The final item of business today is a members’ business debate on motion S6M-20795, in the name of Jackie Baillie, on recognising the pressures facing accident and emergency departments.
Motion debated,
That the Parliament recognises the reported pressures facing A&E departments; is concerned that recorded waiting times are persistently high, with the number of people waiting more than 8 hours and 12 hours reported in 2025 as 171,854 and 74,052 respectively; notes the consequent rise in corridor care adversely affecting people in the Dumbarton constituency and across Scotland; considers that using the metric of acute hospital bed occupancy as well as A&E waiting times can help to relieve these pressures, and notes calls on the Scottish Government to ensure that reductions in occupancy act as the mechanism by which the whole system is held to account.
17:10
There was a time when hearing the sirens of an ambulance meant two things: first, that somebody was in trouble and needed help; and, secondly, that they would be rushed to hospital and immediately seen. Sadly, that is not the case any more. Delays happen too often, waits at A and E are too long, and corridor care is the new normal.
On a Sunday morning in December last year—
Will the member give way?
No—I am about to tell the cabinet secretary a story.
On a Sunday morning in December last year, Jean, an 85-year-old great-great-grandmother who has dementia, fell out of bed and broke her hip. Her family called for an ambulance at 11 am, but no ambulance had arrived by the afternoon. After multiple phone calls, an ambulance finally arrived at 4.30 am the next morning, 17 hours after the family first asked for help. Finally, an ambulance drove Jean to Wishaw hospital, only to join the back of a queue of ambulances, because there was no room in A and E. It was 3 pm before Jean was finally taken into A and E, 28 hours after her family first called for help.
Jean’s daughter Karyn told me:
“We were sitting in the ambulance outside Wishaw Hospital for seven hours, thinking there must be people in their houses sitting and waiting too.
You hear about the state of the NHS and you think that can’t be right, but it is.”
One thing that Karyn wanted to make clear was that the paramedics could not have been more helpful. In fact, she felt sorry for them, because they were unable to do their jobs—indeed, not just the paramedics, but the nurses, doctors and other emergency medicine staff, too. They deserve our thanks, because they go the extra mile, and none of this is their fault. People who enter those professions do so because they want to spend their lives helping others. Imagine the frustration of staff who know that, for all their training and compassion, they are fighting a losing battle, because of Scottish Government incompetence.
Jean’s MSP, Davy Russell, wrote to the Scottish Ambulance Service about her case, and this was the chief executive’s reply:
“I do not feel that this is an acceptable situation or one that I wish to see repeated, however I must acknowledge that the entire system has been under extreme pressure due to limited flow through our acute hospital due in no small part to the approximately 2000 delayed discharges in acute hospital beds.”
I remind members that the Scottish National Party pledged to end delayed discharge in March 2015, yet figures published today show that, in January 2026, 1,973 beds were lost to delayed discharge every day, making it the worst January on record.
I am grateful that Jackie Baillie referenced the staff, because they are not apparent in her motion.
I wish to pick up on a point that Ms Baillie raised at the start of her speech, the suggestion being that, somehow, ambulances will not arrive for patients. Does she accept that it is very important, in this place, that we are careful with our language and that we do not scaremonger patients or, indeed, put further pressure on staff? Will she reflect on that in the comments that she is making? What she said is not accurate.
It was staff in the Royal College of Emergency Medicine who asked me to bring the motion to the Parliament. It is patients who tell stories about delays in ambulances. I am bringing their voice to the chamber, and I hope that the cabinet secretary pays attention.
Jean’s story would be shocking if it was a one-off, but it is not. In January, the number of people waiting for more than eight hours and 12 hours at A and E was at its highest point on record. In fact, for waits of over 12 hours, this is the first time on record that the figure has exceeded 10,000.
At the Royal Alexandra hospital, which is used by patients in my constituency, the number of people waiting more than 12 hours rose from 66 in December to 314 in January. The proportion of patients who were seen within four hours declined from 70 per cent to 62 per cent over the same period. Things are actually getting worse, not better. As Dr Fiona Hunter, the vice president for Scotland of the Royal College of Emergency Medicine, put it:
“This grim milestone should be cause for profound concern among our health service and government leaders. But more importantly, behind this headline figure are individuals who have been let down at their time of greatest need, by a crumbling system that has been neglected, despite repeated cries for help.”
