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Chamber and committees

Meeting of the Parliament (Hybrid)

Meeting date: Thursday, June 9, 2022

Agenda: General Question Time, First Minister’s Question Time, NHS Staff Recruitment and Retention, Business Motion, Portfolio Question Time, Census, Covid-19 Inquiry, Scottish Local Government Elections (Candidacy Rights of Foreign Nationals) Bill: Stage 3, Decision Time, Ukrainian Refugees (Trafficking)


NHS Staff Recruitment and Retention

The Deputy Presiding Officer (Liam McArthur)

I ask those leaving the chamber and the public gallery to do so as quickly and as quietly as possible, because business is resuming.

The next item of business is a members’ business debate on motion S6M-04464, in the name of Rhoda Grant, on national health service staff recruitment and retention. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes the reported ongoing issues with staff recruitment in NHS Highland, while it attempts to expand its services by providing a National Treatment Centre in Inverness and to support NHS Grampian by providing obstetric services for Moray; considers that the Highlands and Islands has a world-class university in the University of the Highlands and Islands (UHI); understands that UHI previously carried out successful training of midwifery staff for the Highlands and Islands region to meet staffing demand as part of a two-year pilot in response to a specific workforce need; further understands that funding for this programme has now been moved to Edinburgh Napier University to cover the whole of Scotland; notes the view that NHS staff should be trained close to home in order to enhance recruitment and retention of staff, and further notes the call, therefore, for the Scottish Government to develop training for NHS staff at the University of the Highlands and Islands.


Rhoda Grant (Highlands and Islands) (Lab)

I thank the members who signed my motion, allowing this debate to take place. I also thank all the individuals and organisations that have provided briefings—far too many to name, which shows the level of interest.

Staffing issues are common throughout the NHS—indeed, last weekend, in a Royal College of Nursing survey, 90 per cent of nurses said that their latest shift had been understaffed. Currently, across Scotland, 6,209 nursing and midwifery posts are vacant. In NHS Highland, that figure is 296, which is 8 per cent of all nursing and midwifery posts in the board area.

When there are staff shortages across Scotland, we in the Highlands bear the brunt of them, because it is easier for people to change their careers without that impacting on their families when they live in the central belt. In the north, we need to make it attractive not just for the person to move but for their whole family to be uprooted. Therefore, it is a lot harder for us to recruit.

Added to that is a shortage of affordable housing, local services and public transport. Therefore, it is no surprise that waiting times in NHS Highland are among the longest in Scotland.

NHS Highland is attempting to recruit from all over the world. It is not for the want of trying that it finds itself desperately short staffed. Portree hospital’s urgent care unit is closed more often than it is open. Home care services and care homes are also desperately short staffed. The new Broadford hospital, which was opened by the Cabinet Secretary for Health and Social Care only weeks ago, cannot be fully utilised because of a lack of staff. Dentistry in Moray is so dire that NHS Grampian is requiring dentists in Aberdeen to step in and help. Dunbar hospital’s minor injuries unit only recently reopened as there were staffing challenges due to staff being moved to support the Covid response.

Staff are totally burnt out by the pandemic. Some are off sick with stress or other mental health issues, and some are leaving the profession altogether or taking early retirement.

I turn to maternity care specifically. Since Caithness general hospital’s maternity service was downgraded, women whose births are likely to involve complications have been sent, usually by road, to Inverness—more than 100 miles away. This week, a petitioner made the point that that is like a mother in Edinburgh travelling to Newcastle for maternity care.

At the time of the downgrade of the Caithness maternity unit, clinicians in Inverness expressed concern about staffing in Inverness and whether they would cope with the additional numbers. Members of the local community in Caithness were obviously concerned about the long distance that women needed to travel to access those services. Risk assessments of the service in Caithness were carried out due to the lack of paediatric support, but nobody has risk assessed the journey from Caithness to Raigmore hospital in Inverness.

Alex Cole-Hamilton (Edinburgh Western) (LD)

I share Rhoda Grant’s sentiments about the unacceptable distance that expectant mothers are expected to travel from Caithness to Raigmore. She will recognise that a lot of work has gone into addressing a similar situation in Moray, and a solution has largely been found. However, no such solution has been found to the Caithness situation, nor has any Government time been devoted to addressing it. Does she agree that that is a crying shame?

Rhoda Grant

I do, and I have written repeatedly to the cabinet secretary to ask him to visit and speak to people in the Caithness community. I understand that he is going to do that, which is extremely welcome.

