Meeting of the Parliament [Draft]

Meeting date: Wednesday, March 13, 2024

Official Report 1124KB pdf

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National Health Service Waiting Lists

The next item of business is a debate on motion S6M-12455, in the name of Jackie Baillie, on bringing down national health service waiting lists.

14:56  

I thank all staff who are employed in the NHS. We know that they work incredibly hard to care for us, but they are being let down by the Scottish National Party Government.

It has been two years and seven months since Humza Yousaf published the Scottish Government’s NHS recovery plan. The First Minister at the time, Nicola Sturgeon, said:

“This plan will drive the recovery of our NHS—not just to its pre-pandemic level, but beyond.”

That was in August 2021.

Since then, we have had a new First Minister—who is, of course, a former health secretary—and we are on to our third health secretary. They all committed to the recovery plan. They promised to build 10 national treatment centres to provide an additional 55,500 procedures per year by 2025-26. They promised to increase the number of diagnostic procedures by 78,000 in 2022-23. They promised to deliver 800 additional general practitioners by 2027 and to give every general practice access to a link worker.

The truth is that those promises have been broken. Only three national treatment centres are up and running, with the rest being delayed and over budget. The number of people on diagnostic waiting lists is up by 55,000 since 2020. Only 271 whole-time equivalent GPs have been hired in the past six years, and work has not even started on providing much-needed link workers in general practices.

Why is that important? Since the SNP promised Scots that it could fix the crisis in our NHS, the number of people on a waiting list has grown by almost 20 per cent, from 608,000 to 825,000. Let us picture the scale of that for a second—that is enough people to fill Murrayfield stadium not just twice or four times over, but 12 times over. Those are real people who are living in pain and discomfort, and with anxiety and uncertainty about when they will get the treatment that they need. The Scottish Government can spin it in any way that it wants—and we know that it will try—but the reality is that it has fundamentally failed people right across the country.

Here are some facts that might be uncomfortable for members on the Government benches. Ten years ago, just over 800 people on an in-patient waiting list still had not been seen after 12 weeks. In 2023, that figure was more than 101,000, which represents a 125-fold increase. That is not the only thing going up. Since 2013, the number of people on an out-patient waiting list has doubled; the number of people on an in-patient waiting list has more than doubled; the number of people waiting longer than the 31-day target for a cancer referral has more than tripled; there has been a seven-fold rise in the number of people waiting longer than the 62-day target for a cancer referral; and there has been a 27-fold rise in the number of people waiting for over 12 weeks for a referral for out-patient care.

Here are some more facts about accident and emergency departments. In 2023, more than 7,300 Scots waited more than a day in A and E, and a freedom of information request that we lodged revealed that patients waited in A and E for as long as 122 hours. That is almost five days waiting to be seen in accident and emergency.

In January this year, the number of people stranded in A and E for over eight hours soared to more than 17,800, and the number who waited for over half a day rose to more than 8,800. That is the highest number on record. In the same month, 57,860 days were spent in hospital by people whose discharge was delayed. That was higher than the number at the same point in 2023. The SNP promised to end delayed discharge way back in 2015.

The reason why that is serious is that the Royal College of Emergency Medicine has calculated that there will be an excess death for every one in 72 patients who spend between eight and 12 hours in an emergency department. Based on those figures, that equates to up to 2,000 excess deaths last year alone. That is heartbreaking because it is preventable.

Broken promises matter, because the failure to clear the waiting lists has real-life consequences. That is the legacy of the SNP Government. It has even broken its own statutory 12-week treatment time guarantee 680,000 times since it introduced it and 320,000 times before the pandemic itself. However, it still denies any responsibility.

What about the long waits? It was Humza Yousaf who promised to eradicate two-year waits by September 2022, I think. That date has come and gone, and we still have 7,170 Scots who have waited two years for treatment. That is 25 times more than the 282 patients who have been waiting that long in England. That is utterly shameful.

Please do not insult our intelligence by trotting out the same old excuses. Health is devolved. The SNP has been in charge for 17 years. It must tell the people of Scotland—the people whom it has failed—what its plan is now. It must tell them what it will do to stop the delays to the new national treatment centres. They are delayed in Ayrshire and Arran, in Grampian, in Lanarkshire, in Lothian and in Tayside. It must tell them where the £300 million for waiting lists that was announced last year will come from, because it is not in the budget.

The SNP is out of time and out of ideas. When it comes to the NHS, the SNP’s record is a blizzard of rhetoric to hide a litany of deadly failures.

You need to conclude.

I move,

That the Parliament is concerned that almost 825,000 patients are stuck on NHS waiting lists for tests and treatment, whilst long waits have continued to rise, despite the current First Minister promising to eradicate them; is disappointed that the statutory 12-week Treatment Time Guarantee has been broken 680,000 times since it was introduced, and 320,000 times before the COVID-19 pandemic; notes that the Scottish Government’s NHS Recovery Plan commitment to deliver 55,500 additional inpatient and day-case procedures by 2025-26 will not be met, in light of its decision to pause the National Treatment Centres programme, and calls on the Scottish Ministers to urgently tackle delayed discharge to increase capacity and publish a revised plan for bringing down waiting lists, including clarifying whether it still intends to reduce waiting lists by 100,000 patients by 2026, and to set out the source of the £300 million funding package that it announced in October 2023.

I advise members that there is no time in hand for the debate.

15:02  

First of all, I will address one of Jackie Baillie’s criticisms around responsibility. I absolutely accept responsibility. I apologise to anyone who has waited too long for treatment. We have been repeatedly clear that our NHS needs continual investment and reform to help with the recovery from the impact of the Covid pandemic and the pressures that were evident before the pandemic.

For most people, the NHS offers an incredible service that is delivered by dedicated professional staff in a timely manner. However, I accept that that is not the case for too many. That is the key driver behind the reform that we will be embarking on.

Our accident and emergency departments face pressures for two principal reasons: the demand that they face and the challenges of patient flow through hospitals. We are working with health boards to address both challenges.