It is time that the SNP stopped producing press releases claiming that everything is wonderful and started listening to patients and staff about how to ensure that hospitals are once again run in their interests. I have talked about waiting times, but using the metric of acute hospital bed occupancy can also help to free up A and E. To quote Dr Fiona Hunter again,
“The A&E crisis is not caused by floods of barely-sick people rocking up to our departments, but by a lack of beds in inpatient wards, which is itself driven in no small part by an under resourced social care system.”
In other words, it is not, at source, a hospital problem, but a social care problem.
I have spoken many times in the chamber about the current social care crisis, including the £560 million funding gap that is facing health and social care partnerships in the current financial year. At the latest count, there were 26 per cent more people waiting on a social care assessment for a package of care in comparison with the same time last year. In total, that is 10,810 people waiting for social care assessment in February alone.
We know that targeting delayed discharge can improve hospital flow, because the Royal infirmary of Edinburgh does that. Consultants worked with the local health and social care partnerships to fund care packages and help patients out of hospital. The number of patients who were seen within four hours increased by more than a quarter, and there were almost 8,000 fewer 12-hour waits. It is better for patients, and better for staff—what is not to like about that?
We must tackle the pressures on emergency departments now. I do not know any member of NHS staff who signs up to keep people waiting for longer than necessary in A and E, and we know that long waits lead to poorer outcomes. The Royal College of Nursing has highlighted issues with nursing recruitment: 2,800 NHS nursing vacancies are unfilled, and 1,000 fewer people applied to undergraduate nursing courses in 2025 in comparison with 2019. The reality is that NHS Scotland has at no point employed the number of nurses that it says that it needs.
The Scottish Government must act, therefore, to stop the crisis getting worse before it leads to more corridor care, more burn-out and even fewer nurses on hospital wards—[Interruption.] I do not think that I have time to take an intervention.
The member is concluding.
Most of us live our lives trying to avoid A and E as much as we can, but we all want to know that if we call for an ambulance, it will come, and that we will be seen as fast as possible and treated with dignity.
I call on the Scottish Government to adopt the Royal College of Emergency Medicine’s metric of acute hospital bed occupancy, but collecting the data is not enough. The Government must also act on the data. It must invest in social care to create more care packages and reduce delayed discharge. It must show leadership and take accountability for the whole system—for what happens not just in emergency departments but in the rest of the hospital, and outside hospital, too. It must invest in primary care so that more patients are seen early and do not need to go to A and E in the first place. It must create a proper workforce plan so that emergency departments can recruit and retain staff.
When the paramedics turned up 17 hours late to collect Jean, they apologised, but it was not their fault. The accountability lies with the Scottish Government. It is time that ministers took responsibility, and took action to get A and E waiting times down.
We move to the open debate.
17:19
I thank Jackie Baillie for bringing the debate to the chamber. I will start on a point on which I can agree with her: there are, of course, huge pressures in our A and E departments—I would be telling an untruth if I was to stand here and say that I did not know that. Like, I am sure, every other member in the chamber, I have a significant volume of queries from constituents who have had to experience long waits, often being left in corridors and so on. Everybody will be aware of those general queries that we get from constituents; most of my constituents use the A and E at Monklands hospital.
That is the starting point on which I agree with Jackie Baillie, and I think that we need to make changes in that area. I know that the cabinet secretary will refer to that situation in summing up, because he is obviously aware of it. However, that is probably where my agreement with Jackie Baillie on the issue ends, because I feel that the rest of her speech was about targeting the Government, as if the issue with A and E departments has simple solutions and is unique to Scotland. It is not unique to Scotland: we all watch the national news and see that, across the United Kingdom, there are issues with A and E just now. They were there before the Covid-19 pandemic—we all know that; let us face it—but they were exacerbated by Covid and they have not really recovered since.
We in this Parliament need to look at how we, as politicians, work together to try to alleviate some of the difficulties that A and E departments are facing.
I will highlight some of the stuff that the Scottish Government is doing. One of the big things just now, which I am sure that the cabinet secretary will touch on, and which he has spoken about over a number of weeks, is bringing down waiting list times. That is crucial, because the more people are being seen for the treatment that they need, the less likely they are to present at A and E, so that will have an impact.
In addition, the Government is investing in general practitioners—Jackie Baillie mentioned GPs—and in the new walk-in clinics, which I am really hopeful will have an impact with regard to who needs to present at accident and emergency departments. I hear regularly from constituents who are unable to access their GP and are then referred to A and E.
