Official Report 340KB pdf
The next item of business is a debate on motion S7M-01003, in the name of Angela Constance, on the programme for government: improving lives through delivering for Scotland.
15:34
Yesterday, the First Minister introduced the programme for government to the Parliament and the nation, and fundamental to that is the delivery of significant reform of our public services.
Let me be clear: those vital services for the people of Scotland require partnership and require to be delivered by the exceptional workforce that we are very blessed to have. We absolutely value the work of those services and all those who work in them.
However, it is time for change, and time to look with clear eyes and open minds at the shape and size of our public sector. We must ask: is it in the right kind of shape for the challenges that this country faces now and in the future? Do our systems fit around people, or are we expecting people to fit into systems?
Public services that were designed for the 20th century must be ready for the realities of the 21st century. That is why, over the current session of Parliament, we will rewire the Scottish state. Public service reform will be at the very heart of delivery in this Administration.
I stress that that is not about marginal change. It is about working with communities, those who rely on services, the workforce and trade unions to reimagine the state—a state that is more joined up, more efficient and more focused on prevention as early as possible. In that, the people of Scotland must come first—not the systems, nor habits, assumptions or institutions. These public services reforms will be the biggest reform in this country since the Scottish Parliament was reconvened in 1999. However, as Nye Bevan, the founder of our beloved national health service, said, there are also many dangers to staying in the middle of the road.
Why do we need change? Let us be frank. If all of us in the chamber were to sit down today and design a modern, efficient and responsive Scottish public sector on a blank sheet of paper, it would not look like the current picture. There are 134 public bodies in Scotland. In health and social care, there are 14 health boards, seven special health boards, 31 integration joint boards, 31 health and social care partnerships and 84 accountable officers. Those multiple layers of decision-making remove services further and further away from the people in need on the ground.
Would the cabinet secretary recognise that, in the past 19 years, it is actually her Government that has been responsible for creating some of that institutional clutter? I point to health and social care partnerships and integration joint boards.
Of course, the Government has to bring forward proposals—as we have done in the past—that Parliament either does or does not endorse. In all sincerity, we have had an election campaign in which we have critiqued the past. Now, in this parliamentary session, it is time that we debate the future and ensure that our public services are fit not for 20 years ago or the 20th century, but for today and tomorrow—for the 21st century.
The point is that the current complex and cluttered landscape that members of the public need to navigate demonstrates why we need to simplify how decisions are made and who makes them, thereby reducing unnecessary complication and confusing duplication, and addressing the inconsistency and variability in how services are provided.
I agree with the cabinet secretary about the need for simplification. However, can she tell us how local accountability will be secured if we are moving to two geographic health boards rather than the number that we currently have? Does the Scottish Government have a number on the amount of money that it would expect to save from that particular move?
On whether there are up-front costs or longer-term savings, we are currently in the design phase, and there will have to be a full business case so that we can lay out all the intricate detail to partners and others, but Mr Fraser makes an important point.
Mr Fraser’s other point is about local accountability. I also support the spirit in which he endeavours to make that point, because we need accountability at each and every level of the system. That starts with the Government, but there must always be local accountability as well.
The point that I want to emphasise to Parliament today is that the simplification of decisions, governance and planning does not mean the centralisation of service delivery. Our reforms are about putting people and their care at the heart of our services, wherever they may live. The intention is that local services remain local, wherever that is the best way to meet the needs of communities. Our reforms must ensure that, no matter where people live in Scotland, they can access the same high-quality care. I have seen that happening at first hand during the summer, when I visited Dr Gray’s hospital in Moray and during the time that I spent with staff and citizens in Kirkwall. Our vision is of a Scotland where citizens enjoy excellent public services, delivered to meet their individual needs, regardless of geography, and we want the staff who provide those services to feel valued and empowered to make a real difference to people’s lives.
Public service reform will be led by our health and social care services. In the reform structures that we want to see, health reform is the first stake in the ground. Since the foundation of our national health service 80 years ago, the demands that we create and our expectations of the health service have changed. Those changes are led by changes in demography. We have an ageing population, and people are living longer with more complex health conditions, and we still have areas of deprivation across our country where health outcomes are poorer. There is a rise in demand, a change in expectations and a rise in costs. Unless we radically shift course in our delivery of health and social care services, they will not be in the best position to respond to the needs of our people. Reforming the NHS is future proofing it for generations to come. The first step on this journey of reform is simplifying the structure of the NHS.
We will replace the current territorial health boards with two strategic health boards—east and west. That will reduce unnecessary duplication and make responsibility much clearer. Beyond territorial boards, we will build on the already planned reforms to further reduce the number of special health boards. Simplifying the structures will give us a platform to allow people to access the care that they need—quickly, safely and with dignity.
We will do that alongside continued investment in local community services such as general practitioner walk-in centres and the hospital at home service; digital transformation, led by the MyCare app; and redesigned services to ensure that people receive the right care in the right place at the right time.
An example of that will be how we deliver a new national plan for orthopaedics, where simpler structures will increase access to elective procedures and eradicate long waits. People should not have to wait longer for an operation or procedure because of where they live. If there is capacity in our system, that must be used. By streamlining structures in that way, we will empower our senior leaders to make decisions that benefit patients faster and in a more dynamic way.
As I have mentioned, we are committed to empowering communities. We will enable bespoke solutions for our islands, including the implementation of single authority models where that is desired, and local governance arrangements to enable decision making to be better tailored to the needs of the place.
Let there be no mistake: this Government is absolutely committed to the founding principles of the national health service. A Scottish National Party Government will always be clear that our NHS will never be for sale. To safeguard its future, we must do more than reform structures. That is why the programme for government focuses on prevention, supporting people to live longer, healthier lives, and reducing demand on our NHS. We must continue to make the shift from reacting to illness to preventing it.
We already have well-established strategies and frameworks for that. We will continue to embed prevention across Government and public services, with investment in programmes that prevent illness and detect diseases earlier, including vaccination and screening.
That is why we are working with Chest Heart & Stroke Scotland to deliver new heart and lung MOTs, and we will strengthen action on healthy weight, physical activity and other wider drivers of health. Work is progressing on helping people to access practical help before health problems escalate, including through our vital fight against Scotland’s drug deaths emergency.
Prevention cannot be delivered by the national health service alone. It requires co-ordinated action across the Government, working in partnership with local government, businesses, communities and the voluntary sector.
The cabinet secretary will know that the Liberal Democrats secured extra support for long Covid, myalgic encephalomyelitis and chronic fatigue syndrome clinics, but work on those has not advanced in the way that we would have liked. Will the cabinet secretary give an update on when those clinics will be implemented?
I will write to Mr Rennie with the details on that. I believe that there is recurring funding for some conditions, such as long Covid and postural tachycardia syndrome, on which people have been writing to me regularly, but I will check and write to Mr Rennie in greater detail.
The preventative measures that I have mentioned should be more integrated with the services that treat people closer to home, which will avoid the need for acute hospital care. We have already made significant progress to increase activity and bring down long waits for operations and procedures. Our new health and care improving flow plan will result in the creation of one connected system, with simpler routes to care. It will declutter the landscape, ensure that we more effectively plan for unplanned care, improve the movement of patients through hospital and tackle delayed discharge. We want people to spend less time waiting and more time receiving care. That is our new contract with the public—we will make it clear what the public should expect in return for accessing care in the right place.
I do not wish to open old wounds that were felt in the Parliament during the debates on the national care service. However, social care must be central to our reforms. That is vital if we are to make headway in reducing delayed discharges and ensuring that people are cared for closer to home. Our vision is clear: people should be able to live healthy, independent and fulfilling lives, connected to their families, friends and communities, for as long as possible. That is why we will use the next three months to reach agreement with local government on the next phase of social care reform. Together, I hope that we can develop a model that delivers fairer and more consistent services.
Above all, our approach will be shaped by the voices of those with lived experience. Thousands of people who access, deliver and support care have shared their experience and insights with us in recent years. Their message has been consistent: services must be easier to navigate and should be person centred and joined up. Our aim is to meet those goals. I urge local government to work hand in hand with us to design an approach that works for the people whom we were all elected to serve.
That offer extends to members across the chamber. I have already had some early discussions with the Greens, Labour and the Tories about their views on public service reform, and my door will be very much open to those parties and to the Liberal Democrats, too. It is important that members’ voices help to shape the future of how our services will be delivered.
The Government will always look to find and create common ground in pursuit of a better Scotland based on fairness, compassion and inclusion. Let me reassure members that we will, from the outset of this process, work closely with staff and trade unions to draw on their expertise, leadership skills and required capabilities to design and deliver better services for our people and communities.
The Government does not have a monopoly on good ideas, so we invite leaders across local government, public bodies, trade unions and delivery partners to join us in shaping a clear vision for the future. We make the most progress when we work together. I think that we all know that public sector reform cannot be deferred, but the people of Scotland must be at the heart of the reform process. After all, they are why we are all here. It is with that in mind that we will take forward this work to improve the lives of all who live in Scotland.
I move,
That the Parliament notes the publication of the Scottish Government’s Programme for Government, Ambitious for Scotland, which commits to renewing Scotland’s public services through prevention, integration and reform; recognises the Programme for Government’s focus on public service reform and commitment to ensuring that decision-making and service delivery sit at the level best placed to improve people’s lives; agrees with the need to empower communities and regions to make the decisions that improve delivery; further agrees with the need to reduce NHS waiting times, support the shift of care from hospitals into communities through strengthened primary care, digital innovation and expanded community services; welcomes the need for action to tackle health inequalities, improve population health, and treat substance misuse as a public health priority, and agrees that public service reform must be shaped by and with the workforce, while delivering better outcomes for people and communities across Scotland.
15:49
I am sure that we all share most of the cabinet secretary’s vision. We are grateful for her speech, and nobody disagrees that the NHS in Scotland needs reform. Indeed, the Reform party manifesto asked for an independent expert health and social care commission to look at the whole system, so that we could move work on reforms forward.
Unfortunately, the health and care improving flow plan is not worked out. It is a distraction to fulfil the 100-day promise and soundbites, but there is nothing underneath it.
Will the member take an intervention?
Not at the moment. I want to get started.
I will start with the good bits. We are glad to see that the app—MyCare.scot—has been launched. The hospital at home service has been successful, and the roll-out of that is good. Many have asked for more use of allied health professionals, and the Health and Social Care Committee heard this morning that they have already been working in schools and elsewhere to improve outcomes.