We know that Scotland is not unique, because services across the United Kingdom continue to experience similar challenges. On long waits in accident and emergency departments, the latest comparable 12-hour statistics for England in January show that 13.2 per cent of patients waited for 12 hours compared with 7.7 per cent in Scotland and 15.5 per cent in Wales. Planned care data for the last quarter of 2023 shows that, in Scotland, there were 124 patients per 1,000 population waiting for treatment time guarantee and new out-patient appointments. The measures that are used in England and Wales, which I accept are distinct from our measures, show that, in England, there were 134 patients per 1,000 population on the referral-to-treatment list while, in Wales, there were 244 per 1,000 population.

That is, of course, no comfort to those in Scotland who are waiting too long, but it serves to underline the shared challenges and pressures across the UK. In spite of some of the commentary—including some of what I expect we will hear today—those challenges in performance are not unique to Scotland.

There are signs of progress. Over 2023, new out-patient activity increased from the previous year, and the new out-patient list decreased for the first time since the end of 2021. To add to that, in-patient day-case activity for the last quarter of 2023 was the highest since the start of the pandemic.

We have seen a substantive reduction in new out-patient waits of over two years since the targets were announced, with the number waiting over two years for a new out-patient appointment down by 66 per cent from the end of June 2022. The number of waits of over two years for in-patient day-case treatment is also down by 25 per cent.

Cancer remains a priority. That is why we published our 10-year cancer strategy along with an initial three-year cancer action plan in June last year. To support cancer services with the highest waits, there is additional focus on urology, colorectal and breast cancer, and clearing diagnostic and treatment backlogs. We are also working to ensure that all capacity is maximised, including our network of robots, to support cancer patients in receiving timely access to surgery.

When it comes to investment and reform in our NHS, we are determined to go further. I will set out my thinking, including on the process of engagement, soon. However, we are trying to do that with one hand tied behind our back by the UK Government.

Last week, the chancellor had the opportunity to invest in public services such as the NHS and in needed public infrastructure; instead, he cut tax. In fact, the Tory chancellor delivered a real-terms cut to front-line health spending in England. Funding for NHS pay deals in England was not baselined, which means that the consequentials from health were a reduction on what was provided in 2023-24. The chancellor promised investment for improving productivity in the NHS, but not a single penny of that promised investment will be spent in 2024-25.

In short, the chancellor’s budget brought yet more pain to the NHS to pay for tax cuts and put off the necessary investment in reform. It was the last desperate act of a Tory Government that is gliding towards the exit door with all the grace of a hippo on roller skates.

Sadly, the Labour election co-ordinator Pat McFadden MP confirmed last week that there were no specific policies in the Tory budget that Labour disagreed with. By backing the national insurance cuts from the Tories, Labour is backing that £1.7 billion that could have been spent on the NHS and infrastructure should now not come to Scotland.

Not content with that, it seems that Labour in Scotland has also decided to no longer back progressive taxation. By adopting the progressive model that we have in Scotland, we have made £1.5 billion available for services such as the NHS. It seems that Labour would abandon that. At the very least, if we follow the course that Anas Sarwar set out before his conference, it would reduce the income tax take in Scotland by over £560 million.

Will the cabinet secretary give way?

I am sorry. Time is short, just as it was for Jackie Baillie’s contribution. I apologise.

I suppose that the question for Labour is this: in forming the next UK Government or its policies here, what will it cut? It is not enough to promise that it will fund the NHS. It needs to put its money where its mouth is. It has to will the means as well as the end. We have not seen any evidence of that thus far. It has to be straight with the people of Scotland. If Labour is pursuing tax cuts, where will its cuts fall?

As for the Tory amendment, I suggest that Mr Gulhane might want to double check his figures.

You need to conclude.

If he checks the Treasury country and regional analysis, he will find that, had front-line health spending in Scotland matched per head spending levels in England, it would have seen our NHS get cumulatively around £15 billion less investment than it received under the SNP Government.

I am committed, and the Scottish Government is committed, to making the changes that are essential for facing on-going challenges and ensuring that we provide a sustainable future for our NHS.

I move amendment S6M-12455.2, to leave out from “is concerned” to end and insert:

“recognises the impact that the COVID-19 pandemic has had on health service waiting times across the UK, and around the world; commends the dedicated NHS staff who work to provide the best care possible; believes that all long waits are regrettable and welcomes the progress in delivering a significant reduction for the longest waits; welcomes the opening of two National Treatment Centres within the last 12 months, with a further two centres opening in the coming months, which will provide capacity for an additional 20,000 procedures each year; notes that the Scottish Budget provides over £19.5 billion for health and social care, ensuring a real-terms uplift for the NHS in the face of UK Government austerity; acknowledges that, without the distinct and progressive approach to income tax in the Budget, the NHS and other public services would have £1.5 billion less funding; understands that the UK Government’s decision to cut the Scottish Government’s capital budget by £1.3 billion in real terms by 2027-28 has a direct impact on health infrastructure projects; believes that the £20 billion that the UK Government will lose as a result of its decision to cut national insurance should instead have been invested in NHS services and in infrastructure investment, and understands that the share of Barnett consequential funding that Scotland has lost as a result is around £1.6 billion, and believes that, in order to recover from the combined impact of the COVID-19 pandemic, Brexit and UK Government economic mismanagement, reform and innovation across the health service is required.”

We have no time in hand. I give due warning that I will cut speakers short at their allocated time.

15:08  

I draw members’ attention to my entry in the register of members’ interests as a practising NHS GP.

I also draw members’ attention to the Scottish National Party Government’s 2021 manifesto, in which it promised to deliver a new Monklands hospital, renew the east of Scotland cancer care centre and enhance primary care facilities throughout the country. Let us also not forget Humza Yousaf’s so-called NHS recovery plan, one of the most underwhelming and poorly thought-out pamphlets in NHS history. It promised to boost in-patient and day-case activity through rolling out national treatment centres during this session of Parliament. However, instead of investing, the SNP has frozen all investments in new NHS projects over the next two years, at least. That means that at least a dozen facilities are on ice across six health boards. Therefore, for people who live in the NHS Lothian, Ayrshire and Arran, Tayside, Lanarkshire, Highland or Grampian areas, it is not happening.

