Official Report 128KB pdf
Good afternoon. Our first item of business is a debate on motion S7M-00228, in the name of Angela Constance, on investing, protecting and renewing Scotland’s national health service. I invite members who wish to speak in the debate to press their request-to-speak buttons now.
14:00
I very much welcome the opportunity today to give my first speech in my new role as Cabinet Secretary for Health and Care. I commit to the Parliament that I will do absolutely everything in my power to protect, renew and reform our national health service, which is our most precious asset. That demands that I work hand in hand not only with our exceptional health and care workforce and partners but with members across the chamber to address local issues and improve the health of our nation.
I take this opportunity to thank my friend and colleague Neil Gray for the focused leadership that he has shown over the past two years, which has seen our NHS turn a corner. Mr Gray and I will continue to work together on matters that require joint action between the worlds of health and justice. I also very much thank my good friend Jenni Minto for her pioneering work on the women’s health plan. People will be aware that Scotland was the first country in the United Kingdom to deliver a women’s health plan. That work will now be progressed by Maree Todd, who has always been a champion for women’s health, whether as an MSP or as a pharmacist.
Before I provide an update on progress, I note my support for the amendment that was lodged by Miles Briggs, which—although it was not accepted by the Presiding Officer—rightly highlighted the importance of high-quality, accessible palliative care and the vital role that hospices and community services play for people and families across Scotland. I commit to working constructively with the member on the issue in order to ensure cross-party input on the future of palliative care.
I support the sentiment of the Greens’ amendment. We will introduce a workforce plan on pay. I very much recognise that pay is a barrier to people entering the social care workforce, and I am determined that we will do more to improve pay and terms and conditions. However, the budget is set for this year, and to increase the minimum rate to £15 an hour now would cost around £325 million. We remain open to negotiating with the Greens ahead of the next budget, but the reality for this year is that cuts would have to be made elsewhere in our NHS in order to deliver such an increase, which is why we cannot support the Greens’ amendment today.
I support the policy of mandatory sectoral bargaining, but we are constrained by the reserved nature of employment law. We will support the UK Government’s Employment Rights Act 2025 when it comes forward for legislative consent. In the meantime, our support for the policy is why, in March, we introduced plans for voluntary sectoral bargaining, which the Greens have called for. We are already working with partners on that. I also support improvements to terms and conditions, including measures such as enhanced maternity leave provision and protection of vulnerable groups checks. More broadly, the Government this year supported providers to deliver the real living wage, and we were clear that support was conditional on providers upholding our fair work principles.
I hope that the measures that I have set out provide an indication to colleagues of my keenness to work together with them, and I ask that they support the Government’s motion today.
I say to the Liberal Democrats that I will make a statement on maternity services next week. I say to Reform UK that I do not support the establishment of a health and social care commission, because the public are telling us that we need to focus on delivery right now. I say to my colleagues in the Labour Party—particularly Jackie Baillie—that, although their amendment is not the worst that I have seen from the Labour Party, I had hoped that we could perhaps start on a slightly more positive note. However, we will work on that together, because that is what the public demand of us all.
Turning to the substance of today’s debate, I note that, as we will all recall, the pandemic was one of the greatest challenges that the NHS has ever faced. The system responded with remarkable dedication to the immediate crisis and to the journey of recovery. Therefore, it is right that I begin by recording my sincere thanks to all health and care staff for the incredible work that they do.
Today, I had the pleasure of visiting the NHS Golden Jubilee hospital, where the commitment was clear to see. The hospital has now become the UK’s largest centre for hip and knee operations. My visit also allowed me the opportunity to speak to patients. Although I absolutely recognise that some people are still waiting longer than any of us would like, I am hearing about the progress that we are making, which is having a real impact on patients and their families.
I am also hearing about the creative solutions that are being used to ensure that patients receive the right care in the right place at the right time. That includes expanding our innovative hospital at home programme by the end of this year so that it becomes Scotland’s largest hospital, as well as harnessing digital advances such as artificial intelligence to speed up lung cancer detection in Grampian.
NHS leaders are spearheading a new subnational planning approach, which has already resulted in better collaboration and a sharper focus on shared priorities. That represents a material shift in how we think about population-based planning and delivery. The approach will result in health boards across the east and west of the country working together to develop and deliver services jointly, which will help by more effectively directing and sharing resources, reducing duplication of effort and improving equity of access. The approach underpins the transformation that we need by shifting care closer to home, focusing more on prevention and inequalities, and better aligning resources with needs—for example, during periods of increased demand such as the flu season.
The cabinet secretary has spoken about working collaboratively and moving care closer to home. How does she intend to implement the recommendations of the Ritchie report and reintroduce 24/7 urgent care at Portree hospital? Will she meet me and the SOS-NHS Skye Portree hospital group to explain how she will do so?
I very much appreciate Mr Baxter’s intervention. I have been advised that significant progress has been made, but I will want to test that, and I would welcome a discussion with Mr Baxter on those matters.
Our commitment to tackling long waits is unwavering. Although we did not meet our March target, that was a stretching ambition and what matters are the actions that we are taking to go further. The latest data shows that the number of new out-patient waits of longer than 52 weeks has fallen for 11 consecutive months, with the number of in-patient and day-case waits of longer than 52 weeks having reduced for 15 months. Since July 2025, the number of waits of longer than a year for new out-patient appointments has fallen by 76 per cent and the number of waits of longer than a year for in-patient and day-case appointments has almost halved.