As Alex Cole-Hamilton said, there is the same situation in Dr Gray’s hospital in Elgin, which is part of NHS Grampian. Again, the plan is to reroute complex cases to Raigmore hospital in Inverness. However, this time, clinicians, management and the community know that that cannot happen without additional staffing and investment at Raigmore. Despite that, it appears to be a fait accompli.

We read in the news at the weekend about two cases—one in Moray and one in the south of Scotland—in which babies were born by the roadside. Those births were deemed to be too complex to be supported in the local community midwife-led unit, yet it is somehow safer for those babies to be born by the roadside without any support. I really do not believe that.

The risk to mothers and babies that is created by that system is enormous, especially in the winter months, and it puts added pressure on paramedics, which is also unacceptable. I beg the cabinet secretary to take that risk on board, because it should not take a death to prove it.

We need to act. We need to train more staff in all disciplines but, crucially, in maternity care, obstetrics and paediatrics. In the Highlands and Islands, we have our wonderful, world-renowned university—a new university that is at the cutting edge of delivering education and research differently. It used to run a fast-track midwifery course, which was open to nurses, was held close to home and allowed them to enhance their training in midwifery. The course was building steadily and would have provided the maternity workforce of the future, albeit that it was drawing from the already stretched nursing workforce. However, as so often happens, the course was centralised in Edinburgh Napier University.

In my opening remarks, I alluded to the difficulty that that creates. People are reluctant to uproot their families to further their careers. Therefore, to grow our workforce, we need to provide training close to home. Evidence from NHS Education for Scotland highlighted that midwives are more likely to remain in the area where they were trained. I am sure that the same goes for other disciplines.

The current situation also adds costs to our health boards. Employing locum or bank staff is much more expensive than employing a full-time member of staff. The use of locums also creates issues for patients, because there is very little continuity for them.

There are also issues in how we train our professionals. We focus on team working within specialities. In rural areas, we need generalists who are able to turn their hand to treating a number of conditions, and they need to be able to work with very little support. We currently recognise a depth of knowledge through career progression and salary, but those with a breadth of knowledge find their skills unrecognised, both professionally and financially.

Although I have based my points on maternity services, the same is true in other disciplines. Mental health services in Caithness are at breaking point, with tragic consequences. General practitioners are handing back their practices to health boards, and we have some of the longest waiting lists in Scotland. The situation is untenable.

I urge the cabinet secretary to act. Any further delays will lead to loss of life.


Jackie Dunbar (Aberdeen Donside) (SNP)

I am pleased to take part in this important debate, and I congratulate Rhoda Grant on securing it. I will start by agreeing with her that there are many complex challenges in our NHS, particularly in relation to recruitment and retention in Scotland and across the rest of the United Kingdom.

The Covid-19 pandemic systematically changed the way that we provide healthcare in Scotland, and there is no doubt that the pandemic exacerbated pre-existing challenges in health and social care. It caused staff to change their working patterns and practices as they adapted to enormous challenges and hugely demanding environments. It is self-evident that that will have an impact on recruitment and retention, and what we do to address those issues is important. We should also bear in mind the combined impact of the pandemic and Brexit, which, it must be accepted, has created massive barriers to the recruitment of staff in our health service.

The challenges that Rhoda Grant’s motion cites are not confined to the Highlands and Islands; we have our own challenges in Aberdeen Donside and across NHS Grampian. Continued workforce supply challenges, alongside high levels of vacancies—particularly in medical specialties and in nursing and midwifery—and a recent increase in the number of vacancies in allied health professions, have resulted in an overreliance on supplementary staffing across our NHS, including in Aberdeen. The currently available supply of staff is insufficient to meet the ever-increasing demands on our health boards.

However, there are opportunities to look at alternative supply pathways. Participation in further international recruitment initiatives—using the networks of current NHS staff—continued development roles, links with further education, apprenticeship programmes and a review of all agency placements will be key to making the changes that are necessary to address the supply challenges.

How will that be achieved, particularly for NHS Grampian? The Scottish Government must continue to support the board to extend the workforce market to a wider range of potential applicants. We must utilise current supply pathways, while seeking to widen those routes through innovative approaches, and implement an easy and intuitive process that encourages individuals to apply for posts and improves candidates’ experiences of recruitment.