However, sadly, the flow plan seems to be mainly about public relations. It starts with the bits of the NHS that most people see, and the question that the Scottish National Party seems to have asked itself is “What can we do about queues at accident and emergency departments and bed-blocking corridor care?” The answer to that seems to be to not let folk into A and E, and, if they get in there, to tell them that they are getting out in three days to receive the mythical care in the community. Further on, when it has been worked out, I will welcome hearing where that care is.
Some key phrases jump out of the Government’s plan, such as “realistic medicine”. Then there is self-care and care in the community. We have heard about care in the community before—it means “Stay at home with your loved ones.” Then there is GIRFEC. Oh—sorry. I did not mean getting it right for every child—the Government likes a slogan. I meant getting it right for everyone: GIRFE. The one I particularly like is “waiting well”, which I assume means people being told how to feel better while they wait for care to come.
It seems as though the SNP has not learned anything from the failure of the national care service bill. There has been little consultation, and the people who would implement what is in the plan seem to think that it is not going to do the job that the Government wants it to. In fact, it is like rearranging the deck chairs on the Titanic. I have spoken to many representatives of medicine and nursing, and one, who was almost in tears, said after seeing the plan that it will not cut it.
I am interested to know which of the immediate priorities in the flow plan the member disagrees with. Does she not support rolling out discharge without delay programmes across the country? Does she not support the increased use of frailty units? Does she not support the expansion of care at home? Those are all tangible actions that show what will be done during the winter to improve the situation.
We support a worked-out plan. We support knowing where the money is going to come from to get support in the social care sector. Those things are not evident in the flow plan. As I was saying, somebody on the front line, who was very distressed when she saw the plan, said that it will not cut it. Those in the emergency services are on their knees.
The Royal College of Emergency Medicine estimated that more than 800 excess deaths were linked to A and E waiting times. Would there be fewer deaths if those people were waiting well at home?
This is a real emergency, and I will come on to where we should be going, but, first, what caused it? The Scottish Government gave various reasons—older people and more sick people—and although there was little mention of drugs and alcohol in the plan, I welcome the fact that the cabinet secretary mentioned it. However, one obvious factor is having an impact. The Scottish population has gone up by 370,000 in 20 years, and the number of beds in hospitals has gone down. That is one contributing factor, so it might be that we have to build more hospitals. However, we need to consider the lessons. If one hospital replaces three, what happens when that hospital is in major trouble? Healthy life expectancy is also dramatically decreasing: it has gone from 65 years to 59 years, on average. Staff are constantly on red alert. Perhaps the Scottish Government should consider building Nightingale-style hospitals for convalescent homes, because it would free up beds that we do not have.
However, the Scottish Government might not be keen on building hospitals, because its record of doing that is not great. I visited the Queen Elizabeth university hospital at the weekend. I am not sure whether the cabinet secretary has been since she arrived in post. I hope that she has. If she has not, I hope that she will visit soon. The QEUH, which was opened only in 2015, is in a constant state of disrepair. There is scaffolding inside and out, internal cladding that seems to have been stripped and unfinished doorways that are meant to be fire doors. Worst of all, the air may not be still fit for immunocompromised patients, and people do not trust the water. What third-world country are we living in? The SNP has been in charge for 19 years.
Brodie’s inquiry will report soon. We will see what happens six years after it started and with £31 million down the drain. Will there be prosecutions? One thing that we know is that we should not be waiting for the report—action should be taken on the Queen Elizabeth now. Yes, there have been apologies to the families, but what action will be taken?
My heart goes out to the staff. The issue is not the staff, who struggle to pick their way round buckets in order to do their job. All the other hospitals must be asked what they need, too. What will the cabinet secretary do about the third of the NHS Scotland estate that has major structural or maintenance problems? Will she give a statement on the Scottish hospitals estate, leaving out the Queen Elizabeth if we cannot speak about that yet because of the inquiry?
If we consider the cunning plan for health boards, it seems like the magic figure of two health boards is based on the subnational planning structures of Scotland east and Scotland west.
Will the member give way?
Why not?
I had the good fortune of reading the Reform UK manifesto for Scotland last night. It mentions the establishment of an independent Scottish healthcare reform commission. How much would Reform’s proposals for healthcare cost versus what the Government is proposing, which is to reduce the cost of health boards, which is currently about £15 billion? All that I see in the Reform manifesto is commitments to spend more money, not public service reform.
It will not cost as much as pursuing the wrong plan and creating further problems with these hospitals. The Government does not have costings for the plan that it intends to implement.
I said at the beginning of my speech that we have proposed the establishment of a health and social care commission, and it is important that it be independent. However, we are where we are, and the question concerns health boards.
Quite recently, I heard from a senior surgeon who was quite worked up about the proposed east and west health boards, given that Inverness is in the west and Aberdeen is in the east. Anyone who lives in those areas knows that the hospitals in those two cities have worked together since time immemorial because of their geographic circumstances. That needs to be considered.
All around the country, chief executive officers of health boards must be asking themselves, “Oh, no—I’m near NHS Greater Glasgow and Clyde. Am I going to inherit its potential legal liability?” How will joining up these health boards work? We should not deal with failing institutions by joining them up with each other. We need somebody to be put in who knows how to recover failing things.
Can you wind up, please?
Sure.
The Scottish Government believes that single authorities are fine for the islands. It wants simplicity. Perhaps we could consider that for the rest of Scotland. If we want to reduce costs, we could, indeed, consider that. However, the SNP’s answer is always to centralise and to try to take control, which is ironic for people who want to get more control from Westminster. Perhaps they should practice what they preach.
I move amendment S7M-01003.5, to leave out from “, which commits” to end and insert:
“; is disappointed that the only tool that the Scottish Government is using to reform public services is centralisation; believes that the proposals to create only two health boards for the east and west further marginalises rural communities in the north and south; further believes that it is hypocritical for the Scottish Government to talk about making services local, when the proposed actions would remove locality by further centralising health services; notes that the Parliament has been told many times during the last 19 years by the SNP administration that it will empower communities, reduce NHS waiting times, support the shift of care from hospitals into communities, roll out digital innovation and expanded community services, tackle health inequalities, improve population health and treat substance misuse as a priority; believes that, over nearly two decades, the actions taken to address these priorities have been ineffective to such an extent that the current administration is still seeking agreement to take action on them; calls on the Scottish Government to set out in detail the capital and revenue budgets required to deliver healthcare reform and establishes an independent scrutiny body to oversee these reforms, and is opposed to a simple expansion of the existing governance structures, which it considers could be likened to the Scottish Government marking its own homework.”
15:59
We are now on our fourth health secretary in as many years. Those who have tried to get a grip of Scotland’s NHS in that time include Humza Yousaf, Michael Matheson and Neil Gray. Some are now no longer members of this Parliament, but they all have in common their failure to support Scotland’s NHS and to deliver for the patients it serves.
Let us look at the facts as they are right now. Out-patient waiting lists have risen four months in a row. There are more than 700,000 ongoing waits for tests and treatment in our NHS. The use of the private sector has increased exponentially. A and E waiting times this summer have been the worst since records began. We have 3,000 nursing vacancies. Delayed discharge continues to rise, even though the SNP promised to abolish it more than 10 years ago, and social care is on its knees. The cabinet secretary has inherited a mess from her predecessors, and I have, in the past, offered to work with the SNP, but no one calls, no one emails and no one writes. I really look forward to that changing, because the SNP’s priority has too often been to protect its Government from criticism rather than putting Scots’ health and wellbeing first.
I very much welcome the SNP’s Damascene conversion to supporting a reduction in the number of health boards, but the purpose of doing so must be to shift the balance of care, not to centralise it. It must be about delivering the best standards of care, not making cuts, and the SNP needs to acknowledge that it was the party that created the institutional clutter—after all, it created the 31 health and social care partnerships and the 31 integration joint boards 10 years ago. Therefore, the reduction must be about improving accountability and the local delivery of social care, not treating it as the NHS’s poor cousin, because social care must have parity of esteem and the same level of priority for ministers as the NHS. The SNP botched the national care service. It spent millions of pounds on unworkable legislation that did not deliver a single penny for care packages, and I really hope that these reforms are not an attempt to do the same thing by centralising care under health boards.
However, the immediate challenge is resourcing. Earlier, I said that social care is on its knees. I repeat that, because those trying to deliver in the social care sector—
Will the member take an intervention?
Of course. I am happy to give way.
I am interested in Jackie Baillie’s line of argument about social care arrangements, because what drove the reforms that the Government undertook in the past was the pursuit of integration. That was the purpose of the integration joint boards, and I think that we have all come to the conclusion that however well-intentioned that approach was, it has not delivered the level of integration that is required.
Yesterday, I set out that, although I am not proposing a prescriptive solution, I cannot see how we can deliver integration of social care without the national health service being in the lead. I wonder what Jackie Baillie’s view is on what model of operation for social care would deliver the integration that she and I both want to secure.
I do not think that the answer is to hand it back to the health boards. There is a model in which you can revise how health and social care partnerships operate and enable those who actually deliver on the ground, including the third sector in particular, to deliver local services and accountability in a different way. The problem is resourcing, which is what I will come on to.
Those who are genuinely trying to deliver in the social care sector are not adequately funded and the staff are low paid. As members will know, we have long demanded £15 an hour for social care staff, and I do so again, but commissioning itself is in desperate need of reform. Last year, social care faced a £500 million shortfall, and the cuts that were made impacted directly on care. Yet, when I study the programme for government carefully, I see three months’ conversation, making the best use of money that is already in the system and achieving economies of scale. There is nothing about closing the gap between the commissioning rate for a service and the actual cost of delivering it. There is nothing about addressing the growing level of unmet need, which is not sustainable.
The scale of the task that is before the cabinet secretary is clear for all to see, but I will end on what I hope will be a point of consensus. I turn to the question of women’s health, which has been sorely neglected. We are all familiar with the urgent issues at hand, including long waits for an endometriosis diagnosis. The wait was eight and a half years when the women’s health plan was first published; it now sits at 10 years, which is the worst delay in the UK. There are the failures in maternity care that we discussed earlier, as well as the postcode lottery for women experiencing miscarriage, the centralisation of sexual health provision, the lack of access to menopause support, the waiting time for hysterectomies—four years, in the case of one woman in NHS Lanarkshire—and the waits for gynaecology of more than a year for more than 4,000 women.