The SNP is big on words and woeful on delivery. Under Humza Yousaf’s Government, one out-patient in 10 is now waiting nearly a year for an appointment, while one in-patient in 10 is waiting a year and a half. Fewer operations are taking place than before the pandemic. The cabinet secretary states that cancer is a priority, but only 65 per cent of patients who have been referred for colorectal cancer treatment received it within 62 days.

Of course, the SNP-Green Government blames anyone but itself, and that is because it does not take responsibility for its failings. Instead, it will cry that it is all Westminster’s fault. I know that it does not like to hear this, but the Scottish Government decides how to spend its budget and what to prioritise. The fact is that, year in and year out, the SNP Government has chosen not to pass on the full Barnett consequentials for healthcare from the UK Treasury to Scotland’s NHS. That is some £17 billion of healthcare spending that the SNP has spent elsewhere on pet projects while waits for diagnostics and treatments grew.

Healthcare is devolved and Scotland needs solutions. The Conservatives agree with healthcare professionals who argue for a national conversation on our NHS. We are the first of Scotland’s political parties to put pen to paper and develop a vision—a detailed, credible contribution to that conversation. We call for a modern, efficient and local approach to healthcare delivery. We would invest 12 per cent of the NHS budget into GP clinics to open new facilities, recruit more staff and make more appointments available, particularly in rural areas. We would introduce an online booking system.

We would also hold NHS management to account for its decisions. Unlike the SNP Government, which rewards executives in failing health boards, we would provide better conditions for front-line staff and reward them. We would also allow flexibility so that they can enjoy a better work-life balance, which is key to staff recruitment and retention.

We must be strategic and ditch SNP-style short-term solutions that buy a little time between health secretaries but result in devastating long-term consequences.

I move amendment S6M-12455.1, to insert after “programme”:

“; recognises with deep concern that the Scottish Government has provided no guarantee of when new healthcare investment will resume; notes with alarm that one in 10 patients in Scotland are forced to wait more than a year for a new outpatient appointment and more than a year and a half for an inpatient appointment; expresses further concern that, because of the increasing shortage of GPs, the true scale of the treatment backlog may be even higher, as patients find it increasingly difficult to access their GPs and obtain referral for diagnosis and treatment; condemns the consistent failure of the Scottish Government to pass on the full Barnett consequential funding for healthcare, cumulatively short-changing the NHS in Scotland by £17.6 billion; emphasises that long waits for treatment and diagnosis cause suffering and death”.

15:12  

Again and again we come back to this topic but only, it seems, in Opposition time. The facts that are laid out in Jackie Baillie’s motion make grim reading. Almost 825,000 patients in Scotland are languishing on NHS waiting lists for tests or treatment.

The Government is out of ideas for how to address the crisis. It seems content to make empty promises and then to do little to keep them. I refer to examples such as Humza Yousaf’s failed promise to eradicate waiting lists, which only continue to rise, or the statutory 12-week treatment time guarantee, which has been broken 680,000 times since it was introduced. There is also the Government’s promise in the NHS recovery plan to deliver more than 55,000 additional in-patient and day-case procedures by next year. The hard stop on the construction of national treatment centres means that that target will not be achieved. That, too, goes down as yet another broken promise by the half-hearted SNP-Green Government.

Unacceptable waits have become synonymous with Scotland’s NHS. I also feel compelled to mention—on today of all days, as they gathered outside our Parliament—the 180,000 Scots whose lives have been shattered by long Covid. Many of them are long haulers and entering their fifth year of grappling with that terrible condition, but they are still forced to wait in vain for recognition, support and treatment pathways from the Government.

I have lost count of the number of times that we have had such debates in the chamber. I fear that the Government has become all too comfortable with crisis and is almost inured to it, but something has to give. It simply must. Every time we raise the state of the NHS in the chamber, ministers seek to blame the pandemic. When they do so, they insult the intelligence of us all and seriously test the patience of staff and people who seek care.

We all know that the issues in our NHS were there long before anyone had heard of Wuhan in China or Covid-19, and people are tired of hearing such excuses. Nowhere is that more true than among NHS staff. The chair of the British Medical Association in Scotland said that NHS staff were “exhausted and facing burnout”. Staff and patients alike need new hope.

Our health service needs leadership and stability but, when it comes to the position of health secretary, it seems that there is no stability to be had—just a grim game of musical chairs. Neil Gray now needs to show the Parliament and the watching public that he is capable of innovative thinking and open to reform. When Humza Yousaf was in that position, he repeatedly ignored my party’s calls for a plan to address staff burn-out and to set up a health and social care staff assembly. The Government has shown pigheaded contempt for policies that would guarantee annual leave, ensure safe staffing levels and champion the expertise of those who know our health service best. We need to retain experienced staff if we are to bring down waiting lists.

Rather than making the meaningful investment that our health service needs, the Government is relying on short-term fixes to plug the gap. It is also failing to tackle the huge issue of delayed discharge, which is leaving people languishing in hospital wards when they should be at home. That causes an interruption in flow throughout the whole of the NHS, and it is manifest in emergency care delays. The Government is indulging its bureaucratic tendencies in the name of a vast, expensive and unwanted centralisation of social care.

I could go on, such is the litany of problems in our NHS under the present Government’s watch. People need to know that they can rely on a health service. They need to know that they will be tested, diagnosed and treated in a timely fashion, so that they have the best chance of recovery. The competent management of our health service is perhaps the primary thing that we elect a Scottish Government to do, but it is failing in that regard.

The health secretary needs to do three things.

You need to conclude, Mr Cole-Hamilton.

I will, so I will tell you about that the next time we come to this subject in Opposition time.

Thank you. We now move to the open debate.

15:16  

Today’s debate is of critical importance, and it is right that we continue to use our time in the chamber to debate the topics that match the priorities of the Scottish people. Although the SNP Government might want to hide from its responsibilities and its record when it comes to the NHS, we on the Labour benches have a responsibility to hold ministers to account on behalf of patients and staff who have been let down for too long.