That approach must invest in marketing the brand of NHS Grampian by offering a range of jobs and career opportunities, and it must create a service model that is service based and influenced by the diverse resource, capacity and skills of the existing and future workforce. That model must be applied in a way that uses skills, generates effective teams and is efficient, so that it creates a workforce that is fit for purpose.

In order to ensure retention, the board must be supported to implement the staff governance standards within a culture in which staff and their contributions are valued and listened to, and we must ensure that the current workforce is offered appropriate development opportunities.

Today, I asked the cabinet secretary for a commitment that the board will be supported with those aims and that all action will be taken to ensure sufficient staffing of our valued NHS, which is so important to many constituents across Donside.

I have heard lots of complaints about an ageing workforce being an issue that faces our NHS. However, when I touched base with NHS Grampian ahead of the debate, I learned that it recognises that an ageing workforce presents an opportunity, because staff are highly experienced. I pay tribute to the board for exploring new and innovative ways of working and opportunities for staff who wish to continue working beyond their retirement age. The board fully supports the ageing workforce and, in many cases, provides opportunities for older staff to move into mentoring and senior roles, as well as opportunities for career advancement.

I welcome this debate and the steps that the Scottish Government is taking to support NHS recruitment and retention, and I reiterate my asks of the cabinet secretary.


Sandesh Gulhane (Glasgow) (Con)

NHS staff have played a vital and enduring role during the Covid pandemic. Like all my colleagues in the Parliament, I reiterate my thanks for their efforts and continued resilience as we begin rebuilding from the pandemic.

Jackie Dunbar spoke of an ageing workforce. Actually, the worry is not about their age but about the possibility that the ageing workforce will retire with no one to come in behind them.

I share Rhoda Grant’s concerns that the Scottish National Party Government has yet to adequately support NHS staff in Scotland. We are faced with serious recruitment and retention problems, and not only in the Highlands and Islands. Many of the issues that we see today are the result of failed workforce planning.

The SNP Government is not treating long Covid with the urgency that it requires. The number of people who have suffered for more than a year has doubled in just six months. Across Scotland, it is estimated that more than 150,000 people are suffering from long Covid, and, of those, 64,000 have been experiencing symptoms for more than a year. That is increasing the strain on services and on NHS staff.

The recent workforce plan was insufficient and lacked ambition. The number of unfulfilled registered nursing posts in NHS Scotland continues to grow, which increases pressure on already overworked and exhausted nursing staff. The latest statistics on the nursing workforce, which were published two days ago, show that 9.5 per cent of registered nurse posts in Scotland were vacant as of 31 March 2022. That is a record high. The rate equates to 4,605 unfilled registered nurse posts compared with 4,500 by the end of 2021.

The overall number of vacant nursing and midwifery posts was 6,209 as of 31 March 2022, which was up from 4,495 on the same date in 2021 and was an increase of more than 38 per cent in 12 months. Non-Covid sickness absence in the whole NHS workforce has increased to 5.7 per cent, up from 4.7 per cent on 31 March 2021, which increases the pressure on the whole service.

Colin Poolman, the Royal College of Nursing interim director, said that nurses

“deserve more than to turn up to work shift after shift and be expected to deal with significantly increased demand with fewer and fewer nursing staff.”

I could not agree with him more. Immediate action is required to support staff retention.

To address long-term recruitment issues, we need to take a comprehensive approach to workforce planning for the whole of NHS Scotland—in every profession and at every level. Furthermore, we would remove the cap on the number of funded places for front-line medical students in order to increase the number of home-domiciled students, because we know that they are more likely to continue working in NHS Scotland.

Successive SNP health secretaries have simply failed to adequately address workforce planning in our NHS, and the devastating results are clear for us all to see.


Jackie Baillie (Dumbarton) (Lab)

I join others across the chamber in thanking NHS and social care staff for their hard work, and I congratulate Rhoda Grant on securing this debate. She makes a powerful case for training NHS staff as close to home as possible and specifically for training to be provided at the University of the Highlands and Islands. I support her in that call.

I want to talk in more general terms about staff recruitment and retention. The Royal College of Physicians and Surgeons of Glasgow summed it up for me when it said that

“there is not enough staff to meet the needs of our patients”,

and that

“the challenges of workforce shortages ... are not new. They existed long before the pandemic and have deteriorated since.”