Against that backdrop, it is disappointing that the First Minister removed women’s health as the specific responsibility of one minister. Irrespective of that, his health team are now all women, so I hope that the issue is a priority for that entire ministerial team. We might have disagreements and debates in the coming months, but, above all else, we must put the health and wellbeing of the people of Scotland first.
I move amendment S7M-01003.1, to leave out from “welcomes” and insert:
“recognises that a properly funded social care sector, with a fairly rewarded workforce, will be necessary to achieve these aims; further recognises that mental health services require urgent attention; welcomes the need for action to tackle health inequalities, including in women’s experience of healthcare, to improve population health, and to treat substance misuse as a public health priority; agrees that public service reform must be shaped by and with the workforce, while delivering better outcomes for people and communities across Scotland; regrets that the Scottish Government has had 19 years to transform public services but has failed to deliver, and believes that, if Scottish Ministers are committed to deliver, they must engage in cross-party working, especially in health and social care.”
Before we move to the next speaker, I remind colleagues that five members who said that they wish to speak in the debate have not yet pressed their request-to-speak button. Please do so now.
16:05
I enjoyed hearing from Jackie Baillie on opposing cuts because, not that long ago, when I was in the City of Edinburgh Council chamber, her party was signing off on a lot of social care and third sector cuts, no matter how hard we tried to stop them.
Will the member take an intervention on that point?
Sure—why not?
Was that not actually just down to the lack of funding from the Scottish Government to health and local government?
Both things can be true.
Yesterday’s announcement has caused significant concern for staff, patients and communities about the future of local healthcare in Scotland. Unison’s Scottish secretary, Lilian Macer, who spoke at today’s Health, Care and Sport Committee meeting, said:
“You cannot just restructure your way out of a public service crisis.”
Greens love a bit of radical change, and, as we have heard, all the parties understand the need for public sector reform. However, what is proposed appears to be too blunt a centralisation of services and a worrying change in how front-line healthcare is delivered. We understand that the programme for government is not the full picture, but our job in opposition is to ask the difficult questions and get in early to make sure that reforms are delivered effectively, carefully and with the right people from the start.
I want to first talk about general practice because if general practice fails, the whole NHS fails. About 90 per cent of the encounters in today’s NHS are conducted in primary care, but it is being starved of funding. GPs spend far more of their time on chronic issues rather than those that need acute reactive care. The burden grows while the budget shrinks.
For those who may not know, I point out that GP surgeries are not technically part of the NHS but are independent businesses with one customer: their local health board. That profit partnership model has shown itself to be the cheapest, but is it the most effective? Can members imagine a situation where surgeons were paid based on how many incisions they made at speed? On attraction, growth and retention, GPs say that NHS managers’ priority should be to stall the general slide towards specialism and reverse the growing lack of respect for generalism. I could go on to give more examples.
We know that, when a population gets older and sicker and needs are more complex and intersectional, the cost for the NHS is much greater. Spending cannot continue in the current manner. We need credible alternatives, because the status quo is not an option. This year, we need a clear understanding of what the two-board structure will look like. I look forward to hearing the cabinet secretary’s and Government’s thought process on the issue. However, like many others across the chamber, we are looking with concern at what appears to be the drawing of a line down the middle of Scotland and hoping for the best.
In reality, people just want to know how the proposals will get them an appointment with their GP today. How many beds will be opened up at their local hospital? How will this get a care package for their gran that involves more than fleeting visits? How will it help a care worker who is burning out and struggling every day to help our most vulnerable? My plea to the Government is simply to not keep us in the dark.
I very much welcomed the First Minister’s words this morning with regard to there being no compulsory redundancies, but we must be exceptionally clear that that includes compulsory redundancies by the back door—for example, when people are offered either redundancy or relocation to the other end of Scotland for another job.
Health and social care workers have endured years of relentless pressure from understaffing and uncertainty—we all know that. They should not now be forced to pay the price for a rushed reorganisation done behind closed doors. The Scottish Government must engage meaningfully with trade unions and the workers who understand our NHS better than we do before decisions are made, not after the structure has already been decided. Workers must have a genuine seat at the table, their terms and conditions must be protected and no one should be forced into worse roles or unreasonable relocation.
The Government should urgently publish the details behind these plans, including the responsibilities of the proposed boards, the future of integration joint boards and how local services will be protected. Until then, NHS workers and patients are being asked to take an enormous leap into the dark.
I will finish on local delivery. As I alluded to, I am a councillor in the city of Edinburgh and I know the difficulties that are faced by the health and social care partnership and integration joint board of our capital city. I also know that local authorities are the perfect vehicles for governance, keeping care in the community, listening to local needs and incorporating cross-directorate approaches, for example, in housing and environmental services—they just need the resources to do so. There is no point in tearing up paper to shoddily glue it back together; we might just need to admit that we need a new sheet of paper.
However, I heard some hopeful whisperings this morning in the Health, Care and Sport Committee about the two-board system. We were told that it could give us some flexibility and the opportunity to enact policy intent on prevention, which would be great. We heard that we need to get out of the “repair shop mentality” when it comes to health strategy. I welcome the focus on prevention and helping people before escalation is needed. We could also see better governance and workstreams, while boundary changes might make it easier to scale up good practice on intervention while learning lessons about poorer practice.
However, for those who are struggling today and just want to know, and for the sake of the service, the workers and the users, I say again to the Government, please do not leave us in the dark.
I move amendment S7M-01003.2, to insert at end:
“; notes the reported concerns raised by workers, patients and communities regarding the proposed centralisation of NHS services; calls for assurances that there will be no compulsory redundancies or loss of frontline services as a result of the scrapping of regional health boards, and further calls on the Scottish Government to urgently publish further information on Integration Joint Board reform, the responsibilities of the proposed two strategic health boards and how responsibility for local service delivery will be managed.”
16:12
As the cabinet secretary stated, yesterday’s programme for government was billed as the biggest change in how we structure our public services in Scotland since the advent of devolution. The questions that ministers are asking about what size and structures we need as a country and how we can make our public services adapt and respond are critically important. If ministers get the answers wrong, that will have profound effects on how we deliver public services in this country in the future.
I agree with the First Minister when he states that he wants to see a shift towards an outcomes-based approach for our public services. For too long, process has been the focus of how public services are delivered, and what matters to people, families and communities is often not reflected. The Scottish Conservatives will approach the proposals and reforms in the spirit in which they have been outlined by the First Minister and the cabinet secretary and we will offer constructive suggestions. It is important that we place delivering local accountability and decision making at the heart of any reforms, with an understanding of the distinct challenges facing communities across our country, especially our rural and island communities.
I do not know where the Scottish Government’s rationale for two strategic health boards has come from. I would have started with the three Scottish cancer regions, which operate well-developed pathways for cancer treatment and well-planned services. As the cabinet secretary has already outlined, it is clear that the integration of health and social care has not delivered the outcomes that were envisaged. We need a new model of delivery. I look forward to some more detail on what that can look like, but it will not be easy.
I hope that ministers will start with the opportunity to significantly reform palliative care, which all parties committed to undertaking in our manifestos in the recent election. I am disappointed that the programme for government did not better reflect the strength of feeling on improving palliative care that emerged towards the end of the previous parliamentary session. That can be the first test of how the NHS and social care reform can deliver improved care pathways and outcomes and shift towards a hospital and hospice-at-home model that meets the demographic challenges that we face as a country.
I welcome the fact that the programme for government reiterates the commitment to deliver pay parity for hospice staff over the course of this parliamentary session. However, there is still uncertainty around the funding settlement for 2027-28.
There is now a need for a new national funding framework for hospice care. The Government first committed to such a framework in 2023, and it remains an essential part of protecting our hospice services and providing the stability and support that they need as we take forward health and social care reform. Therefore, I hope that the cabinet secretary will engage further with me on my proposed right to palliative care bill with a view to considering how we can improve hospice care.
I very much welcome the recognition of the campaigning efforts of the family of the late Anthony Bundy and yesterday’s announcement by the First Minister that he wants 24/7 thrombectomy cover to be delivered, regardless of geography. I would like to pay tribute to my friend and colleague James Bundy for his campaigning on the issue, on which I have been pressing ministers for many years. It is a prime example of the postcode lottery that exists in our health service.
Today, people in the NHS Lothian area are lucky to have a stroke service that means that, if someone has a stroke and a decision is made to treat them, they can access a thrombectomy from 9 to 5, Monday to Friday, although they cannot do so at the weekend. There needs to be a national 24/7 thrombectomy service. I understand that the Government intends to provide more detail later—
Will the member take an intervention?
Yes—if I can get the time back.
I am grateful to Mr Briggs for giving way. The example that he gave of a 24/7 thrombectomy service is a very good example of why we need to consider the provision of services of a very specialist nature on a national basis, because health board boundaries can often get in the way of delivering such services across all localities. Mr Briggs makes a valuable point that exemplifies why the Government is taking the policy course that it is proposing to Parliament.
Before you respond, Mr Briggs, I remind you that time for interventions is not taken from members’ speaking time.
Thank you, Presiding Officer, and I thank the First Minister for that intervention.
It is critical that there is increased investment in digitalisation. That issue has not been mentioned, but I think that digital health services and digitalisation need to be progressed.
Our NHS is a cherished national institution that is important to all of us. Reforms are desperately needed, but ministers must make them in partnership with the Parliament, patients and—perhaps most importantly—our NHS and social care workforce so that we can shape a better future.
I move amendment S7M-01003.4, to insert at end:
“; notes the projected £5 billion gap in public service funding after 19 years of an SNP-led Scottish Government; further notes the First Minister’s recognition that underperforming areas must change, but notes that Scottish Ministers have failed to outline how social security spending will be reformed in response to estimates that the Scottish Government will be spending more than £9.2 billion a year on benefits by 2030-31; welcomes the debate around public sector reform, which guarantees the delivery of local accountability for services and equity of access to services as close to or in people's homes, and agrees with the principle of creating a state that spends Scottish taxpayers’ money more wisely.”
16:17
I think that this is the first opportunity that I have had to properly welcome the cabinet secretary to her new role and to wish her all the best, so I do that now.
