The final item of business is a members’ business debate on motion S6M-17486, in the name of Brian Whittle, on securing the long-term sustainability of Scotland’s health service. The debate will be concluded without any question being put.
Motion debated,
That the Parliament welcomes the publication of the Scottish Fiscal Commission (SFC) 2025 Fiscal Sustainability Report, which was published on 22 April 2025; notes with concern that the report indicates the potential for growing fiscal pressures over the next 50 years, largely due to the combination of Scotland’s ageing population and increasingly poor public health driving up health spending; understands from the research that health spending, which is already the largest area of spending within the Scottish Budget, is projected to grow from 34% of devolved public spending in 2029-30 to 47% by 2074-75; notes the analysis indicating that, as a result of demographic change, the Scottish Budget will face a significant challenge within the next 20 years unless action is taken soon to address rising levels of preventable illness, including long-term chronic conditions; further notes the view that, without any intervention, the worst case scenario set out by the SFC would leave a future Scottish administration being forced to choose between cuts to the health service or sacrificing other public services to sustain health spending; considers that helping people across Scotland, including in the South Scotland region, to live longer, healthier lives can reduce growth in healthcare costs as the population ages; notes the belief that this can be achieved through the delivery of a robust, preventative health agenda, integrated across multiple policy portfolios, that promotes inclusion, physical activity and good nutrition; further notes the view that it is essential for the Scottish Government to set out how it proposes to address the issues identified in the 2025 Fiscal Sustainability Report, in particular the specific steps that it will take to address the forecast gap resulting from poor public health, and notes the belief that politicians from across the political spectrum must have a shared commitment to improving public health if that goal is to be achieved.
17:22
I thank members from across the chamber for supporting my motion so that the debate could take place.
Members will recognise that I have been known to argue that the solution to most problems in our society is to go for a run. Today, however, I will not make that argument; instead, I will set out why improving public health is the solution to many, if not most, of the intractable long-term issues that our economy faces. I will, of course, weave into my argument the importance of being physically active.
The Scottish Fiscal Commission’s 2025 “Fiscal Sustainability Report”, which was published in April this year, set out that Scotland’s annual budget gap is set to widen in the coming decades, and that that is being driven in no small part by an ageing and less healthy population. The fact that the population of Scotland is predicted to age more quickly than that of the United Kingdom as a whole means that those pressures will arrive with us more quickly.
As a society, we are living longer, which is welcome, but there is a difference between life expectancy and healthy life expectancy, which is the number of years for which someone can expect to live in good health. Scotland’s average healthy life expectancy recently fell to a near 10-year low, with women expected to have 60 years of good health and men 59.6 years. Across the country, there is huge variation in healthy life expectancy. In North Ayrshire, men and women can expect to have around 52 healthy years of life, while people in Perth and Kinross can expect to have at least 13 more healthy years than that.
As we live longer, we are likely to spend more years in poor health, which means more years with chronic illness, disability or dependence on others for care, all of which comes at a price. The demand on the national health service grows as more people need more treatment for longer. Social care and welfare costs rise as more people are unable to work or care for themselves. On the other side of that coin, economic activity, productivity and tax revenues decline as the size and health of our working-age population declines. It is a vicious cycle and, as the SFC’s report makes clear, we must act to arrest it now if we are to have any hope of avoiding crippling budget challenges in years to come.
Healthcare already accounts for a major percentage of Scotland’s total budget. If we do not take tough decisions today, we risk our successors in the Parliament having to make impossible decisions a few years from now. The biggest opportunity for change is to reduce the demand for healthcare by increasing our healthy life expectancy. There are many ways in which to achieve that aim, but any approach must include reducing obesity, promoting a healthy diet and widening opportunities for activity. It means tackling poverty, improving our housing stock, making better use of education—not only to promote a healthy lifestyle but to create new opportunities—and, of course, increasing participation in sport and physical activity.
Over the summer, working with the think tank Enlighten, I published a paper that is aimed squarely at preventing illness. It sets out how we can embed prevention within our education system and make better use of the facilities and resources that we already have to prevent illness and to ensure that members of the next generation live longer, healthier lives.