We are also seeing really good progress in diagnostics. In the latest quarter, activity was at its highest level since reporting began, in April 2024. That means that thousands more people are getting their scans and scopes sooner, which is helping them to get a faster diagnosis.
I am pleased to confirm that we have not only met but exceeded our additional activity target, as we delivered more than 168,000 additional appointments and procedures in 2025-26 compared with the number for the previous year. Data published yesterday shows a 7 per cent increase in the number of operations performed in the past 12 months. Our national treatment centres have been vital to that success, having delivered more than 34,000 surgeries and procedures between April and December 2025—surpassing our annual target three months early.
I want to go much further—and we have to. I want a system that is in balance and that can respond to demands, ensuring that all patients are seen quickly. That means delivering on our manifesto commitment that, by the end of this parliamentary session, no patients will be waiting longer than 26 weeks for treatment.
We are seeing improvements in cancer services, too. We are treating more patients on time, within both standards, than we did pre-pandemic. For example, more than 95 per cent of patients started treatment within 31 days of the decision to treat, with a median wait of just two days, which is the joint lowest figure on record. That progress has been helped by expanding the roll-out of our rapid cancer diagnostic services, including the new service in NHS Forth Valley, which opened last year. We are working on a new cancer action plan, which we will publish later this year.
I know that pressures in unscheduled care will be a concern for the public. Let me be clear: corridor care and long waits in accident and emergency are simply unacceptable. I am absolutely committed to improving care, improving performance and reducing delays. The reality is that those pressures do not start at the front door; they are caused by blockages across the whole system. Our focus has to be on practical, immediate action to tackle the underlying challenges, working collaboratively across the NHS, local government and key partners to deliver better, faster care. That is why, within the first 100 days of this session, we will publish a clear plan to improve patient flow, building on the progress already made through our investments in NHS 24, the Scottish Ambulance Service and the front-door frailty services that we now have in every health board.
Lasting improvement also means addressing the challenges in our social care sector, which have been exacerbated by the UK Government’s hostile approach to migration and the financial burden heaped on providers thanks to the increase in employer national insurance contributions.
A significant part of tackling pressures in our hospitals involves our continuing to move more care into communities, with new community health hubs, new lung and heart health MOTs and 30 walk-in general practice centres from Shetland to Stranraer.
I join other members in thanking NHS staff, including maternity services across rural communities, particularly in Galloway, where they are under pressure. If reform and renewal are to mean anything to families, the cabinet secretary must ensure that there is real progress at pace. In January, the Government said that Stranraer would be among the first rural areas targeted by the new maternity and neonatal task force, yet women in Wigtownshire have seen no change and there are still no planned births at Galloway community hospital, which results too often in a 70-mile dash to Dumfries. What has changed for families in Galloway since Stranraer was defined as a priority? When does the Government expect to report on and provide clarity on maternity services, particularly in Stranraer?
I very much appreciate Finlay Carson’s contribution, and I assure him that what he touches on is an important issue for every minister—for me, Maree Todd and Alison Thewliss—as we work to renew and reform the NHS. I will be happy to ensure that Finlay Carson is briefed about the work of the task force, which has a focus on the workforce—where it is, how it works and how we will support it in the future. At its core, the work of the task force concerns how women and their babies are looked after.
As I said to the Liberal Democrats, I will return to the chamber next week to make a full statement on a range of issues that impact on maternity services. In particular, I have been made very aware, by my colleague Maree Todd, of the challenges that rural parts of our country face, whether in Stranraer or in Caithness.
Six general practitioner walk-in centres are open already. GP numbers are going up, and, in tandem, we are delivering on the historic deal, reached with GPs last year, to invest £531 million in primary care. That will further boost the recruitment of GPs.
Supporting people closer to home is only part of the story. We also need to act earlier to prevent ill health wherever possible. We are focused on the wider factors that shape people’s health. For example, in October last year we took the important step of bringing in legislation to limit the promotion of foods that are high in fat, sugar and salt.
The cabinet secretary may not have the answer to this question yet, because she is new to the job, but when can we expect to see an NHS app with functionality like the one that exists down in England? I have been asking for that for years. Frankly, patients in England are doing a lot better than ours are.
I will come to that very issue in a moment—there is some important progress for us to update the Parliament on. I hope that it will reassure Mr Simpson in relation to that functionality and how we will end up with the best app on these isles. If he bears with me, I will come to that.
My remarks before that intervention were about public health and protection. The Tobacco and Vapes Act 2026, which gained royal assent in April, is a landmark step in delivering a tobacco-free Scotland by 2034. In the first 100 days of this Government, we will consult on a ban on vape and nicotine product displays.
Alongside improvements in other areas, mental health remains a key focus. The subject area is very close to my heart—I am a former social worker and mental health officer who worked for several years at the state hospital and in three prisons. I am conscious that access to service is improving, particularly for our young people. The number of long waits for child and adolescent mental health services is at a historic low and we have met and maintained the standard for CAMHS waiting times a year ahead of target. We have also invested an additional £3.5 million to improve our 24/7 response to mental health emergencies. That includes the expansion of our existing NHS 24 mental health hub to include psychological therapies. The service responds to around 10,000 calls from the public each month.