The Government’s motion provides a lot of warm words and big plans but, by themselves, warm words will not cut waiting times or the care bottleneck. We should, of course, be ambitious about reforming public services. We should look at how we can deliver better care, reduce waiting times and move more care into our communities, but there is a very simple test that should sit at the heart of any reform process: will it actually make life better for patients and for the people who work in our NHS?
If we ask patients what they want, the answer is not particularly complicated. They want to be able to call an ambulance and know that it will arrive quickly. They want to be able to turn up at A and E and know that they will not be sitting there for hours. They want to be able to get the operation that they might have been waiting months or years for. If they or their loved one is struggling with their mental health, they want to be able to ask for help and get it.
NHS staff want something pretty straightforward, too. They want to be able to provide good-quality care, to finish their shifts when they are supposed to and to go home in the knowledge that patients have received the care that they need. That is what NHS reform should be about, and there are parts of our NHS that desperately need that change.
It is clear that the Scottish Government has been reading the Lib Dem manifesto again, because the programme for government includes positive commitments. [Interruption.] We have long championed joined-up, person-centred care that is provided closer to where people live, and tackling delayed discharge. I welcome all of that. However, there is a difference between putting those commitments down on paper and delivering them, and I worry that the Government is once again reaching for a very big structural solution to problems that are fundamentally about capacity. We have been here before.
In fact, I said in my speech that structural reform alone will not be enough. However, on his good point about capacity, does Adam Harley agree with the principle of removing unnecessary geographical boundaries to ensure that we can use capacity so that patients can be treated and to bolster fragile services in our more rural communities?
Right now, there is no detail on whether any of the Government’s plans would do that. We also know that these things can drag on for years. There are issues in the NHS that need to be addressed right now, and I worry that the administrative upheaval that this could cause would distract from the issues in the NHS today. We have been here before.
I am also instinctively deeply sceptical about the idea that this does not constitute a huge centralisation. Liberal Democrats believe that decision making should sit as close to local communities as possible. That particularly matters to people in rural and island and remote parts of Scotland, who already feel removed from decision making. However, patients right across Scotland will look at these proposals and reasonably ask whether they will, in fact, improve care for them or their loved ones. That brings me to my amendment.
We know that there are people who are medically ready to leave hospital but who cannot leave because there is no care package to receive them in the community. That is leading to patients being treated in corridors. If the Government is serious about eradicating corridor care, we need to know exactly how much of it is happening. We need to accurately measure it. We know that patients have been treated in corridors throughout the summer, long before winter pressures hit. I therefore hope that the Government and the Parliament will support our amendment.
I will finish by talking about something that members will hear the Liberal Democrats mention a lot over the next five years in the chamber, which is mental health. People are asking for help but, far too often, they are being turned away or forced to wait for years. That is not because the people working in the system do not care—they care enormously—but because the system itself simply does not have the capacity to help everyone who needs help. Sometimes, we get only one chance to help someone: a brief window when someone finally feels able to ask for help. When that moment comes, we need a system that is there for them and that does not exclude people. We believe that that help needs to be close to home and embedded in GP practices.
I welcome some of what is in the programme for government in relation to the locality of mental health care. I am very willing to work with the Government where we can find solutions. I am a wee bit offended that I represent the only party that has not had a sit-down with Angela Constance, so I look forward to that—
I think that you have. [Laughter.]
Do you know what? You are right—I have had a sit-down with you. How could I forget? It made my day. [Laughter.]
What I meant was a sit-down on the issues that the cabinet secretary mentioned at the beginning of her speech. As she mentioned, she has met every party apart from the Liberal Democrats, so I am looking forward to sitting down with her. We will always work together constructively, as Willie Rennie has mentioned many times in the chamber.
It is crucial that we get all of this right for the benefit of our constituents when it comes to social care, corridor care and mental health. We want the Government to succeed on this and we are willing to work constructively with it. However, we will also hold it to account, as I told Angela Constance when we had that sit-down. [Laughter.]
I move amendment S7M-01003.3, to insert at end:
“; believes that there is no way to fix the NHS without fixing care, and that removing the care bottleneck would tackle the number of patients remaining in hospital due to delayed discharge, reduce waits in departments such as A&E, and reduce instances of corridor care; agrees that where public service reform seeks to improve lives and end practices that may cause harm, there should be mechanisms in place to evaluate proposals and properly measure outcomes, and calls, therefore, on the Scottish Government to set out how it will measure, monitor and report on the volume and frequency of corridor care as part of the work required to eradicate it.”
We move to the open debate.
16:24
Scotland has changed enormously since this Parliament reconvened in the last months of the 20th century. Medicine has advanced, industries have changed, and technology has transformed how we live and work. The expectations placed on Government have changed, too. However, too much of the way in which our public services are organised has not kept pace with those changes. That is why the renewal and reform of our public services must be one of the central focuses of this Parliament in the next five years.
The first generation of devolution was about building institutions, and this generation has to be about making them work better. The scale of that ambition in the programme for government matters: 14 health boards will be brought down to two, public bodies will be brought together where functions overlap, and resources will be shifted away from duplication and bureaucracy and towards the services that people actually use. We cannot enter the 2030s with public services that were designed for a different age.
Ultimately, I agree with much of what has been said. People will judge those changes by whether they make their lives better. In Angus, that means whether people can get an appointment, get treatment sooner and get care closer to home. That is why I particularly welcome the confirmation that Arbroath will be home to one of Scotland’s new general practitioner walk-in services. For people in my constituency, that will mean another route to care that will be open seven days a week as part of a national network that will expand in the next three years. Alongside that, the programme commits more than £530 million to a new deal with GPs that is focused on recruiting more family doctors.
The ambition behind our wider NHS changes is clear: it is to simplify the system, cut duplication and improve care. That ambition is matched by a clear commitment on what patients should experience. By the end of this parliamentary session, nobody should wait more than 26 weeks for treatment. That is an outcome that people can measure, and it is one that will improve lives.
Renewal is not only about how services are organised; it is also about acting earlier. Too often, Government intervenes when the problem is harder, the choices are narrower and the cost is greater. We spend more because we act later and achieve less because we wait longer, and the person at the centre pays the highest price of all. Prevention cannot simply be the paragraph that we all agree with but the budget line that nobody owns. That is why the new prevention unit and the Scottish prevention investment framework matter: they mean that more healthcare will be delivered in communities, that earlier action will be taken to prevent homelessness, that support will be in place to overcome barriers to work before those barriers become permanent, and that we will have a public sector that is looking ahead rather than catching up.
The programme protects free university tuition, builds on the Scottish child payment and expands support with everyday costs. An action by the Government is expected to keep 100,000 children out of relative poverty this year. That is what a focused Government can achieve when it decides what matters, puts its weight behind it and delivers. Over this parliamentary session, that same determination will deliver the national roll-out of £2 bus fares and legislation that will improve our bus network. Those are political choices—choices about whose side the Government is on. When some tell us that the years ahead can only be about difficult choices, I see something else as well: an opportunity to focus, deliver, protect what works and change what does not.
There is a wider point here about Scotland’s future. The case for self-government has never been simply about where power sits; it is about what we can do with it. Our responsibility is to use every power that we have now to improve lives and to prepare Scotland to use the full powers of independence. The more we take decisions in Scotland, the more we can shape our economy, our public services and our future around the needs of the people who live here. The work of building the Scotland that we want does not begin on independence day—it begins right now. Independence will give us the full powers to take that work further. The challenge now is to bring that ambition to how our public services work. We should not be attached to structures; we should be focused on outcomes. Scotland has moved forward and it is time that our public services moved forward with it.
16:28
I am genuinely excited to see and have prevention at the heart of Government policy; thanks to the Scottish Government’s ambitious and bold programme for government, we are doing just that. Public sector reform should never be just about cutting funding, slashing the workforce or reducing services. That would not be reform—it would simply be callous and destructive demolition. It is important to note that, should that approach ever be taken, the hope of improving the outcomes for our nation would be lost for generations. Today, I whole-heartedly welcome the commitment to renew our public services through prevention, integration and reform.
I welcome that the First Minister and his Government are leading with hope and optimism. Yesterday, I listened carefully to the choice of words that he used as he set out his bold programme. Phrases used, echoed today by the cabinet secretary, included,
“putting the individual at the heart of the changes”;
“what the needs of our citizens are, rather than the needs of the existing structures”;
and
“citizen-centred delivery”.—[Official Report, 1 September 2026; c 29, 32, 34.]
On Monday, I met the director of the South Ayrshire health and social care partnership. I heard at first hand about the positive preventative work that is already happening. Its ageing well strategy is in place, and I heard how wellbeing pledges are changing lives. This is about putting people at the heart of decisions.
I would like to think that, across the chamber, we are all individuals who care deeply about our communities and the people we serve. Of course, we have different opinions and views on what that looks like, but fundamentally I would hope that we can all agree that care and keeping people at the heart of our decision making are the right things to do.
Change is never easy, but we must face the task ahead and we must confront the impact of decades of damage that has been caused by successive UK Governments, driving austerity, and the continuing pursuit of a damaging Brexit. We can see that damage in our communities, as well as, in reaction, some of the wonderful work that is already starting to be delivered in those communities to address the fall-out.
I recently met Cumnock Juniors Community Enterprise, when I heard about the vast array of projects that are being delivered, including its new youth ambassador project, which focuses on the prevention of drug misuse.
In the summer, I spent time at the River Garden at Auchincruive, which is an incredible place that describes itself as a “recovery community” that helps people to rebuild their lives after drug and alcohol addiction and, importantly, has the wider community as part of those journeys.
Getting from where we are today to where we need to get to will not be easy. People might get uncomfortable, and structures that have been built up over the years might need to come down, but radically changing our approaches and being creative in finding solutions is not a choice—it is a necessity.
Tackling health inequalities is a must. According to Public Health Scotland, women who live in the 10 per cent most deprived areas have a healthy life expectancy of 44.2 years, while women who live in the 10 per cent least deprived areas have a healthy life expectancy of 70.9 years. That is a healthy life difference of more than 26 years between the most and the least deprived areas. The inequality in health is completely unacceptable, and that is exactly why we must move into the health prevention space. Hopeful and optimistic—that is what I see in the programme for government, and our communities are ready to work with us.
I will share a final example from my constituency. At the start of the summer, I attended my very first New Cumnock Development Trust fitfest, which is an interactive day to inspire the local community to live healthier lives. It was a great day out and, thankfully, I got the all-clear and my blood pressure was all good.
