Skip to main content

Language: English / Gàidhlig

Chamber and committees

Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, September 14, 2021

Agenda: Time for Reflection, Business Motion, Topical Question Time, Covid-19, Urgent Question, Health and Social Care, Parliamentary Bureau Motion, Decision Time, Tokyo Paralympics


Health and Social Care

The Deputy Presiding Officer (Liam McArthur)

Before the cabinet secretary’s crutches give rise to any further mishaps in the workplace, we move to the next item of business, which is a debate on motion S6M-01190, in the name of Humza Yousaf, on a caring nation—recovering, remobilising and renewing health and social care in Scotland. I invite members who wish to participate in the debate to press their request-to-speak button now or to type R in the chat function if they are joining us online.


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

I apologise to Mr Carlaw for the unfortunate positioning of my crutches. We would not have wanted to add to our waiting lists, given the significant challenges that we already have.

I am delighted to open the debate on behalf of the Government. We are living in extremely challenging times, through a global pandemic that has brought significant challenge for health and care services across the world. Right now, our national health service and social care system are under more pressure than they have been under at any other point in the pandemic. In fact, the NHS is undergoing the biggest shock of its 73-year history.

Today, there are more than 1,000 Covid patients in our hospitals. That number has more than doubled in the past two weeks. To provide wider context, our hospitals have dealt with more than 31,546 Covid admissions over the past 18 months, which is enough to fill well over half of Hampden Park, and more than 2,455 of those people have been admitted to intensive care units. Those numbers are not just staggering in their scale but tragic in terms of the human impact that they have had on so many people. My thoughts and those of everyone in the chamber go to every family and community that has been bereaved by the impact of Covid.

At the same time, we have seen our NHS continue to deliver emergency and urgent care—for example, for cancer—as well as standing up the biggest vaccination, testing and contact tracing programmes ever seen in this country. I suspect that they are the biggest that we ever will see.

Through the first two waves of the pandemic, we responded by standing down non-urgent procedures and pausing some important aspects of our health service, such as some screening programmes. Critically, demand for primary care and accident and emergency services was significantly reduced because people stayed at home or, sadly, were reluctant to seek advice on their symptoms.

The pandemic is not over, however—far from it. The third wave has already brought pressures to a new level. Covid case numbers are high again—in the past couple of weeks, they have been at record levels—and we are still dealing with urgent and emergency procedures, we are restarting paused services as quickly as possible, and we are still running our test and protect and vaccination programmes.

On top of that, we are seeing record levels of presentations to A and E services. One statistic that demonstrates that challenge is the fact that, during the last week of August, more than 27,000 people presented at A and E. The previous time there were more than 1,000 people in hospital with Covid, which was last December, there were just over 19,000 presentations to A and E, so we have seen a 40 per cent increase, which is currently placing even more pressure on our NHS.

Acute bed occupation across our health boards is sitting as high as 98 per cent in some cases, so there is simply not the headroom that we had at the beginning of the pandemic. Important infection prevention and control measures mean that it takes longer to assess people and to move them to discharge or admission. All of that, coupled with increased lengths of stay in hospital due to people presenting at hospital later and sicker, means that our hospitals are fuller than ever with people who have a wide range of ailments, not just Covid.

By definition, the workforce has been under sustained and unprecedented stress. NHS staff are not immune to stress, and nor are they immune to Covid. They live in communities like the rest of us, and with high prevalence comes staff absence across health and social care settings. That means that it can take longer to discharge people who are ready to leave hospital but cannot be accommodated in care settings due to staffing pressures, which adds to pressure on hospital beds.

No single part of the health and social care system operates on its own. We are all aware that those parts are interconnected and interdependent. That is why we are tackling the challenges that we face on all fronts with a comprehensive programme of investment, and that investment is not targeted at just one part of the health service—we have taken a whole-system approach across GP services, NHS 24, the Scottish Ambulance Service, our acute sector and social care.

Willie Rennie (North East Fife) (LD)

I assume that the cabinet secretary will come on to the justification for the centralisation of social care. This will be the third such bureaucratic reorganisation since the Scottish Parliament was created. The others have not worked, so what makes the cabinet secretary think that, this time, another reorganisation will make a difference?

Humza Yousaf

I will not go into past battles around Police Scotland, but, on that issue, the Liberal Democrats were thoroughly defeated.

On the national care service, we would like to improve the terms and conditions for social care staff right across the country, and we can do that by ending the postcode lottery of social care by ensuring that it is accountable to ministers. I am sure that we will speak at length in the chamber on many occasions about the national care service.

Our colleagues across the health and social care system—

Will the cabinet secretary take an intervention?

I will.

Stephen Kerr

The cabinet secretary was speaking about waiting times and waiting lists. How many people in Scotland are currently on a waiting list for treatment, and how long does the model estimate it will take to get the backlog under control?

Humza Yousaf

I will come on to the detail of waiting lists, which, as Stephen Kerr knows, is an extremely significant issue. He also knows that it is a challenge that Governments across the United Kingdom face. He is right to ask how long it will take to resolve, and I have two things to say on that. We are still adding to the backlog, because we are in the middle of a global pandemic. The pandemic has not ended, so we are still facing challenges and pressures. However, our NHS recovery plan, which is backed by more than £1 billion of investment, sets out in detail how we will recover in regard to the backlog.

Will the cabinet secretary give way?

If you do not mind—oh, my goodness! As it is Mr Ewing, I will give way.

Fergus Ewing

It is very generous of the cabinet secretary to give way—I thank him. The cabinet secretary has given details of the heavy burden on NHS services throughout the country, which is perhaps largely a result of the Covid pandemic. Plainly, with the 26th United Nations climate change conference of the parties—COP26—close on us, we will see the arrival in Scotland, with a focus on Glasgow, of several tens of thousands of people, and there are concerns about the importation of new strains of the virus. Will the cabinet secretary assure members that the Scottish Government has given the fullest consideration to, and carried out a detailed assessment of, what possible contingent consequences there may be with regard to the arrival in Scotland of such a large number of people at a time when we have concerns about mass events?

I can give you back a bit of that time, cabinet secretary.

Humza Yousaf

I give those assurances to Fergus Ewing. We are working with the UK Government, the United Nations and all stakeholders to make the event as safe as possible. However, I cannot stand here and tell Fergus Ewing, in all honesty, that it will be a risk-free event. We will do our best to mitigate the risk as best we can.

I will give some details of some of the funding that we are providing right now—we are not simply waiting for the pandemic to be over before taking action to help our care and health service. Additional funding of £30 million has been given to the Scottish Ambulance Service and NHS 24; £12 million has been given to support acute care, which will help in opening additional bed capacity; £23 million has been given for the redesign of urgent care, which will reduce demand at A and E by providing more support in the community; £155 million has been given for primary care, including for the restoration of face-to-face treatment and additional support for NHS 24 and the Scottish Ambulance Service; and £120 million has been given for mental health services, which will focus on prevention and early intervention, as well as on helping to clear the challenging child and adolescent mental health services backlog.

Some of the immediate actions that we have taken to address social care pressures include funding support to advertise vacant posts on a dedicated social care web page and targeted communication with further and higher education health, care, nursing and social work students to encourage applications to join the workforce. That is in addition to our provision of funding to ensure that social care staff are paid at least the real living wage. We will do all that we can to support and reward those who work in health and social care. We have already implemented a 4 per cent pay increase for agenda for change staff, which is the biggest single-year rise in the lifetime of this Parliament.

As I said in my response to Mr Kerr, our recovery plan sets out how we will deal with the significant challenges that we face. There is a significant backlog. I know that there were challenges before the pandemic, but it is fair to say that those have been significantly exacerbated by the shock of the pandemic.

Will the cabinet secretary give way?

I have not yet given way to a Labour member and am happy to do so.

Paul Sweeney

The cabinet secretary notes the significant pressures that the health service faces in the current situation. He may have noticed the particular case of Brian Sneddon in today’s Daily Record. The case relates to ambulance services. Brian suffered a stroke last week but was left in his house for more than two hours. His son and his son’s cousin eventually had to drive Mr Sneddon to the hospital. Because he did not get treatment within four hours of suffering a stroke, he now faces a far more complex journey to rehabilitation, which in turn creates further long-term costs and pressures for the NHS.

I urge the cabinet secretary specifically to examine ambulance responses to urgent cases such as those of stroke victims. I do not think that there is much that he can say to assuage the suffering of Brian and his family as a result of the complexities that he now faces, but the situation is particularly problematic and we must get on top of it quickly.

How much time do I have to the end of my speech, Presiding Officer?

I can reimburse you. You have 12 and a half minutes. We are quite tight for time.

Humza Yousaf

I was going to say that you were being generous.

I have seen the details of the very serious case that Mr Sweeney raises. I extend my sympathy to Mr Sneddon, but Mr Sweeney is right to say that it is not my sympathy that he needs; it is action. I have just detailed some of the work that we are doing to invest in the Scottish Ambulance Service. Mr Sweeney will understand that I cannot wave a magic wand to make the effects of the pandemic that we are living through disappear, but I promise that I speak regularly to the Scottish Ambulance Service to see what more we can do—and not only to invest in the ambulance service. If we improve the flow of patients into A and E, that will allow ambulances to be discharged to other patients sooner. I thank Mr Sweeney for raising the important case of Mr Sneddon.