Our manifesto commits to doing more. Today, the First Minister visited the nook in Glasgow, which is run by Scottish Action for Mental Health. We will be supporting SAMH to deliver more drop-in mental health centres across Scotland and expanding the use of mental health triage cars, which the Ambulance Service already utilises in Fife, Inverness, Dundee and Glasgow.
I am confident that the progress that I have set out provides a strong foundation to build on, and I am clear about my determination to do just that. A significant step in our programme of public service reform is the establishment of Public Services Delivery Scotland. From 1 April, we brought together the functions previously delivered by NHS National Services Scotland and NHS Education for Scotland within a stronger, more streamlined national delivery body. PSD Scotland supports our once-for-Scotland approach, strengthening national capability while remaining responsive to local needs. It is important to stress that PSD Scotland is not only for the health service but can bring other benefits to the public sector.
Looking to the future, digital infrastructure and technological innovations are key, and we are already making marked progress. Our digital dermatology service, which was introduced last year, is now available across all GP practices in Scotland. We estimate that 130,000 dermatology referrals a year could be made through that service, which would reduce dermatology waiting lists by up to 50 per cent.
Let me respond to Mr Simpson’s point. In April, we made MyCare.scot available nationally. MyCare.scot gives people a simple, secure way to see and manage aspects of their own health and social care online. A downloadable version of the MyCare.scot app will be available in app stores early this summer. We are committed to NHS Scotland data always being in the hands of the NHS, unlike what has happened elsewhere. Data will remain in the control of our NHS, and we will not get involved with the likes of Palantir. I make it clear, for the avoidance of doubt, that Scotland’s NHS will never be up for sale.
The progress that we are making is undeniable, but I do not shy away from the fact that there is much more work to do. We must do the hard work of reforming our public services, cutting unnecessary bureaucracy and making access to healthcare easier for the people we all serve. Above all, this is about people—the staff who deliver dedicated care each and every day and the patients and families who depend on our health and care services. They will be at the heart of absolutely everything that I do.
I move,
That the Parliament recognises and commends the hard-working staff across Scotland’s NHS; thanks them for the significant progress they have delivered, including long waits down 11 months in a row, and welcomes the Scottish Government’s commitment to working with all staff across Scotland’s Health and Social Care sectors to deliver further reform and renewal.
I call Helen McDade to make their first speech.
14:21
Thank you, Deputy Presiding Officer. I congratulate you on your new role, and I thank the cabinet secretary for her speech and congratulate her on her new role.
As this is my first speech in the Parliament, I thank the constituents of Mid Scotland and Fife who have belief in a new approach and voted for Reform, and I thank all those who campaigned with us across Scotland. I wish to reassure all residents in the region, regardless of who they voted for, that I will do my very best to assist constituents when they need it. I would really like to thank the parliamentary staff, who have been wonderful in helping all 64 new MSPs.
I also thank those members who, regardless of political differences, have been pleasant and welcoming. They know who they are—or perhaps it is more accurate to say that those who have not been pleasant and welcoming know who they are. That is okay. Most politicians here have said, “We’ll work together with everybody, as the voters have made it clear that they want that to happen.” Some politicians seem to be struggling a bit more with that, but we in Reform have an invisible shield. We are used to being vilified by a tiny fraction of society, so a few people behaving childishly by walking out of the chamber during a member’s maiden speech or turning their backs does not really faze us. It will not stop us talking common sense and calling out nonsense. I am grateful to those who have been welcoming—which is, of course, most people in the room.
There is a lot of talk just now about the reputation of politicians. Perhaps members might consider how actions such as walking out of the chamber because they do not like what is being said look to the general public and how they affect the reputation of not only the whole Parliament but the individual. I remember being in the public gallery about 20 years ago, when a members’ business debate on the illness ME came up. I will come back to that later. The then cabinet secretary got up and walked out, as seems to be the custom with members’ business debates, leaving his deputy. There were many affected people and carers in the gallery who had made huge efforts to be there and who, not knowing that that was the custom, were shocked. My mother-in-law said, “I’ll never vote for him again.” Knowing my mother-in-law, I am sure that she never did. So, it is worth remembering that everybody is looking all the time.
That debate was the start of my surprising journey to being here today. At that time, a cross-party group on ME was set up, a petition was submitted to the Public Petitions Committee and a Scottish Government working group was set up. However, 20 years on, I came back to campaigning for sufferers of ME only to find that almost nothing had changed. Indeed, another petition with almost the same wording had been lodged in 2018 by a young woman who had been struck down by the disease.
The Parliament cannot be just a place where important things are discussed and admirable policies are announced. There must be concrete action and identifiable, positive change in people’s lives. There need to be specific, measurable, achievable, relevant and time-bound—SMART—outcomes. I would never have thought that I would be using business jargon, and my family will certainly laugh, but such an approach is necessary. Plans are great, but only if they are put into practice.
Of course, laughing is better than crying, which is what many sufferers and carers have done over the years when they have seen their hopes of progress on healthcare policy on difficult issues, the responsibility for which lies here, run into the sand.