We must encourage change not only among young people. The SFC tells us that the greatest challenge for our economy will come as those who are currently in their 30s and 40s reach old age. Although those who are over 55 at the moment are most likely to drink and smoke to excess, those in the generation below them are struggling with obesity, inactivity and a more sedentary lifestyle. Even a small change in habits today can have an outsize effect on health outcomes down the line. The biggest factors by a long way in a person’s long-term health outcomes in later years are their VO2 max, which is their ability to absorb oxygen, and their muscle mass in the middle years. Those two things can be improved if relatively small actions are continued over time, which is why I am such an advocate for a concerted shift towards prevention now. The sooner we act, the better.
Why is it so hard to make that change? First, prevention is, by its very nature, hard to measure. It is far easier to say how much we are spending on treating cancer or supporting people who are dealing with addiction than it is to say how many cancers have been prevented by improving people’s diets or how many people took a different path because a community organisation got five years’ guaranteed funding. Secondly, when the health and social care sector is under so much pressure, many within it are naturally resistant to the idea of any of the money that they are spending now being diverted towards prevention.
I suggest that prioritising one element does not necessarily mean deprioritising another. Rather, it might reduce the need in certain areas. That would have to be a gradual shift and not an overnight change but, because it would be gradual, we must begin the process now if we want to maximise its impact. We must be ready to overcome the resistance to changing priorities within the NHS and must accept the need to shift the less-effective elements of the existing spend to prevention.
Almost every aspect of what the NHS does today could be argued to be essential, but the judgment that we must make is not whether something is essential but whether it is effective. That criterion of effectiveness is crucial. Too often, the most effective long-term approach loses out to the one that is more politically expedient or cheaper today, even if that means a higher cost tomorrow. Equally, those of us whose role is one of scrutiny can be guilty of having our own reasons for choosing the path of opposition over collaboration. Short-term thinking tends to result in long-term losses, and although the nature of politics means that we will not—and, indeed, should not—agree on everything, we are in danger of losing sight of anything that is not on our immediate horizon.
The Scottish Fiscal Commission’s report lays out in stark detail the consequences of continuing down that short-term path when it comes to the intersection between health and our economy. Health is far from being the only factor that will influence our future fiscal position, but many of the other factors are, for better or worse, outside our control. Healthcare and the health of our population are very much the responsibility of this Parliament. As is true of anyone’s efforts to improve their own health, improving the nation’s health is not something that we can achieve instantly with one action; it is the result of a lot of small changes that work together, over time, to achieve a cumulative effect.
That end result has the potential to be transformational. We could see improved productivity thanks to a healthier workforce, an end to the seemingly ever-growing number of people who are condemned to a life on welfare because of preventable illness, and fewer people struggling with poor mental health. We could also take the pressure off Scotland’s NHS, better allowing it to see beyond the immediate future.
Taken together, those steps would give us a genuine chance to address the fiscal threat that the Scottish Fiscal Commission has set out and would take us at least some way towards closing the looming budget gap. Even more importantly, they would enable us to help more people in Scotland to live longer, healthier lives. Ultimately, if we in this chamber cannot find a way to focus on long-term gain for the country, how can we hope to convince the public to do the same for their own health?
We move to the open debate.
17:29
I thank Brian Whittle for lodging his motion on a hugely important subject that he has consistently—and rightly—raised over his time on the Health, Social Care and Sport Committee, which both of us have been members of during this and the previous session of Parliament.
It will be a challenge to cover the diverse issues in fower minutes, but I wanted to highlight some of the work of the Non-Communicable Disease Alliance. In Scotland in 2022, 53,000 deaths—about 85 per cent of all deaths—were attributed to non-communicable diseases.
The Government and the professionals who deliver public health policies from day to day place a huge emphasis on preventative healthcare. That cannot be overstated. However, for much of its early existence, our health service was mainly reactive, due partly to the economic circumstances and post-war austerity and partly to the medical technology that was available for front-line professionals. In recent decades, there has been a quantum leap in the technology and science that are available for our front-line staff to deploy where they need it.