I thank the Scottish Government for being bold, for being brave and for ensuring that people and communities continue to remain at the heart of all that we do.
16:33
I refer members to my entry in the register of members’ interests, which shows that I worked as director of a social care organisation until May.
I am delighted that the motion recognises the need for investment in preventative community-based support. I believe that we reached a cross-party consensus on that in the early weeks of the session, as we did on the need for proper support and multiyear funding for the third sector, which often provides those community-based services. We are 15 years on from the Christie commission and the shift to prevention that was envisaged then cannot be delayed any longer.
I noted the First Minister’s comments about social care governance yesterday. It is true that integration joint boards are not functioning well. I hope that, whatever structure we end up with, we can have that culture shift to the ethical, collaborative commissioning that was envisaged by the Feeley review of social care in 2021.
For social care to thrive, it needs to be recognised as a sector in its own right, not a poor relation to health on integration joint boards and not some kind of subsidiary of the NHS, as seemed to be hinted at yesterday in the chamber.
The NHS will not perform better without improving social care, and care services will not be improved by treating that as their only role. Social care must be about providing a good life that is well lived in the community, including for people who have lifelong support needs and not just for those who are experiencing delayed discharge from hospital.
For a sustainable social care sector, we need a properly recognised, trained and rewarded workforce. The real living wage for social care workers does not address the considerable disparities that now exist in the pay and conditions of those in commissioned services, those employed directly in local authority services and workers of equivalent skill and responsibility in the NHS. That is not to mention the fact that social care employers have to compete with those in retail and hospitality. Commitment to the £15 an hour that is advocated by trade unions and promised in Labour’s manifesto warrants consideration if we are to see professionalised, high-quality services that will reduce the need for acute health or mental health admissions.
I look forward to the mental health and wellbeing delivery plan and the much needed focus on the issue. I welcome the investment in both triage cars and the community mental health hubs that were also included in the Labour manifesto. However, although initiatives such as those are truly welcome, a joined-up approach should not neglect our acute clinical services. Currently, in many places, quite acute crisis is required for someone to be referred from primary care to clinical mental health support, and, last year, a quarter of consultant psychiatrist posts were either vacant or covered by locums. These clinical services require proper workforce planning, which is currently lacking across much of our NHS.
In 2021, the Scottish Government promised a learning disabilities, autism and neurodivergence bill to address the unmet needs, rights and poorer life outcomes of highly marginalised communities. Stakeholder groups, professionals and people with lived experience spent several years contributing to its development. In 2024, 877 responses were received for the official consultation. Those people who have given their time, told their stories and, in many cases, relived their trauma will be feeling deeply let down by the Scottish Government’s decision to abandon the bill, as communicated to stakeholders by letter yesterday, just a couple of hours after the First Minister failed to answer my question directly on it during First Minister’s question time. They are feeling that they have been marched up a hill and left stranded. Yesterday’s programme for government did not mention the accountability mechanisms, mandatory training or statutory strategies that were sought by the bill.
If the Government is serious about delivering for all of Scotland, it will need to rebuild trust with those marginalised and excluded communities, and it will need to meet their needs in a way that it has hitherto failed to do. We cannot wait another 15 years for meaningful change.
16:37
I am glad to offer my support for the Government’s legislative agenda and programme for government. Last night, I had the enormous privilege and pleasure of spending the evening debating with Daniel Johnson and Comrade Offord on the television, and I was quite struck by the fact that, in the course of that entire debate, Mr Johnson and Mr Offord were falling over themselves to say how much they largely agree with this, although they do not think that it will go ahead. At certain times, in many respects, it felt that the Labour and Reform foxes had been shot—that is “shot”, not “hunted”.
There will be politics in the chamber—people will say that this is about claiming credit for what was in their manifestos. However, members should go and have a look at the manifestos. For example, in Mr Offord’s party’s manifesto, there are no named bodies; there is just a general commitment to abolish quangos. However, when you look at yesterday’s programme for government, you will see that the Scottish Government has put its money where its mouth is. It talks about merging the Scottish Environment Protection Agency, NatureScot, Zero Waste Scotland and, potentially, Scottish Forestry. It makes a very clear commitment to bring Transport Scotland back in-house, and I have already beaten a path to the cabinet secretary’s door this morning to tell him that I think that there are plenty of opportunities to bring other things in-house, too. Looking at the manifestos, you find that there is not a lot of detail in the Reform manifesto, whereas what we saw yesterday was detail down on paper about how we want to move forward. The same is true of the Scottish Labour Party’s manifesto, which says that we should reduce quangos and external public bodies by at least a third, but, again, it does not name any of them. Whereas, yesterday—I see that Ms Baillie is getting to her feet. Come on in.
I am conscious that Mr Linden is one of the new MSPs. Had he been here over the past 10 or 15 years, he would know that we have been naming those bodies and making suggestions to the Government that it has so far rejected. However, I welcome anybody who changes their mind.
My mind is very much set in place; it is just a shame that Lord Sarwar changed his and joined the House of Lords.
I say to Ms Baillie that it is important. I will come on to a couple of things. The Labour Party in Glasgow set up a lot of external bodies, and there is an opportunity for us there when it comes to public service reform.
The Labour manifesto talks about annual reviews of Government working groups, the scrapping of inactive and ineffective taskforces, and
“a team for government efficiency”
inside a
“new Scottish Treasury”.
That sounds an awful lot like setting up more organisations—which is the last thing that we need, because the issue is about decluttering the public sector landscape.
Yesterday, the focus was on health boards. We spend roughly £15 billion on the 14 territorial health boards, so I welcome a commitment to move that number to two.
I will give two practical examples of why it is important that we reform health boards. First, during the campaign, I met Community Pharmacy Scotland, which spoke about a number of issues of bureaucracy in the invoicing, charging and processing of prescriptions across health boards. That puts it in a nutshell.
Secondly, I visited HMP Low Moss only a couple of weeks ago, and heard the harrowing story of a woman who was moved from one part of the female prison estate to another but, because she was moving between health boards, her cancer scare was not picked up and, therefore, when she transitioned to the second health board, she went down the list. That is a practical example of how that massive bureaucracy is causing problems.
My last point relates to Jackie Baillie’s attempt to lay much of the blame for the cluttered public sector landscape at the door of the SNP. Unfortunately for her, I am a Glasgow politician and have a very long memory of the mess that the Labour Party in Glasgow created when it set up white elephants such as City Property (Glasgow), City Parking (Glasgow) and Glasgow Life, which has absolutely covered the city with lots of problems. When it comes to local government reform, there is an opportunity to look at the role of such arm’s-length external organisations.
Will the member take an intervention?
Go on, why not?
It is a matter of fact that the SNP created the 31 health and social care partnerships and the 31 integrated joint boards to which the cabinet secretary referred. Does David Linden deny that?
The facts are on the record when it comes to IJBs, and the same is true of alcohol and drug partnerships. However, Ms Baillie will be aware that I was talking about ALEOs, which have cluttered the local government landscape and need to be looked at. I very much support a move to reduce from 32 local authorities in Scotland and I think that that gives us an opportunity to deal with a lot of the ALEOs that caused so much trouble in Glasgow.
There are a number of other things that we can do. In this debate, my parting message to the Government is to be bold and stick to its guns, because I suspect that, for all the hot air last night on the television, most parties in the Parliament agree with the need for public service reform; after all, they said it in their manifestos.
Push will come to shove when the year 1 bill for public sector reform is in front of us. Parties will need to vote for it, because the election is over, folks, and we have been sent here by our constituents to deliver public service reform, with a message that they want fewer chief executives, fewer communications departments and more teachers, nurses and social workers. That is what we should deliver.
16:43
The programme for government demonstrates the SNP’s commitment to placing prevention at the heart of public services and ensuring that Government acts proactively to improve outcomes for people across Scotland, as was eloquently voiced by Kayleigh Kinross-O’Neill.
I welcome the proposal to reduce the number of NHS boards because, in a constituency such as mine, which falls between two health board areas, I regularly see the consequences of a fragmented system. It causes confusion and frustration to constituents and can lead to inequitable outcomes.
Welcome progress has been made in reducing waiting times but, despite the Government’s best intentions, when it comes to delivery from our partners, patients in some areas—such as those awaiting cancer treatment in NHS Grampian or orthopaedic surgery in NHS Tayside—continue to wait far too long for care. By strengthening integration, the reforms offer an opportunity to deliver more consistent, efficient and patient-centred services, and—hopefully—less of a postcode lottery. The Government’s commitment to ensuring that, by 2031, no one waits longer than 26 weeks for treatment demonstrates the ambition that underpins the reforms.
Since NHS boards were directed last year to strengthen regional collaboration through the NHS Scotland east and west structures, we have already begun to see the benefits of greater partnership working and more strategic, population-based planning. However, as those reforms progress, it is essential that place-based planning remains at the heart of decision making, and I am looking forward to discovering the detail of the new structures.
The healthcare needs of someone living in the Angus glens, for example, can differ significantly from the needs of those who live in towns or cities. Any new strategic health structures must therefore retain the flexibility to respond to those local needs as, unfortunately, that flexibility has not always been evident in the current territorial board model. That is demonstrated by the fact that hospital at home services in NHS Grampian have not been expanded to my constituency because of the distances involved from Aberdeen. That is a clear example of how a one-size-fits-all approach can fail rural communities and why future reforms must reduce, rather than reinforce, inequalities in access to care. I hope that the new model will do that.
The commitment to invest £200 million annually to expand elective capacity is very welcome. As ministers take forward that work, I urge them to recognise the important role that Stracathro hospital can play in reducing waiting times and supporting the delivery of planned care in Angus and the Mearns and across the north-east, and to ensure that the resource for the maintenance of the infrastructure is also committed in order to keep that facility open.
Furthermore, I recognise the Scottish Government’s recognition of the need to shift further towards community-based healthcare. Commitments to expand diagnostic capacity and improve access to hearing, vision, dental and mobile healthcare services will be particularly important for rural communities, where access to care can often be much more challenging. The popularity of the pharmacy first service among my constituents highlights the importance of that approach. By enabling people to access advice and treatment quickly through their local pharmacy, it allows them the help that they need without always having to try to get a GP or even travel to the GP surgery. We need to make it as easy as possible for patients to access the support that they need across the board.