That leads me to the lack of ambition in the motion, although I recognise that the Cabinet Secretary for Health and Care has announced a lot of new initiatives, which are welcome. Of course, it is only right to recognise the work of the NHS and care staff. We should never forget what they did during the Covid pandemic and the legacy that that has left for the staff and the public. However, I suspect that staff want more than is offered in the motion. They would like their jobs to be made a bit easier by their being able to help patients earlier and to say, “Yes, we have a bed for you,” or “Yes, we can give you that knee replacement soon,” or “Yes, we can help you with adequate care so that you can remain in your home.”
Working conditions are certainly among the things that need to be looked at. By “delivering the best care”, do we mean staff working a 12-hour day routinely so that they are on a four-day week? I do not know, but I would like to see somebody giving the data on that. Who wants to be the patient who is attended by a doctor or nurse who is in the 12hour of their fourth day?
Training, recruiting and retaining more qualified staff is essential, but I have met fully trained nurses who cannot get a job although locum use is high. Perhaps that is because they need flexibility in their working hours or—very likely, if they are in a rural area—they need accommodation near the hospital or surgery. In the past, there was tied accommodation for essential workers. I come from Caithness, so I know the problem of staffing Caithness maternity services, and I was glad that the cabinet secretary mentioned that issue. There are harrowing accounts of women giving birth in ambulances at the side of the road. Would the NHS owning a few houses help to solve that problem? We have to look at different actions. How have we come to think that such situations are acceptable in the name of finance?
There are many reasons why Scots are often frustrated with and angry about the NHS and care services. A major one, which has been referred to already, is that of waiting lists. I was glad to hear the cabinet secretary say that there are many plans to reduce waiting lists. Of course, the Government can say that waiting lists have come down, but that does not mean that they are acceptable when what they have come down from is the record high that they reached after the Covid pandemic and they are still not anywhere near pre-Covid levels.
Improvement is very welcome, and we should welcome it. A much-needed start has been made, and staff are to be congratulated on their considerable efforts. Nevertheless, people are still waiting too long for action that will alleviate painful conditions or treat potentially fatal illnesses, including cancer. I therefore welcome the cabinet secretary’s announcement on the cancer plan. I know that the organisation Young Lives vs Cancer asked the Scottish Government to commit to a new, up-to-date national cancer strategy for children and young people, but I do not think that she mentioned that—I apologise if it was on her list.
The Government often talks a good game, to use the metaphor of the moment, but it often fails to deliver. It often says that it is hampered by Westminster austerity. However, the fact is that the Scottish NHS budget has had an average 6 per cent increase every year for 25 years of this Parliament. However, in many areas, Scotland has recovered from the pandemic less quickly than England. The number of consultations per consultant is an example of that.
According to data from the think tank Enlighten, 93 per cent of Scots believe that the NHS needs to be reformed, and we in Reform are committed to that. Although we are committed to a service that is free at the point of use, we believe that a fresh approach is needed.
I trained as a veterinary surgeon, so I believe in diagnosing the problem. When the cabinet secretary says that she does not support a health and social care commission, I am disappointed, because we need a good diagnosis of what is happening. We need to look at a number of different issues, including training and retention of the workforce and joining up health and social care. Without knowing the detail of what happened, I am sorry that the Government’s plans to bring health and social care together were not put into practice. One obvious issue that needs looking at is bed blocking, but I do not think that I heard about that in the cabinet secretary’s speech.
What does the current state of the NHS mean to people in practice? One area is the inadequate care that people with chronic health conditions receive. I come back to my family’s involvement with ME. Because I am a vet, I looked a lot at research on the topic. In some ways, encouragingly, that is coming on. Sadly, however, the reports are that doctors are not doing much more to help those people. They leave the patient feeling helpless and unsupported. When I was in that space, I used to think that, if I went to an appointment and came away without one of us being in tears or absolutely furious, that was not too bad.
We must have specialist nurses and doctors for chronic illnesses. There has been only one specialist ME nurse in Scotland in the 20 years since that debate in the Parliament, which some current members attended. We had one nurse—Keith Anderson, who, sadly, died prematurely. I would like his family to know that we recognise his dedication and the wonderful care that he gave to thousands of ME patients and, latterly, long Covid patients.
I return to my personal starting point in the Parliament. After two decades, on just one common, painful, distressing and often lifelong condition, the result is that we are no further forward. That must change. In addition, we must see that, after Covid, there are tens of thousands more such people. I will be delighted to join the Covid group and the medical inequalities group. However, carers are dealing with the bulk of things.
The cabinet secretary will be pleased to know that I do not lay all of that at the Government’s door. In fact, the medical professions need to be brought to the table with patients and carers. We have the latest research on some of the illnesses, and mandatory continuing professional development is required. The Government should look at what medical research it is funding and monitor that closely for outcomes. A commission could steer the NHS through those changes, and I ask members to support my amendment.
I move amendment S7M-00228.1, to leave out from “including long waits” and insert:
“; further recognises that 93% of people in Scotland think that the NHS needs to be reformed whilst continuing to deliver services free at the point of use, and calls on the Scottish Government to set up an independent, Scottish Health and Social Care Commission, comprising experts, staff and service users to review health and social care delivery, produce a workforce plan to train and retain more doctors, nurses and social care professionals in Scotland, propose solutions for delayed discharge, and actions to streamline frontline services through greater integration between community health and social care services and local GP surgeries.”
