Meeting of the Parliament

Meeting date: Tuesday, January 10, 2023

Official Report 1189KB pdf

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National Health Service (Winter Pressures)

The next item of business is a statement by Humza Yousaf, who will give an update on national health service winter pressures. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.

14:42  

I wish to update the Parliament on the extraordinary pressures that our national health service faces this winter, and on the measures that the Scottish Government is taking to address them.

Let me begin by stating a simple fact: this is the single most challenging winter that the NHS in Scotland has ever faced. Our NHS and its committed workforce are facing a perfect storm of intense pressures, which is leading to extreme difficulty, disruption and delays across the service.

We suspect that this especially challenging time for the NHS will continue for the coming weeks and, as I have said previously, the full recovery of our NHS will take not weeks or months, but years.

Presiding Officer, I take this opportunity to thank once again our incredible NHS and social care staff for continuing to provide exceptional care in the most difficult of circumstances. Our entire health and social care system faces the continuing impacts of the pandemic—the biggest challenge that our NHS has ever faced in its 74-year existence.

Covid remains a pressure on our health system, with the most recent statistics showing that Covid cases are at their highest level since the summer. In the week ending 1 January, there were more than 1,200 patients in hospital with Covid-19, which is a 15 per cent increase from the week ending on Christmas day, and is double the number of patients from four weeks ago, when there were more than 600 Covid patients in hospital.

Recent flu admissions have been about three times higher than emergency admissions due to Covid, and cases of Strep A and other respiratory viruses have been rising. Challenges around delayed discharge of patients also continue to impact by driving up accident and emergency waiting times.

Overall pressures on the health system are significant. Last week, the latest management information showed that hospital bed occupancy across Scotland was over 95 per cent. Some sense of the intense pressure that is being felt can be also seen in the almost 100,000 calls to NHS 24 over the two four-day breaks of the festive period. That is the highest festive-period demand in over a decade. Traffic in December to the NHS Inform website and the symptom checker was at its highest-ever level, with 12.7 million page views.

The impact on the Scottish Ambulance Service has also been significant. It dealt with more than 16,000 emergency incidents last week. That is 11 per cent more than the average of the previous four weeks.

Although the situation highlights the significant levels of demand that we face, it also profiles the innovative ways in which we are seeking to tackle the issue through providing effective triage and supporting hospitals and social care settings.

However, the challenge is significant. The seasonal pressures come against the backdrop of the United Kingdom Government’s mishandling of both Brexit and the nation’s finances, which have had dire consequences for Scotland’s social care sector in particular.

Although we fully acknowledge the multiple difficulties that we face, the Government is determined to continue taking action to alleviate pressure on our NHS and social care. I am convinced that we should pursue a whole-system approach to tackling the issues and to supporting, through all parts of the Government, the NHS and social care through the coming critical months.

Last Friday, the First Minister chaired a meeting of the Scottish Government resilience room—SGoRR—to determine the next steps in addressing the unprecedented pressures across the NHS. As well as ministers, senior representatives from the Convention of Scottish Local Authorities, the NHS, integration joint boards and the Scottish Ambulance Service attended the meeting. A number of measures that are being taken to alleviate pressures on the system were reviewed. The measures include use of flow navigation centres as part of the redesign of urgent care; the hospital at home service; and Ambulance Service staff providing treatment, where appropriate, to help people to avoid hospital admission. Additional actions will now be rolled out across the health and social care system.

I can today outline a further course of action to unlock additional capacity to alleviate the pressure on the system from delayed discharges. As I have mentioned, delayed discharges and their impacts on patients continue to be a significant issue. The problem has been exacerbated by increases in staff absences due to self-isolation requirements and sickness, and the number of care home places has been impacted by home closures, too.

There is no doubting that high inflation and high energy costs have significantly impacted on a sector that was already facing multiple challenges. I know that teams throughout the country are working exceptionally hard to ensure that people receive the right care in the right setting, but it is a fact that, at present, there are currently more than 1,700 people in hospital who do not need to be there for clinical reasons, and whose interests are not best served by their being there, because care packages that would allow them to be discharged to go home or to a care home are simply not in place.

To that end, and as an additional and exceptional measure, COSLA and the Scottish Government have worked with partners across the care home sector to identify additional interim spaces in care homes in order to provide additional pathways for people to be discharged from hospital in a timely and safe fashion. In order to support health and social care partnerships to secure the extra provision, we are making available funding of £8 million so that beds can be purchased at 25 per cent above the national care home contract rate.

We will work closely with partners across the NHS, health and social care partnerships and local authorities to ensure appropriate use of funds and to ensure that we have evidence of the impact of that funding. That is a time-limited and in extremis measure that is required to help us with the current capacity issues that we face. The additional funding is intended to meet the increased costs of utilising those beds for a short time.

With partners working collaboratively, we have managed to identify that around 300 interim beds are available. They are in addition to the 600 interim beds that are already helping patients in the system.