On Tuesday, NHS workforce statistics were published. They show that 9.5 per cent of registered nurse posts are vacant, which is a record high, while the overall number of vacant nursing and midwifery posts has gone up by 38 per cent to 6,209 in the past 12 months alone. The day before that, the Royal College of Nursing published what was, frankly, a shocking survey that told us that eight out of 10 nurses had patient safety concerns while working on their most recent shift, because they were so understaffed.

Earlier this year, six out of 10 nurses were actively considering leaving their job; at the start of the pandemic, it was three out of 10. The key reasons for leaving included feeling undervalued, being under pressure at work, unsafe staffing levels and low pay. Forty per cent are working beyond their contracted hours, while 67 per cent are too busy to provide the level of care that they would like.

When the Royal College of Midwives surveyed its members, it found that 70 per cent are considering leaving the service. Like the RCN, its members cited the safety of their patients due to the lack of staffing as a very real problem. Faced with all that pressure, it is little wonder that staff are leaving the NHS.

It is not just nurses. One in five consultants are leaving the NHS well before retirement, citing burnout as one of the key reasons. There is a shortage of allied health professionals and a shortage of GPs, too. In fact, the workload of GPs is enormous and there are simply not enough of them to cope with rising demand. Although I think that we would all welcome the Government’s plan for 800 more GPs, I reflect on the words of Dr Andrew Buist of the British Medical Association, who said:

“training an extra 800 is not the same as getting them into practices where they are needed to improve access to patients.”

Getting workforce planning right is critical, but it will take time, so the retention of existing staff must be an urgent priority for the Government. We need to care for staff so that they can continue to care for us, and that extends beyond their welfare, important though that is. We need to pay them better and to recognise and reward their hard work—and that applies to both health and social care. We also know that the NHS lacks flexibility. Instead of letting 40 years of experience walk out the door, can we not see if we can retain that knowledge and those skills on a part-time basis?

Above all, let us implement the Health and Care (Staffing) Act 2019, which everybody in this Parliament voted for, to ensure that we have safe staffing levels. It has been on the statute book for three years now, and nothing has happened. The cabinet secretary says that he will publish a timetable by the end of June, which is welcome, but a timetable that is vague and which pushes implementation years down the line will simply be unacceptable.

There is a huge crisis coming that has been unfolding for years, and the cabinet secretary is giving the appearance of being asleep at the wheel. I hope that he wakes up before it is too late.


Alex Cole-Hamilton (Edinburgh Western) (LD)

I start by thanking Rhoda Grant for securing parliamentary time for this important debate. I also associate myself with her remarks about the difficulties faced by expectant mothers who travel from Caithness to Raigmore hospital to deliver their babies. It is in nobody’s estimation safer for a baby with complex needs to be born by the side of a road than in the care of a hospital nearer to their home, which should be our aspiration for those families.

The Cabinet Secretary for Health and Social Care (Humza Yousaf)

I do not disagree with Alex Cole-Hamilton’s comments. However, does he recognise that the decision on Caithness was taken by the health board itself, because of a very tragic case, and that patient safety was at the heart of that decision when it was taken a number of years ago?

Alex Cole-Hamilton

I recognise that. However, the decision was taken a number of years ago, and things have moved on. We need to listen to the community and clinicians and actually make it safer for mothers to deliver their babies close to their homes in Caithness.

I also thank the Royal College of Nursing, which, alongside others, has worked tirelessly to provide the country with the information that we are debating today and which illuminates the current crisis in nursing—and I repeat that it is a crisis. It is unfortunate that the information makes such bleak reading, given that we have been talking about this issue for what feels like years.

The RCN Scotland survey report, which, as we have heard, was released this week, has revealed that awful statistic of 90 per cent of nurses who responded believing that the number of nursing staff on the last shift that they worked was not sufficient to properly meet patients’ needs. Not only is that dangerous for patients, but, as the report highlights, it puts an inordinate amount of stress on staff. They sacrifice their own wellbeing to deliver the care that their patients need, and as a result, 63 per cent of staff in Scotland have said that they feel “exhausted” to the point of negativity by the end of the shift. I would like to highlight that that statistic is only 10 per cent higher than the average UK figure. The daily reality is dire and is, in fact, quickly becoming untenable.

Describing their experience in another recent RCN report, one nurse said:

“One day I walked into my shift, and ... I was on my own in the entire floor. I can’t describe how I felt at the end of that shift, emotional, physically”.