I call Jackie Baillie.
14:32
Thank you, Presiding Officer. [Interruption.] Oh! Did I make that noise with the microphone?
I will start the debate on a consensual note. I very much welcome Angela Constance to her new post as Cabinet Secretary for Health and Care. I have considerable respect for her as an individual—I hope that my saying that is not career ending for her—and as a politician, and I wish her well in her portfolio.
Our NHS needs her to do well. The cabinet secretary will, of course, expect me to hold her feet to the fire and, on that score, I will not disappoint, because the NHS is our most loved public institution. We care deeply that it remains true to its founding principles and is free at the point of need, but we recognise that it faces huge challenges. Thousands of Scots languish on NHS waiting lists. The situation with A and E remains chaotic, with long waits now almost baked in. Burnt-out NHS staff are voting with their feet, and the social care sector is in crisis.
Fixing the NHS will require fresh thinking. The Scottish National Party has been in power for nearly 20 years, and I genuinely believe that, if it had any idea how to turn things around, that would have happened by now. I look forward to what Angela Constance is going to do. However, to quote Samuel Johnson, that is perhaps expecting a
“triumph of hope over experience”.
Angela Constance’s predecessors were very good at creating NHS plans—in fact, they could probably paper the walls of St Andrew’s house with them—but they were much less effective at delivering them. In many cases, the plans were excellent; they were informed by people who worked in that sector. However, with no timelines and no money, they simply gathered dust.
The Scottish Government’s flagship promise last year was the commitment to end, by March 2026, treatment waits of more than a year. I distinctly recall the First Minister making that commitment. It should have been delivered more than three months ago, yet there are still 32,279 treatment waits of more than a year, 3,433 waits of more than two years and, at the last count, more than 750,000 ongoing waits for tests and treatment.
Behind those figures are people in pain, who are waiting day after day for the appointment letter that never comes. In the meantime, their lives are on hold. Some become so desperate that they use their savings to get private surgery. We know that the number of Scots who are using private healthcare is the highest ever on record. The reality is that the SNP has presided over the growth of a two-tier health system in which people who have savings are raiding them to pay for treatment and those who do not are left languishing in pain. If the new cabinet secretary is true to her word and serious about getting waiting lists down, she must use all available theatre capacity. I also recommend that she ensures that money follows the patient instead of their being left at the mercy of health board bureaucracy.
Emergency departments are under pressure, too. Each month, thousands of patients are still waiting for more than eight or even 12 hours at A and E. A significant proportion of those patients would not be there at all had they been able to access care earlier, but many people are still struggling to get through to GPs. Patients are still waiting for the facility to book GP appointments on the NHS app, and I look forward to that being rolled out at pace.
The cabinet secretary knows that the percentage of the NHS budget that goes to primary care has dropped from 11 per cent to only 6 per cent, that the number of patients per GP has increased and that qualified GPs are out of work because GP practices cannot afford to hire them.
Doctors have already made clear their concerns that GP walk-in clinics are not effective and do not provide what I think we all strive for, which is continuity of care. The message is that we should just fund existing GP practices, which should be the walk-in clinics in everybody’s community.
Does Ms Baillie agree that reform is necessary and not optional? Does she also agree that it is right to implement innovation? People who have busy working lives, as I do, need an appointment when we need it, but people such as my mother will indeed want continuity of care. It is not a case of needing one thing or the other; we need different services for different people, at the right time.
I absolutely agree that we need innovation and to be able to move forward, and that it is not a case of putting one thing against another. However, we have not thought through how to secure continuity of care and how to make other aspects work better, such as deciding where test results go when they show up—to the GP or to the walk-in clinic. I do not have a GP walk-in clinic in my area; the walk-in clinic is the GP practice, so let us fund that adequately.
Better-resourced GPs will deliver more preventative care, which, in turn, will mean fewer people requiring operations or turning up at A and E. However, reducing pressure on hospitals also means investing in social care. Nearly 2,000 Scots are stuck in limbo due to delayed discharge, which means 2,000 beds that would otherwise have been available to new patients.
Meanwhile, Scotland faces a social care crisis. Social care is about much more than just helping the NHS; it is key to people living healthier and happier lives in our communities. I welcome Alison Thewliss to her post as Minister for Community Care; she has many challenges to deal with. For example, at the start of May, 9,572 people were waiting for either a social care assessment or a social care package. Health and social care partnerships had to make cuts to local care services of more than £500 million, and that figure is expected to be worse this year. The cabinet secretary and her new minister will need to intervene urgently if the present crisis is not to deepen.
It has come after five years of our asking for care workers to be paid at least £15 an hour, but I welcome other parties’ new-found commitment to doing so. We cannot expect to recruit and retain social care staff when they could be paid more for stacking supermarket shelves.
The minister has rightly thanked NHS staff for their hard work. The NHS and social care would be nothing without dedicated staff, but the reality is that front-line staff feel demoralised and burnt out, and some of them are voting with their feet.
[Made a request to intervene.]
Neil Gray is the past health secretary—he can sit down.
She knows what I am going to say.
Perhaps he should listen.