Our recovery plan gives a great deal of detail of how we intend to meet the challenges of remobilising, renewing and recovering our NHS. We will increase in-patient capacity by 20 per cent and out-patient capacity by 10 per cent. We will recruit an additional 1,500 staff for our network of national treatment centres. I leave it to my colleague Kevin Stewart to give more detail of the national care service, which I know is of great interest.

We all know how challenging the past 18 months have been for everyone, and we would all agree that the staff in our national health service and in social care have made heroic efforts. That is why a common thread throughout the NHS recovery plan is ensuring that we invest in the wellbeing of our NHS and social care staff. We have committed to an £8 million package of support within which £2 million is targeted at social and primary care. We will continue to work closely with the NHS, trade unions and others to see what additional support we can offer.

We all agree that NHS and social care staff make a heroic effort every day, and they have done so particularly in the past 18 months. I thank them all and give them an absolute guarantee and promise that the Scottish Government—and all in the chamber—will ensure that they are recognised and supported for what will still be a challenging period ahead.

I move,

That the Parliament thanks Scotland’s NHS and social care staff for their heroic efforts during the COVID-19 pandemic; recognises that the pandemic has been the biggest shock that the NHS and social care services have ever faced; notes that the NHS is currently under intense pressure due to the pandemic and that primary care, ambulance and hospital staff are working around the clock to deliver care to patients; recognises that well in excess of £1 billion has already been provided this year to address COVID-19 pressures in health and social care and that further funding will be allocated to support service pressures; welcomes the £1 billion NHS Recovery Plan that will significantly increase NHS inpatient, outpatient and diagnostic capacity; notes that this increase includes recruiting an additional 1,500 staff to work in the network of National Treatment Centres; recognises that the Plan puts particular focus on early cancer diagnostics and referral pathways as well as child and adult mental health services; agrees that the mental health and wellbeing of health and social care staff is a key priority and central focus of the Plan; supports the commitment to create a National Care Service; recognises that ethical commissioning, and setting terms and conditions that meet the Fair Work principles, could greatly improve how social care is delivered, and believes that the voices of lived experience, including those who access support and care, the workforce and unpaid carers must be central to the ongoing consultation on the service.

We are quite tight for time. I encourage members to make and take interventions but to do so briefly. I will try to reimburse speakers for that time.


Craig Hoy (South Scotland) (Con)

Covid-19 has been linked to nearly 11,000 Scottish deaths, and one in three of those, tragically, has taken place in our care homes. Our thoughts go out to the families of all those who have died during the pandemic.

The cost of cancelled operations, delayed diagnoses and the inability of many patients to access healthcare will be significant, but ministers must accept that many of those problems pre-date the pandemic. Before I turn to the proposals for the creation of a national care service, I note that a brief review of the challenges that are facing our national health service has proved to be sobering.

In our accident and emergency units, over a quarter of patients are still not seen within four hours, and 115,000 patients are waiting to be seen for key diagnostic tests. Performance against the 12-week treatment time guarantee is at its third-lowest level since records began, and a fifth of patients are waiting too long for mental health treatment.

Will the member take an intervention?

Craig Hoy

I would like to make some progress, first.

Drug deaths have tripled under the SNP Government, and waiting times for residential rehab regularly exceed a year. The chairman of the British Medical Association Scotland, Dr Lewis Morrison, says that doctors are exhausted and that many are simply considering leaving the NHS altogether. The Royal College of Emergency Medicine says that there is genuine concern that hospitals will not be able to cope this winter.

Covid has contributed to those challenges, but it is not, ultimately, the root cause. Years of this Government’s poor workforce planning are finally taking their toll on our NHS. The First Minister told Parliament last week that the creation of a national care service is

“the most significant public service reform since the creation of the national health service.”—[Official Report, 7 September 2021; c 13.]

The builder who botched the extension is now asking whether they can build a new house, all while a public health typhoon is blowing.

According to the Feeley review, the creation of a national care service will put adult social care on “an equal footing” with our NHS, but a brief look at our NHS in the present crisis raises serious questions about whether this is the right time to embark on such significant reform of adult social care. The Scottish Conservatives readily concede that social care in Scotland needs reform and investment, so we will look closely at the Government’s final proposals. The question is how far and how fast the process should go.

Hard-working staff are exhausted and the system is under immense strain. There are long-term demographic, structural, staffing, commissioning, funding and delivery challenges. Last year, the Care Inspectorate issued 197 warnings about staff shortages in care homes. In Fife, 395 people are waiting an average of 77 days for care-at-home packages. However, rather than looking to fix the urgent failings in the system, ministers now propose to bite off far more than they can chew, with a widespread reform programme.

Despite the current crisis in care, the Scottish Government proposes to consolidate adult social care, social work, children’s services, justice social work, alcohol and drug services and areas of mental healthcare in one service under direct ministerial control. Those reforms focus on structures for tomorrow and ignore the crisis in social care today. Although I welcome Kevin Stewart’s commitment to further consultation, I wonder whether he is genuinely listening. If he is, he must already be hearing the alarm bells ringing on the scope of the proposed service.

The Minister for Mental Wellbeing and Social Care (Kevin Stewart)

I thank Mr Hoy for giving way. I challenge him and other members to go and talk to folk with lived experience. Covid has shone a light on social care; folks are not happy with the current situation and they want change. I ask Mr Hoy, please, to talk to the stakeholders and not just to the people who are normally listened to in Parliament.

Craig Hoy

I recognise that families and people with lived experience have raised legitimate concerns about social care, but I do not think that they have asked for a major structural review to fix it.

The president of the Convention of Scottish Local Authorities, Councillor Alison Evison, has rightly asked why local government services were wrapped into plans for the national care service at the very last minute. She said:

“If there is nothing to hide it should be a fairly straightforward question to answer”.

Where was the consultation—unless I missed it—on the decision to significantly expand the scope of the Feeley recommendations?

Will the member give way?

Craig Hoy

I will not.

Despite repeated disasters in Government information technology procurement, the plan glibly proposes a wholesale data-sharing system across all care settings, including an interface with NHS medical records, despite the fact that the two commonly used GP record systems—EMIS and Vision—do not currently speak to each another. Almost all large-scale SNP-commissioned public sector data systems have hit serious cost overruns, yet the minister appears to be confident that that huge IT project can be achieved in the current session of Parliament.

Ministers must do more to explain why a centralised service under direct ministerial control will lead to better outcomes. The lessons from Police Scotland tell us that centralisation undermines local delivery and leads to poor and, sometimes, tragic outcomes, as we saw, sadly, only last week. The plans amount to an attack on local authorities and local accountability.

By proposing to scrap health and social care partnerships and integration joint boards, ministers are finally admitting that their previous attempts to deliver greater integration have failed. Why, then, is the Scottish National Party Government so confident that making Scottish ministers accountable for social care while driving local delivery through new community health and social care boards will lead to any meaningful positive impact on social care outcomes? In fact, centralisation ignores the clear need for services to be designed and delivered as close as possible to the people who use them.

Centralising children’s services runs the risk of placing vulnerable children far from the local agencies and communities that understand their past problems and present needs. How can that possibly lead to better outcomes?

When it comes to staffing, pay and the absence of structured career development in social care, will moving to a system of national pay bargaining really tackle the recruitment, retention, and career development crisis in our care system? The Royal College of Nursing has said that the reform process overlooks the nursing contribution in social care.

What of future capital investment? Fears are growing that centralisation will lead to creeping nationalisation, which will undermine future investment by the private sector.

The proposals for a national care service go way beyond the plans that were set out in the Feeley review. It is yet another blatant and unjustified power grab by the Scottish Government. After years of hollowing out councils’ finances, the SNP is now mounting a direct assault on local authorities. It proposes to scrap local accountability by imposing a system of direct ministerial control. So far, the Scottish Government has failed to outline exactly how much those vast reforms will cost.

In conclusion, I say that we have very real concerns about the current operation of the NHS and the future operation of a national care service. The reforms are all about structure and are not about improving patient care, and they fail to address the growing crisis in Scotland’s social care sector.

That is why I move amendment S6M-01190.3, to leave out from the second “recognises” to end and insert:

“believes that concrete plans should be set out on tackling the immediate crisis in the NHS, such as the record A&E waiting times; recognises the publication of the consultation for a National Care Service; notes that the proposed scope of the National Care Service is a significant expansion of the recommendations contained in the Feeley Review and that the health and social care system is already under immense strain due to the pandemic and previous Scottish Government failures; considers that such a significant service reorganisation could be hugely damaging at this time, and believes that local delivery is key in delivering services.”

I call Jackie Baillie to speak to and move amendment S6M-01190.2. Ms Baillie—you have around six minutes.


Jackie Baillie (Dumbarton) (Lab)

It is absolutely right that we express our deepest gratitude to those who work in health and social care, for all that they have done not just during the pandemic but, equally, before it. They risk their lives in order to keep us safe.

However, I do not want just to thank them, because if the applause on Thursday nights is to mean anything, the Government needs to step up to the plate now and to truly appreciate and support what they do. Instead of the complacency that has been displayed by the cabinet secretary and the First Minister, the people of Scotland need and deserve action. They need that now because—make no mistake—the NHS is in crisis now.