Will the member give way?
I have quite a lot to get through. It depends on how strict the Deputy Presiding Officer is going to be with time.
A lot of members want to speak, and I am keen that they all get a chance to have their four minutes.
I will continue on just now, then—sorry, Mr Kerr.
We also need to be more innovative with new solutions that are out there to enable people to look after their own healthcare.
Those are all things that the Scottish Government is doing. Sometimes, in my view, people think mainly about A and E when they think about healthcare, because it is perhaps the only place, other than their GP surgery, that they access. The situations in which people attend A and E—I have had cause, in the past year or so, to be in A and E with a family member—can be quite frightening, and they can be busy and difficult places. There is a lot going on, and people may be seen in different places in an A and E department. They are difficult places, but there is a lot of good stuff going on in the national health service in Scotland in general that I think will bear fruit for A and E departments as well.
As the cabinet secretary said in his intervention, we cannot forget the absolutely fantastic staff who work in A and E under pressure. One of our good family friends has been the head of A and E at Wishaw general—another NHS Lanarkshire resource—and I have had many discussions with her over the years. She tells me often what a demanding, difficult and high-level job it is, but she does not often recognise the negative political discourse that she hears in the Parliament. The lesson of that for us is that we all have to come together—both the governing party, whoever that is, and the Opposition parties—and work together to find solutions to what is a very difficult issue that is affecting A and E departments everywhere in the UK, not just in Scotland. We need to make our A and E departments better, and we need to do so by working together.
17:24
I thank Jackie Baillie for bringing the debate to the Holyrood chamber this evening.
It is a busy period, and Parliament is debating a number of new subjects, while the news continues to carry more extraordinary stories of global instability each day. However, one topic that has never gone away concerns the quality and efficiency of accident and emergency departments in Scotland. Ever since the Scottish Government first came to power in 2007, admission times have been a constant source of difficulty for the NHS, and they have gradually got worse over time.
It seems a distant memory when it was considered poor for a health board to see fewer than 95 per cent of patients within a four-hour timeframe. However, after years of cuts and incompetence, a performance even remotely close to that would today be considered a triumph. In fact, four hours used to be pretty much the only standard by which we would measure these things. The idea that someone would wait for eight, or even 12, hours, was so far-fetched that hardly anyone even bothered to record it. As we have heard, however, all of that has changed for the worse.
I am particularly concerned about the wellbeing of casualty departments in rural areas. I understand that the big city hospitals tend to get the headlines, but the constant threats to the very existence of rural health facilities haunt people in communities outside the central belt, who are already forced to travel long distances for certain treatments and appointments. The rural nature of those communities and the appallingly poor infrastructure are additional elements that people across South Scotland have no choice but to factor in.
We know well the impact that poor A and E services has on patients. There is the short-term pain of long waits, sometimes in extremely uncomfortable settings, and the medium-term impact of those delays on their health. In addition, in the long term, the issue plays into their fears that the NHS is quite simply not there for them when they need it. There is an impact on hard-working, hospital staff, too. None of this is their fault, and it impacts their wellbeing as well. Nevertheless, they are the ones who have to front up the consequences, constantly apologising for something that is in no way a reflection of their professionalism, attitude or ability.
Hospital staff are not the only workers who are affected by the A and E crisis. Paramedics, whose job on the streets is hard enough, are often stuck at the back door, as part of the delay, when they need to be back on the front line. Police officers, too, are being dragged into the mess. Just today, we read comments from the chief constable of Police Scotland, whose patience appears to have snapped with her force being used as a mental health intervention service. She rightly points out that police officers are there to deal with matters of law and order, not to spend their shift responding to repeated mental health call-outs. That is placing incredible strain on an already stressed policing frontline.
Whatever the Scottish Government is doing in relation to accident and emergency waiting times, it is not working, and it has not worked for years. We need to know how the ministers in charge of that intend to turn the tide. A failure to do so harms pretty much everyone involved, and—as we have heard tonight—a badly performing casualty unit provokes problems not only across the rest of the hospital, but across other vital emergency services, too.
17:27
My thanks go to Jackie Baillie for bringing this incredibly important debate to the chamber, and for recounting the experience of one of my constituents, Jean.