I witnessed the advances in technology when I worked for the NHS as a registered nurse. I am still a registered nurse, and I like to keep up with the inventions and the on-going tech. Today, our healthcare staff have access to an incredible and efficient range of diagnostic tools. Blood samples can be taken from patients, tested and analysed rapidly—that includes immediate point-of-care testing and rapid results. The scale at which testing and screening can take place has increased almost exponentially. Magnetic resonance imaging and CT scans are absolutely routine across the country, and labs operate around the clock. The fact that mass screening programmes are deployed across the country to thousands of people allows for much earlier diagnosis and treatment.
There has also been an incredible development of vaccines across our population. Many of us will have memories of seeing those who survived polio but were left disabled by its effects. Thousands died from the polio virus every year, with little hope of treatment and no vaccine to prevent the disease in the first place. Mass vaccination has saved thousands of lives and saved tens of thousands of people from long-term health conditions that would affect their quality of life and demand increased care and support from our healthcare system.
That is why the purposeful disinformation on this side of the Atlantic—and, sadly, from the heart of Government on the other side of it—is so dangerous. Already, drops in vaccination rates in some areas of England have resulted in measles outbreaks. Measles isnae a benign virus; it is a serious and potentially deadly one.
I agree with Brian Whittle that the projected scale of funding for our health service over the next five decades is, in some ways, pretty terrifying. Fifty years ago, back in the 1970s, the idea that we could have the capacity or the technology to vaccinate every two-year-old against flu, to rapidly develop new vaccines for threats such as Covid-19, to begin to eliminate cervical cancer through the human papilloma virus vaccine, to screen for bowel cancer for 25 years everyone who reaches their 50th birthday, or even to routinely screen women for breast and cervical cancer—I could go on—would have been at the edge of science fiction. Today, those things are embedded in our health service, and our biggest challenge is driving up the uptake rates when invitations for screening are sent out.
Brian Whittle is also right to highlight the fact that healthcare and being healthy are cross-portfolio issues. Active travel spending has increased in recent years; that is not just about transport policy, as it will deliver healthier lifestyle benefits.
I am concerned about the rise of ultra-processed food and how that relates to poor health outcomes. I want the good food nation plan to address that. The promotion of shopping local, short supply chains, keeping local butchers and greengrocers open and the planning policies of the 20-minute neighbourhoods help to drive better health and wellbeing, even though, on the surface, it may not look as though those are health portfolio policies.
The issues that Brian Whittle highlights are not unique to Scotland. Nearly all the western world faces similar public policy challenges. I believe that the preventative and holistic approach that I have outlined is at the heart of the Scottish Government’s agenda and that it is absolutely the correct one.
Therefore, I hope that members can work across parties, collegiately, as we often do in the health committee and when I speak in debates led by Brian Whittle. We need to work collegiately to ensure that, in future decades, we can look back at this era as one of continued progress and continued improvement in our nation’s health.
17:35
I thank Mr Brian Whittle for bringing the debate to the Parliament and I thank the Scottish Fiscal Commission for its report. As we are in the last six months before this session of Parliament is dissolved, it is a welcome reminder of the long-term implications of the work that the Parliament undertakes.
Although the financial implications of demand for health services—bearing in mind the ageing population and lower birth rates—are critical, we must not forget that, when we see the old recipe of increasing demand on health services coupled with the lack of adequate financial planning, it is a recipe for disaster.
It is not the service cuts that we see; it is the increasing waiting lists. My inbox is creaking at the seams with messages from constituents who have been told that they are on a waiting list—12 months for a new hip, two years for cataract surgery and 18 months for a ganglion cyst that is making life torturous for the individual concerned. There is one woman who has waited seven years for reconstructive breast surgery after bravely undergoing a double mastectomy—it is truly heartbreaking.
If we do not make profound reforms to our health service delivery model, we will not need to wait 50 years to see the problems that are described by the Scottish Fiscal Commission—they are chapping at our door now. We need to move away from the Scottish National Party’s national sickness service and return to a true national health service.
Across the country, patients are finding it impossible to speak with their general practitioners. Recently, in my constituency, it has become more difficult for patients—mostly senior members of the community—to get routine blood tests or even blood pressure readings, as they are pushed away from their local surgeries to a centralised service. Many elderly people now need to take two buses to get something that they could get round the corner and, particularly in poor weather, that is a ridiculous situation. Where is the thought for the patient? The bureaucrats make uncaring decisions based on what suits them, rather than the patient.
