Meeting of the Parliament

Meeting date: Tuesday, December 6, 2022

Official Report 991KB pdf

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Topical Question Time

The next item of business is topical questions. Any member seeking to request a supplementary question should press their request-to-speak button during the relevant question or indicate that by entering “RTS” in the chat function. As always, I make a plea for succinct questions and answers to match.

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Group A Streptococcus

To ask the Scottish Government whether it will provide an update on Strep A cases in Scotland, including what it is doing to mitigate any risks. (S6T-01020)

A number of children in England and Wales have, sadly, died from invasive group A strep—GAS—infections since September. My deepest condolences go out to their families during this unimaginably difficult time.

Reports of GAS have increased across Scotland, but there have been no reported deaths in Scotland related to that or, indeed, to invasive GAS infections. I understand that the reporting of GAS infections will be concerning. I can offer some reassurance. The vast majority of GAS infections present as mild illness that is easily treated by penicillin or other antibiotics, and invasive infections are, thankfully, very rare. Peaks in the numbers of GAS infections are expected during winter and spring, and there are typically spikes every three or four years. Current numbers do not significantly exceed previous spikes.

Nonetheless, we are not complacent. Health services across Scotland are on alert and will act swiftly to identify and treat GAS infections. Guidance has been prepared for nurseries and schools, particularly in relation to maintaining good hygiene and managing outbreaks, and everyone affected should self-isolate until they have completed 24 hours on antibiotics.

I will provide a further update if needed, but I stress again that the vast majority of cases are, thankfully, mild and easily treatable.

Strep A symptoms include a sandpaper-like rash, flu symptoms—such as a temperature over 38°C, a sore throat and swollen glands—and a strawberry red-looking tongue. I urge people who have such symptoms and, in particular, those with children under 10 with symptoms to speak to their general practitioner, because antibiotics can very much help in such cases.

In the House of Lords yesterday, the option of using antibiotics as a preventative measure in schools in which there are cases was raised. Is the Scottish Government actively considering prophylaxis?

I have asked Public Health Scotland and my clinical colleagues to give advice to that effect. As I said, the GAS infections that we are seeing are, thankfully, not invasive; they are mild. Current levels have not exceeded the peak levels that we have seen in previous years, and there have, thankfully, been no deaths in Scotland so far, but we are not complacent. We expect case numbers to rise over the coming weeks, which is why I have asked clinicians to give advice on the very issue that Sandesh Gulhane has raised.

I have spoken to multiple patients in my GP surgery who are concerned about Strep A and their children’s health. Parents’ concerns are only exacerbated when they know that, if their child gets sick, they will struggle to get an appointment with their GP, will spend hours waiting during calls to NHS 24—many people hang up in frustration—or will spend even longer in an accident and emergency waiting room.

Today, the worst-ever A and E waiting times have been published, with one in 20 people waiting more than 12 hours. Can the cabinet secretary promise patients that they will not spend 12 hours-plus in an A and E waiting room this Christmas?

Public Health Scotland has issued an alert to healthcare services in Scotland, including clinicians in primary care, so that they are aware of the increase in the number of group A Strep infections and of the potential severity and complications of such cases. That includes the recommendation that primary care clinicians use a low threshold when prescribing antibiotics, as penicillin is the first-line therapy for children who present with features of GAS infection.

I saw some media reports about potential shortages of amoxicillin in other parts of the United Kingdom. I have checked with my clinicians and the chief pharmaceutical officer, and she advises that there are no shortages of penicillin. Therefore, I am confident that, if people—particularly parents—raise cases with their GP, they will be seen and given the appropriate treatment.

A couple of weeks ago, Glasgow’s Royal hospital for children warned parents about attendance at A and E. As we have already heard, this morning’s statistics reveal that our emergency departments are under incredible pressure. Will the cabinet secretary explain what additional capacity and guidance have been provided to health boards to ensure that children who take unwell can be seen without any delay?

Jackie Baillie asks a very important question. First and foremost, as well as Strep A, other respiratory viruses in children are resulting in the increase in attendance at children’s hospitals. That is borne out in the statistics that have been released today, which Jackie Baillie is right to mention.

As I said in my answer to Sandesh Gulhane, we are supporting all our healthcare services. NHS 24, for example, told me that, over the weekend, there was a significant increase in the number of calls about children under the age of 14, so all our healthcare services, right across the board, are being given appropriate advice about the advice that they can give to parents and others who call in with concerns about Strep A. That applies not only to NHS 24 but to services right across the board, including our accident and emergency services.

If people have concerns and need more information about the signs and symptoms of Strep A, that information is available online. First and foremost, people should go to their primary care clinician—their GP—who should be able to treat the condition with antibiotics.