I fully expect that the Government will judge Jean’s experience to be “unacceptable” or “not what we want to see”—I do not think that it would disagree with that—but the sentiment is hollow when it is not followed by prompt remedial action. Perhaps that feeling of unacceptability will be wiped away by the notion that the issue is anecdotal or that it would not happen today. However, my office has been handling cases such as the one that Jackie Baillie highlighted for months and months. My constituents have been left in pain and panic, trying to get an ambulance to the same A and E departments that they share with the health secretary’s constituents.
The issue is not anecdotal—it is systemic. Time and again, I hear from constituents with a long list of praise for the health staff once they get there or when their family member has been seen. We simply must extend our appreciation to our emergency health staff who, day after day, go above and beyond the call of duty. It is only because of those countless extraordinary individuals that our emergency departments have lasted this long, and not one ounce of blame for the current mess should land at their feet.
Jean is not alone in having to wait 17 hours for an ambulance. I know that there are worse cases out there. She is also not alone in having to wait nine hours in the back of an ambulance outside A and E. I heard from a constituent who had three separate ambulance crews spend their whole shift waiting with them outside A and E.
In the past couple of weeks, I have heard about the inevitable escalation of the situation from another constituent who was suffering from the side effects of his diabetes. An ambulance was called for him, but it did not arrive for nine hours. By the time the paramedics arrived, he needed to be resuscitated. An ambulance had been dispatched after seven hours, but it had been diverted to someone in even more dire need.
It is inevitable that, without immediate and transformative change in our A and E departments, people will die. The health secretary must immediately look at the real situation on the ground, not his own press releases. He must heed Jackie Baillie’s warning and look at the statistics that bear out what we have seen in relation to issues such as acute hospital bed occupancy, so that we are working towards real improvement and real increases in the quality and pace of patient care.
The health secretary must also listen to the words of the chief executive of the Scottish Ambulance Service, who points to mismanagement and a lack of planning in our social care sector on the part of the Government working its way up the chain to our acute medicine settings, with potentially deadly results.
17:31
I declare an interest, in that my wife is a practising GP with the national health service.
I thank Jackie Baillie for bringing this important debate to the chamber. We had a bit of back and forth with Labour’s business manager about the content of the motion, but that was not about what the motion said; it was about how we can ensure that we deliver the best for our staff, as well as the patients.
As I always do when talking about the NHS, I start by acknowledging that, as has been said already, there are some amazing staff doing incredible jobs. In particular, I pay tribute to the staff in Dr Gray’s hospital and Aberdeen royal infirmary in my region. The NHS is a sprawling organisation, and things go wrong sometimes. It is important that, when things go wrong, managers are on top of that and try to get things right. However, I recognise that, every day, staff on the ground are doing incredible work.
The main reason why I wanted to speak in the debate and was keen to support the motion is because it feels like, every day, I am having more and more conversations with constituents—particularly in Grampian, but also across the Highlands and Islands—about ambulance waiting times and ambulances stacking outside hospitals. I believe that NHS Grampian is still among the worst in Scotland in that regard. The briefing that we were given by the Royal College of Emergency Medicine told us that the issue is caused not by demand but by problems with flow through the hospital—again, that has been mentioned in the debate.
I am not here to lay blame, but at the heart of our NHS are people who are often in very vulnerable circumstances, and they look to the Government to make effective change. What they are saying to me is that they are not seeing that change.
I know that community hospitals have shut. I was on the integration joint board in Moray when some were shut down in that area, and I disagreed with the move then. A few weeks ago in the chamber, I asked the cabinet secretary when we were going to get more beds in Grampian, because a lack of beds has an impact on the ability to get patients through accident and emergency. If we can get more people out of A and E and into beds, we can stop ambulances stacking outside. However, he did not really answer that question, so I am asking it again today. Given all the money that is being spent, NHS Grampian must get more beds in Aberdeen royal infirmary and in Dr Gray’s hospital. That is of critical importance if we are to reduce waiting times.
We also need to think again about community hospitals. If it is true that we cannot get care packages in place and that, despite the desire for care in the community, that approach is not working, we will have to find another solution that gets people out of acute beds and into community settings, which will allow a better throughput in our major hospitals.
I want to address the issue of minor injuries. After the Covid pandemic, almost suddenly, and without much consultation, NHS Grampian shut down its minor injuries units across the north-east of Scotland. There were widespread questions from a lot of communities about why that happened, because surely those units were taking some of the demand off the acute A and E settings.
