did not declare my interest as a practising national health service GP.
Thank you, Dr Gulhane. That is duly noted. Obviously, the expectation is that any declaration of interest prefaces a member’s contribution in the chamber, but thank you.
That concludes portfolio questions on NHS recovery, health and social care. There will be a short pause before we move on to the next item of business.