The NHS is my party’s proudest achievement. It is our country’s most beloved asset, and it is an asset that belongs to everyone. When Bevan and Attlee established the NHS, it had the key founding principles of being free at the point of need, being a high-quality employer delivering first-class service and being an institution that would never discriminate when it came to the provision of healthcare. The founding principles of the NHS were important in 1948, and I argue that they are even more important in 2024.

The BMA Scotland chairman, Dr Iain Kennedy, has said:

“We have sleepwalked into our current situation ... We are now seeing the founding principle of the NHS, namely that it should be free at the point of need, threatened. This is the inevitable consequence of years of ducking the hard decisions”.

And yet it continues: in its amendment, the Scottish Government has managed to blame just about every factor other than its inability to meet the challenges facing the NHS today. Its self-congratulatory amendment will not be well received by the hundreds of thousands of Scots from across the country who are on needlessly long waiting lists. Let us be in no doubt that waiting lists are soaring, people are waiting in pain and our NHS is under extreme pressure.

The cabinet secretary knows that I am never fearful of calling out Tory austerity. In this instance, however, the Scottish Government is responsible for using devolved powers for the NHS. Because of serious mismanagement and, I think, broken promises, along with the arrogance of not accepting any responsibility, we are not in a good place for patients or staff here in Scotland’s NHS. The SNP wants to be in power, but it refuses to take responsibility. I think that patients and staff are tired of the endless excuses. Our NHS needs change, and there is a recognition that this tired Government is not up to delivering that change.

I accept that the cabinet secretary is only just in post, but, thanks to his predecessor, the challenge before him is significant. One in seven Scots is on an NHS waiting list, and that number is rising, despite, as we have heard, the First Minister’s commitment to eradicating that, and a treatment time guarantee, which, I will repeat, has been broken 680,000 times. No one underestimates the impact of the pandemic on our health services, and staff agree, but the reality is that, as is outlined in the Labour motion, the guarantee was broken far too many times—320,000 times—before the Covid-19 pandemic.

It is fair to say that key commitments in the NHS recovery plan are not being met. Those issues are being exacerbated by the Scottish Government’s decision to halt NHS capital projects, which are so desperately needed. Not only has the cabinet secretary let down my constituents in South Scotland, who will be waiting longer for the national treatment centre at Ayr, he cannot even get a hospital built in his own back yard. The impact of that decision will be longer and longer waits.

People must see the Government act. Under this Scottish Government, our tremendous NHS staff have been pushed to the limit. Services are at breaking point—

You need to conclude.

—and the Government must take action.

15:21  

Waiting for an operation or treatment undoubtedly adds pressure and stress to what is an already stressful time—for some, intolerably so. I appreciate that waiting can exacerbate the problem for a patient who is waiting for treatment, and it brings additional issues such as stress and anxiety. I will never minimise that human impact.

The challenges that Scotland’s NHS faces are not unique, and the significant impact of Covid-19 since 2019 on the normal operation of the NHS cannot be overestimated. In saying that, I am not pretending that everything was perfect prior to the pandemic; I am simply acknowledging the reality of where we are now and the scale of the challenge that we face.

Opposition parties should, of course, put whatever they want in their motions, but it will not be lost on folk that Labour has lodged a motion about NHS pressures and not included a single mention of the impact of the Covid pandemic. All MSPs receive regular contact from their local health boards, so we should all know the impact that it has had. There is no doubt that the pandemic has been the biggest shock that the NHS and health services in Europe and globally have faced. That shock is not unique to Scotland and cannot be ignored. It is clear that the pandemic has impacted on health services across the UK. Acknowledging the reality of where we are is important.

The member rightly mentions Covid, but, as she may know, we have met people who have suffered from long Covid, and there is no support for that coming from her SNP Government. What does she suggest to those people?

I acknowledge the difficulty that people with long Covid face.

The cabinet secretary outlined a number of steps that the Scottish Government is taking. Ministers have published the national health and social care workforce strategy, which sets out a long-term vision for achieving a sustainable health and social care workforce. The fact that the Scottish Government values the NHS workforce and is committed to investing in it is demonstrable.

The Government has taken a number of steps, but we are short of time, so I will not go through them all. Scotland remains the only country in the UK to have successfully averted NHS strikes. I point that out not by way of self-congratulation but because actions on staffing will make the difference to the running of our NHS and how our citizens experience their care within it.

The recruitment and retention of staff, and the wellbeing of staff, are important to the sustainability of NHS Scotland’s ability to provide efficient services amid the current challenges that it faces. We need to look closely at routes to a rewarding public service career in the NHS and reflect on when previous decisions might have had unintended consequences. For example, where surgeons now specialise at the beginning of their careers, there is a lack of general surgical consultants. That is causing some challenge in my health board area.

In relation to allied health professionals and nursing, we could consider more apprenticeships and earn-as-you-learn and work-type programmes, which could provide progression and development opportunities for existing health and social care staff. That would also be attractive to adults who wish for a career change but for whom four years at university is not an option.

I welcome the minister’s comments on those issues. I know that some work is on-going, but it feels like we need to pick up the pace on this, as it could be beneficial for individual citizens and the healthcare system as a whole.

15:24  

I thank the Labour Party for holding this debate on health issues. We seem to discuss such matters only during Opposition time, which is a disgrace. It is also a disgrace that the cabinet secretary wants to amend the motion to put a lot of the blame on Covid.

Let me give some of the facts. Prior to Covid, the orthopaedic waiting list in NHS Highland had well in excess of 2,000 people on it, the ophthalmic list was so long that we were flying people up from south of the border to do operations at weekends, and treatment times were appalling. On top of that, we had an unappreciated staff workforce and bullying was rampant. We ended up having to pay £2.8 million in compensation to the people who were bullied. There were high sickness rates and a huge number of vacancies—especially in the radiology department. Those are the facts, and those things happened before Covid.

Now, post-Covid, we have orthopaedic waiting lists that—as judged by a university the other day—could extend waits to seven years. The people on those lists cannot be treated in the national treatment centre because they are too sick; their orthopaedic operations require too much care for them to go into the national treatment centre.