What I am trying to say in all of this is that A and E departments are critically important in life-and-death situations for people across Scotland, and particularly in rural areas such as those in my neck of the woods in Moray and across the north-east, and I want them to work well for staff and for patients. At the moment, we have a lot of patients in corridor care, and that is not good enough. We need the Government to deliver, and, in the next session of Parliament, we will have to make that change.
17:35
I thank my colleague Jackie Baillie for bringing this important debate to the chamber.
In 2007, the Scottish Government set a target that 95 per cent of patients should wait no longer than four hours to be seen and admitted, discharged or transferred. However, data that was released this morning revealed that, as of the end of January, there were recorded waits of more than eight hours and more than 12 hours, which are the highest since records began. More than 15 per cent of patients spent more than eight hours in A and E, while 8 per cent spent more than 12 hours there—both of those figures are well above the monthly average for 2025. I know that the cabinet secretary understands that it is our responsibility to bring such issues to the chamber.
In NHS Ayrshire and Arran—the health board that covers the area where I live—the A and E department of Crosshouse hospital exceeded capacity by 50 per cent in December 2025. Staff were left with no choice but to treat patients in corridors. It is important to be clear that that was not just a winter issue—Crosshouse A and E exceeded capacity in seven months last year.
A similar situation prevailed at the Glasgow royal infirmary. Does the member agree that the main issue has been the collapse of social care beds in Scotland over the past decade or so? That means that people are backing up into hospitals and A and Es and causing system failure, and it needs to be addressed at a system level.
I absolutely agree. Members across the chamber can see the situation that we are describing, but what we do not see is action happening to change that.
Constituents have contacted me to say that they have had to spend hours and hours in A and E and that they are suffering as a result. As other members have said, they describe that as being the result of the Government’s incompetence. They have nothing but positive things to say about the staff; they feel that the issue is about Government mismanagement.
As we have heard, it is not just patients who are paying the price. Long waits in A and E and issues such as corridor care not only affect patient safety but have a detrimental impact on the wellbeing of our staff. Working in an overstretched and overcapacity environment can lead to staff burnout, occupational injuries and lower job satisfaction. I know that the cabinet secretary has read the report that reveals that nurses say that they feel ashamed, demoralised and distraught because they cannot care for their patients in the way in which they have been trained to.
The Royal College of Nursing has made it clear that corridor care due to overcapacity is not just a winter problem but a year-round crisis in the NHS. However, due to the lack of data, the true scale of the problem is not known.
The cabinet secretary will know that, at the start of the year, I asked the First Minister for an update on the progress that has been made on capturing data on corridor care at national and local levels. I was greatly disappointed with his response. He claimed that, despite pressures facing one A and E department, it was operating in a sustainable fashion. I think that we can agree that what is happening is not sustainable. The pressures are there all the time for staff, and being honest about that is probably the first step towards changing it. There is a culture of hoping for the best every winter, and that has meant that our NHS has not made progress.
The NHS in Scotland needs a genuine workforce review and a long-term plan to identify areas of greatest strain, so that we can support staff in their roles in those workplaces. Corridor care compromises patient privacy and dignity, and it should not be accepted as the norm. Our constituents deserve to receive the best possible care—I know that the cabinet secretary believes that—and our staff deserve to work in an environment that protects their wellbeing and allows them to get on with the job that they are trained to do. Therefore, I ask the cabinet secretary to set out some actions that will be taken so that we can strive to get to where we need to be.
17:39
I thank Jackie Baillie for bringing this incredibly important debate to the chamber. For the benefit of the cabinet secretary, I say from the outset that the staff in A and E are exceptional. We are not talking them down—we are talking about this issue because they have asked us to do so. It was the Royal College of Emergency Medicine, at an event that Jackie Baillie and I attended, that asked for the issue to be raised in Parliament.
According to the RCEM,
“Compared to 2021 … six times more patients now wait over 12 hours to be either admitted, transferred or discharged from hospital. In 2024 alone, we estimate 818 excess deaths in Scotland were due to delays to admission of over 12 hours.”
The RCEM has also stated:
“It is important to note that whilst”
there has been
“a stark rise”
in 12-hour waits from 2020,
“waits were already starting to increase before the pandemic”
and
“Covid-19 cannot be solely blamed for increases.”
The A and E department is the canary in the mine, because it is an indication of a system that is creaking and failing.