As reforms continue, it is vital that the new NHS structures address the persistent ambulance handover delays, such as at Aberdeen royal infirmary. Too often, ambulance crews are left waiting outside emergency departments rather than being able to respond to more patients in the community. In June alone, the Scottish Ambulance Service lost 768 hours as a result of handover delays at ARI.
As the cabinet secretary acknowledged in her statement, at the heart of that issue is not simply the pressure in hospitals, but the wider challenge of delayed discharge. Too many patients who are medically fit to leave hospital remain in acute settings because the necessary social care packages, community support or suitable accommodation supplied by health and social care partnerships are not in place. That reduces bed capacity, delays admissions from emergency departments and contributes to the bottlenecks that are placing increased strain on the NHS and the Scottish Ambulance Service.
I hope that the reform process will strengthen collaboration between the NHS and the HSCPs so that delayed discharges become much less commonplace. I therefore welcome the cabinet secretary’s intention to continue the reform of social care services.
I also echo Jackie Baillie’s comment on women’s health. Too many women are dismissed and disrespected when attending doctors’ surgeries, and that culture needs to change from the top down, so I hope that that will also be taken forward.
That said, overall, the programme for government is a positive and ambitious vision for our country. While I believe that Scotland will ultimately fulfil its potential as an independent nation, this programme demonstrates how we can use the powers of devolution that we have today—as outlined by my colleague, Lloyd Melville—to strengthen our NHS for the future—
Can you wind up, please?
Yes—I am just finishing, Presiding Officer.
I am pleased to support the programme for government and I look forward to working with ministers to ensure that its ambitions are translated into real and lasting benefits for the people of Angus North and Mearns and for Scotland.
16:49
I welcome the programme for government and its commitment to renewing Scotland’s public services through prevention, integration and reform. It is a wide-ranging programme, but I want to focus my speech—and, hopefully, some minds—on one particular issue. If we are serious about improving lives while delivering for Scotland, the test must surely be a simple one: what difference will we make to people’s everyday lives? I want to focus on those who live with a disability and on something that perhaps does not always get the attention that it deserves: the provision of equipment that allows disabled people to live independently. We are talking about not luxuries but essentials: wheelchairs, communication aids, specialist equipment, adaptations and technology—equipment that can determine whether somebody can leave their home, go to work or college, participate in their community or simply live an independent life.
The Scottish Government already recognises the importance of prevention and early intervention through the provision of equipment and adaptations, acknowledging the role that they can play in avoiding hospital admissions and reducing the need for more intensive care at a later stage. I think that, during this session of Parliament, there is an opportunity to perhaps go even further.
I recently asked the Scottish Parliament information centre to look at wheelchair provision in Scotland. I was prompted by significant changes that have been introduced in France. Since last December, the French Government has moved to fully fund wheelchairs through its national health system, whether purchased or rented over a long term. The principle behind that reform is powerful. Mobility and the ability to live independently should be a right, not something that is determined by an ability to pay.
I am not suggesting that Scotland should simply copy the French system. Our circumstances are very different. We are a much smaller nation and, as SPICe has highlighted to me, we lack some of the Scottish data that we would need to properly understand what such an approach would cost and the level of unmet need that it could address.
SPICe estimates that a comparable approach could cost between £11 million and £34 million a year, but its research also identifies something that should concern all of us. We do not have a centralised, up-to-date picture of wheelchair provision, usage or expenditure across our nation. Asking questions that enable us to address that issue would be a good place to start. Are people getting the equipment that they need? Are they getting it quickly enough? Does the support available depend on where in Scotland they happen to live? Are we recognising the long-term savings that can come from providing the right equipment early, rather than waiting until somebody reaches a crisis point? The issue is not simply about spending more money or saving it—it is about using our money better.
That brings me to integration. For someone who needs specialist equipment, health, social care, housing, education and employment can all be relevant, but the person does not experience their life as a collection of separate public services. They experience it as one life. That is why joined-up assessments, decision making and delivery matter. There should be consistency, so that where somebody happens to live does not determine whether they can access the equipment that they need. There is also a need to be flexible and to recognise individual circumstances and needs. Reform should not simply make the system easier for us to administer; it should make the system work better for the person who needs it.
If prevention is to be at the heart of public service reform, we should recognise that providing the right equipment at the right time is a practical example of prevention. A wheelchair power-assist device can allow somebody to remain active and independent. An adaptation can allow somebody to remain in their own home. A communication aid can allow somebody to participate in their education, employment and society as a whole. The right technology can prevent somebody from needing much more intensive and potentially much more expensive support later on. We should think about disability equipment not simply as an expenditure. It is an investment in people’s independence, dignity and ability to live their own lives. Any reform that is undertaken through the programme must be shaped by that principle and by the people who use the services. Disabled people’s organisations in the third sector have enormous expertise, and they should be at the heart of that conversation.
I believe that we have an opportunity in this parliamentary session to build a clearer national picture of provision, waiting times, unmet need and geographical differences, and then, with disabled people themselves, to consider whether we can find better ways of funding and delivering that support.
Access to the right equipment is a practical test of the ambitions that are contained in the programme for government relating to prevention, integration, inclusion, compassion and equality. Independent living is not an abstract policy objective. It means that someone is able to leave their home, communicate, work, study, see their family and participate in their local area. Sometimes, the difference between being able to do those things and not is simply having access to the right piece of equipment. For some, that equipment is the difference between isolation and participation, between dependence and independence.
If we can make that system work better, use public money more efficiently and give disabled people greater choice, dignity and control over their own lives, that is exactly the kind of practical difference that this programme for government should seek to deliver.
We move to closing speeches.
16:54
I think that most of us, if not all of us, hear daily from our constituents that they struggle to get the care that they need for their health. We all probably agree that changes are needed to how the NHS and social care operate in order to improve people’s lives. As my colleagues Miles Briggs, Adam Harley and Dawn Black said, from different sides of the chamber, we should not have a postcode lottery in Scotland, with people not getting the right urgent care that they need depending on what day of the week it is or where they live.
However, I am mostly frustrated to see grand plans about health boards announced with little or no feedback from us, those who represent the people. The Liberal Democrats are all about local decision making, but communities cannot be empowered if they are not given the resources to deliver and if decisions are made further away from them. As my colleague Kayleigh Kinross-O’Neill said, we cannot just restructure to get out of a crisis. We need creative alternatives.
We need to look at and be inspired by other successful healthcare systems. The cabinet secretary spoke about prevention, but what does that involve? One of the skills that I try to use to solve people’s problems is to benchmark across the world’s best systems in helping residents. I am sorry but, compared with those systems, we are decades behind in prevention and restorative healthcare.
A leaflet of exercises does not replace planned antenatal and postnatal physio classes, which avoid troubles later in life and invasive and expensive surgery. More physio and ergotherapy to help our elderly get back to themselves after surgery or injuries will alleviate the need for and the length of home care and lead to better health. Fixing our kids’ teeth, instead of pulling them out when they are unfortunately damaged, will help with speech, jaw growth and healthy food habits.
I welcome the commitment to strengthen primary care, but I hope that the cabinet secretary will confirm that, in addition to extensive work with our GPs, the Government will finally catch up with other European countries by working with the 14 allied health professions, which are critical to prevention, supporting healthier communities and keeping people out of hospital.
Treating more patients in community settings will require fixing social care. As my colleague Adam Harley made clear, ending corridor treatment is a huge challenge, but the Lib Dems always fight for positive changes in healthcare, so we are ready for it. I look forward to working with members on that.
16:57
As my colleague Craig Hoy pointed out yesterday, there is a large gap at the centre of the programme for government: how is the Scottish Government going to deal with the looming £5 billion black hole in the public finances? We might reasonably have expected the First Minister to tell us yesterday how the Scottish Government is planning to address that issue, because it could have a huge impact on the delivery of public services, but we heard next to nothing about it.
What we did hear were announcements about public service reform, which, at the margins, might start to make a difference. The proposal to reduce the number of territorial health boards to just two was at the centre of the announcements that were made yesterday. In the area that I represent, I doubt that many tears will be shed for the end of NHS Tayside after the Eljamel scandal or for the end of NHS Fife after its disastrous handling of the Sandie Peggie case, but there are a number of unanswered questions about how the health boards will operate. I tried to tease out some of the answers from the cabinet secretary earlier. What will be the lines of accountability? What say will there be, if any, for local communities?
I will give an illustration of why that matters. Two weeks ago, a report in The Courier disclosed that there had been private discussions in NHS Tayside about the closure of the emergency department at Perth royal infirmary. That provoked serious concerns being raised with me by local residents. If we are to have a health board with even less connection to local people, it is understandable why such issues might be raised and might cause concern. It is therefore essential that there is local accountability under whatever new structure we have and that local services are protected so that they stay close to the people they serve.
I do not think that we can expect significant cost savings from reorganisation. We await the details, but it is not going to deliver much in the way of savings if all we do is lose a few very well-paid senior executives, who will then have to be redeployed elsewhere because they cannot be made compulsorily redundant. I therefore do not think that scrapping health boards will make significant savings in a £20 billion NHS budget.
Public service reform is vital if we are to address the financial challenges that the Government faces and improve the quality of services for people. In that respect, I will make three constructive suggestions to the cabinet secretary. I hope that she will take them in the spirit in which they are intended.
First, it is time that we changed the antiquated NHS appointments system. If I make an appointment with my dentist, I can choose a time and date that suit me. I get an email confirmation, I get an email reminder the week before, I get a text message the day before, reminding me of the appointment, and I then have to reply to say whether I am actually going to turn up. As a result, the number of no-shows at my dentist is absolutely minimal. In contrast, if I go to see my GP and I am referred elsewhere, I have to wait weeks before a letter that somebody has printed and put in an envelope arrives through the post with a date for the appointment, and there are no reminders. If that date is not suitable, I have to phone up and ask for another appointment and wait until another letter arrives that somebody else has put in an envelope and posted, offering me another date sometime in the future. It is no surprise that that very inefficient system sees so many no-shows at NHS appointments. That could easily be fixed, because the technology already exists, and surely it could be done at lower cost than that of somebody physically printing letters and using the postal service to send them out to individuals.
My second example is the NHS app that has existed in England since 2019. Only now has the MyCare.scot app appeared, and it has less functionality than the app that is used south of the border. The technology exists, but, based on Scottish Government documents that were released following freedom of information requests, we know that concern was expressed about the political optics of adopting an English solution. I do not think that people care about political optics; they only want an app that works and one that comes timeously.