The NHS recovery plan has been criticised by a number of professional bodies, including the BMA, which described it as “unrealistic” with a number of “worrying gaps”, especially on how to tackle staff shortages. It is one thing to be criticised by the Opposition, but it is entirely another to be criticised by clinicians. That demonstrates to me that the Government is simply not listening.

The problems that are being experienced by the NHS are happening now, in real time. However, we should be honest and say that that is built on 14 years of the SNP’s mismanagement and neglect of our NHS. It was, frankly, astonishing to hear that the First Minister blames staffing shortages on Brexit, given that, as a health minister, she cut training places for nurses and doctors.

We should also not forget that it was Nicola Sturgeon who failed to pass on to the health service all the funding that was given to her by the United Kingdom Government in her first two years as health minister. That means that the NHS is now £1 billion worse off, under the SNP.

The SNP’s lack of awareness is simply extraordinary. [Interruption.] I want to make progress. Given that track record, how can the SNP Government expect us to take it seriously? A crisis is unfolding under its watch. Ambulance waiting times are, on average, six hours for urgent and critical cases. Some people have waited as long as 30 hours, and their condition has deteriorated to such an extent that it has become life threatening.

The Red Cross, for goodness’ sake, is having to provide support and assistance to ambulance crews and to patients who are waiting in queues outside the Queen Elizabeth university hospital.

Waiting times for diagnostics are up and waiting times for treatment are up; there are currently 600,000 people on waiting lists in Scotland. Those who can afford to do so are going private. The 62-day waiting standard for cancer treatment is going the wrong way; in fact, it has not been met since 2012. That is shameful.

Some of the biggest health boards have cancelled elective surgery. Covid infection rates are rising; there have been more than 1,000 hospitalisations, and test and protect is failing to contact people, with performance now well below World Health Organization standards. Delayed discharge is—of course—also up by 50 per cent.

The workforce is struggling. A paramedic described how ambulance workers are feeling “exhausted, undervalued and overwhelmed”. Doctors and nurses go home from a shift at A and E crying because of the stress that they are under—and all that is before the winter flu season starts.

The NHS recovery plan does not address any of those immediate challenges. It talks about a rise in activity starting in 2022. Outpatient increases that were, during the election, promised for next year will not happen until 2025. As for workforce planning, in the last session of Parliament three plans were published that simply failed to address the shortage of staff.

Scottish Labour set out very clear plans for what we would do differently to remobilise our NHS and support the staff who work so hard on our behalf. I commend them to the cabinet secretary to read.

Let me turn to social care, which will be covered substantively by my colleague, Paul O’Kane. The Government’s approach to that is—frankly—hugely disappointing. Instead of changing culture, as the Feeley review recommended, the focus has all been on structural change. It looks like a case of rebadging and of shifting the deck chairs when what is required is a move away from funding of crisis to funding of prevention, and a move away from limiting care based on budget to doing an honest needs assessment and building care on that basis, so that people can live independently.

As for the £800 million that was promised over the next five years, Feeley identified the gap as being about £660 million, so there is little room for growth and little headroom available. Frankly, the Government does not need to wait for the establishment of the national care service: it can do things now. Where is the remobilisation plan for social care—restoring people’s care packages, restarting respite care, ending non-residential care charges and pausing commissioning? The Government could do all those things now.

When we talk about valuing staff, it applies equally to social care. Social care staff have been at the front line in the pandemic. The epicentre of Covid cases was our care homes; one third of Covid deaths have occurred in our care homes. Social care staff had to fight for testing and for access to PPE. The cabinet secretary knows that it is a predominantly female workforce that is characterised by low pay. I know that the SNP is opposed to giving them a wage rise to £15 per hour—indeed, the SNP is aligning itself with the Tories. The Greens promised it in their manifesto, but it has been sacrificed at the altar of expediency in exchange for ministerial positions.

We have a real opportunity to change care, to value the workforce, to treat people with dignity and to create a system that enables people to live independently. The Government’s plans are found wanting in that regard, and the voices of carers and people who are cared for are not being heard, which is a disgrace.

I move amendment S6M-001190.2, to leave out from “thanks” to end and insert:

“appreciates all health and social care staff for their hard work both before and during the COVID-19 pandemic; recognises that the pressure they are currently facing is compounded by the historic workforce planning failures of the Scottish Government; regrets that the impact of the current COVID-19 pandemic on the NHS has been exacerbated by 14 years of Scottish Government mismanagement, which left NHS services struggling to keep up with demand long before the pandemic, with patients waiting too long to access medical treatment, and hardworking staff facing burnout and stress, and feeling undervalued; considers that the NHS is currently in crisis, with the average wait for an ambulance now at an alarming six hours, and recent statistics showing A&E under significant pressure as only 81.5% of patients were admitted, transferred or discharged within the four-hour target in July 2021, which is the lowest monthly percentage for at least 14 years; acknowledges that, despite there being over 600,000 people on NHS waiting lists for treatment, diagnosis or outpatient appointments in Scotland, the NHS Recovery Plan published by the Scottish Government does not include proposals on how to increase activity to address this backlog until next year; agrees with the BMA that the commitments within the plan are ‘unrealistic’ and that it has a number of ‘worrying gaps’, especially on how to address staff shortages; believes that tackling the mental health crisis facing Scotland should be an immediate priority for the Scottish Government, with new statistics showing that the number of children and young people waiting for appointments is at a record high, with almost 12,000 young people waiting to be seen at the end of June 2021; strongly believes that the Scottish Government urgently needs to get the pandemic under control by improving the Test and Protect system, which is currently failing to meet the World Health Organization’s standards on contact tracing, as only 60.5% of contact tracing in the week ending 29 August 2021 was completed within 72 hours; notes the Scottish Government’s commitment to create a National Care Service, but urges the Scottish Government to also address immediate issues in social care by restarting respite services, ending non-residential care charges and addressing poverty pay in the sector by supporting a pay rise for social care staff to at least £15 per hour.”

I call Alex Cole-Hamilton to speak to and move amendment S6M-01190.4. You have four minutes, Mr Cole-Hamilton.


Alex Cole-Hamilton (Edinburgh Western) (LD)

I start by echoing the thanks that have been offered to our valiant health and social care workers. We will never be able to fully repay the debt that we all owe them.

American clinician Atul Gawande once wrote:

“The battle of being mortal is the battle to maintain the integrity of one’s life—to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be.”

The provision and effective delivery of social care is a vital part of how we answer that challenge and offer dignity, agency and independence to our most vulnerable residents. It is a critical piece of the jigsaw when it comes to all other aspects of treatment and care in our society.

Let me put it simply: if social care is broken, it interrupts flow throughout the whole health service. We know that the record-breaking A and E waiting times are not caused by a deficiency in emergency care but are the result of insufficient social care provision in our communities. People are waiting in A and E departments for admission to the main hospital because in-patient beds are taken up by people who are well enough to leave hospital but lack the necessary care provision that would enable them to be received at home.

We need to reform social care—of that there is no doubt—but we need to do so by paying care workers handsomely, dealing with market inconsistency, reforming self-directed support and making care a profession of choice again. We do not reform social care by stripping decision-making power and money from the local care partnerships that currently deliver it. The last thing we need is a big, clunking, centralised bureaucracy that is ultimately run by the Scottish ministers—the same ministers who are, in part, responsible for the catastrophe in our care homes in the foothills of the pandemic.

It is cynical of the Government to brand its proposals a “national care service”, when they are in fact a ministerial takeover of social care. The branding exercise is designed to make the proposed arrangements sound like our most treasured national institution, the national health service, but that is where the similarity ends. The NHS was forged in the rubble and poverty of war. It offered, for the first time, medical care and treatment to every citizen in the United Kingdom, free at the point of delivery. It is the most successful model of socialised medicine in the world. The proposal behind the national care service is not for a service that will be offered free at the point of delivery. There will not be a socialised model for the delivery of care; nor will care be nationalised—it will still be provided by the private and charitable organisations that account for the lion’s share of the market.

The naming of the project is a cynical attempt to win public support, when, in all actuality, the delivery of care will suffer. The new model simply transfers power from local authorities and communities and gives it to ministers, to determine the shape of the care service.

Will Mr Cole-Hamilton give way?

I will.

I think that Mr Cole-Hamilton—

Wait to be called before you make your intervention, Mr Stewart.

Kevin Stewart

I beg your pardon, Presiding Officer.

Mr Cole-Hamilton said that the Government will set the frameworks. That is right. We want to see standardised and high levels of care throughout the country, rather than the postcode lottery that folks moan about just now—

Briefly, Mr Stewart.

How does Mr Cole-Hamilton suggest we tackle the postcode lottery?

Alex Cole-Hamilton

The Government’s meddling in centralisation projects that have gone before has not helped people at the business end of the delivery of services and the approach will not help with the delivery of care. Liberals stood against the centralisation of Police Scotland and we shall stand against the centralisation of our care system, because our party believes, as a matter of principle, that decisions are better when they are made closer to the people whom they most affect.

For all that the Government wants to be remembered with the reverence with which Nye Bevan, the father of the NHS, is remembered, its national care service is a cynical power grab and nothing more.