A recent survey by the Royal College of Nursing found that seven in 10 nurses felt that staffing levels on their last shift were below or well below what was needed. The organisation’s latest report, which was published in May, warned that
“Scotland cannot build the sustainable nursing workforce that it urgently needs by asking staff to continue to work short-staffed and under relentless pressure while feeling demoralised and undervalued.”
The same could be said of the consultants, GPs and resident doctors who are leaving the country because they cannot get specialty training places. That is true for a range of allied health professionals and for social care staff.
The cabinet secretary must urgently implement a 10-year workforce plan that covers everything from training and recruitment to retention and career progression. That workforce plan must be combined with a drive to cut out unnecessary bureaucracy, streamline data and invest in up-to-date equipment—for example, investing in 24/7 thrombectomy services would allow staff to treat more patients more effectively.
In closing, I offer a plea to the cabinet secretary: change the culture of the SNP Government; be open, be transparent, admit mistakes and just occasionally listen to the Opposition, who have the shared interests of the NHS and social care at heart; and above all, listen to the staff. We have the best staff in the world—if only they could get on with the jobs that they are trained to do. Their resilience, hard work, motivation and innovation should be an inspiration to us all. I urge the Scottish Government to learn from them and get on with delivering for the Scottish people.
I move amendment S7M-00228.4, to leave out from “recognises” to end and insert:
“thanks hard-working NHS and social care staff across Scotland for their care and dedication; commends them for the progress made in recovering services despite the Scottish Government’s failure to meet its own promises, and believes that protecting and renewing Scotland’s NHS for the next generation requires a proper emergency waiting times plan with funding that follows the patient, embracing new technology to improve productivity and patient experience, prioritising primary care and delivering proper investment in social care, which will not only reduce pressure on acute services but support healthier and happier lives in the community.”
14:41
I welcome the cabinet secretary and her ministers to their new roles.
I begin by recognising the extraordinary dedication of our health and social care workers across Scotland. Every day, doctors, nurses, allied health professionals, porters, cleaners, administrators, care workers and countless others provide care, compassion and expertise in extraordinarily challenging circumstances. They deserve our thanks, but they also deserve honesty. If we are serious about investing in, protecting and renewing our NHS, we must recognise the fundamental truth that the challenges that our hospitals face cannot be solved within hospital walls alone.
The Scottish Greens have long argued that health is not simply about what happens when someone reaches an A and E department, joins a waiting list or goes to their GP. Health is shaped by whether someone can afford to heat their home, whether they have secure housing, whether they can access nutritious food, whether they are supported in their communities and whether they can get help before a crisis develops.
That is why our amendment highlights the need to reduce health inequalities and tackle poverty alongside reforming health services. We must also focus on prevention, community services and reducing those health inequalities, not simply managing illness after it has taken hold.
Too often, the people who rely most heavily on NHS services are those who have been failed elsewhere. We see the consequences of poverty in our hospitals, those of poor housing in our GP surgeries and those of precarious work in our mental health services. If we ignore those realities, we will never relieve the pressure on our NHS workforce.
That is particularly true in the north-east. Constituents across the region that I am privileged to represent continue to experience challenges in accessing healthcare, while NHS Grampian and NHS Tayside face significant workforce pressures, recruitment difficulties and growing demand. Rurality, ageing populations and the challenges of retaining staff in key specialties all place additional strain on services. The staff working in those board areas have continued to deliver under immense pressure, but they cannot be expected to carry ever-increasing burdens without the support, investment and long-term planning that they need.
That brings me to workforce planning. For years, professional bodies, trade unions and staff have warned that Scotland lacks the long-term workforce planning that is needed to meet rising demand. We need a sustainable workforce strategy that supports staff today while building the workforce that we will need tomorrow. That means investing in education, training and career development and creating more routes into health and care professions, including high-quality apprenticeships. The Royal College of Occupational Therapists has highlighted the importance of those things in building a sustainable workforce and addressing future staffing needs. However, workforce planning is not simply about numbers; it is also about valuing people.
The Royal College of Nursing has highlighted the continued pressures that nursing staff face with many reporting exhaustion, unsafe staffing levels and care being compromised because demand exceeds capacity. The British Medical Association has similarly raised concerns about doctors’ wellbeing, burnout and the need for workplace cultures that support staff rather than pushing them beyond breaking point.
I acknowledge the work that was done earlier this year to avert industrial action by doctors and to engage constructively with staff representatives. Meaningful dialogue, fair pay and staff wellbeing matter, and creating workplaces where concerns can be raised openly and safely matters, too. A sustainable NHS depends on valuing every part of its workforce.
Too often, discussions about NHS leadership focus solely on a narrow group of professions, despite the enormous contribution that is made by allied health professionals. Physiotherapists, occupational therapists, speech and language therapists, radiographers, podiatrists and many others play a vital role in helping people to recover and to maintain independence, and in enabling them to avoid unnecessary hospital admissions.
The Allied Health Professions Federation Scotland has rightly called for genuine representation of allied health professionals at every level of leadership and decision making, alongside creating parity of esteem with nursing leadership. If we want services to be designed around prevention, rehabilitation and person-centred care, the voices of those allied health professionals must be present wherever decisions are made.