I appreciate the point that Brian Whittle is making, and I thank him for giving way. The pandemic undoubtedly exacerbated the issues—not just in Scotland but across the UK—not only around the pressure and the demand that is being placed on our accident and emergency departments and social care systems, but around the complexity of the care that is required to be delivered to those patients. Does the member accept that that is also driving the increased demand and the pressures that we are seeing in A and E and in social care?
I say to the cabinet secretary that this is 2026: where is the Covid recovery plan that we were promised way back by the health secretary, two predecessors ago?
The trouble is that if patients cannot get to see a GP or get through to NHS 24, where do they go? They end up at the front door of A and E, probably with a problem that has deteriorated.
I have received a number of emails from people in my South Scotland region about minor injuries clinics being closed, being relocated to a central area or having their opening times reduced. That means that more people are being funnelled through A and E. The current Scottish Government promised that, by summer 2025, every type 1 emergency department would have direct access to specialist frailty team staffing, but that pledge has yet to be delivered. That means that, as Scotland’s population ages, A and E staff also have to deal with frailty issues that could have been addressed through a frailty clinic.
What are the outcomes of that? A Herald investigation revealed that the three A and E departments in Lanarkshire had exceeded capacity in at least 10 of the past 12 months, with Wishaw operating at 225 per cent of capacity last December. The problem is that we have no step-up or step-down care, so we have bed blocking. The lack of co-ordinated workforce planning and social care leads to exactly the problems that were highlighted earlier—ambulance queues outside A and E and corridor care becoming more of a norm than it ever should be.
The system needs to change. We need to either reduce the numbers of people coming to the front door or increase the staff head count. I would say that we need to do both—we need a complete overhaul of the system. I have talked a lot about A and E and the need for prevention, technology and workforce planning. How often have we talked about workforce planning in the chamber in the 10 years that I have been in Parliament? The Scottish Government is letting patients and staff down, and it is time for change. I thank Jackie Baillie for bringing this incredibly important debate to the chamber.
17:43
I say well done to Jackie Baillie for bringing the debate to the chamber, but I am incredibly disappointed with the cabinet secretary. I like Neil Gray—I hope that he knows that—but I have to say that he let himself down with his intervention on Jackie Baillie. Trying to police the language that we use or the subjects that we debate is not the way forward; he is better than that.
Will the member take an intervention?
I will, but the cabinet secretary does not need to be so defensive about the issue. Part of the way to deal with it is to be completely open about what is happening and the fact that we are in a crisis situation.
I accept Stephen Kerr’s point, as I do Jackie Baillie’s point: that there are too many people waiting for too long in accident and emergency departments. I made the point about the narrative because, last week, Paul Sweeney, Gillian Mackay, Clare Haughey and I were in a meeting with senior medics and medical representatives about workforce planning and the future of the medical workforce, and one of the asks that was made of all politicians was for a more respectful narrative about our health service. That is why I said that it is important that we do not scaremonger. Of course we need to address the challenges—I will come to that in my speech—but that is why I made the point that I did to Jackie Baillie.
I dispute the suggestion that we are scaremongering. We are bringing the voices of our constituents to the chamber, and that is exactly what they expect of us. [Interruption.]
Cabinet secretary, please let Mr Kerr continue.
That is what our constituents expect of us, and I hope that the cabinet secretary accepts that we are expressing a genuine level of concern on our constituents’ behalf. Those constituents are not just patients and not just staff; they are staff and patients. Tim Eagle was right to say that we are not seeing enough change. We should not pretend that there is change when there is not change. He pointed out some of the ridiculous executive decisions that have been made about, for example, reducing the presence of minor injuries units in parts of Scotland and closing community hospitals.
Over Christmas and new year, I spent several hours in the emergency department at Forth Valley royal hospital with a family member. I have spoken directly to the senior leadership of NHS Forth Valley about what I saw. I saw professionalism under strain; I saw calm, decency and commitment; and I saw staff doing their absolute best in circumstances that would stretch any workforce in any setting. They deserve our gratitude, but appreciation is not a strategy.
As has been repeated by a number of colleagues in the debate, the central issue is flow. Bed occupancy is persistently high; patients cannot move on; treatment areas are backed up; ambulances are queueing; and corridor care becomes normalised. Bed occupancy should be treated as a front-line accountability measure. If hospitals are routinely operating beyond safe margins, ministers must answer for that. There is accountability.
The pharmacy first approach needs to be reinforced. Pharmacists are highly trained clinicians and, for minor conditions, they are the right first call. However, that policy does not work in practice. If a parent cannot find an open pharmacy, they will—as is rational—go to A and E. We need round-the-clock access to pharmacies, clear signposting and a public campaign to shift behaviour; otherwise, A and E will remain overwhelmed.