I move amendment S6M-01190.4, to leave out from “welcomes” to end and insert:

“notes that the NHS is under intense pressure because ministerial mistakes in workforce planning since 2007 contributed to the failure to meet key waiting times targets for years pre-pandemic; believes that the NHS Recovery Plan should be strengthened with a trajectory for meeting those targets to give new hope to overworked staff and patients waiting; further believes that there should be new national entitlements to guarantee quality of care for service users, with the funding to match, and new national fair work standards for staff to improve pay, conditions and career progression; believes, however, that Scottish Government proposals for a centralised ministerial takeover of social care will distract and detract from those ambitions; recalls the mistakes of previous centralisations conducted by the Scottish Government, and calls for the additional proposals contained in the Scottish Government consultation to use centralisation to seize control of other services, including children and young people, community justice and social work, described as an attack on local government, to also be withdrawn.”

The Deputy Presiding Officer

We move to the open debate. As a result of a number of fairly lengthy interventions, whatever headroom we had in terms of additional time has been exhausted, so any interventions will have to be accommodated in members’ allotted time.


Dr Alasdair Allan (Na h-Eileanan an Iar) (SNP)

To say that our health and care services have been through an unprecedented shock in the past year and a half would be a triumph of understatement. We are all aware of the impact that the pandemic has had on those services in our communities.

As the cabinet secretary said, the health and care workforce has been instrumental in delivering an amazing vaccination programme since December, despite the numerous challenges that it had to overcome in the process.

Dr Allan, could you move your microphone slightly towards you?

Dr Allan

Yes. Is that better? Good.

Families have often faced distressingly minimal contact with loved ones in hospital and care settings, staff have had to deal with the physical and emotional exhaustion of a year and a half from hell, and all of that is before we consider the huge stresses on staff of trying to treat individual people with Covid. I mention all that not as a platitude to everyone concerned, nor as a means of deflecting from the challenges ahead. This winter will bring with it some daunting challenges, not least of which, as other members have pointed out, will be dealing with the backlog of non-Covid procedures that clearly now exists.

The plan that the Scottish Government is setting out today is genuinely ambitious, with, not least, the billion-pound NHS recovery plan, the development of a national care service and the recognition of the needs of our care workers. The policy of ensuring that at least 10 per cent of front-line health spending will be dedicated to mental health is a major step forward in its own right, and the plan’s focus on providing alternative pathways of care to allow people to be treated more quickly closer to home will, I am sure, be welcomed. When fully operational, the national treatment centres will provide capacity for more than 40,000 additional surgeries and procedures across 12 specialties, including cataracts, and hip and knee surgery. It will mean recruiting an additional 1,500 staff to run the centres.

Standing still is not an option for our health and care services. The way ahead demands that we make changes, and there are many to be made. I have an island constituency, so I make no apology for asking today that those changes are island proofed.

Stephen Kerr

The member is making a very good point about island proofing. COSLA has commented that the consultation

“cuts through the heart of governance in Scotland”

which will have

“serious implications for Local Government”.

Does the member agree?

Dr Allan

Before I come to the island issue, I will merely say that, understandably, members regularly raise what is referred to as a postcode lottery in services. If we are going to address that, we will have to think about what it implies for how we provide the same high standard of care across the country. As I say, that will mean change.

People in the islands who have a family member in hospital on the mainland face significant extra stresses and costs just to visit them or even just to find out what is happening to them—stresses and costs that are multiplied if there is not good communication between different parts of the NHS, as well as with patients, airlines and families. I am afraid to say that hospitals have not always quite appreciated, for instance, what discharging a frail person in Glasgow and asking them to find their way home to the Outer Hebrides actually implies. We need a stronger protocol in place about those issues. Healthcare cannot be seen in isolation from wider economic issues in the islands. If we are going to have more care workers in rural areas, for instance, we will need to do some serious planning about where they will live.

Today is an opportunity for the chamber to unite—if such a prospect is not altogether far fetched—and recognise the needs of our health and care services and the ways that we can make those services fit for the future.


Sue Webber (Lothian) (Con)

Scotland’s accident and emergency service is in crisis. Waiting times have spiralled out of control and referral times are equally bad. Our workforce in the NHS is at breaking point. A fifth of patients, and more than a quarter of all vulnerable children, are waiting too long for their mental health treatment.

There is no doubt that the creation of a national care service would be a massive undertaking. Has the SNP reached a new low in self-awareness? I am sure that I am not alone in wondering why the Scottish Government thinks that it can run a national care service, given all the issues that it faces running the long-established NHS. The drug death rate has almost tripled on the SNP’s watch, deaths caused by alcohol are at their highest level since 2008, waiting times for residential rehab can be up to a year, Frank’s law has not yet been fully implemented, and yet the SNP wants more powers and responsibilities, when it is incapable of using those that it already has.

We know that, under the SNP Government, Scotland is facing an A and E crisis and that NHS waiting lists are faring no better. We have heard that, before the pandemic, 450,000 people were on the waiting lists and now that figure is topping 600,000. The crisis is an indicator that the entire system is fractured. Behind every statistic is a person—often in chronic, debilitating pain—or a family who are desperate for help. They have all been failed by the SNP, which has shown no leadership or detailed plan of action.

The SNP has neglected the NHS and the people of Scotland for years. The SNP should stop trying to rewrite history when the facts clearly tell a different story. The pandemic did not cause this crisis—the SNP did. Bed capacity had been routinely operating at 95 per cent before the pandemic. The SNP spoke of admissions, but not of discharges.

The public have demonstrated immense gratitude to all those working in the NHS throughout the pandemic and beforehand. Covid has made NHS staff work harder and faster than ever before. I know that at first hand because I have stood and worked alongside them for many years. I am not telling how many years—it gives my age away.

Other amendments focus on the workforce challenges. One in 17 people already work in the NHS in Scotland and there is now a longstanding recruitment crisis. Across Scotland, a record 4,854 nursing and midwifery posts are vacant. A significant number of nursing staff are on work-related sick leave through stress and other mental health issues. Where are we going to find the 1,500 new staff for the treatment centres? How long will it take us to train them?

In 2017, SNP ministers pledged to recruit 800 general practitioners by 2027. However, with just over 200 GPs added to the overall national headcount right now, it looks like that target will be missed, too.

Mr Hoy spoke of the 197 warnings that were issued by the Care Inspectorate over staff shortages in care homes. Staffing levels are reaching crisis point in all healthcare sectors across Scotland. There is no overnight solution to the workforce crisis. The SNP’s NHS recovery plan is a flimsy pamphlet that recycles old promises and fails to tackle the longstanding issues—[Interruption.] I have literally 12 seconds left.

The plan is full of gaps. The Scottish Conservatives believe that healthcare professionals should be given the support that they need to end the backlog in treatments in hospitals, restore A and E waiting times, speed up our ambulance service and return to full, face-to-face GP surgeries. Scotland’s NHS needs a real plan to get our health service back on track.


Clare Adamson (Motherwell and Wishaw) (SNP)

Covid has changed all our lives. As my colleague Kevin Stewart pointed out earlier, it has shone a light as never before on the challenges faced by those who depend on social care and health services, showing us the impacts on carers, those in isolation, those on shielding lists, those with disabilities, and those who are lonely in our communities. It has also shown the civic spirit in our communities, as they rose to the challenges of Covid.

We must learn the lessons from that. It is not about getting back to normal, but about getting back to better—building better solutions in our communities and a patient-centred service that has the wellbeing of the workers and fair work at its heart.

In 2009, I was a councillor, and something that disturbed me deeply at that time was a Scottish council that commissioned services by a reverse auction. It was a race to the bottom on cost, which was not about the quality of service, an existing quality workforce or the wellbeing of those who would have to deliver the services.

Having fair work at the heart of the national care service will mean that the wellbeing of those workers will be better and they will be paid at least the living wage. It is crucial that we build a care service that delivers dignity and respect to our neighbours, families and friends and those in our communities who depend on those vital services.

It will be no surprise to those who have been here for a while to hear that for many years I have championed the cause of tackling pancreatic cancer. I have worked with the community over the years, and it is asking for a sea change in the way that we look at and tackle pancreatic cancer. It is an unforgiving illness like no other. It has one of the poorest survival rates of any cancer, with late diagnosis frequently an issue. What are days and weeks for pancreatic cancer can be months or years for survivors of other cancers.

One of the things that the community has asked for is a pathway to diagnosis that meets the needs of those who come into contact with this terrible disease. The cancer recovery plan that was announced in December is investing £114.5 million to tackle the disease and help those with pancreatic cancer. The early patient support that will be given and the one-stop shop of diagnosis and treatment will immeasurably change the lives of people who come into contact with the disease. In addition to that, the Scottish HepatoPancreatoBiliary Network now has a patient support network. That was all championed by Jeane Freeman and has been happening during the Covid pandemic, and it is testament to our health service people that they have made such progress in the area despite the immense pressure that they have been under. We have to move forward with that.

The independent review of social care gives us a road map for recommendations for future care provision in Scotland that we can all be proud of and take part in. It meets the needs of our friends, neighbours and communities, and builds dignity for those in receipt of those services and those who work in them.