Perhaps nowhere is the connection between workforce pressures and patient outcomes clearer than in social care. For too long, social care has been treated as the neglected partner of the NHS, yet delayed discharge, pressure on hospitals and growing waiting lists are all connected to a care system that is underfunded and undervalued. Care work is skilled work, and it is essential work. It enables people to live independently, with dignity and choice. It supports families and prevents avoidable hospital admissions, and it helps to ensure that people can leave hospital safely when they are ready to do so.
That is why our amendment calls for social care workers to be paid at least £15 an hour. For the Scottish Greens, good care and fair work go hand in hand. We cannot build a resilient care system on low pay, insecure contracts and workforce shortages. If we truly value care, we must value the people who provide it.
The NHS remains one of Scotland’s greatest collective achievements, and protecting it means more than funding hospitals. It means investing in prevention, tackling poverty, reducing inequality, supporting staff wellbeing, strengthening social care, creating sustainable career pathways and valuing every member of the workforce. If we want a renewed NHS, we must also build a fairer Scotland.
That is the spirit of the Scottish Greens’ amendment, and I urge colleagues to support it.
I move amendment S7M-00228.2, to insert at end:
“; recognises that issues in hospitals cannot be solved without addressing the crisis in social care, reducing health inequalities and tackling poverty; believes that social care workers should be paid at least £15 an hour, and calls on the Scottish Government to address long term workforce planning to support current staff and patients.”
14:48
I welcome the cabinet secretary to her new role in government, and I look forward to working with her in that role. The cabinet secretary and I, as Lothian MSPs, have worked cross-party during all the time that I have served in Parliament, mostly on health issues. I think that it is important that MSPs, as part of their job, are able to speak to cabinet secretaries about issues. I very much look forward to working with the cabinet secretary on such issues, and I welcome both Maree Todd and Alison Thewliss to the health team as well. I pay tribute to Neil Gray, because health secretary is probably one of the hardest jobs in government.
Those of us who have returned to Parliament have, I hope, taken a bit of time to reflect on what we, as MSPs, can do. One of my greatest concerns is the fact that most of my time has been spent as an advocate for patients who, for some—or no—reason, have not been able to access services. New members will find that lobbying for people to access our health service is sometimes one of the hardest aspects of the job. That should not be happening in Scotland today. I hope that the start of this parliamentary session gives us an opportunity to genuinely change that. I thank Neil Gray, because a lot of the work that I did behind the scenes with him was lobbying for constituents to get what they should have been entitled to. I also thank the many health organisations and charities that have reached out to me and I look forward to working with them over this session of the Parliament.
I am pleased to lead, once again, for the Scottish Conservatives on health and care. I served in the role between 2016 and 2021 and I relish taking it up again. I have to say that it feels as though not a lot has changed during the time that I did not have this portfolio. From speaking to many health representatives, I know that there is a sense of frustration about the lack of reform. We need to focus on a number of priorities that can make a real difference. The Scottish Conservatives have a number of priorities in this session. I have always been a proud advocate for our wonderful hospice sector, as were colleagues Bob Doris and Marie McNair in the previous session of the Parliament. I raised the issue in my first speech in the Parliament when I spoke about the love and support that was given to me and my family when my mum died from cancer when I was just seven. We should all celebrate the hospice movement in our country and we should all want to see it improve and grow.
The national debate about assisted dying and access to palliative care services, which took place prior to the 2026 elections, resulted in cross-party support in all our party manifestos that were developed for the election. In those manifestos, we looked towards how we would take forward new funding models for the hospice sector and the delivery of palliative care services in each of our communities, in order to support people across our country. I welcome the progress that has been made. The publication of the “Palliative Care Matters for All” strategy is a welcome step forward, with the principle that anyone who needs palliative care should be able to access the best quality support. I welcome the progress on pay parity, for example. I believe that the cabinet secretary now needs to look towards a vision that we should all have for Scotland, by the end of this session, to be the best country in which to access palliative care. I welcome the cabinet secretary’s opening comments in the debate. We should all be able to collectively agree on the establishment of cross-party work with the sector to develop a new funding model for hospices, to ensure that annual public funding keeps pace, and to agree on the need to guarantee that pay parity be maintained throughout this session of the Parliament.
I will touch on a number of aspects where I think reform needs to take place, notably in relation to the third sector. Although, quite rightly, the Scottish Government talks about the importance of the third sector, we look too often at the third sector as a place where we can make cuts. If the Government is looking at where it can make changes and reform the health service, I am concerned that the third sector, as it has always been under the integration joint boards, will be the first point of contact. For example, the Scottish Huntington’s Association provides a nationwide specialist service for families that have been impacted by Huntington’s disease. Statutory funding is typically provided only on a 12-month basis via a patchwork of scores of local funders that have different reporting requirements. Often, funding is not confirmed for those services until a new financial year has started. That provides complete uncertainty for front-line staff and, more importantly, for vulnerable service users, there is an annual fight to keep the services that they rely on simply to live. We need to look at reforms such as regional commissioning as positive solutions. I hope that the cabinet secretary can investigate that sort of model and look at how it could be taken forward in any reform that the Government is minded to introduce.