Let us look at audiology. In Inverness, the news about waiting lists is not so bad. There is a 28-week wait to get an appointment, and, when a person gets their appointment, they then have to wait for 49 weeks to get a hearing aid. However, the situation is substantially worse if the person is in Wick, as they have to wait 31 weeks for an appointment and 64 weeks for a hearing aid. From start to finish, that is nearly two years to get a hearing aid—but people can pop down to Boots and get one in three weeks. That is a disgrace, and it is not acceptable.

I applaud the Government for saying what it has said about the national treatment centre. It was late and over budget, and, although it is working for our orthopaedic patients, it is doing so only for a certain number of them—those who are less ill and can be treated overnight. We have ophthalmic theatres in the national treatment centre that are not being used. Why are they not being used? It is because it has not managed to recruit the surgeons who are needed to do the surgery. We can build as many centres as we like, but, if we cannot get the staff to work there, the centres are no help.

I will now talk about neurological development assessment waiting lists, which I find deeply disturbing. I have tried to find out how many people are on the waiting list for neurological development assessments in the NHS Highland area. Doing so is not easy, because the information is held partly by the Highland Council and partly by NHS Highland. The latest figures that I got showed that there were 800 children waiting for neurological development assessments on the NHS Highland waiting list and a further 600 children waiting on the Highland Council waiting list to get on to the NHS Highland waiting list. That means that there are approximately 1,400 children waiting to get a neurological development assessment. That is unacceptable, especially as I was told that the person at the bottom of the list will have to wait 15 years to get a neurological development assessment. That means that they will finish school before they get the help that they need.

I also point out briefly—as I know that my time is running out—

You do not have time, Mr Mountain.

It appears that, in NHS Highland, a waiting list is not a waiting list; it is a waiting list to get on a waiting list.

We have to move on.

15:29  

I start by commending the work of our incredible NHS staff across Scotland. I hope that we can all agree that they have been doing remarkable work, given the challenges that they face. However, their already challenging work is being made significantly harder by the neglect that has been inflicted on the NHS by the Scottish National Party Government.

Although the NHS is struggling across all of Scotland, I highlight the pressures that services in Lothian face. Our hospitals are already under huge pressure there, and waiting times for vital operations are increasing. Those pressures will continue as our population grows, as 84 per cent of Scotland’s future population growth will be in Lothian, so its NHS services urgently need investment.

Nowhere is that clearer than in the case of the Edinburgh eye pavilion. The building was declared unfit for purpose in 2014—that is a decade of unsuitable facilities for people who need vital, life-changing services such as eye surgery. How did the SNP Government respond? With yet more broken promises and, ultimately, by freezing capital spending on the desperately needed new eye hospital, along with other national treatment centres that are urgently needed across Scotland.

It is an issue not just for Lothian residents. A quarter of people with sight loss in Scotland are having to rely on facilities that are not fit for purpose, with zero reassurance and nothing in the way of timescales from the Scottish Government to give them any confidence that things are going to change.

The end result for patients is that life becomes significantly harder and treatment often becomes inaccessible. People experiencing sight loss are often more restricted in their transport options, yet they are being made to travel to Clydebank or even to Newcastle, at personal cost, if they want to receive NHS treatment for their eye condition. That is not acceptable, because every patient on that waiting list is a real person with a real experience, not a statistic.

We spoke to a constituent who was facing a 17-month wait for treatment. She simply could not wait that long, as her sight was deteriorating. When she wrote to my office, she was about to take on significant debt just to pay for simple but life-changing treatment in the private sector, because she could not wait for that NHS treatment. That is unacceptable. It is an unthinkable choice—going into debt or losing your sight—and it is a choice that she never should have faced. It is a direct result of the failed promises of the SNP Government, which continues to let down patients across Scotland and, as Carol Mochan highlighted, is undermining the key principles of our NHS. Such stories are commonplace, and I am sure that members across the chamber have similar tales to tell.

In Lothian, waiting times have trebled over the past nine years and the number of people waiting more than 16 weeks has increased from 156 to more than 9,000 patients. As Jackie Baillie and Carol Mochan highlighted, the pressures that our NHS faces have been created and compounded by the lack of support offered by the SNP Government. It is not enough just to blame the UK Government—that is a refusal to take responsibility for the problems on our doorstep over the past 17 years. It is not just the eye pavilion that is not happening, but the national treatment centre in Livingston and our urgently needed new cancer centre in Edinburgh.

The SNP Government needs to act now to bring down waiting list times, to ensure that everyone in Scotland gets the treatment that they need, when they need it. Waiting time delays are not “regrettable”, they are utterly unacceptable, and our constituents deserve better.

15:33  

I remind members that I am a registered nurse, former clinical educator and perioperative clinical practitioner.

Of course, it is important to reduce NHS waiting times, but I want to highlight the example of how we work in the perioperative environment in theatre. It is a complex environment that requires specialist surgical teams—consultants, surgeons, anaesthetists, nurses and perioperative support workers—as well as ancillary co-ordination with labs, blood banks and radiology. Everyone requires knowledge, skills, competency and training, and everyone who works in those areas and across the NHS must be commended for their commitment to providing the best care for their patients.

Tackling waiting times is no easy feat. The Scottish Government is choosing to invest more than £19.5 billion in health and social care in 2024-25, giving our NHS a real-terms uplift, despite UK Government austerity. That includes £14.2 billion of investment in our NHS boards, with additional investment of over half a billion pounds—and it is worth noting that NHS Dumfries and Galloway and NHS Borders, in my South Scotland region, are receiving a real-terms uplift in funding, too.

Of course, that does not come without its challenges. It is worth noting that the current budget, passed by the Parliament, will do more for our NHS. It will provide an additional £230 million to support delivery of the pay uplift to a minimum of £12 per hour for adult social care workers in the third and private sectors from April 2024, representing a 10.1 per cent increase for all eligible workers. It will invest more than £2.1 billion in primary care to improve preventative care in the community, supporting the development of multidisciplinary teams in general practice, sustaining NHS dental care through enhanced fees and continuing free eye examinations. It will also support spend in excess of £1.3 billion for mental health services, for which there is an ever-increasing demand. Those are welcome commitments, given the current strain on all budgets due to economic mismanagement from Westminster.