I will raise one more issue in the time that I have. A small minority of people behave disgracefully in our emergency departments—they intimidate the staff and harass other patients. That is unacceptable. Abuse and violence must carry visible consequences. Zero tolerance must mean zero tolerance.
My colleague Sharon Dowey raised another subject, which was also raised by the chief constable yesterday. Too many police officers are stationed in emergency departments for entire shifts to deal with people experiencing mental health crises. We need a joined-up approach to mental health management, so that police officers do not become de facto mental health practitioners. They are not trained to do that.
I hope that Neil Gray will accept the reality that, as his party has been in office for nearly 20 years, ministers cannot default to defensiveness. Leadership means facing hard truths. It means capacity and workforce planning and dealing with the future, not just today’s crisis. We have seen the numbers for today—there are record levels of waits in A and E. We must see change; we must be grounded in realism; we must take responsibility; and, collectively, we must encourage the Government to have the courage to change course.
17:48
There is a shared understanding across the chamber that the pressures facing accident and emergency departments are serious and unacceptable for patients and staff. Those pressures have been exacerbated post-Covid and I will set out the steps that are being taken to address that. I also express my gratitude to all the teams working in those departments every single day. They operate in extremely challenging circumstances and continue to provide compassionate and professional care to people when they need it most.
We all agree that too many people are waiting far too long when they attend accident and emergency. I accept that—that is the candour that Stephen Kerr asked for. We know that long delays create real harm and that receiving care in a corridor is undignified and unsafe, as Carol Mochan pointed out. The Royal College of Emergency Medicine has highlighted that one third of patients were cared for in non-clinical spaces last year.
However, Fulton MacGregor is absolutely correct: Jackie Baillie failed to reference in her motion that Scotland is not the only part of the United Kingdom facing these challenges. Although—
Will the cabinet secretary give way?
Hold on a second.
Although they might like to pretend otherwise, the reality is that the very same challenges that are being faced in our hospitals are persisting in England and Wales. Regardless of the challenges that are being faced in Wales or in England, the current standard of care is not what this Government wants for Scotland. I agree with Jackie Baillie that the case that she referenced about Mr Russell’s constituent, Jean, is unacceptable. To understand how we can fix that, we need to be clear about the cause.
Overcrowding in accident and emergency does not begin at the front door. It happens when hospitals are full, when beds are not available and when people who need admission cannot move to a ward. Brian Whittle and Carol Mochan referenced that. When the flow stops, queues build up and staff must care for people in spaces that were never designed for treatment. The real issue that we must address is hospital flow, bed occupancy and the delays that prevent people leaving hospital when they are ready to do so.
Will the cabinet secretary give way?
Do I have some time in hand, Presiding Officer?
A wee bit, yes.
We accept that flow is the big issue, but there is also a lack of pathways for people to access the help that they need when they need it—whether in the evenings, at weekends or on public holidays. Those services simply do not exist in our communities, and as a result, the pressure is concentrated at the front door of the hospital.
We are taking steps to address that, including the points that the member referenced about NHS pharmacy first Scotland, broadening the front door of the health service through the expansion of general practice, and through GP walk-in clinics, which I believe his colleagues oppose.
Will the cabinet secretary give way?
I will give way to Brian Whittle briefly.
Do you not accept, cabinet secretary, that until we stop judging the level of our NHS services by whatever happens to outperform those of England and Wales, we will fail? The problem is that health is devolved, and the biggest failing of this Parliament has been our inability to do things differently and to make progress.
I did not say what Brian Whittle has set out. I said that we have shared challenges and are facing the same issues. The decisions that we are taking mean that, far from the Scottish Government being at fault for having a worse position than the rest of the UK, we actually have a better one. The decisions that we are taking are the right ones, and they are moving things in the right direction. I will come on to why that is the case.
High occupancy is the single-biggest barrier to moving patients from accident and emergency into wards. That is why our operational improvement plan is specifically designed to bring occupancy down by improving discharge, strengthening support in the community and expanding services that allow people to be treated safely at home. We are seeing significant improvements in that regard, and I believe that we will see improvements in four-hour performance, which is the canary in the mine, as colleagues have said.