That support is intended for use as an additional tool that health and social care partnerships can deploy to support them in the current situation and to allow additional flexibility in order to maximise capacity within our hospitals. We will work with partners to utilise every available bed. Such interim beds might not be a family’s first or, indeed, second choice for their relative, but I hope that families agree that this is, in the current circumstances, about making the best possible choice for those who are in our care.

The measure will be in place for only a limited time to directly support our hospitals in dealing with pressures at the front door. It will enable some people to move from an acute setting to a more appropriate community one, in recognition of the risk of prolonged stays in hospital.

In addition, a ministerial advisory group has been established for a number of months to respond to winter pressures. The group, which meets weekly, brings together Cabinet members—including the Deputy First Minister, me and Shona Robison—with the Convention of Scottish Local Authorities and key stakeholders, including Scottish Care, to advise on pressures in the system and to consider possible actions to mitigate them.

This week, further guidance has been issued to health boards to make it absolutely clear that they can and should take steps to protect critical and life-saving care, if that is judged to be necessary. Boards can, of course, ask the Government for advice as and when it is required.

We believe that local health boards are best placed to judge what reasonable measures should be taken in each board area. Those measures could include opening or procuring additional capacity; moving staff to areas of pressure; increased engagement with the third sector; and, potentially, delivering a different model of care for a short period.

In my role as health secretary, I retain the emergency powers and ability to direct that are set out in the National Health Service (Scotland) Act 1978. I am well aware that more severe measures, such as a blanket pause on elective procedures or on key diagnostic tests, are not without impact on the health service and on patients, so it is important at this time that we ensure that NHS boards have the ability to respond flexibly to local circumstances and to deploy local solutions. Advice has recently been issued to local leaders that provides clear guidance on the expectations for assessment, discharge practice and care home oversight arrangements.

Record numbers of patients are also being delayed under the Adults with Incapacity (Scotland) Act 2000. Although such patients are clinically ready for discharge, they cannot legally be discharged until a court-appointed guardian is in place. Officials have been working with the Scottish Courts and Tribunals Service and the Law Society of Scotland to investigate where improvements can be made to ensure that people are discharged in a timely manner. I have also met the Mental Welfare Commission for Scotland and the Equality and Human Rights Commission this winter to discuss matters that affect adults with incapacity.

Some of the measures that I have just announced are intended to help in the short term with the immediate pressures that we face, but we are also putting in place the necessary long-term steps to address social care challenges that we face. We have invested significant additional funding to support social care. In the current financial year, that includes £124 million to enhance care-at-home capacity, £200 million to increase the hourly rate of pay to £10.50, £20 million to support interim care arrangements, and £40 million to enhance multidisciplinary teams. A further £3.6 million has been made available in the 2022-23 budget to support further development of hospital at home services across Scotland.

It is clear that our accident and emergency services are being impacted severely by winter pressures—of course, that situation is not unique to Scotland. Scotland’s A and E services continue to outperform those in other parts of the UK, and have done for the past seven years, but that is cold comfort for those who are waiting far too long for treatment.

Scotland already has record numbers of NHS staff, and we are recruiting more staff as part of our winter plan. However, it is clear that far too many people are waiting far too long for care—whether that is for an ambulance response or for treatment when they attend our A and E departments. We have taken action to improve A and E waits, including plans to recruit 1,000 new NHS staff and to roll out the £50 million urgent and unscheduled care collaborative to help to drive down such waits. Measures include initiatives such as providing the hospital at home service, ensuring that people are directed to the most appropriate urgent care settings and scheduling urgent appointments to avoid long waits in A and E. We have also increased the amount of virtual capacity—for hospital-level care that is provided at home—to the capacity of a large teaching hospital.

We will also bolster workforce capacity within NHS 24. NHS 24 is an incredibly effective service, and because of the expert advice that it offers, the overwhelming majority of those who call NHS 24 do not need onward transfer to already busy A and E departments. This winter, NHS 24 is taking forward the planned recruitment of around 200 new starts before the end of March. As part of that recruitment, the board appointed over 40 whole-time equivalent call operators, call handlers and clinical supervisors in the run-up to Christmas. Although call wait times for NHS 24 were often longer than usual over the festive period, the vast majority of calls that were received were dealt with through the initial contact.

Despite the pressures that I have outlined, we are seeing progress being made in some key areas across the system. For example, excluding NHS Lothian, the latest figures show that, despite continuing pressures, almost 19,500 operations were performed in November 2022. That is almost 21 per cent higher than the number in November 2021, when more than 16,000 operations took place. It also marks the highest proportion—over 91 per cent—of planned operations to have been performed since the start of the pandemic. That is progress in relation to our elective care.

We are offering more support outside hospital settings to assist people who seek help with common winter illnesses. NHS Inform has issued self-help guides to let everybody know when to stay at home and when to seek more care. General practitioners and pharmacies can be also be contacted as a first port of call for non-critical, non-emergency care. I would like to add, as a reminder to all, that people who have symptoms of respiratory infection should try to stay at home and avoid contact with other people. If people need to leave home, we strongly recommend that they wear a face covering.