They go on to say:

“Something should be done about the staff shortage and fast otherwise nurses will be forced to leave one by one and the few remaining will die of stress and burnout”.

That reality is particularly stark in remote and island communities.

I think that those words speak for themselves. The reality is that we as a Parliament have passed legislation that should not allow this to happen. In the safe staffing legislation that we passed, we as a Parliament recognised that we cannot allow shifts to proceed in such unsafe ways—and yet still they do. I welcome the fact that the cabinet secretary has finally announced a long-overdue timetable for implementing the legislation, but we have been waiting for three years now. I reiterate the point that I often make that this is not just about head count; we need to be sure that every shift has the right mix of skills and experience to deliver patient care safely.

As the nurse whom I quoted made clear, the unbearable working conditions mean that more and more staff are being lost to the profession. They are forced to give up the job that they love, which potentially puts off people who are considering entering the profession. That will lead inexorably to fewer staff, putting more pressure on current staff and making working conditions worse than ever before. It is a vicious cycle that we need to break.

This is why the Liberal Democrats have called for the establishment of an NHS staff assembly to learn from the lived experience of staff, and I was heartened yesterday to hear Humza Yousaf agree to look seriously at the proposal. It is also why our party has repeatedly called for a burnout prevention strategy, which would implement mental health help for front-line staff and support them in their job. However, that suggestion has been voted down on successive occasions and routinely dismissed by the Government, including in an exchange yesterday, when Humza Yousaf referred to the idea as being just a piece of paper. The problem is that, despite the health secretary telling us repeatedly about the money that is being invested in staff welfare, the Government has yet to produce its own piece of paper saying how that money will be spent on supporting NHS staff. A burnout prevention strategy is exactly what those people need.

The motion also refers to training NHS staff in all areas of Scotland, not just the central belt, which is something that the Liberal Democrats are fully supportive of. This cannot be a postcode lottery. Widespread training programmes are an important step in producing widespread care, which is vital to ensuring our nation’s health.

I will end—you have been very good to me, Presiding Officer—with the words of Pat Cullen, the RCN’s chief executive, who said:

“To those from government listening to my words—we've had enough. The patients and those we care for have had enough.”

It is long overdue that the Government not only listens but acts.

Thank you, Mr Cole-Hamilton. I am always good to everybody.


Carol Mochan (South Scotland) (Lab)

I, too, thank Rhoda Grant for bringing this important motion to the chamber. I echo the points that she has made on the difficulties of recruitment in rural areas, including her area of NHS Highland. Recruitment is a major concern across the NHS, but that concern is definitely heightened in rural areas.

As Rhoda Grant has said, the RCN advised us before the debate that in NHS Highland 224 registered nurse posts—nearly one in 10—are vacant. That situation is reflected in other rural areas. It is a significant cause for concern that the Government ought to take very seriously and act upon.

NHS staff recruitment and retention is an on-going issue that has been debated many times in the chamber and raised repeatedly by nursing trade unions. As I say regularly in the chamber, the Scottish Government cannot take the time to pat itself on the back while vacancies remain high across the country, staff remain under pressure and services continue to be strained.

The Government must consider carefully the ways in which recruitment can be improved, and that must include the training of NHS staff close to home. As someone who covers a rural constituency, I hear time and time again many of the points that were made by Rhoda Grant earlier in the debate. We have first-class university and college facilities across Scotland, and it is important that training programmes are rolled out in our rural areas such as the Highlands and my area of the Borders to ensure that people who wish to enter the healthcare profession can train and then—we hope—take up posts close to home.

Moreover, in our efforts to ensure that care is community based and available locally, we must recruit more people in key areas such as mental health and learning disabilities, as was referenced in the RCN’s briefing, to ensure that such services have the staff to meet demand and can be delivered close to the people who rely on them. That helps patients and staff, both of whom can benefit from having facilities close to home. That is so important in rural areas.

As we know—and as has been mentioned by members across the chamber—recruitment and retention are closely linked. Just last month, at First Minister’s question time, I highlighted discussions with the Unison trade union on how workplace pressures in NHS Borders had led staff to report to the union issues such as staffing levels that are dangerous for both patients and staff and staff not receiving proper rest breaks.

That situation is unacceptable. I know that the Government has acknowledged that and that it says that it will address the issue, but we on the Labour benches have to keep pushing to ensure that the safe staffing legislation is enacted and that the Government takes the issue seriously. Those points have previously been made in the chamber, and we must now start to enact some of that work.