Carol Mochan (South Scotland) (Lab)

Like the cabinet secretary and previous speakers, I wish to mark the heroic efforts of our incredible NHS and social care workers during the Covid-19 pandemic, and I recognise the work that they will no doubt have to continue doing for some time. However, let me be plain: the best way to recognise that heroism is to give staff the pay increase that they deserve. A round of applause is nice, but a pay rise will keep a roof above your head and food on the table. It is of course welcome news that further staff capacity will be added to the health service, which is struggling from years of poor management and underfunding, but the best way to retain staff and make them feel valued is through good well-paid jobs.

BMA Scotland has correctly described the proposed 3 per cent pay increase for medical and dental staff as doing

“virtually nothing to help low morale”

or end serious difficulties with staff retention, and the slightly larger increase for staff on agenda for change grades has been contentious to say the least.

It is clear that the annual difficulties in getting a fair settlement for NHS staff is rooted in the fact that the work of those in the community, hospitals and emergency response is not valued as highly as it should be. In one area in particular, the problem is becoming acute. I could go on for a long time about the problems in mental health services in Scotland, but I have only four minutes.

Members are more than aware of the need to improve mental health services, but a key starting point for any forward plan has to be the recognition of what has gone wrong. However, I do not see that from the Scottish Government. In fairness, it says things but never does anything, which says to me that it does not recognise the scale of the problem.

I remind the Government that the number of children and young people waiting a year or more for mental health appointments is at a record level, and there has been an increase of 115 per cent in that number over the past year. The Government’s target for 90 per cent of referrals to be seen within 18 weeks has never been met—not once. Almost one in four referrals to CAMHS is rejected, and there is little data on what happens to those who are not accepted.

Undoubtedly, successive lockdowns, though necessary, have taken a considerable toll on services and the mental health of many, but we should not pretend that Covid is the cause of those startling failures—it all stems from policy decisions and where priorities lie.

It is a fact that mental health has never been given the precedence that it warrants by the Government. Until that changes, the spiralling decline in the mental health of thousands throughout Scotland will continue.

Does Carol Mochan agree that the Government is the first Government in the four nations of the UK to have a mental health minister?

Carol Mochan

Yes, and we would therefore hope that we would be making more progress and fewer reports, and that we would be changing services for the better of the people.

To start to make progress, we need dedicated mental health workers in every GP practice, not just access to one, and a significant increase in mental health spending across the NHS without detriment to other services that are equally under strain. We need the resources. There are not simply possibilities at this point; there are absolute necessities.

If we are to get the country back on its feet, we will be asking people to work hard and rebuild Scotland, but we have to do our bit. We have to work hard for them.

Will you bring your remarks to a close, please?

Carol Mochan


That means giving people the world-class treatment that Scotland was once famed for. The cabinet secretary can play a leading role in that, but the Government needs to take action.


Paul McLennan (East Lothian) (SNP)

The first line in the Scottish Government’s “NHS Recovery Plan 2021-26” is:

“Scotland’s National Health Service is our most precious institution.”

We can all agree on that. It continues:

“In our hour of greatest need during the pandemic the women and men who staff our NHS provided exemplary care in the most trying of circumstances.”

It says:

“The aim of this plan is to drive the recovery of our NHS, not just to its pre-pandemic level but beyond. This recovery plan is backed with over £1 billion of targeted investment over the next 5 years to increase NHS capacity, deliver reforms in the delivery of care, and get everyone the treatment they need as quickly as is possible.”

We have only four minutes in which to speak. I want to focus on a couple of key points in health and social care.

The plan sets out key actions for the next five years to help to address backlogs in healthcare and increase capacity by at least 10 per cent. Other key actions include

“increasing investment in National Treatment Centres ... to more than £400 million, contributing to delivery of over 40,000 additional elective surgeries and procedures per year”.

I know that my constituents will welcome that at East Lothian community hospital. The other key actions include

“raising primary care investment by 25%, supporting GPs, community pharmacists, dentists and optometrists”

As well as work to support workforce capacity and planning, a national workforce planning strategy that supports remobilisation, recovery and the rebuilding of health and social care services is vital—[Interruption.] We are tight for time. I am sorry.

The strategy will be published by the end of the year and will articulate a long-term health and social care workforce vision alongside our priorities for workforce growth, recruitment, retention, and training and development. I know that the Cabinet Secretary for Health and Social Care is dedicated to that really important piece of work. The strategy builds on on-going work to support the boards’ workforce capacity.

A national care service will be among the biggest-ever achievements of the Parliament.

Will the member take an intervention?

I am sorry; I will maybe take an intervention later on. I am tight for time.

The member has said that he is not taking an intervention. [Interruption.]

Paul McLennan

I am sure that he did not.

The social care sector directly employs 205,000 people in Scotland, which is approximately 8 per cent of the country’s workforce. It has been estimated that the sector contributes around £3.4 billion to Scotland’s economy, so it is a really important part of it.

Like everyone else, I received Oxfam Scotland’s briefing for the debate, which was on placing care at the heart of the Covid-19 recovery. We have to remember that. Oxfam Scotland mentioned care issues and poverty, which are deeply linked. Those who care for adults unpaid report escalating care needs and financial pressures. Polling that has been conducted during the pandemic shows that nearly 30 per cent reported struggling to make ends meet. Oxfam Scotland also says that Scotland must commit to a new national outcome on valuing and investing in all forms of care.

We had the Cabinet Secretary for Social Justice, Housing and Local Government, Shona Robison, and the Convention of Scottish Local Authorities at the Local Government, Housing and Planning Committee. They also said that outcomes are really important. A proposed new national outcome on valuing and investing for care is vital as we move ahead, and it is to be embedded in the national performance framework to drive policy and spending decisions.

I turn to unpaid carers for the disabled and the elderly. They provide support and care for family members with additional support needs without pay. Prior to the pandemic, there were an estimated 788,000 carers, including 44,000 young carers, in Scotland. I know that a national care service will take into consideration that most of the care done in Scotland is unpaid, while ensuring that those paid to care are protected from poverty; it must deliver for the people doing unpaid care and those supported by the carers.

The actions that the Government is taking will put us in a better place as we recover from Covid.


Sandesh Gulhane (Glasgow) (Con)

The year 2021 has exacerbated the situation for an already crumbling Scottish health service and shone a light on how bad we have it. A and E waiting times are at record levels—one patient was forced to wait on the floor in a corridor for almost 18 hours. Ambulances are queueing around the block to get into hospitals, forcing patients to wait at home for extraordinary amounts of time. Waiting lists for out-patient appointments are at all-time highs. Non-emergency surgery has been cancelled across Glasgow. GP demand is at record levels and—wait for it—we are the European capital of Covid. All we hear is deflection, blame and whataboutery, but this is down to the SNP Scottish Government, which has had devolved control of our Scottish NHS since 2007. The Scottish NHS, Scottish patients and the Scottish people need action now—we need help now.

The £1 billion recovery plan is full of rhetoric and catchy soundbites, with X millions here and Y millions there—[Interruption.] I am afraid that I will not get the time back if I take an intervention.

There is no detail and no plan. Let us take the example of recruitment. The Association of Anaesthetists tells me that there are 2,000 job vacancies and the Royal College of Nursing says that there are 3,000 job vacancies, but the Scottish Government will recruit 1,500 staff. We are still in deficit—that will not even make a dent.

On the lack of a plan, anaesthetics does not form part of the recruitment strategy. That branch, which, as I told members, has 2,000 vacancies, is the key to allowing both emergency and elective surgery to be performed. With Covid numbers surging, anaesthetists are the first to be pulled into ITU and the most likely to suffer burn-out, but they are not deemed worthy of being part of a coherent recruitment strategy. There is no plan. When I asked the Cabinet Secretary for Health and Social Care to tell me about his redesign of the referral pathways, he proceeded to tell me about the diagnostic centres that are opening up in 2025-26, with one perhaps opening in 2022. That is not detail but simply rhetoric. Where is the detail on design? The NHS recovery plan sets up a vision for the future, but it neglects us today.

I turn to social care. I have a patient who has home help, but her carers are frustrated because they do not have enough time to do the things that they want to do for her. The scope of the redesign is too big—it will take too long to get everything organised and set up. I implore the Government to get help to where it is most needed so that we can then set about doing more. Do I have hope that that will be implemented and delivered on time? I see ferries, superfast broadband and the taking of responsibility for 11 devolved benefits—all delayed and full of broken promises. Therefore, I have little hope.

We can all agree that Covid has set us apart, but morale was at an all-time low before Covid. The Medical and Dental Defence Union of Scotland now tells us that most GPs and dentists are thinking of leaving the profession. Morale really is at rock bottom, but the First Minister and the Cabinet Secretary for Health and Social Care say that we are not in a crisis. We have record A and E waiting times, ambulances queueing around the block, record waiting lists, cancelled surgeries and GP demand at record levels—yesterday, I had 80 patient contacts in my surgery. The situation is not sustainable. If this is not a crisis, I do not know what a crisis is. I say to the ladies and gentlemen watching at home that we are in a crisis.

To paraphrase JFK, the Chinese have two brushstrokes for the word “crisis”—one means “danger” and the other means “point of change”. I hope that the Government can finally admit that we are in crisis. The NHS is in danger: the Government should accept that. We are here to work across the chamber to create a plan and provide expertise to deliver a workable solution for Scotland, but I ask the Government please to focus on today and help the people now.

On a point of order, Presiding Officer. Is it right that, if a member takes an intervention, they do not get any time back?