We need to move towards a health model that prioritises keeping our population healthy by focusing on prevention, early intervention, timely local assessments and treatment, access to therapies for those with mental health concerns, and early diagnosis of autism and attention deficit hyperactivity disorder, as well as help with educational issues around health, healthy eating and fitness. That all starts with better resourcing for local GP surgeries, not centralised hubs that might look better on paper but which do not work for real people.
I would have loved to stand here and speak about the positive initiatives that Scotland should be at the heart of and leading the way on. However, as usual, we seem to be embedded in a firefighting approach, where our service delivers policies rather than heeding the old adage that prevention is better than cure. If we are not getting the basics of community health right, I am not convinced that my constituents are getting the sustainable health service that they deserve.
17:39
I thank Brian Whittle for bringing the debate to the chamber. I should first register an interest: my wife is a GP up in Moray.
I think that I was probably in the Parliament no more than about five minutes before I had my first conversation with Brian Whittle about the preventative health agenda—he is a true champion on this subject—and it is something that I am deeply proud of. That is partly because I know a lot of doctors and I know the stresses that the NHS can come under, although I do not want this debate to be about negativity; I want it to be about what we can do. It is also partly because of my time as chair of Moray Council’s children and young people’s services committee, which made me aware of just how important sport and leisure and healthy eating are for our children—and, in fact, for all of us. That is why I support Liz Smith’s Schools (Residential Outdoor Education) (Scotland) Bill. It is vital to get people out into the countryside and realising the value of outdoor pursuits, activities and sport.
I will be 95 in 50 years’ time—I hope that I am still alive then—which is when the Scottish Fiscal Commission’s report says that we will be spending nearly 50 per cent of the Scottish budget on the NHS. That is a worrying figure because there is so much else that we need to do with our Scottish budget. Preventative health—everything that Brian Whittle talks about—is therefore vital, because we need to ensure that we use every penny of that tax money as well as we can for the people of Scotland.
In the little time that I have left, I will focus on sport and leisure. For a long time, and certainly since I became a councillor, I have been deeply concerned that we do not take sport and leisure as seriously as we should. I have seen services in decline across the Highlands and Islands, and particularly in my patch in Moray. Every year, swimming pools have come under threat, as have sports clubs, because they cannot get the funding that they need. We should be 100 per cent behind them. Not only are swimming pools in our coastal communities essential for saving lives, they bring people the ability to maintain a healthy weight and they also support mental health. By being part of a team, we can be stronger as people.
Brian Whittle touched on lifestyle support, support for mental health, and early detection and screening, which are all things that we need to do more of. I am not an app developer, but I am convinced that, in a digital world, there is more that we can do to deliver for the Scottish population and help people to have healthy and long lives.
I have always been a strong supporter of the NHS. I am ultimately very proud of it and I do not want to risk losing it—so it worries me when I hear stories about more people moving to private healthcare—because the NHS is something that is uniquely British. I have some statistics here. Last year, one in eight of the population were admitted to hospital, and there were 1.2 million hospital admissions and 4 million out-patient appointments. We want to have a healthy, thriving NHS where our doctors and nurses feel valued and people know that, in the worst of times, they are going to be looked after.
I fully support Brian Whittle in his members’ business debate this evening. I hope that the Scottish Government and members from every party that is represented in the chamber will come together and make sure that we truly fund the future of our NHS but also fund our preventative programme to ensure that we do not need our NHS as often.
Thank you, Mr Eagle. That was an ingenious way of subtly boasting that you are still in your 40s, I think.
17:42
Like everyone else, I thank Brian Whittle for bringing this important debate to the chamber. As everyone has said, he has been a champion of this subject.
Our health, and the health of our friends and family, is the most important thing in all our lives, and public health must always be viewed as a priority in guaranteeing a prosperous and thriving Scotland. However, the truth is that Scotland has the lowest life expectancy and healthy life expectancy in the UK and the lowest life expectancy in Europe. That should drive us, as politicians, in how we talk about health and health spending, and it is why we must prioritise the preventative health approach.