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Local Government Budget

To ask the Scottish Government what its response is to reports that local government directors of finance have written to the finance secretary regarding an unprecedented £1 billion budget gap, and of the Convention of Scottish Local Authorities stating that the current spending plans will lead to job losses. (S6T-01023)

The autumn statement did not do enough to support devolved budgets to address the 41-year-high inflationary pressures that are impacting Scotland’s families, businesses and public services. I have already taken the unprecedented step of making an emergency budget statement to Parliament to reprioritise more than £1.2 billion of expenditure. Although most portfolios were required to make savings in that exercise, ministers took a conscious decision to protect local government, and the funding available to councils actually increased. Despite that, Parliament should be under no illusion that we are facing the most challenging budget circumstances since devolution. I will set out the financial support for local government in the Scottish Government’s budget next Thursday.

Right now, across local government, 6,000 jobs are at risk amid a cost of living crisis. Earlier today in my region, Falkirk Council’s executive was asked to agree to sell off 131 public buildings, including swimming pools, Grangemouth stadium, sports halls, gyms, village and community halls and park buildings—they are all to be sold to fill the council’s deficit and, with that, keep 200 jobs. Given the scale of the crisis engulfing local government, does the cabinet secretary acknowledge the seriousness of COSLA’s calls, and will he commit to looking again at the current spending plans for local government?

I recognise the gravity of the financial challenge. I am faced by that every day in wrestling with the Scottish Government’s budget just now. I am dealing with the profound implications of inflation, public sector pay and energy costs, and those implications will be felt by public bodies the length and breadth of the country. Last week—I think that it was on Friday—I met COSLA leaders to hear their views on the Scottish Government’s budget, and my officials followed up that discussion on Friday with supplementary discussions. As I said in my earlier answer, I will set out the financial support for local government in the Scottish Government budget next week.

I look forward to seeing that.

It is not politicians who are flagging up this financial black hole; it is directors of finance who are saying that they are £1 billion short. It is the Scottish National Party COSLA president who has told us that the Scottish Government spending plans as they stand will see council services

“either significantly reduced, cut, or stopped altogether”.

It is the SNP COSLA resources spokesperson who has talked about councils stopping preventative spending, saying that that will end up costing the NHS “significantly more money”.

The directors of finance have asked for the shackles of ring fencing to be removed. Will the cabinet secretary agree to that and ensure that local government has the fullest flexibility to cope with the cost of living crisis?

As Mr Griffin will know, when I set out my first budget to Parliament in 2007, I took decisive action to reduce ring fencing. I acknowledge that ring fencing has come back into a number of areas, but that is largely to assure the Government and, indeed, the Parliament that expenditure that is decided on in Parliament is deployed by local authorities on particular policy priorities. That applies particularly to the challenges that we face in relation to social care, where the Government is allocating substantial additional revenue. However, delayed discharges are at their highest level in our hospitals today, and that is a result of issues in the social care system. Therefore, there are tough issues to be wrestled with here.

Mr Griffin cited the letter from the directors of finance and the point on ring fencing. Another point that the directors of finance made to me, and which is part of the dilemma that we all face, is that they asked for the Barnett consequentials from the United Kingdom Government to be targeted to support the vital services that local government provides.

If I followed that, no extra money would be given to the health service, and I do not for a minute believe that that is what Mr Griffin wants. I have to take a balanced position. I cannot do everything that is asked of me in the letter, because it would be impractical to do so and would starve the health service of resources, and I do not think that anyone in Parliament wants that to be the case.

The local government core settlement has seen a real-terms reduction of 15.2 per cent since 2013-14, with COSLA noting in March that increasingly directed funding and pressure on core budgets mean that councils have limited flexibility. Council leaders are saying that there is nothing else to cut and we also know now that the national care service will destabilise the planning and delivery of services within local government. Is the cabinet secretary looking at pausing the national care service, given all the pressures that local government is facing and the disruption that it will bring?

For all the reasons that I set out in my last supplementary answer to Mr Griffin, the national care service is an important reform to ensure that we can make progress in addressing the challenges, which I think that all parties are agreed on, in the delivery of social care in Scotland. Therefore, the Government will take forward those proposals. They are the subject of consultation and dialogue. We are listening very carefully to what parliamentary committees say in relation to the national care service and we will take forward the steps that the Government has already announced.

I understand that the directors of finance in local government have written to ministers calling for financial sustainability for local authorities. Would the Deputy First Minister agree that financial sustainability would be helpful for our councils and the essential services that they provide to people and communities?

I agree with that point. The Government has increased local authority funding to the tune of 23 per cent since 2013-14. We have treated local authorities fairly. There is a real-terms increase in local authority funding of 6 per cent in the budgets from last year into this. We do all that we can within the resources available to us to ensure that local government is properly funded.