The Deputy Presiding Officer

That is a matter for the chair. By way of clarification, I add that, as the Presiding Officer who was in the chair before me made clear, there is no time in hand. We are trying to allow everyone to have their four minutes, but, if we have extensive overruns on each member’s speech, there might be a point where that might not be possible.


Gillian Mackay (Central Scotland) (Green)

I, too, would like to extend our sincere thanks to our health and care workers who are working hard to keep us safe and well. They have been going at a superhuman pace throughout the pandemic, and I can only imagine how exhausted they must feel. It is only right that we take every opportunity to express our gratitude for and appreciation of everything that they do.

My amendment, which was not selected for debate, focused on mental health. We know that the pandemic has had a devastating impact on our collective mental health, but we have not all been equally affected. The most recent report from the Scottish Government’s Covid-19 mental health tracker study found that young adults, women, people with physical and/or mental conditions and people in a lower socioeconomic group are more likely to report experiencing poor mental health.

The Scottish Government’s mental health strategy was published in the time before Covid-19, and we have to recognise that circumstances have materially changed since then. That is why I welcome the Government’s commitment to publish a refreshed mental health strategy and a mental health workforce plan as part of its agreement with my party. It is, of course, vital that the refreshed strategy takes account of how some people have been disproportionately affected by Covid-19. It must consider the social determinants of mental health if it is to effectively address the huge rise in mental distress that has been caused by the pandemic.

There must also be more of a focus on non-communicable diseases as we begin to emerge from the worst of the pandemic. Smoking and drinking rates among those who smoke and drink the most have increased over the pandemic. We need to prioritise good health for our nation, improving outcomes through reducing poverty, improving access to food and reducing the availability of health harming products. No company should be allowed to profit from damaging people’s health. We have the ability to make this the public health session of Parliament, and I hold on to the hope that we can work across parties to achieve that.

I want to focus on social care. The Scottish Greens and the Scottish Government are committed to ensuring that the national care service upholds the principles of fair work, which is why we have committed to a system of national collective bargaining on pay and terms and conditions within the social care sector so that we can build on all care staff receiving the living wage as a minimum while working towards a higher rate of pay.

Paul O’Kane (West Scotland) (Lab)

In their manifesto, the Scottish Greens committed to £15 an hour for care workers. Are they still committed to that position, given that they are now in government, and will they support Labour’s amendment today?

I, personally, am still very much committed to working towards £15 an hour—[Interruption.] I am still committed to it—[Interruption.] Well—

Ms Mackay, you do not have that much time left. Please continue.

Gillian Mackay

We also want to better recognise the contribution of unpaid carers, without whom our social care system simply could not function. Almost two thirds of unpaid carers have been unable to take a break from their caring role since the start of the pandemic. Too often, unpaid carers become worn down and exhausted due to inadequate support and may even be forced to neglect their own health. That is why the Scottish Greens and the Government are committed to introducing a guarantee of short breaks and flexible healthcare appointments for unpaid carers. We will also ensure that care workers and unpaid carers can access bereavement services whenever they need to, so that they are not left unsupported at one of the times when they are in greatest need.

I will end my speech by focusing on the NHS recovery plan. I welcome its publication along with the acknowledgment that the pandemic has placed our NHS under severe pressure and that there is much more work to be done to help it to recover. However, I have concerns about workforce shortages undermining the plan’s ambitions, and I would like the cabinet secretary to reflect on that in his summing up.


Christine Grahame (Midlothian South, Tweeddale and Lauderdale) (SNP)

I put on record my thanks to all working at the Borders general hospital and in primary care services across Midlothian South, Tweeddale and Lauderdale, including GPs, pharmacists, those who work in the ambulance service and first responders.

I will focus my short contribution on the care sector, including those who deliver care at home and in residential settings. The horrid pandemic exposed as never before that care is a Cinderella service, with low pay and low regard. It is a service that is provided by people who serve and care for the most vulnerable in our society with kindness and skill. None of us in the chamber, or in general society, is innocent when it comes to taking those care professionals for granted. Therefore, I welcome the Feeley report, the creation of a national care service and the scrapping of non-residential care service charges. I was here in 2002, when we introduced free personal care for over-65s in Scotland, limited though it was. Such free personal care was not introduced in England. I was also here for the introduction of Frank’s law, which extended that care to the under-65s.

I was here when the integration joint boards were launched to ease the transition from hospital to home. That is an extremely difficult nut to crack, but a start has been made. Money was wasted—[Interruption.] Sorry, I have not got time to take an intervention; I only have four minutes.

I recognise the Fair Work Convention’s report into social care and the work to embed fair work principles for the social care workforce, leading to better terms and conditions.

I would like to see more publicity for existing college courses, through which someone can transition from the care sector to nursing in a way that means that professional progression is available.

In all this, the voice of the carers and those for whom they care must be not only heard, but heeded. Like many, I was extremely moved by the clap for carers on Thursday evenings, when the tenements around me echoed with cheers, the rattling of pots and pans, the blowing of whistles and even the occasional sound of the bagpipes. However, being moved is not enough, and I want to see more than recognition; I want to see pay that better matches the skills and commitment of those in the care sector and which recognises not only their duty to their job but that the job of caring for the most vulnerable is a vocation. That would be a good place to start.

For generations, we left much of the care of the elderly in residential settings to companies in the commercial sector, some of which were good, and some of which were bad, as was the case when local authorities provided the care. It is time that we made sure that our very elderly—I might have to declare an interest—are cared for properly when they come to the end of their years.


Katy Clark (West Scotland) (Lab)

I add my voice to the tributes to all NHS and social care workers. In the short time that is available to me, I will focus on the national care service.

It is right that we recognise that social care, like the health service, is an essential component of the welfare state, and there is much that is positive about the Scottish Government’s proposals. However, my concern is that the proposals are for a national care commissioning service, not a national care service, which will lead to a huge rise in the amount of tendering and further centralisation, with an erosion of the powers of councils.

The idea of a national care service was modelled on the NHS. The NHS employs doctors, nurses, lab technicians, porters, cleaners and many others. It provides a service, and a considerable amount of effort has gone into preventing it from being privatised. The proposed national care service will not employ care staff but will commission services from the private and third sectors—and, I presume, from the public sector, too. It is not clear that the bodies in the public sector, such as councils, will even have preferred bidder status.

Last year, the First Minister said that she supported calls to remove the profit motive from the care home sector. However, the consultation does not mention the word “profit” once. In the consultation, there is no acknowledgement that the private sector’s explicit obligation is primarily to shareholders, not the needs of residents. Yet, in the proposals, outsourcing is encouraged and nothing is done to challenge the current private sector-dominated model.

I therefore have a number of questions to put to the minister. Are there any companies that currently deliver care that will not be allowed to bid under the new care system? A 2019 investigation by The Ferret found that at least 44 Scottish care homes were owned by companies based in tax havens such as Jersey, the Isle of Man and Gibraltar. Will the Government follow the example of countries such as Denmark and ban offshore ownership?

The Government proposes extending the scope of the national care service to children’s services, community justice, alcohol and drug services, social work and an element of mental health services. Will those services be open to tendering processes, too?

Will the Government legislate to ensure that no contracts will be awarded to companies that fail to recognise trade unions or that do not apply union-negotiated rates of pay, in line with the demands of the Scottish Trades Union Congress?

The principle of setting up a national care service that operates like the NHS is right, and, as I said, there is much that I hope will be positive in the Government’s proposals. However, as they stand, the proposals would not deliver a national care service in the public sector that would be free at the point of use. I believe that that is the kind of social care service that we should be continuing to campaign for.


Emma Harper (South Scotland) (SNP)

I welcome the opportunity to speak in this debate on recovering, remobilising and renewing health and social care in Scotland. I too, offer my sincere thanks to all our health and social care staff, who are working flat-out every day under intense pressure due to the pandemic.

I remind members that I am a nurse. I am about to join the flu and Covid vaccination programme locally next week.

During the past 18 months, NHS colleagues and health and social care staff have really stepped up in the face of Covid-19, but many of my colleagues and NHS contacts are feeling undervalued. There are many reasons for that, including the fatigue that everybody is feeling. All the work that was being done in healthcare prior to Covid and that is being done now in dealing with Covid is driven by evidence and science-informed research. Science, research, healthcare and medical experts, GPs and consultants in acute care must all be valued by us all—by politicians, the media and members of the public. I therefore ask the minister in his closing remarks to provide assurances that those professionals are valued and that their knowledge, expertise, input and scientific evidence will continue to be considered when tackling Covid and when future healthcare decisions are made.

The Scottish Government’s NHS recovery plan is backed up by more than £1 billion of investment over the next five years. It is imperative to ensure that people receive care, including some cancer screening and non-elective procedures, which were paused during the pandemic.

Alasdair Allan mentioned the £400 million investment in national treatment centres, which will contribute to the delivery of more than 40,000 additional elective surgeries and procedures each year. That includes the new fast-track diagnostic centres, one of which was opened in Dumfries and Galloway in June.

The plan also provides £8 million to support the mental health and wellbeing of our health and care workforce. Mental health support has already begun. That includes access to counselling, support for managing stress and support for optimal work practices.