Thirdly, it has gone beyond the point where we should be considering annual health checks only for the over 50s. Recently, high-profile individuals such as Sir Chris Hoy and Jeremy Clarkson have highlighted the risks of prostate cancer for men of a certain age—and I declare an interest, Presiding Officer. However, we know that many men are reluctant to make appointments with their GP. If annual health checks were offered routinely for men and women, we would identify cancers, heart disease and the risk of stroke and other serious conditions at very early stages.
Wind up, please.
Not only would the implementation of those annual checks save the NHS considerable sums of money; more important, it would deliver much better patient outcomes. It is a win-win situation.
I hope that the cabinet secretary is listening, and I hope that, if we do see public service reform, we can actually get some of that done and make Scotland a better country for us all.
17:03
The Scottish Government has put public sector reform front and centre of its programme for government. Based on my reading of the document, it will be done in three main strands: the NHS, local government, and everything else.
Reform of the NHS is going to affect every single one of us, as parliamentarians, representing our constituents, and personally, as we are all users of the NHS. As Murdo Fraser pointed out, we can all think of ways in which the NHS could be more efficient when, for example, we get a letter in the post about a procedure that will take place in 14 months’ time and we stick it in the bottom of a drawer, then get no reminders and have no digital appointment interface available. As Murdo Fraser pointed out, dentists—and even local restaurants—are able to remind us of appointments by text or email. It is way overdue that the NHS has the power to do something similar.
My colleague Kayleigh Kinross-O'Neill will be leading for the Scottish Greens on NHS reform.
I am very pleased to see that the Scottish Government is open to significant reform of local government. Getting that right is important. Local government is where people experience politics. It covers bins, social care and high streets. How people experience those aspects makes the difference between their seeing politics as something in which they have a say and their seeing it as something that is done to them. All of that happens at the sharp end of local government. We hope that the Scottish Government will hold its nerve, stick to its intentions and make significant changes even in the face of what I anticipate will be howls from Opposition parties, which continually call for change but have a tendency to block it when it actually comes down to it. I hope that the Scottish Government will go further and reform council taxes and non-domestic rates as part of that overhaul. Putting councils on a fair and sustainable financial footing needs to be a part of the process.
My colleague Kristopher Leask, who is also a councillor in Orkney, will be leading for the Greens and working with the Scottish Government on local government reform, which leaves me, as the portfolio lead for public sector reform, to look at all the rest of it.
I was pleasantly surprised by the level of detail in some of the programme for government. I am talking specifically about the section on “Simplifying and decluttering delivery”. Dismantling Transport Scotland is a project that I can get behind. That is a good start.
I have some other suggestions. I hope that assessing the potential to simplify the management of our national cultural assets will be a precursor to dismantling Historic Environment Scotland. As we watched Holyrood park burn for the second time this summer, and as my former constituents in Linlithgow head into another decade of their lovely loch being too polluted for children and dogs to swim in, it is clear that HES is simply not coping. A different set of expertise, a different allocation of resources and a different structure are needed. Naturally, however, I am somewhat wary of the idea of joining together all the environment and nature agencies. That could go well or it could go very, very wrong.
Scotland is one of the most nature-depleted countries on planet earth, and we are not on track to meet our climate goals. A new mega-environment body must have the powers to implement the Scottish Government’s biodiversity strategy, the circular economy road map and a climate change plan that actually gets us to our targets.
I can see the potential advantages of having a single point of contact on the environment and nature. Among the challenges that I faced as a regional MSP in the previous session of Parliament was helping constituents to understand the limits of what the Scottish Environment Protection Agency could do with, for example, the pollution of Linlithgow loch and the oil spill in the River Esk. A single agency that could undertake investigations, enforcement and clean-up and that could provide guidance and community engagement might get us away from the impression that the Scottish Government does not care about pollution incidents and that it is powerless to do anything about them.
If we are going down that route, though, I would like to see the Scottish Government remove the licensing and biodiversity responsibilities from the marine directorate and incorporate them into the new mega-body. It just does not make sense for licensing and biodiversity to be split by things that are dry and by things that are wet: they should all be part of the same licensing and biodiversity strategy.
The programme for government mentions the work of the SPCB Supported Bodies Landscape Review Committee, which I hope means that the cabinet secretary is taking seriously the committee’s proposal to give the Scottish Public Services Ombudsman own-initiative powers. That would be a substantial step towards improving public services and preventing failures by making the ombudsman’s role proactive rather than reactive. It would also be in line with the cabinet secretary’s prevention agenda.
I am a bit sceptical about the idea that undertaking reform activity with National Records of Scotland and Registers of Scotland will do anything to complete Scotland’s land register. Until we know who owns what, we will continue to waste thousands of pounds in trying to establish the situation every time that we want to build major infrastructure or, indeed, even minor infrastructure. I know of charities, for example, that struggle to set up premises because they cannot find out who owns the ransom strip next to their property. We need to know who owns Scotland. Until we know who owns what, we cannot design efficient public services or effectively undertake things such as landscape-scale flood management. Until we know who owns what, we will struggle to reform grant funding and land-based taxes in a way that is fair and transparent for everyone.
There seems to be consensus in the chamber that substantial public service reform is needed. We cannot allow the changes to be driven by the wealthy and powerful, by those who deny climate change and by those who believe that profit is more important than people or planet. We have this chance to get it right, and it is up to all of us to see that we do.
17:09
I refer to my entry in the register of members’ interests: I am a councillor in South Lanarkshire.
This Parliament was shaped with the promise of new politics. It was to extend democracy, improve accountability and be more representative of the nation. Power was to be shared, not hoarded at the centre, and consensus was to be valued over confrontation. It began with high expectations, noble ambitions and a progressive character, but that spirit was lost long ago, and we have to bring it back. As the scale of the challenges facing the Parliament has grown, our politics has become smaller.
Central to the programme for government and the wider public service reform agenda is the principle that prevention comes first, that social determinants of health and inequalities are driving demand for public services and that public spending is too reactive and less focused on the early interventions that can change lives. I agree, but that is not new. That principle was well established 15 years ago by the Christie commission, which delivered a powerful, comprehensive report that was backed by evidence and consensus. However, our small politics failed to deliver the system-wide shifts towards prevention that Christie demanded.
That is not the only example. The Parliament debated how to address the size of Scotland’s prison population just before the summer recess. However, very little was debated that had not been debated 18 years ago, following the Scottish Prisons Commission report. Our prison population numbers have surged to a record high. The programme for government promises action on delayed discharge more than a decade after a previous First Minister promised to eradicate it. A housing emergency was declared, yet 10,000 children will go to bed in temporary accommodation tonight.
The rewiring of the state is about so much more than restructuring its architecture, which has been a recurring theme today. As important as that restructuring is, it is about the reform that produces better, transformative and more equal outcomes. If the approach is to be different this time, we have to rediscover the spirit of new politics that gave the Parliament life. It must be a collaborative politics, an accountable politics, a self-aware politics and a progressive politics that is serious about change.
In that spirit, I echo what Jackie Baillie said yesterday—we will work with the Government where we can, challenge them to go further where we believe that they must, and hold them to account.
To turn to an example in the Labour amendment, we believe in the importance of a “properly funded” health and social care system with a fairly paid and valued workforce. In response to budget pressures in previous years, the Scottish Government removed a £38 million package to support better conditions for social care staff, and that set back fair work in the sector. Those missing millions should be reinstated, the promise of sectoral bargaining should be kept and the Government should work towards closing the gap between conditions in the commissioned sector and the public sector, in order to strengthen health and social care.
Before coming to the Parliament, I led South Lanarkshire Council, which was one of three Marmot places in Scotland. The council worked with Public Health Scotland and University College London to develop evidence-based policy in this field. Early intervention, family support, shifting the balance of care and building local power and wealth—that is how we liberate communities from inequality, and that is how we liberate public services from the costs of inequality. In a society in which, as the population health framework says, 80 per cent of what affects people’s health happens outside the NHS, better health means better social outcomes, and better social outcomes mean better health. However, that takes social investment and spending to save.
My warning to the Government is that it is in the area of spending that the programme falls down. Reform that is driven by job cuts or unachievable targets will cost us more in the long run, and that is where the Government must produce more information. Austerity is the very reason that some of the inequalities that we are grappling with are so profound.
With trade unions threatening strike action and the Institute for Public Policy Research saying that the Scottish Government’s workforce reduction target already risks Scotland slipping into austerity, the Scottish Government must confront an essential truth: reform that is driven by head-count reductions and spending restraint will fail. Only reform that is driven by evidence, investment and social change can succeed. It must be a programme that is developed with the workforce and one that rises to the challenges that our small politics has neglected.
That is the fork in the road for Scotland. Neither path is easy, but only one is right. Our responsibility is to build a progressive consensus and turn it into progressive action.
17:15
I rise to support the amendment in the name of my colleague Helen McDade.
Every MSP who represents the Highlands, Moray or the islands will have healthcare at the top of their inbox and postbag. Failures in the delivery of healthcare services have been a recurring issue for so long, and many of my predecessors from all parties have attempted to tackle the Government on the issue. We are still here, trapped in a toxic cycle of downgrading services and restarting them, but still with that lingering threat of a downgrade yet again or, in the case of the far north, its falling on deaf ministerial years that local services should be restored so that Caithness mums can give birth at home rather than in Inverness.
Yesterday in the chamber, the First Minister answered my question—about the pausing of paediatric services at Dr Gray’s hospital in Elgin—by addressing the structural arrangements of health boards and referring to the 14 territorial health boards being a constraint on the delivery of care. In his words, the proposals in the programme for government would help deliver care for Moray residents
“as close to home as possible”—[Official Report, 1 September 2026; c 22.]
I want to quote back to the Government one of my constituents whose newborn baby was affected by that abrupt halt in paediatric services at Dr Gray’s. They wrote to me:
“I fully appreciate that not every specialist service can be delivered in every hospital, and patient safety must always come first. However, the continuing centralisation of services away from Moray appears to place an enormous burden on families while potentially creating substantial transfer costs for the NHS.”