The healthcare workforce gives so much to the community and to our country, but it often feels that it gets so little back. Is it any wonder, therefore, that vacancies remain so high and that staff feel under so much pressure? If we want to recruit and retain a skilled workforce that serves every part of our country, including rural areas, we must start by alleviating some of the barriers to the recruitment of students and addressing the workplace pressures that staff currently face in order to make the healthcare setting an appealing one in which to work.

As Rhoda Grant’s motion makes clear, the Highlands have seen the removal of a key training programme from a local university to the large city of Edinburgh. It is also clear from today’s contributions—and, indeed, from trade unions and NHS workforce briefings—that current workforce pressures are significant and put strain on the ability to deliver the service that patients deserve.

Those two clear issues that are highlighted in the motion and which relate to recruitment and retention can be fixed by bringing training programmes closer to home. For rural areas, that would mean having valued NHS staff close to home who could provide those services. It is a significant point that the cabinet secretary should follow up.


Brian Whittle (South Scotland) (Con)

I, too, congratulate Rhoda Grant on introducing the debate. As I think she will recognise, it is not the first time in the past couple of sessions that we have discussed such issues in the chamber.

When my daughter was at university, I had a conversation with her in which she told me that she had decided to change from studying law to studying midwifery. That was a switch—law to midwifery. When we looked at the possibility, we found that there were 10 applications for each available place to study midwifery at college. I raised that with her, but she still wanted to do it. On she went, and she got one of those places.

Having looked at midwifery, I then looked at other medical professions, such as nurses and physios, and found that there were four times as many applications as the number of available places. My colleague Sandesh Gulhane talked about the cap on medical students from domiciles in Scotland, but the fact is that there is no lack of applications from them.

As has been mentioned, when it was previously highlighted that Scotland had a shortfall of 864 GPs, the Government responded by suggesting that a further 800 GPs would be trained over the next decade. However, that failed to take into account GP turnover. Indeed, an Audit Scotland report suggested that, in 10 years, we would still be left with a shortfall of 600 GPs.

Early in my political career, a constituent unfortunately lost a child in childbirth at Crosshouse university hospital, which had an inordinately high number of baby deaths. We managed to get Healthcare Improvement Scotland to carry out a report into the situation, and it discovered that the neonatal unit was 24 staff short. My daughter now works in that neonatal unit, but when she first qualified as a midwife, she could not get a job in Scotland and had to travel to Preston to do three 12-hour shifts before getting the train back up. Fortunately, she now works in the Scottish NHS.

So where is the workforce plan? One issue that I suggest we look at, especially with regard to the lack of GPs and the importance of having Scotland-domiciled students, is the fact that where those students work tends to relate to the postcode that they put on their Universities and Colleges Admissions Service form. I think that that is highlighted in Rhoda Grant’s motion.

One of the issues that we are discussing today is recruitment and retention, but the phrase is the wrong way round. The first thing that we should do is ensure that we retain the staff that we have. If we do not, it will be like trying to fill a bucket with a hole in it.

We need to create an environment that our medical staff want to work in. We must take more cognisance of reports of bullying; we must ensure that there is advancement; and we must ensure that the hours and shifts that staff have to work provide a more balanced life. I remember talking five years ago about ensuring that hot meals are available for staff who work evening shifts, which is something that does not always happen.

A more important issue these days is ensuring that mental health support is available for all our healthcare staff. If we want to invest in health services further upstream as part of the prevention agenda, which is my passion, we need a workforce that can deliver them. One of the first things that I said in the chamber was that, to improve the health of our nation, we had to start by looking after the people who look after us. When we discuss recruitment and retention—or, I should say, retention and recruitment—we must ensure that what we actually mean is that we will look after the health of those who look after us, because that will go an awfully long way towards starting to deal with the issues outlined in the motion.


Michael Marra (North East Scotland) (Lab)

I, too, thank my colleague Rhoda Grant for bringing the debate to the chamber and for highlighting the needs of her constituents, in relation to not just workforce planning but the particular challenges that pertain to the dispersed population of the Highlands. Special accommodation must be made for that population if we are to ensure that our national health service provides for them appropriately.

Unsurprisingly, I want to talk about my constituents and the similar challenges that they face with regard to workforce planning in particular. There are major shortfalls in the numbers of oncology consultants in NHS Tayside, particularly for breast cancer patients. Many of the workforce planning issues that have been raised so far impact on that situation.