On mental health, it is extremely welcome—and right—that there is a focus on ensuring that the wellbeing of young people is supported. Through my casework, I know how pressed child and adolescent mental health services are and how that can have a negative effect on young people. They have had a particularly challenging 20 months so far. They have had to adapt to home schooling and they have not been able to partake in their usual activities, which has had an impact on their wellbeing. Therefore, ensuring that at least 10 per cent of front-line health spending is dedicated to mental health and the recruitment of 320 child and adolescent mental health service workers is necessary. The charity Scottish Association for Mental Health welcomes those measures.

The NHS recovery plan commits £130 million to delivering on Scotland’s national cancer plan. Although it is great to hear about that and about the commitment to re-establish a national centre of excellence for remote and rural medicine, I want to touch on the modernising patient pathways programme, which is also being progressed as part of the recovery plan. The programme will look at cancer pathways, and I ask the health secretary to commit that that work will ensure that no patients in D and G—including in Wigtownshire—will need to travel to Edinburgh for treatment when Glasgow is closer.

There is much to welcome in the Government’s recovery plan, including an increase in funding for primary care, GPs and allied health professionals that is worth more than £12 million, along with improved training and systems to enable more efficient triage of patients. Most important, the plan sets out the foundation for establishing a national care service. Other members have touched on that, but I will not because of time constraints. I welcome the plan and look forward to its progressing.

We move to winding up speeches.


Willie Rennie (North East Fife) (LD)

It was an extraordinary start to the debate. We were told that it would introduce the central reform of this session of Parliament—the creation of a national care service. However, the health secretary hardly mentioned that in his opening speech. If it is going to be such a major change to the way in which the social care service is run, it deserves to be better led than it has been in this debate. That is no way to lead a major reform.

There have been some excellent speeches in the debate. Sandesh Gulhane set out from his great experience the long-standing difficulties that we see in the NHS now, which were there before the pandemic and meant that we were not ready for the pandemic when it came. We are now suffering the consequences, as Jackie Baillie set out—the long waits to get treatment.

Craig Hoy’s very good speech set out in detail some of the problems around diagnostics; the legally binding treatment time guarantee that has not been met for years, since way before the pandemic; and accident and emergency service waiting times. Carol Mochan and Gillian Mackay set out the problems with mental health services, which my party has been dedicated to reforming for some years. As yet, those services have not seen the improvement that I think we deserve.

Despite that backdrop of those years of failure on the NHS, the Government thinks that it is best placed to take control of this country’s care service as well. It should sort out its own problems before taking on other people’s problems. The Government is exhibiting typical avoidance behaviours, avoiding the big central problem of the care service. Jackie Baillie said that that is more about culture than about organisation, and she is right.

Will the member take an intervention?

Willie Rennie

I will, in a second.

This is the third major bureaucratic reorganisation of health in the 20 years of the Parliament. We started off with the joint future initiative. Then we had the IJBs and the health and social care partnerships. Now we have central control. None of the other reforms through big bang reorganisation made any great difference, so I am not sure what the Government thinks will be different this time. The cabinet secretary—whose intervention I will take in a second—said that the current structure is preventing him from paying health and social care staff properly. That is utter nonsense. If the Government wanted to pay those staff more, it could do that right now. There is absolutely nothing preventing it from doing so.

I will take the intervention now.

Humza Yousaf

I wanted to intervene at the point when Willie Rennie said that we think that the Scottish Government is best placed to create a national care service, which we do. Does Willie Rennie not recognise that we were also given a mandate by the people of Scotland, who voted for us for the fourth time? I know that sticking to manifesto promises is not his strong point, but does he recognise that the creation of a national care service was in our manifesto and that we therefore have a mandate to take that proposal forward?

Willie Rennie

When the minister gets cheap, Parliament knows that he does not have an argument to justify his case, and that is the case this time. If what we have seen with the centralisation of the police was not the biggest warning, which the Government should heed, I do not know what would be. If the Government undertakes big bang reorganisation in a rush to solve a problem that it does not have actual solutions for, the consequences are severe.

Political decisions have consequences, and we need to be incredibly careful about that. Alex Cole-Hamilton rightly set out that this is a cynical attempt by the Government to compare its reforms with the creation of the national health service. However, the national health service was free at the point of delivery, whereas this is nothing more than a central power grab.

The Government should do better at setting out its case than the pathetic attempt that it has made today.


Paul O’Kane (West Scotland) (Lab)

A common thread has run through our debate. As colleagues have already done, I thank all our hard-working NHS and social care staff for all that they have done and will continue doing. They have worked hard on the front line, caring for us all and for the sickest people in Scotland and keeping services going in unimaginable circumstances. We owe them our deep gratitude.

As we have heard, warm words of thanks are not enough. Words will not solve the crisis in A and E, whereby people are waiting an average of six hours for an ambulance. Praise from ministers will not address the more than 600,000 people waiting for treatment or diagnosis. Applause does not make a £15 per hour wage for key workers a reality.

A Government motion and a thin recovery plan that fails to recognise the scale of the crisis are cold comfort to those who know what is happening on the ground: the doctors, nurses, healthcare assistants and support staff who, as we have heard today, use words such as “exhausted”, “undervalued” and “burnt out” to describe their day-to-day experience.

I know that ministers and SNP members are quick to retort that these are unprecedented times. Of course they are. The cabinet secretary continually cites the pandemic as he seeks to justify the serious and imminent challenges that have been referred to today. However, he refuses to acknowledge not only what we in Parliament are saying but what professionals, patients and carers are telling him: that the crisis has been growing since before the pandemic and has been exacerbated by it.

My colleague Jackie Baillie spoke about the stress that is experienced by people on waiting lists. There were 400,000 people languishing on waiting lists before Covid-19. As Craig Hoy said, BMA Scotland has been warning about workforce pressures in the healthcare sector since before the pandemic. Ambulance turnarounds were taking longer before the pandemic, with 17,926 turnarounds taking more than an hour, which is a shocking increase of 634.4 per cent since 2014. How can the Government be taken seriously when it talks about the planned recovery but refuses to admit that the crisis has been unfolding on its watch for 14 years?

The cabinet secretary has recently been fond of saying in his answers to members’ questions on these issues that he does not have a magic wand, but he clings to his plan as if that might be a magic wand. That plan has been described as “only a best start” by Dr Lewis Morrison, the chair of BMA Scotland, and further described as “unrealistic” and having a number of “worrying gaps”. The RCN has said that there is little detail in the plan on how issues such as staff burnout can be addressed and has warned that nurses have felt undervalued and underresourced for far too long. Sue Webber and others have said that it is time for the Government to show how it will support and retain exhausted staff in the system.

I turn to social care. Scottish Labour first advocated a national care service in 2011. As my colleague Jackie Baillie likes to remind the Government, we welcome all converts, however late. We have always been clear, as we heard from Willie Rennie and others today, that any such service must be about culture and not solely focused on structure. A national care service must be about those who live in our communities and who need access to the right care in the right place at the right time. Clare Adamson was right to speak about rebuilding our communities better.

The service must ensure that older people are supported holistically as they live for longer in our communities and must ensure that care homes adhere to rigorous standards and are held to account for those in order to drive up quality and improve the training and retention of staff. It must ensure that people who have learning disabilities can live their lives with choice and control and do not simply face false choices from ever diminishing budgets.

People want to have a seat at the table where decisions are made. Carers want to have a voice at the table and those who use social care want a meaningful say in the decisions that impact them. If the Government insists on driving an agenda that is about drawing power towards the centre and does not recognise the importance of local decision making, in which people who use services have a say, this will simply be upheaval and structural change with little real change on the ground.

The people of Scotland cannot wait five years for the Scottish Government to work out its big vision for a national care service. Action can be taken now, and action is needed now. There are practical steps, which Jackie Baillie alluded to, that will make an immediate difference to the lives of people who are in receipt of social care and those who support them. Those steps include restarting respite services and creating a plan around that; ending non-residential care charges; pausing commissioning; and addressing the poverty pay in the sector, which we have heard about, by supporting a pay rise to at least £15 an hour for social care staff. I welcome Gillian Mackay’s support for that and the fact that she has held true to the Green manifesto. I hope that she will influence her colleagues in ministerial office.

Our social care workers deserve more than warm words. As my colleague Carol Mochan pointed out, they must be valued. In its motion, the Government speaks of fair work, but it has failed to deliver. One in five workers are on insecure or temporary contracts and 15 per cent of staff work unpaid overtime. Once again, we on the Labour benches call on the Government to give care workers the pay rise that they deserve and show that they are valued.

It is clear that, after 14 years in power, the SNP Government has mismanaged the NHS, and we are facing a serious crisis before we even get to the crisis that winter will bring.

Mr O’Kane, will you bring your remarks to a close, please?

Paul O’Kane

Certainly, Presiding Officer.

The Government is letting down health and social care staff. If it is serious about the challenges that Scotland faces, it must show that it values every single member of staff in the NHS and create a plan to match.


Miles Briggs (Lothian) (Con)

As others have done, I start by saying thank you to all those who have provided care to our fellow Scots throughout the pandemic. We have faced significant challenges from the outset of the public health emergency, and the negative impact on all our care systems across Scotland, but perhaps most important on those who provide unpaid care, has been at the forefront of our concerns. I am disappointed that we have not really heard ministers outline that today.