For two reasons, that speaks to the motion that we are debating today. First, we need to understand that, behind the bureaucracy, the only focus should be on the outcomes for patients and their families. Secondly, I genuinely fear that the Government is confusing genuine reform, which would have our support, with the sticking plaster of reorganisation. By centralising its way towards fiscal rationalisation, the Government is simply replacing 14 silos with what seem to be two super-silos. How will that deliver better outcomes for people who rely on Caithness general hospital, Dr Gray’s or the Belford hospital?
The recess that has just come and gone was a good opportunity to go home and take the pulse of the local mood. A regular feature of my surgery tour was speaking to people in Forres, Findhorn and Kinloss, who said to me that they cannot understand why they are forced into appointments in Aberdeen because the territorial extent of NHS Grampian extends west almost to Nairn, rather than have the option—I stress that it would be an option—of planned procedures at Raigmore hospital in Inverness.
When the First Minister talks about territorial constraint, I agree that that is a problem, but what will a new east-west axis of two health boards, which will probably be run from Edinburgh and Glasgow, do for people in the north? That is the challenge and the question that I pose to the cabinet secretary, and it needs an answer. Likewise, yesterday, the First Minister made a commitment on thrombectomy. I welcome that commitment, but I would like to see how far that geographic commitment extends and whether it will apply to the far north, too.
Looking to the broader national picture, I push the Government for an answer on duplication. It says that it wants to remove duplicate top-heavy management structures. The question that I would pose is whether we really need to have 14 directors of public health in 14 territorial health boards when that function is already fulfilled nationally by Public Health Scotland. Surely there is scope for a review to see whether those functions could be consolidated.
On workforce, the fiscal sustainability delivery plan promises a 0.5 per cent reduction each year. The assessment of the Institute for Fiscal Studies on that has been quite blunt: in aggregate, there has been no progress. Devolved public sector employment in the first quarter of this year was 0.6 per cent higher than in the year before. The entire net increase was in the NHS, where it was up by 1.6 per cent. I have a degree of sympathy for the Cabinet Secretary for Public Service Reform, because he has already been kneecapped by the First Minister, who says that there will be no compulsory redundancies. I look forward to hearing how he will square that circle. Perhaps a good place to start would be to ask Audit Scotland to review the Government’s homework and report back to the Parliament.
We were elected to be not just a party of opposition, but a responsible Opposition that turns up and engages seriously. In good faith, I reference what the First Minister said yesterday when he hoped that I would engage constructively with the debate. I had hoped that that was evidence that he has changed his mind away from attempting to create a quasi-iron or tartan curtain that would stop democratically elected MSPs in this Parliament from engaging with the Government. However, I am afraid to say that, earlier in her remarks, Ms Constance confirmed that that would not be the case, which is very disappointing indeed.
I say to the Government that my colleagues and I will continue to engage in good faith with the Government as it sets out its legislative agenda. However, as I said in my first speech to the Parliament, that will not be on the back of a centralising agenda that is to the detriment of our constituents.
17:20
This has been an interesting and reflective debate, so I will cover some of the speeches before I embark on the main substance of my remarks.
It is interesting to reflect back on the manifestos from Reform and the Conservatives. Reform’s manifesto stated that it would
“Shut down the Quangos and return their powers to democratically elected ministers”,
which is the complete opposite of what Helen McDade proposed today. Meanwhile, the Conservatives’ manifesto stated that they would
“reduce bureaucracy and improve productivity within our NHS”,
reduce
“the number of quangos by at least a quarter”,
and
“tackle Scotland’s cluttered quango landscape.”
We are taking forward those steps at pace and with substance. What we announced yesterday is not far away from taking that quarter of quangos out of the landscape, and there is still a long way to go with regard to consolidating public bodies.
Kayleigh Kinross-O’Neill and Adam Harley made important points about the impact on service delivery and how the changes that we are making will translate into supporting that. They are right that the purpose of the changes that we are implementing in health and more widely is to improve service delivery. It is about getting money to the front line, making best use of capacity across the whole system and removing silos that stop effective delivery. David Linden and Dawn Black highlighted examples of where that is currently the case—where individuals do not get the service that they should because of the bureaucratic hurdles that are in the way.
Murdo Fraser made a constructive contribution. He talked initially about how we will bridge the fiscal gap and he proceeded to give us a long list of areas that would help to do so. He is right that there are many places where we can save money and improve service delivery at the same time, which is exactly what the PSR programme is about—it is about closing the gap by improving services and making them more efficient, using many of the interventions that he talked about.
Lorna Slater’s speech was helpful and constructive. It highlighted the need for change in local government and the centrality of empowering local communities, which is core to the empowerment agenda that sits at the heart of our public service reform work. She also highlighted a range of opportunities across public bodies, which I do not have time to cover now, but I look forward to engaging with the Greens on that wider agenda in a constructive way. We will find many other opportunities to improve services and make them more efficient in order to get money to the front line.
Lloyd Melville made a hugely important point about public services being fit for the future and also laying the foundation for the independent state that we are working to deliver.
Joe Fagan’s speech was, in the most part, constructive. He made a point about rewiring the state and said that reform is not just about the structures, which I understand. The programme is also about rewiring how money flows through the system and how we do budgeting, particularly preventative budgeting. It is about rewiring how data flows through the system to ensure that it is joined up and used more effectively, and it is about rewiring culture, which relates to how people look at the programme and provide leadership across it.
In all those regards, it is important to recognise that rewiring the state is a broad issue. This Government is very much in the business of rewiring the state. Our public service reform programme underpins the Government’s priorities, which are driving economic growth, eradicating child poverty and tackling the climate crisis.
Most of us recognise how critical public services are to the type of Scotland that we want to be. We want to deliver a fairer future that gives everyone the opportunity to flourish, while recognising and dealing with the democratic and fiscal challenges that we face. Public services are an asset and an investment in that future, and we must invest wisely and take the bold choices that the Government has taken this week, and will continue to take, to protect service delivery in the here and now and ensure fiscal sustainability for the future.
This week, the Government has shown that it will make the bold choices that are necessary and will ensure that the services that people need are improved and made sustainable. The sustainability of those services is not the same as the sustainability of corporate structures. Public service reform is about changing how services operate to fit round the people who use them, rather than expecting people to fit round the boundaries of individual organisations.
The PSR strategy that we published last year is our blueprint and foundation for change. I have always been clear that empowerment is core to that agenda. That involves recognising the strengths of people and places across Scotland, empowering the front line to deliver for service users and empowering public service workers to come forward and offer suggestions about how things can be done better, as they have the best perspective and the best ideas in that regard. We need to design services with communities and ensure that they are focused on what is important to people. Outcomes improve when solutions are tailored to local needs and circumstances.
Building on our democracy matters work, we will deliver greater empowerment of communities so that people can better influence local decision making. In many cases, some decisions will best be taken by members of communities in the places that they live in and call home.
At the same time, we have a huge opportunity to empower regions by building on the existing work of regional economic partnerships to act at a more strategic level to drive growth across Scotland. I recognise the importance of ensuring that the approaches that we take are tailored to Scotland’s regional and community strengths and reflect our unique geographies. That will include working with our island communities and authorities to deliver single authority models that suit their needs.
Fundamentally, this process is about ensuring that the right decisions are made at the right level—whether national, regional or community—to deliver for people. We will change the governance of Scotland to get that right. The programme for government sets out our intention to engage over the coming months in intensive dialogue with local government, the Parliament, trade unions, public sector partners and third sector partners to agree a shared direction for reform of local governance in Scotland.
The Cabinet Secretary for Health and Care has already set out the opportunity that the reform of health boards offers and her focus on prevention. Considerable work is being done to support and enable prevention by driving preventative budgeting, to invest early, to address challenges earlier and with greater effectiveness, and to ensure that we realise the profound benefits of better lives, less pressure on services and enhanced fiscal sustainability.
Of course, as many members have said, health and social care are closely linked. The proposed change provides us with a new opportunity to reform social care so that it is consistent and high quality right across the country.
As I set out in the PSR strategy, partnership is key, but partnership is not code for slow. We need to move at pace, but we need to work with our partners across the landscape. We are proposing a clear and robust set of changes in public bodies, including in health, and we have set out a clear direction of travel for regions and communities. In the coming three months, we will engage with local authorities, trade unions and others to agree the future of local governance and of social care. The process of starting to implement changes to the public body landscape will be underpinned by our year 1 public service renewal bill.
In the public service reform strategy, I also set out our commitment to ensuring the right delivery landscape. The current landscape across public bodies and Government is cluttered and there are areas of overlap. We will not shy away from the fiscal challenges and the need to drive efficiency at every opportunity.
Change is necessary. To help us to meet the climate, nature and economic challenges that we will face over the next 20 years, we will establish a new integrated environment body that will take on the functions of SEPA, NatureScot, Zero Waste Scotland and, potentially, Scottish Forestry. It was very helpful to hear Lorna Slater’s perspective on that, and I look forward to engaging with her on the detail of it.
I do not see that as the only list. It is just the start. We will undertake the work that is required to make changes right across the public body landscape, and we will identify more opportunities as they arise and will bring in other relevant bodies as we develop the programme.
Has the minister looked at the example of the Inspectorate of Education, which was merged into Education Scotland and subsequently separated from it? Is there a danger that, in putting SEPA in with the same body that looks after the forestry arrangements, we might be repeating the mistakes of the past?
All the proposals need to be considered in that regard. That is why we will engage with partners to understand what the optimal solution is. It does not mean that we will not change, or that we do not recognise the need to do so at pace. However, we will consider all the issues that are raised by partners as we take forward what is a long list of potential improvements across the landscape. I think that everybody would agree that the landscape that we have at the moment is not optimal for delivering efficient, fiscally sustainable public services for our citizens.
I have set out the foundations that need to be in place to drive change through our strategy. First among those is leadership and culture change. I will publish a leadership statement shortly, developed in collaboration with colleagues across public services. To deliver our ambitions, we must work together to build a stronger and more coherent approach to leadership, to enable and support the collaborative leadership that drives prevention, strengthens place-based working and delivers reform across boundaries. I have been struck by the willingness of colleagues across the chamber, local government, the third sector, public bodies and beyond to engage with that approach.
We have a huge opportunity, and a responsibility, in this Parliament to make decisions now, to fundamentally change our system of public services to improve people’s lives. As we deliver those changes, people will see improvement in their public services and their lives. Services will be fit for today and for the future. We will deploy new technology, change our ways of working and make sure that those services are more accessible and more responsive.
That concludes the programme for government debate on improving lives through delivering for Scotland.