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Scottish Government Budget 2021-22 (Underspend)

To ask Scottish Government what its response is to comments from the Auditor General that it underspent its budget by £2 billion in the financial year 2021-22. (S6T-01018)

The Scottish Government annual accounts provide explanations of all significant variances in the portfolio outturn statements and make it clear that the underspend that was reported does not represent a loss of spending power. The underspend includes more than £900 million of non-cash and ring-fenced budgets, is before allowing late funding adjustments of more than £500 million and makes use of the limited carry forward in the Scotland reserve. The Scottish Government has reported transparently on the carry forward position at the provisional outturn and will confirm the final outturn position to Parliament shortly. All funding is fully utilised in supporting the 2022-23 budget.

This Scottish Government is always telling us that it does not have enough money to spend, despite the fact that we know that in the current financial year it has the highest budget ever in the history of devolution. Now we know from the Auditor General that it underspent last year’s budget by £2 billion, so what is the carry forward to this year’s budget from that underspend and how much of the money that was not spent last year represents funds that came from the United Kingdom Government for Covid support, which was not spent on Covid support but siphoned off elsewhere?

First, I make it clear to Mr Fraser—I thought that my original answer had done so, but I will say it again just to make sure that I can make an impact on his presentation of all of this—that £900 million of the underspend reported by the Auditor General relates to non-cash and ring-fenced budgets that the Government cannot spend on other items. It is in relation to annually managed expenditure, which is in the control of the UK Government, and student loan support, which can only be used for student loan support on a demand basis and we cannot redirect it to anywhere else. Those are basic points—really, really basic points—about the public finances, which I would have thought that Mr Fraser might have understood, given the length of time that he has been in this institution.

We assumed, when the budget was passed in the spring, that £450 million would be carried forward into this financial year. That had risen to £550 million by March. I assure Mr Fraser that the underspend that was reported does not represent a loss of spending power in any respect by the Scottish Government.

I notice that the Deputy First Minister did not address the question of Covid support funds being siphoned off elsewhere.

Last week, the Auditor General also called for greater financial transparency from the Scottish Government and for it to fulfil its commitment to produce a consolidated account for the whole public sector in Scotland. Will the Scottish Government fulfil that commitment and, if so, when?

In relation to Covid spending, the Government has spent in excess of the Covid consequentials that have been allocated to us. There was another comment of the Auditor General that Mr Fraser did not cite. He said:

“My independent audit opinion is unqualified. This means in my opinion, I am content the Scottish Government Consolidated Accounts show a true and fair view, following accounting standards, and that the income and expenditure for the year is lawful.”

I would have thought that that would be quite reassuring for Mr Fraser, as a law-abiding citizen, and would provide confidence that, not for the first time, the Government’s accounts have attracted an unqualified opinion. We have had unqualified opinions for our accounts for every single year that the Scottish National Party Government has been in office. That should be a source of great reassurance to Mr Fraser.

On the point about transparency, the Auditor General said:

“The Scottish Government has continued to strengthen aspects of its governance arrangements during 2021/22.”

We will of course consider all the recommendations of the Auditor General as we take forward our accounting practices.

The two richest families in Scotland have more wealth than the poorest 20 per cent of the country. The Scottish Government often says that it has a fixed budget, but has the cabinet secretary had the opportunity to consider the Scottish Trades Union Congress report that was published this week, “Options for increasing taxes in Scotland to fund investment in public services”, which outlines short-term measures that could be taken to raise more than £1 billion for public services, and longer-term measures that could be taken to raise many more billions of pounds?

I am familiar with that report, and I am considering it as I come to take the final decisions in relation to the tax choices that the Government will make and set out to the Parliament next Thursday.

I should make it clear to Katy Clark that, in this financial year, the Government’s budget is fixed; once we have set our tax rates, they cannot be revisited during a financial year. Unless there are consequential decisions taken by the UK Government during a financial year, our budget is locked in. That is the difficulty that I am wrestling with in relation to finding adequate resources to fund the pay claims that we are facing during this financial year.

There is a hard limit on the money that is available this year. Katy Clark raises a completely legitimate set of issues about future tax choices, but, for this financial year, the budget is fixed.

This has been a turbulent year, thanks not least to the economic mismanagement of Murdo Fraser’s chums in Westminster. It is therefore welcome that the Scottish Government has delivered on the requirement for a balanced budget. Can the Deputy First Minister advise the Parliament whether additional fiscal flexibilities would have enabled the Scottish Government to respond even better to the pressures that households and businesses across Scotland are facing as a result of rising costs?

Mr Kidd raises a topical point in relation to the mismanagement of the public services. At the Finance and Public Administration Committee this morning, the chair of the Office for Budget Responsibility revealed that there would be an extra £40 billion-worth of debt due to the fiscal mismanagement of the Conservative Government during the course of the past few weeks. That is £40 billion-worth of debt with which we will all be saddled by 2027-28. There is no escaping the financial implications of that for us and our citizens, and the Government’s budget will be constructed to try to address those issues.

However, Mr Kidd can be assured that the Government is giving every attention to the challenges that he raises in his question. We will do all that we can to address the cost of living challenges that are faced by members of the public the length and breadth of our country.