However, despite that investment, the system is under extreme pressure as a result of the on-going impact of pandemic recovery, Brexit, inflation and UK Government spending decisions. I welcome the fact that the Scottish Government will continue to target resources in order to reduce waiting times, particularly for those who are waiting the longest for treatment, through maximising productivity and additional resources.

Investing in Scotland’s NHS is non-negotiable for the Scottish Government. Against what is a challenging economic and financial context, the Scottish Government is taking the difficult and necessary decisions to ensure continued investment in health and social care services. The UK spring budget was nothing short of a betrayal of public services across the UK. It provided less in Barnett consequentials for health than in-year health consequentials for 2023-24, and it failed to deliver more capital funding for infrastructure. Based on the latest forecasts, Scotland’s capital block grant is now expected to reduce in real terms by £1.3 billion by 2027-28.

I know that my time is short, Presiding Officer, but I was interested to hear Carol Mochan say that she was proud of her party that created the NHS. I wonder whether she is proud of Labour’s shadow Secretary of State for Health and Social Care saying that he would

“hold the door wide open”

to the NHS for the private sector if his party wins the next general election. Our NHS has major challenges, with lots of things to consider, but the threat to Scotland’s NHS comes from Westminster parties of all colours.

You need to conclude, Ms Harper.

Those threats will be damaging for Scotland. However, if we had independence, we would be able to manage much better.

15:37  

I start by thanking all staff who work throughout the NHS.

The debate is on an issue that MSPs probably hear about the most from our constituents. Whatever constituency MSPs represent, the dire and depressing problems in our NHS are having a terrible impact on people across Scotland. Our NHS has been in a constant state of crisis for many years under the SNP, and that sorry situation is getting worse, not better.

I will briefly reiterate some of the shocking statistics that others have highlighted in the debate, in the hope that the Government will finally take notice. More than 820,000 people are on NHS waiting lists in Scotland; January 2024 was the worst month on record for long A and E waits; and one in 10 patients are waiting nearly a year for appointments. It was hard to imagine those statistics getting any worse—then Humza Yousaf introduced his recovery plan and, somehow, it did get worse. His recovery plan did not improve treatment times; instead, it let them spiral further. He made big bold promises when he launched that plan, but almost none of them has been delivered.

That is the really damning thing about the SNP’s handling of our health service. It is bad enough that it presides over repeated failures, but it is a real slap in the face to patients that it keeps making promises that it does not keep. It promised to increase the number of GPs by 800 by 2027, but, so far, GP numbers have decreased by 26. In rural areas, getting an in-person GP appointment can now be a nightmare. The SNP also promised to end delayed discharge and free up hospital beds, but the problem is as bad as ever and is costing Scotland’s NHS a fortune.

Today, I want to focus on one particular broken promise to people in Ayrshire: the promise to deliver a national treatment centre at Carrick Glen. The centre has been delayed for years, and, judging by the SNP’s track record, who knows whether it will ever happen. A network of national treatment centres across the country was originally an SNP election pledge not this year, nor in 2022, 2021, 2019, 2017 or even 2016—a national network was promised way back in 2015. At the time, the SNP’s then First Minister Nicola Sturgeon said:

“If we don’t act to prepare now for 10 and 20 years ahead, our NHS will be overwhelmed by the demand.”

Well, she got one thing right. Nearly 10 years on, the NHS is now “overwhelmed by ... demand”, because the SNP did not act.

Humza Yousaf doubled down on Nicola Sturgeon’s grand promises before the 2022 election, when he came to Ayr for a photo op to announce the Carrick Glen centre. On that day, he said:

“the network of National Treatment Centres will ... be central to NHS recovery.”

Just like his photo ops with the doomed ferries, that one was clearly all for show. He later added that

“The National Treatment Centre ... Programme will deliver the single biggest increase in protected planned care capacity ever created in NHS Scotland.”—[Written Answers, 12 May 2022; S6W-08250.]

However, that

“single biggest increase in ... care”

has turned into the single biggest let-down for patients across Ayrshire. Local people are seeing waiting times for treatment rise; they are seeing intensive care unit beds moved away from Ayr hospital to Crosshouse, because the former cannot recruit staff; and they are seeing long waits for a GP appointment. As it is an election year, however, there is no doubt that they will soon, once again, be seeing Humza Yousaf, in a pair of scrubs, making another big promise that he will not deliver.

The problem for the SNP is that local people also see right through that charade. They deserve a lot better than another batch of soon-to-be-broken promises.

15:41  

We can always rely on Labour to put up a motion complaining about the management of the NHS, full of negativity, with not one word of encouragement to the thousands of staff who are working extremely hard day in, day out to deliver healthcare and keep us all safe. The SNP amendment commends those staff, and I am happy to put on record my thanks to the NHS staff whom I know personally, and to the entire workforce, who are still working under the most difficult times that they have faced in a generation.

The Labour motion is little more than numbers and criticisms, but there is another story to tell. I will share a few facts and figures from Ayrshire and Arran that might help balance out Labour’s narrative a bit. First, though, I offer a gentle reminder that it was our Labour friends who planned to shut the accident and emergency unit at Ayr hospital, and it was the incoming SNP Government that kept it open, much to the delight of the 55,000 or so people in Ayrshire who signed the petition and the many thousands who have continued to benefit since. That decision has never been welcomed by Labour, from that day to this. How dare the SNP reverse Labour’s closure plans for Ayr hospital and save the unit, and save lives as a result?

Covid has not disappeared, and its impact will ripple on for some time yet. Those are not my words, but the words of our excellent chief executive of NHS Ayrshire and Arran, Claire Burden, who is working tirelessly to get us through these times. Last year, more than 1.25 million GP consultations were carried out in Ayrshire and Arran; those are real people, who are getting a fantastic service from their dedicated GPs. We have satisfied 465,000 out-patient appointments; that is a huge demand that is being met, with a range of NHS staff working to achieve that. We have also satisfied more than 100,000 out-of-hours appointments through our Ayrshire urgent care service.