To enable that, we are taking a whole-system approach. That means that every health board now has a specialist frailty service at hospital front doors. Those teams are helping many older people to avoid admission altogether, ensuring that they can return home while receiving the care that they need. That delivers better outcomes for those patients and reduces pressure on beds.
Hospital at home continues to expand. We are working towards our target of achieving 2,000 beds by the end of this year and making it the single-largest hospital in Scotland, providing safe and effective care to people in their own homes and relieving pressure on acute sites. Alongside that, we are supporting boards to strengthen same-day emergency care, improve the availability of senior decision makers and develop better discharge processes so that people who are ready to leave hospital can do so without delay. That includes work to prevent unnecessary admissions.
In the week ending 22 February, 51 per cent of Scottish Ambulance Service emergency incidents were managed without any need for transfer to hospital. I do not believe that the effectiveness of any of the interventions that I have set out to address those issues are disputed by any colleague in this chamber.
Will the cabinet secretary take an intervention?
I am really sorry—I am now pushed for time. I will come back to Ms Baillie when I have made further points, if I have time in hand, Presiding Officer.
I will address Brian Whittle’s point about accident and emergency being the point of least resistance. We are investing a record increase in core general practice funding. We also have more GPs, and we are taking forward GP walk‑in service pilots to relieve pressure on general practice and support the wider system.
I agree with Jackie Baillie that many of the people who are delayed in our hospitals are waiting for social care that is delivered by local authorities. For instance, Jackie Baillie’s motion refers to her local area and the latest statistics show that, in January 2026, 56 people in West Dunbartonshire Council were delayed in hospital, which is 51 per cent more than in January 2025.
The challenges that West Dunbartonshire Council and other local systems face have been exacerbated by UK Government policy decisions. The UK Government’s closure of the care worker visa route is having a devastating—[Interruption.] I hear groans from colleagues, but this issue has been raised by social care leaders. The closure of the health and care worker visa route is having a devastating impact on the social care sector, which was already under pressure to fund an increase in employer national insurance contributions. We have announced £500,000 funding to help mitigate the loss of that visa route.
We are also taking our responsibility to the social care system seriously by investing more than £2.3 billion in social care and integration in 2026-27, delivering on our commitment to increase funding by 25 per cent by the end of this session of Parliament and, in 2026-27, exceeding that by more than £0.5 billion. Our budget delivers record funding of almost £15.7 billion for local authorities—a real-terms increase of 2 per cent.
Moving on to the impact on staff, I acknowledge the dedication of emergency care staff and I have had regular meetings on that subject with the Royal College of Emergency Medicine. I have a huge amount of respect for that organisation, and we have taken steps to address its concerns.
Brian Whittle asked for action on two areas, the first of which was to reduce the pressure on the front door. I have set out what we are doing about that. He also asked us to increase head count, and we are doing that. The number of senior doctors specialising in emergency care has grown significantly over the past decade, and we will continue to support boards as they develop safe staffing plans under the health and care staffing legislation.
Through the new subnational planning structure, we are also taking forward work to address flow consistently across Scotland. We know that some A and E departments, including NHS Tayside, perform better than others
. Jackie Baillie is correct in her assessment of the work that we are taking forward in NHS Lothian, where teams work collaboratively to prevent delays to patient flow.
Will the cabinet secretary take an intervention?
Presiding Officer, do I have time to take Ms Baillie’s intervention?
Briefly, yes.
The situation in Argyll and Bute—it is not West Dunbartonshire, but Argyll and Bute—is that the health and social care partnership is facing a budget cut and, across Scotland, HSCPs now have £562 million less than they need. However, given the success of the approach in Edinburgh royal infirmary that he just referenced—I agree that it is a success—will the cabinet secretary adopt that model more widely across Scotland?
I assure Ms Baillie that we already are adopting that model. We are working with teams across the country, and that work is also part of the subnational planning work that I have taken forward.
NHS Grampian has taken forward great work on the 10 by 10 initiative, which is about getting people discharged by 10 am. Similar work is happening in NHS Greater Glasgow and Clyde and NHS Lothian. That work is already under way.
We know that performance is not where it needs to be. I accept that. We know that too many people are waiting for too long and that staff are under intense and relentless pressure. However, we also know what the causes are and we are taking steps to address them. Through the operational improvement plan, investment in community alternatives and a stronger focus on flow and discharge, we will reduce overcrowding in accident and emergency and improve patient care across Scotland.
That concludes the debate.
Meeting closed at 17:58.
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