I also think that we have a great opportunity. All members who will cover the health portfolio over the next five years will stand up and talk about how we need to look towards the preventative health agenda. I pay tribute to my former colleague, Brian Whittle, who used to bring that to the chamber almost weekly. In order for the Government to achieve preventative health goals, we will need to look not only at the NHS doing that, but at other providers and our whole system doing it. Education is at the heart of that. We need to look at how we adapt and deploy innovation, including cutting-edge treatments and vaccines, and ensure that those are seen as a strategic investment, rather than a cost.
We are lucky, as a country, to have a pipeline of innovation highly aligned to the needs of our Scottish health system. There is enormous potential there. I grew up in Perthshire, and I very much welcome Helen McDade to her position as Reform health spokesperson. I have known Helen for many years, and her advocacy around ME shone today in the chamber. It is important to note that, when I was young and growing up in Perthshire, Perth royal infirmary was seen as a university hospital; it was aligned to treatments and it pushed our health service. Nowadays, it feels like our health service is simply trying to keep up. I hope that we will see a change in attitude that once again aligns our health service to our university sector, which will help with many of the Government’s outcomes, especially around economic growth.
I will close for the Conservatives later, so I will make some comments on members’ opening or first speeches then. To conclude for now, I hope that this session can genuinely be one in which we work together towards a more sustainable NHS for all of us. We all rely on our NHS, and those of us who are lucky to serve our constituents here need to ensure that it works.
We come to the last of the opening speeches. I call David Green to make their first speech.
14:56
Thank you, Deputy Presiding Officer. I congratulate you on your election, and all other members on theirs.
Like many new MSPs, I will begin by putting on record my thanks to my family, friends and supporters for helping to send me here. The responsibility to now represent everyone across Caithness, Sutherland and Ross is one that I take seriously. Over the past few years, people have shared with me their stories, their hopes and their worries—worries that all too often centre on the struggle to access healthcare close to home, particularly for women. It is therefore fitting that I will make my first speech in a debate on the NHS.
Before I make progress on that, however, I wish to pay tribute to my predecessors. John Buchan, the Scottish author, historian and statesman, viewed public service not merely as an administrative duty but as “the worthiest of ambition” and the highest, most honourable adventure. I am honoured to begin that adventure and to follow in the liberal traditions of Bob Maclennan, John Thurso, Charles Kennedy and the only other Liberal Democrat MSP to represent this remarkable constituency, Jamie Stone, whose public service is recognised on every doorstep. All of us have a shared common belief that the best decisions are made when local people are empowered to make them. That principle must guide how we reset this Parliament and our politics. The Liberal Democrats will work constructively with the Government and members from across the chamber to advance that cause.
I also pay tribute to Gail Ross, who is fondly remembered here, particularly as a strong advocate for rural proofing—an issue that I intend to champion in the years to come—and to Maree Todd, whom I congratulate on her return to Government. I thank her for her warm words to me and to my parents, who are in the public gallery this afternoon. I further put on record my thanks to the members sitting beside me, who paved my way to this Parliament. I thank Alex Cole-Hamilton and Willie Rennie for their boundless leadership, and my good friend and former boss here at Holyrood, Liam McArthur, for his many years of mentorship. It is a privilege to sit alongside them now as part of the largest Liberal Democrat group in nearly 20 years.
Caithness, Sutherland and Ross is Scotland’s largest constituency. It presents particular challenges, with sparsity of population, distance and severe winter weather all demanding a different approach to the delivery of services. Let me therefore be clear: what works in the central belt will not always work in the Highlands, particularly where healthcare is concerned. No issue speaks more to that sense of being forgotten and misunderstood than the downgrading of maternity services in Caithness. Surely all members can agree that it is not acceptable that mums-to-be in the far north must travel 100 miles-plus in order to give birth in hospital in Inverness. Many families have shared their stories with me—the fear of battling through winter snow, the trauma when emergency transfer plans go wrong and the anxiety about whether they could ever face having another child under such circumstances.
The cabinet secretary, who I congratulate on her appointment, will be aware that the situation has attracted international attention, with the Caithness Health Action Team taking its case to the United Nations, following a report by the Scottish Human Rights Commission that found that mothers felt “unsafe” and “terrified”. The Caithness Health Action Team has led the campaign with real determination. I am pleased to put on record my thanks to Ron Gunn, Iain Gregory and Maria Aitken for their outstanding leadership.
The cabinet secretary will also be aware that, last November, the Parliament voted for a Liberal Democrat amendment that called for an independent review of maternity services in Caithness. That review must involve a chair who is independent of NHS Highland and the Scottish Government, as well as a real commitment to community-led engagement.
The cabinet secretary has confirmed that she will deliver a statement next week, which I welcome; however, I urge her today to provide my constituents with a clear commitment on those points and the recognition that they have waited for far too long.
On Friday, friends and family of the late Jim Wallace will meet in Dunblane to celebrate his life. Jim was an architect of devolution and a politician defined by his ability to build agreement and respect those with whom he disagreed. In his last contribution in the chamber, he said:
“At a time when politics can be so polarising, surely a common commitment to service, whatever our faith or creed, is something that can unite us.”—[Official Report, 29 October 2024; c 2.]
I hope that the Parliament will rise to the challenge that Jim set us. For my part, I commit to doing my very best.
We move to the open debate. I call David Linden, who is making his first speech in the Parliament.
The rest of this Official Report will be published progressively as soon as the text is available.