Recent statistics reveal that healthy life expectancy in Scotland has fallen to a near 10-year low. We should all note that. It means that people in Scotland not only die prematurely compared with their counterparts in the rest of the UK but can expect to spend more time in poor health. I think that every member would agree that that is what many of our constituents and their families speak to us about. It is not just about having a long life; it is about having a healthy life.
We must recognise that improvements to public health are an investment in our future. Prevention must be viewed as an investment in our communities. As the motion says, health spending is the largest part of the Scottish budget, so it is important, and the Scottish Fiscal Commission expects it to increase significantly over the next 25 years. If we want to see that investment, then, as we all agree, we need to move to a more preventative approach to healthcare.
We also need to acknowledge our responsibility to ensure that there are cross-portfolio approaches, as others have mentioned. We recognise that poor health is not just about individual choice but about what access one has to housing, transport, space, healthy workspaces, secure work, family time and so much more.
We in Parliament and the Government have a responsibility to legislate in a way that tackles rising inequalities. The truth is that the gap in health is unacceptably high. We have a responsibility to close that gap with a robust approach to policies that tackle poverty and inequality. That is a preventative approach.
Those who are living in the least deprived areas spend more years living in better health than those in the most deprived areas—we hear that a lot in the chamber. East Ayrshire, which is in my South Scotland region and is where I live, has some of the lowest healthy life expectancy rates in Scotland, with the average male expected to live 55.8 years in good health and the average woman 55.4 years. NHS Ayrshire and Arran also has the joint lowest healthy life expectancy estimates of all Scottish health boards. It is important to me and my constituents that, in Parliament, we work towards a preventative system.
The health inequalities that exist in our deprived communities must be considered when determining the targeted interventions that are required to improve outcomes. We must also ensure that more targeted interventions happen. More resources and support need to be put into those communities.
I thank Brian Whittle and other members for having this positive discussion about how preventative healthcare can help our constituents. I reiterate that our health and wellbeing is the most important thing in all our lives. Living a long and healthy life is possible. It is possible for us to allow all our constituents to have a long and healthy life, but to do that, we need to take our responsibility as legislators seriously.
I hope that, in closing, the minister will address the measures that the Government is taking and will continue to take, because it is the responsibility of Government to provide sufficient direction and leadership to ensure that Scotland’s population live long and healthier lives.
I invite Tom Arthur to wind up the debate.
17:47
I thank Brian Whittle not only for bringing the motion to the chamber, but for the considered and thoughtful way in which he presented his remarks and set out his views. There is much that we can collectively learn from the approach that he has taken, and from recognising some of the collective challenges that we share, not least of which is the proclivity of our political discourse to focus on the short term at the expense of the medium term and the long term, and the risk that such short-term thinking can pose.
That focus can be particularly present in our discourse on health. Our debates are regularly consumed by immediate and pressing demands—for very understandable reasons, because those are what our constituents routinely come to our surgeries to seek our support and assistance on. However, we have a collective responsibility not just to this generation but to the generations to come. That philosophy and wisdom were very much present in Mr Whittle’s speech.
I also note Mr Whittle’s point about the need for small changes and the importance of recognising that, although significant shifts that take place overnight can perhaps present an insuperable challenge, small changes do make a difference, Indeed, consistency compounds: whether one works in finance or is training in athletics, one has to recognise that it is about consistency and taking small steps in the right direction. I think that, in Scotland, we are collectively taking steps in the right direction.
I welcome the SFC’s report, which makes an important contribution to our debate. As it sets out very clearly, there will be significant challenges ahead if nothing changes. The report underscores the importance of our not only working collectively but recognising the multifaceted nature of public health.
In his speech, Mr Whittle spoke about the implications of public health for the economy. I suggest that it is also important to recognise the impact on public health of the way in which our economy operates. An example is the consumption of products that are harmful to health. There are those who will stand to gain from that through profits and trade, while the externalities that ensue in the form of public health challenges fall to the state. It is important to consider that interaction when considering public health.
Will the minister take an intervention?
Before I take Mr Whittle’s intervention, I note that it is appropriate that we remind ourselves that Nye Bevan was not just the secretary of state for health but was the secretary of state for health and housing. When we think about public health and health more broadly, and the interaction with other portfolios, it is extremely important that we consider that as a cross-Government endeavour.