I know that the cabinet secretary recognises that workforce planning is a challenge across all of Scotland. A 2020 Scotland workforce census showed that an estimated 18 per cent of consultant clinical oncologists are forecast to retire by 2025. My home city has borne much of the brunt of that challenge. How many patients will have their cancer treatment compromised before there is change on a systemic level in response to that?

During general question time, I confirmed to the cabinet secretary that, in the past couple of weeks, the final breast cancer oncologist has left their employment at Ninewells hospital.

There is a considerable history to the issue. We need a comprehensive workforce plan and, clearly, recruitment is part of the response. However, I am fast coming to the conclusion that a recruitment process alone will not deal with the problem.

When a prospective consultant sees an advert, they research the centre, google its record and speak to colleagues in the international community who are involved in the relevant services. For Dundee, they will find a record of conflict between clinical staff and management, a seriously flawed Health Improvement Scotland report and reports of a culture of bullying, which members have referred to in exchanges in the Parliament this very day. Sandesh Gulhane raised that issue today—I will take his intervention.

Does Michael Marra agree that the secret report must be made public and that we must urge the cabinet secretary to intervene?

Michael Marra

I certainly agree that all documents pertaining to the situation should be put into the public domain. Sandesh Gulhane is referring to a report by the Royal College of Physicians in London that was commissioned in 2019. It is shrouded in conflict of interest issues relating to some of the members who were involved in the production of the report. It seems to have been shelved, but the reason for that has never been entirely clear and open. On this issue, we need full transparency and openness around all publications.

There is a further document that I would like the cabinet secretary to produce, which is the right-of-reply response of clinicians in Dundee to the Health Improvement Scotland report. That should be provided as well.

Only when we deal with the underlying issue will we deal with the fact that we cannot meet the recruitment requirements in the specialism in Dundee. The board of NHS Tayside must step up at long last and perform its legal function in the matter to “challenge rigorously”, according to its own code of corporate governance, the executive officers who are presiding over a chronic situation that will be helped only by full openness and real honesty from all parties.

Labour colleagues asked the First Minister these questions in February 2021, which is 16 months ago. There has been more than a year of obfuscation and denial from the Scottish Government. As late as November 2021, the Deputy First Minister appeared in the chamber in complete denial, saying that to raise the issues was to do a disservice to the women of Tayside.

On 27 January, I advised the chamber—and, seemingly, the Cabinet Secretary for Health and Social Care—that further resignations from the service had been tendered. Today, I informed the chamber that there are now no breast cancer oncology specialists in Dundee. The cabinet secretary gave assurances that he

“and other ministerial colleagues have been deeply involved in the issue.”—[Official Report, 27 January 2022; c 5.]

I am afraid that that is becoming as much of a concern as a reassurance.

There is a fundamental breakdown of trust. Only full transparency will restore it and the services that the women of Tayside and Dundee need.


The Cabinet Secretary for Health and Social Care (Humza Yousaf)

I thank Rhoda Grant for bringing this important debate to the Parliament, and I thank members from around Scotland and across the political spectrum who have contributed. Although I might not agree with all of their points, the substantial points that have been made on recruitment and retention, staffing and workforce planning are important.

I will touch on some of the general points, but I would do a disservice to the debate if I did not touch on some of the key themes and points relating to NHS Highland that Rhoda Grant has raised. Of course, other members are correct: the issues that affect NHS Highland are not unique to the area but are often replicated in remote, rural and island communities. Therefore, I will address some of those more general points, too.

As Rhoda Grant knows, I have been to NHS Highland on a couple of occasions in the past two weeks to open two new hospitals there. I am pleased with that Scottish Government investment. However, Ms Grant is right that, when I visited Badenoch and Strathspey and Broadford hospital in Skye, staff repeatedly raised recruitment and retention with me. She is also correct that the issue is not just about job offers—Jackie Dunbar and other colleagues touched on that point, too—but, as we know, about housing, transport links and education. Again, I will try to touch on some of those points where I can.

Workforce recruitment is key. I will touch on retention issues soon. I recognise that vacancies in particular staff cohorts are far too high. A number of colleagues raised the workforce statistics that have recently been published on nursing vacancies. They will not get a difference of opinion from me suggesting that those vacancies are acceptable, but I put on record and robustly defend the action that we are taking. We are doing our best in an extremely challenging and competitive market to recruit as many qualified nurses and midwives as we possibly can. However, overall, I am very proud of the Government’s workforce record.