Our emergency departments, including the one at Ayr, dealt with more than 93,000 life-or-death situations, saving lives every day. Currently in Ayrshire and Arran, the situation is as difficult as it is anywhere else, but, according to our chief exec, the pause in the national treatment centres has not affected service provision there. In the meantime, we have managed to benefit from the recruitment of additional staff down there, as well as an orthopaedic surgeon. We have more capacity than in previous years.

At Ayr hospital, we now have a dedicated station for orthopaedic surgery, and that team has some of the highest levels of productivity and highest performance figures Scotland-wide. Waiting times for out-patients are increasing—there is no doubt about that—because demand is currently outstripping Ayrshire’s ability to get through the backlog. Recruitment is on-going, however, thanks to the additional budget support that the SNP Government has provided.

As for other performance achievements, the numbers of in-patient day cases continue to fall. Performance in relation to the 31-day cancer treatment target also continues to meet the 95 per cent level—and last November, it was actually 100 per cent. Compliance with the endoscopy target has also improved to its highest level since 2020. Finally, compliance with the child and adult mental health services target also reached 100 per cent in November last year, exceeding the target by 10 percentage points.

I therefore say a huge well done to Ayrshire and Arran NHS staff. We will not hear any of that good news from Labour, but members will hear it from me and the thousands of patients who get high-quality care and life-saving treatment daily in Ayrshire and Arran.

Finally, I note a request from NHS Ayrshire and Arran for the public to engage more directly with the legal processes in order to establish power of attorney for their family members, as that will help all health boards improve the delayed discharge situation. More than half of the delayed discharge cases in Ayrshire and Arran that involve loss of capacity are caused by that issue alone, not by performance or lack of community care provision. The worst figures for that problem are in Tory-run South Ayrshire. Who knows—maybe even Labour will welcome that news, and our resident Tory GPs who are in the chamber might be aware of it, too.

You need to conclude, Mr Coffey.

I support the Government’s amendment and ask the Parliament to reject the relentlessly negative Labour motion and Tory amendment.

15:46  

Audit Scotland hit the nail on the head when it said:

“There has been no unified vision”

for the NHS since 2013 under the SNP Government. A decade later, patients and front-line staff are paying the price for the SNP’s mismanagement of the NHS. Only the SNP-Green Government could make the national treatment centres the linchpin of its NHS recovery plan and then yank their funding. You could not make it up. National treatment centres in NHS Lothian, NHS Ayrshire and Arran, NHS Lanarkshire, NHS Tayside and NHS Grampian, in my region, have all been left in limbo.

Meanwhile, as we have heard today, patients who are in chronic pain have been left to languish on waiting lists for months and even years. MSPs’ inboxes are full of heart-wrenching accounts of people who are desperate for treatment. Earlier this week, a constituent contacted me after being referred for a gastroenterology appointment by her GP. The NHS Inform website said the current wait to be seen was six weeks. After speaking to staff, she was told it would be 42 weeks. That is a different la-la land from the la-la land that Mr Coffey spoke about. She said she came off the phone lost for words.

Sharon Dowey talked about the SNP’s broken promise to people in Ayrshire who have been waiting for years for a national treatment centre at Carrick Glen. She highlighted that the SNP knew nine years ago what would happen if the NHS’s capacity was not increased there, but the centre has not been delivered. The SNP has dithered and delayed.

Ruth Maguire today blamed Covid, but Edward Mountain raised serious concerns about NHS Highland before Covid.

The SNP might try to blame everyone but itself for those failures, and the SNP amendment certainly takes a crack at that. The SNP-Green Government has full control over the NHS in Scotland. As the Scottish Conservative amendment emphasises and Dr Sandesh Gulhane highlighted, it has full control over investment in healthcare and how it spends that budget. The cabinet secretary might shake his head, but that is the truth. Dr Gulhane was right to say that, year in and year out, the SNP Government has chosen not to pass on the full Barnett consequentials from the UK Treasury to Scotland’s NHS.

We should take note that the SNP Government is responsible for the decisions that it makes, and that it seems to enjoy the trappings of power but not the responsibility. Today, however, Neil Gray, as the new SNP Cabinet Secretary for NHS Recovery, Health and Social Care, publicly accepted responsibility, which is rich, coming after 17 years of the inertia and inaction of successive health secretaries. Nicola Sturgeon, Shona Robison, Jeane Freeman, Humza Yousaf and Michael Matheson have left our NHS in a desperately sorry state. Despite the heroic efforts of NHS staff on the front line, there are record waits for treatment, record waits to be seen in A and E, massive increases in private operations and major blockages in ambulance turnaround times.

The SNP Government is out of ideas and out of time. It must adopt the Scottish Conservatives’ plans for a modern, efficient and local NHS to secure the future of our healthcare system and to save lives.

15:50  

First and foremost, I thank those who are at the heart of our NHS for their commitment, hard work and dedication to providing the best care possible to the people of Scotland.

I will focus much of my response on mental health, which is in my portfolio. We remain committed to our priorities: driving down waiting times and improving mental health. We have seen a sustained improvement in our child and adolescent mental health services waiting times, which gives us good grounds for optimism. The CAMHS system performance has recovered to better than pre-pandemic levels, and we can take our learning from that and apply it to other areas.

We must recognise where we see improvement. National performance against the 18-week CAMHS standard in the most recent quarter is the fourth highest since records began, and the highest achieved since the quarter ending March 2016.

Will the minister take an intervention?

I have very little time.

The past two years—2022 and 2023—showed the highest number on record of people starting treatment from CAMHS, and one in two people referred to CAMHS now starts treatment within six weeks, which is down from 10 weeks in the previous quarter. That has been made possible by the hard work of our CAMHS workforce, which has more than doubled under this Government, and by improvements that have been supported by direct investment from the Scottish Government—first through the recovery and renewal fund, from which £40 million was allocated to implement the CAMHS service specification, and then through the outcomes framework, which amounted to £55.5 million in 2023-24 for improvements to mental health services, including CAMHS.