Some of my optimism comes from changes that have been made in other countries. We are not other countries; we are Scotland. However, where there is political will, there is a way.
I look at countries such as Japan, which made a political decision to have a nutritionist in every school. Children there must eat a specific healthy diet. Japan, which is the third-largest economy in the world, has an obesity rate of 4 per cent. If we have the political will, change can be made.
Mr Whittle highlights an important point. As he will appreciate, in relation to the differences that we see in life expectancy and healthy life expectancy between different countries, a country’s public health policy has an impact. However, there are wider cultural, historical and economic factors at play as well. That does not, in any way, diminish the importance of his point.
Emma Harper gave an excellent speech. She touched on the wide range of factors that come into play in shaping our public health and our population health as a whole. She touched on how our economic model interacts with public health. For example, shopping locally often leads to the procurement of good-quality, nutritious produce, but it also supports our local economies, sustaining the presence of local businesses and promoting active travel.
Emma Harper also touched on 20-minute neighbourhoods and no-go living. As a former planning minister, I am reminded of the fact that when the first legislation to create what became the modern planning system was introduced nearly a century ago, it came from the public health movement and was a response to the dire housing conditions that were once present. That is worth bearing in mind.
Davy Russell addressed one of the tensions that will always be present in our debates on health, which is the tension between local services and centralised centres of excellence. We have seen that trend in the delivery of healthcare for many years now, owing to the increasing sophistication, complexity and specialisation of services. Delivery models that might have been sustainable with previous iterations of technology have to change and adapt, but, to balance that, I recognise that there is the opportunity for greater localisation of services and a different way of delivering them.
Of course, we live in a world now where procedures that would have meant in-patient stays in previous decades can be undertaken as a day patient or as an out-patient. That reflects Emma Harper’s point about the progress that can be made through the use of technology and innovation. Indeed, Carol Mochan touched on many of those broad aspects in her speech. She also touched on the importance of considering not just life expectancy but healthy life expectancy. She asked me to mention some of the work that the Government is undertaking in that regard.
This year, the Government published and began to enact a series of short-term, medium-term and longer-term actions to realise our vision of a Scotland where people can live healthier, longer lives. Those actions are outlined in three published plans.
The NHS Scotland operational improvement plan, which was published in March sets out a number of actions to be taken across the NHS to improve our services. It is a clear plan to improve services and is supported by £200 million of targeted investment.
The plan was followed by two key frameworks for the future not only of our health and social care services but of the health of the Scottish population. Our population health framework, which was co-produced with the Convention of Scottish Local Authorities, is firmly focused on meeting the challenges that the Scottish Fiscal Commission has outlined. That framework, which was published in June, sets out a cross-Government and cross-sector approach to improving population health over the coming decades, with a firm focus on prevention. It aims to improve life expectancy while reducing the life expectancy gap between the 20 per cent most deprived areas and the national average by addressing the key social, economic and environmental drivers of health and economic inequality. It looks to ensure that we pursue and implement equitable access to health and care services.
The evidence is clear that our health is, as I have touched on, closely linked to the circumstances and environments in which we are born, grow up, live, work and age—the building blocks of health. As I have said previously, that needs a cross-Government and cross-sectoral focus. We know that investing in prevention is one of the most cost-effective interventions that the NHS and wider systems can make in improving population health and reducing inequalities.
The population health framework sets out 30 actions, including the promotion of healthy eating, in line with a new two-year implementation plan to improve the food environment, diet and healthy weight. It looks at tackling obesity, including through legislation to restrict promotions of foods that are high in fat, sugar and salt, and the development of new digital type 2 diabetes remission programmes. The framework also includes work to reduce harms from smoking and vaping, such as work with the UK Government on the bill to increase the age of sale for tobacco products, and work to introduce an advertising ban for vapes and nicotine products.
In concluding, I will touch briefly on the service renewal framework, which sets out how we will strengthen integration across health and social care, delivering services that are preventative, person-focused and built on collaboration. The population health framework, along with the reforms that are outlined in the service renewal framework, set out a collective long-term approach to reform and renewal of health and social care in Scotland.
I again thank Brian Whittle for bringing this important debate to the chamber and for the tenor in which he did so. I thank other members for their contributions.
Meeting closed at 17:56.