Brian Whittle

Does the cabinet secretary agree that the issue is not just about recruiting current staff but about the numbers of staff in training and that, if we had had a long-term strategy five, six or seven years ago, we would not be in the situation that we are in now?

Humza Yousaf

A variety of training programmes are under way. In particular, there are training and incentivisation programmes for rural health boards that help to attract people and keep them. I will come to the point about retention in more detail.

I was about to say that we have a proud record of recruitment in the NHS. Since 2006, there has been an increase of almost 30,000 in the number of whole-time-equivalent staff in the NHS. In NHS Highland, which is an area of interest in this debate, the workforce is up by 33.6 per cent, which is higher than the average growth rate across NHS Scotland. The increase in the number of medical and dental consultants is more than 70 per cent. More recent statistics than those from December 2019—which was before the pandemic—show that the increase in the workforce in NHS Highland is 7.8 per cent.

To go back to the point that I made in response to Brian Whittle, we are doing what we can to recruit and retain, particularly in rural health board areas. That includes a golden hello payment to GPs who are new to rural areas and, via a primary care rural fund to support established GPs, our rediscover the joy programme, which we hope to extend to other health board areas.

Rhoda Grant raised more specific challenges, and I take the point that she made about Caithness, which Alex Cole-Hamilton also made. As Rhoda Grant graciously noted, I have agreed to meet the campaigners in Caithness. I will do that this summer, and I will ensure that MSPs are invited to those discussions.

I give the absolute assurance, which I hope that members will take at face value, that the safety of mothers and their unborn children is of paramount importance to all of us. I agree that giving birth in a lay-by is not what any of us would want for our children. We would not want our own family members to be in that position.

We all agree that giving birth in a lay-by is unsafe. I would be grateful if the cabinet secretary would commit to doing a risk assessment of journey times in emergency situations and, indeed, routine ones.

Humza Yousaf

I will certainly explore how we can do that in a meaningful way.

The point I was about to make is the one that I made in my intervention on Alex Cole-Hamilton, which is that we have to bear in mind that there was a tragic case, and a review of that said that the death was avoidable. That meant that very difficult decisions were taken in Caithness. However, I take Alex Cole-Hamilton’s point that that happened a number of years ago and things should have moved on from there.

Education and training are important, and that point has been raised by almost every member who has spoken. Brian Whittle gave a very personal perspective on it. We are keen to ensure that we can train the workforce in remote, rural and island health boards where possible. That is an important endeavour for the Government.

Members across the chamber will be aware of ScotGEM—the Scottish graduate entry medicine programme—which is Scotland’s first four-year graduate entry medicine programme. It is hosted by the University of St Andrews and the University of Dundee and it went from 55 students in 2018 to 70 students this year. Of particular relevance to NHS Highland is the fact that the ScotGEM programme includes periods of time living and studying in NHS Highland. I have heard from remote, rural and island health boards time and again that if we can get people to live, train or study in those places, we will have a much better chance of retaining them there.

Jackie Dunbar spoke about a more co-ordinated approach across rural health boards. Her points were well made, and I commit to supporting NHS Grampian with its staffing and recruitment. However, I have to say, quite frankly, that at times our recruitment activity can be a bit ad hoc. I am keen to have a more co-ordinated approach, particularly across remote and rural health board areas.

Midwifery training is another key part of Rhoda Grant’s motion. She is concerned about the discontinuation of the pilot at UHI. She will be aware of NHS Education for Scotland’s review of that pilot and midwifery workforce education, which was published in March 2021. She can come back to me if she has any specific points to make on that. The review said that the institutions that are providing training and educational opportunities should continue to do so. That is why, in January of this year, Edinburgh Napier University welcomed students from across Scotland to undertake the new, shortened midwifery programme. Students will qualify in only 20 months, and they will continue to work in their home regions, which include northern Scotland’s health boards.

I have outlined that we are exploring every possible avenue to improve health and social care by investing in those people who mean so much to us: the staff who care for us. They are the people whom we have clapped for and applauded, and that is why we will invest in them—in their pay and terms and conditions. We will also do everything that we possibly can to work with our remote and rural health boards, including NHS Highland, to see how we can support them in recruiting and retaining staff for the future.

13:40 Meeting suspended.  

14:30 On resuming—