Before the Covid-19 pandemic, there were an estimated 788,000 carers, including 44,000 young carers, in Scotland. The pandemic has significantly increased the numbers of unpaid carers in our country, with social care support packages being cut or reduced, respite care being reduced and childcare and school facilities being closed. The pandemic has resulted in a significant expansion of unpaid carers. Research in June 2020 showed that about 392,000 more of our fellow Scots, 60 per cent of whom were women, had become unpaid carers, taking the total number of people in our society who had taken on a caring role for a family member or loved one to 1.1 million. I believe that the Parliament must focus on that group of people and not on top-down reforms.

Unpaid carers have reported significant challenges, with nearly two thirds highlighting the financial impact of additional costs and the impact on family budgets. The economic value of the unpaid care that is provided in Scotland is now estimated to be £37 billion a year.

I want to look at the consensus that we can find across the Parliament, especially on the development of a national care service—or standard, on which we are probably all on the same page. As we come out of the pandemic, we have an opportunity to take forward a number of reforms that will be welcome. We on the Conservative benches have argued in the chamber and in committee for the development of a national clinical standard for social care. That is long overdue and I hope that we will see work progress urgently on it.

In addition, the Parliament has got workforce planning wrong for too long. The Scottish Government needs to look at how we can ensure that the right workforce is put in place for social care but also that career pathways are developed so that people can progress in their chosen career and caring becomes the career pathway that we all want it to be.

As we have heard in the debate, it will be unacceptable if SNP and Green ministers look to take away all local accountability, undertaking a power grab and removing local decision making and choice from care. The proposed scope of the national care service represents a significant expansion of the recommendations in the independent review of adult social care and what the Scottish Government outlined previously, yet we have heard no explanation today of why that is the case.

Local government is only just starting to recover from the pandemic. Ministers have said previously that local government is crucial to Covid recovery, and we hear ministers talk about community wealth building, whereby local authorities should be focused on partnerships and local spend of budgets. As Craig Hoy and Katy Clark both mentioned, a total restructuring of social care in Scotland will be destabilising and will present many significant challenges. The debate has also brought forward some questions to which I hope we will soon hear answers from ministers.

A national care service would involve staff in a change of employer, terms and conditions of employment and pension rights. Likewise, we have neither seen nor heard any detail of what a national care service means for the infrastructure that is in place—for example, council-owned properties, and procurement contracts, which are legally binding documents. How will those things be unpicked? That bureaucratic issue for councils is something on which ministers also need to start answering questions.

Above all, another thing that has not been looked at is what the integration of health and social care has meant. Is the Government turning its back on that flagship project?

Scotland’s local authorities and our vital third sector have been simply outstanding during the pandemic. The can-do attitude with which they have mobilised services for our fellow Scots has been invaluable during the national response. Are SNP ministers truly saying to them that the centralisation of power and top-down reform is the thanks that they can expect? The genuine partnership working that there has been during the pandemic now seems to be under threat. The SNP-Green coalition’s centralising approach is clearly starting to generate serious concern across local government. It is little wonder that COSLA has described the Scottish Government proposals as an

"attack on localism"

that could spell

“the end for anything other than central control in Scotland.”

Those concerns are real and valid, and we have heard no answers today on any of them. Not only are the concerns of local government simply dismissed by ministers; we are not hearing of any opportunity to make sure that their powers are protected.

Scottish Conservatives believe that local delivery and the local accountability of our health and social care services are vital. As the reforms are progressed and brought forward to the Parliament, we will make sure that Scotland’s carers and our local councils are, as is right, at the heart of any national care service.

I support the amendment in my colleague Craig Hoy’s name.


The Minister for Mental Wellbeing and Social Care (Kevin Stewart)

I echo the thanks that many members have given to the staff who work in our health and social care services. In particular, I thank Lisa and Jenny, who are nurses whom I met at CAMHS here in Edinburgh today. Emma Harper asked that we all ensure that professionals are valued. I tell her that those professionals are so valued that I will speak again very soon to Lisa to get even more insight into what they are doing.

I think that we can all agree that our health and social care services are a lifeline for many people. Our current system is under pressure, especially as a result of the pandemic, so I think that it is quite sad that many folk today have not mentioned the fact that the pandemic is still on-going, nor did they mention the challenges that we have had to face because of that global issue.

Recruitment and retention have been challenging for some time, and even more so in the past 18 months. We are also seeing greater demands being placed on the system, with people having higher levels of need for acute and community care offers than was the case before the pandemic began. In the community, that has turned into increased pressure on unpaid carers. I agree with Miles Briggs; many of them are now desperate for a break. The Government will work hard to address those issues by matching reform and recovery with investment.

Alex Cole-Hamilton

I am grateful to the minister for giving way. Does he recognise that one of the main reasons why unpaid carers are on their knees and in desperate need of respite is that his Government refused to allow adult respite services to reopen until now?

Kevin Stewart

Some folk try to avoid listening to clinical advice when it suits them. Many of the day services are now open. They are not up to full capacity yet, because we are still following the guidance that we get from scientists and clinicians. I am more than happy to speak to Mr Cole-Hamilton or any other member about that. They cannot have it all ways; we cannot have a situation in which we could be accused of putting folk at risk by not following that advice.

We cannot wait for a new national care service to be established to address issues. We will act now to improve services for the people who rely on them, for unpaid carers, and for the people who work in our care services.

We are taking action with local partners to address the immediate pressures on care-at-home services, which are, in turn, placing pressures on our NHS. That action includes the establishment of a dedicated webpage for social care vacancies, which will make it easier for people to find and apply for roles in care. We are also issuing targeted communications to nursing and social work students to encourage them to join the workforce.

However, the elephant in the room—if anybody wants to talk about this to any care providers, please do so—is the amount of staff who have left because of Brexit and folk returning to their home nations. That has caused us great grief, which the folks on the Opposition benches will never admit.

We have allocated an additional £380 million to health boards to help with costs that arise from the pandemic in this financial year. That comes on top of the £1.7 billion that was already provided to health boards and health and social care partnerships last year. We will match our ambitions with more funding. We will deliver a 25 per cent increase in investment in social care over this session of Parliament, which equates to about £840 million. That funding will provide better support for people who access services and better terms and conditions for the workforce.

Pam Duncan-Glancy (Glasgow) (Lab)

Inclusion Scotland highlights the importance of opening eligibility for social care, and has said that the 25 per cent increase might not be enough to do that. Will the Government commit to increasing the investment?

Will the Government also commit to living up to its intention to support disabled people’s independent living and the definition of independent living by ensuring that that definition is enshrined in the legislation to develop a national care service?

Kevin Stewart

That is a huge amount for me to answer in a very short time, so I will meet Pam Duncan-Glancy to discuss some of those issues.

However, let me tackle the eligibility issue, which is one of the major difficulties. It causes a postcode lottery in parts of the country, which is why we want to get rid of it. We want national standards so that folk know what they can expect and what they deserve, rather than having that postcode lottery.

Although I do not think that I have much time, I will briefly take Miles Briggs’s intervention.

Miles Briggs

As a former Aberdeen City Council councillor, what does Kevin Stewart say to the president of COSLA, who refers to the national care service—which he has not touched on—as “an attack on localism”? Does he agree with that?

Kevin Stewart

I do not agree with that. I will come to that later in my speech.

I turn to the workforce, which is immensely important. Improvement of terms and conditions will improve the experience of the current workforce and will help to attract and retain new staff in the sector. We will work with COSLA and sector stakeholders through the fair work in social care group, through which we have already developed a set of standards for terms and conditions that promote flexible and family-friendly working.

We have also maintained our commitment to adult social care workers by ensuring that they are paid at least the real living wage. The Government is providing £64.5 million in funding this year—[Interruption.]

The minister is in his last minute.

Kevin Stewart

We accept that we need to go further—there is absolutely no doubt about that—and we will go further. We also have the ambition to bring the pay, terms and conditions of nursing staff who work in the care sector into line with the NHS. We will review options to achieve that. Although we recognise the challenges and complexity of delivering across a varied landscape of more than 1,000 unique providers, the Scottish Government will push for a national wage for care staff and will enter into national pay bargaining for the sector for the first time.

It is vital that unpaid carers be recognised as equal partners in care and that they be able to take breaks to protect their wellbeing. That is why we are consulting on enhanced rights to breaks from caring, alongside the creation of the national care service.

We are proposing the biggest public sector reform for decades—indeed, since the creation of the national health service. With the consultation for a national care service being under way, we are having open and honest conversations about what people want the future of social care to look like. I encourage all members to get as many people as possible to respond to the consultation.

We have also established a group of people who have experience of social care to hold us to account if they think that we are not putting people at the heart of the system.

Please wind up, minister.

Kevin Stewart


The social covenant steering group will be immensely important. It will put human rights at the heart of the system and will drive up standards across the country.

Local accountability will be key to ensuring that the system works for people. Under our proposal for community health and social care boards, people with lived experience will, for the first time, sit on boards alongside locally elected members and health and social care professionals. That will bring people with lived experience into the decision-making process, which is vital.

From the rubble of world war 2, our respected NHS was born. As we emerge from the shadow of Covid, we can build a national care service of which we can be proud and which delivers for our people.

That concludes the debate.

On a point of order, Presiding Officer. I forgot to declare my interest; I am a practising doctor.

Thank you, Mr Gulhane, I appreciate that. Your point is noted.