Through additional investment, we have been setting the conditions needed for long-term, sustainable improvement to the CAMHS system. It has taken time for our investment to be reflected in national waiting times performance, as boards worked hard to clear their backlogs. However, we are now seeing evidence of significant and sustained progress, including high levels of activity in CAMHS and significant improvements in waiting lists.

We have provided, and will continue to provide, enhanced support to those boards where waits are the longest. That enhanced support package will focus on the delivery of the national CAMHS specification and local improvement plans and trajectories to meet the standard, and on the plan to clear backlogs.

Will the minister take an intervention?

I am afraid that I have very little time.

The issue of delayed discharge, which also sits in my portfolio, is a challenging one. We know that the delays in receiving the most appropriate care in the right environment can be detrimental to a person’s physical and mental health. We know that delayed discharges also have significant consequences for the normal flow of patients through hospitals. How do we rise to face that challenge? It is helpful that, in Scotland, we have more beds per head of population and more health professional staff, and that those staff are better paid. Hospital at home is another response; the older people’s service is now similar to a hospital the size of University hospital Wishaw.

Although it is absolutely true that the level of delayed discharge in Scotland is unacceptable, and we take responsibility for that, it is very clear that the problem is not unique to Scotland. It is difficult to make comparisons between UK nations, but the numbers speak for themselves. In Scotland, 22 adults per 100,000 are delayed in acute hospitals; in Tory-run England, that number is 31 adults per 100,000, which is much higher. In Scotland, the total number of delayed discharges is 42 per 100,000; in Labour-run Wales, that number is—wait for it—62 per 100,000.

A number of members made some excellent suggestions. Ruth Maguire’s suggestion on considering alternative training pathways for health professionals was very welcome, and the nursing and midwifery task force is already considering that.

You need to conclude, minister.

The challenges and opportunities that we face need action. Our NHS is our most cherished public service, and we must work together to deliver the changes that we need in order to deliver the sustainable and high-quality services that the people of Scotland deserve.

15:54  

Labour has used its Opposition day today to raise the critical issue of waiting times in our national health service, which is an issue that every one of us has a stake in. Our communities, family members, relatives, colleagues and friends are at risk as a result of the NHS not performing to the best that it can. This Parliament must take cognisance of that, because it is the single most important area of public policy that it deals with.

The facts are stark and incontrovertible. Despite the Government’s attempts to erase those facts in its amendment to Labour’s motion, they remain. Currently, almost 825,000 patients are on NHS waiting lists for tests and treatment. That is more than the combined population of Glasgow and Dundee, and it is simply unsustainable and unacceptable. It creates huge national pressure, and it means that we have a sicker population and a vicious cycle that affects every area of public life.

Long waits have continued to rise, despite the First Minister’s promise to eradicate them entirely. We are not seeing an effort to get ahead of the problem at a sufficient rate. Indeed, the 12-week treatment time guarantee has been broken 680,000 times since it was introduced. That is the equivalent of more than the entire population of Glasgow alone. In addition, the Government’s commitment to delivering 55,500 additional procedures has not been met.

The minister mentioned in her closing remarks that areas of improvement include CAMHS waiting lists. I am afraid that that is a bit of a mirage. I investigated what was going on in Glasgow and discovered that the only reason that the waiting lists have been going down is that face-to-face consultations have been substituted for telephone consultations. That is simply not good enough, and it is not good enough for the minister to come to the chamber and misrepresent what is going on in our CAMHS system in that way.

As I said, it is our families and friends who are languishing on those waiting lists, awaiting care that they desperately need while their health and overall outcomes worsen. Those are the people who email us daily and come to our constituency advice surgeries in desperate situations, eager to get support. It is not good enough for the Government to simply deny their lived experience and their reality. It is our duty as parliamentarians to give voice to their frustrations and difficulties.

The Scottish Government talks about waiting well but, unfortunately, people are dying while waiting. We have heard numerous examples of the terrible situations that are taking place. Indeed, 18,390 patients died in 2022 while stuck on an NHS waiting list, and there has been a 39 per cent rise in deaths since before the pandemic in 2019. It simply is not good enough for the Government to use the pandemic as an excuse. The member for Kilmarnock and Irvine Valley ought to listen more to his constituents in that regard, instead of patronising them in the way that he did in his speech.

Ms Boyack, one of the members for the Lothian region, highlighted our excellent NHS clinicians, but they are being betrayed, too. They are not just working in obsolete facilities such as the Princess Alexandra eye pavilion in Edinburgh. Oncologists who came to the Parliament in the past few weeks told us in devastating terms that they are watching cancer patients go from being treatable at the point of diagnosis to being terminally ill—indeed, I have met those patients personally in Glasgow’s hospices. That is a betrayal. An extrajudicial death sentence is being visited on the people of Scotland in some instances. That is the reality of what is going on.

Taking responsibility does not simply mean saying that there is a problem; it means dealing with it and addressing it. We all have a stake in the matter.

Does the member also accept that taking responsibility means not committing ourselves to Tory spending plans for two years?

That characterisation is simply not true. The fiscal rules that Labour is setting are about improving economic growth by applying discipline to public spending. Here is a good example. The Scottish Government sits here impotently denying that it can invest in national treatment centres because of capital spending constraints while wasting £1.2 billion on delayed discharge. That is incompetence. Saying that there is no ability to undertake capital investment simply does not stand up to scrutiny.

We must address the vicious cycle. I urge the Government ministers to stop thinking like accountants and start thinking like economists, like the Audit Scotland reports have urged it to do. This is all about connecting up a whole system. Mr Mountain, one of the members for the Highlands and Islands region, highlighted the example of hearing aids, which might seem more benign. However, that speaks to back-door privatisation, because the current situation basically means that people cannot get hearing aids—and they cannot access dental treatment or get eye tests either. Those who can, pay, and those who cannot, languish, suffer and cannot go to work or function as citizens. We get a sicker population and a less economically productive society.

The Government must address that vicious cycle. It simply cannot just point at what is happening in other parts of the UK. It should take responsibility and address those issues, as we as parliamentarians in Scotland should be doing here.

That concludes the debate on bringing down NHS waiting lists. There will be a brief pause before we move to the next item of business.