I understand that the NHS is built on the people who work in it, who have had to work through incredibly challenging circumstances for years. The pressure of almost three years of the pandemic has been relentless. I will always be available to talk to our committed workforce, who provide incredible care to the people of Scotland day in, day out.

I am grateful to the members of Unison, Unite and other trade unions who have accepted the Government’s record pay offer for NHS staff. In fact, the majority of trade unions that are on the Scottish Terms and Conditions Committee—the agenda for change pay negotiating committee—have accepted our pay deal. Although I am naturally disappointed that we have not got agreement from every trade union, I am also grateful for the positive engagement that has taken place with the GMB, the Royal College of Midwives and the Royal College of Nursing. I will continue to pursue meaningful dialogue with all trade unions to try to avert industrial action. We sincerely hope that the additional pressure of industrial action can be avoided at this very challenging time for the health service. For my part, I remain absolutely committed to dialogue and to positively engaging with our trade unions.

As I have outlined, unprecedented challenges continue to have a real impact on the NHS and on people across the country. Although we face an extremely difficult period ahead, I remain confident that, with the combined efforts of our incredible workforce and the determined will of this Government, those challenges will be met—and not only met, but overcome.

Presiding Officer, let me end where I started, by thanking our outstanding health and social care staff for their herculean efforts during these extremely challenging times. We will continue to honour them, not just with warm words but through our deeds, too. I thank you for giving me the ability and time to make this statement. Of course, I am happy to take questions from across the chamber.

The cabinet secretary will now take questions on the issues that were raised in his statement. I intend to allow 40 minutes for questions, after which we will move on to the next item of business. I would be grateful if members who wish to ask a question were to press their request-to-speak buttons now.

Under the cabinet secretary’s watch, the Scottish NHS is on its knees. A and E waiting times, cancer waiting times and delayed discharge are all at their worst-ever levels, with no improvement in sight.

While record numbers of patients were waiting more than 12 hours in A and E, where was the health secretary? We heard nothing from Humza Yousaf over the festive period, only for this hastily cobbled-together statement to be given today before another divisive debate on independence—which is timetabled to last longer than this statement on healthcare.

This is a national emergency. People are dying unnecessarily. Our heroic NHS staff are overwhelmed and burning out. Addressing the crisis in our NHS should be a priority for the Parliament, because it is a priority for the people of Scotland, and they will be appalled today.

I simply cannot fathom why the cabinet secretary did not plan for, in his words, the worst-ever winter that our NHS has faced. Cases of Covid, flu and the cold and the number of accidents are all increasing. That was predictable. For months, we have been calling on Humza Yousaf to rethink his failing NHS recovery plan. Just last month, we published a recovery plan of our own, but our warnings fell on deaf ears, and the Scottish people are now paying the price for the complete lack of preparation. The British Medical Association has said that the Scottish Government has run out of ideas.

Over the festive period, I was out seeing patients in different parts of the country. The problems are similar everywhere. Primary care, secondary care and hospitals are overwhelmed. Patients are scared of going to A and E departments. We need to see improvements, and we need to see them urgently.

In relation to the changes that were announced yesterday, when can we expect to see meaningful change in our NHS, such as improvements in A and E waiting times, delayed discharge numbers and cancer treatment waiting times? Can the cabinet secretary confirm the timescales in which he expects to see significant improvements?

I thank the member for his questions. These issues are being faced by every health service across the UK. Dr Sandesh Gulhane asked where I was over the festive period. I was busy talking to our trade union colleagues. If his party had done the same, it might not have had nurses and ambulance drivers walking out on strike.

On planning, I noticed that the Conservatives published their winter plan in mid-December. That was not particularly helpful or useful, because the winter planning that we undertook took place after the previous winter had passed. When it comes to planning, if Dr Sandesh Gulhane was the oracle that he claims to be and could have predicted every pressure that the NHS is facing, he might have wanted to tell his colleagues down south, because these pressures are being faced not only by every health service in the UK but by many health services across the world.

What are we doing about those pressures? We have taken a number of actions. As well as the actions that I have announced today, I have already announced the recruitment of additional staff. In fact, we recruited staff last winter with recurring funding in order to help with pressures this winter. We have also provided additional funding for the Scottish Ambulance Service. In 2021-22, the service recruited record numbers of ambulance staff. I have already given details of how our winter plan, which is backed by £600 million of funding, is already helping in relation to social care.

Therefore, we have taken action. However, notwithstanding that, I have always been up front and honest in publicly stating that, even with those mitigations in place, this will be the most difficult winter that our NHS has ever faced.

In answer to the final question that Sandesh Gulhane asked, I simply say that I expect to see improvements in the very short term as a result of the action that we are taking. However, equally, let me be up front and honest by saying that, as schools return and as people return to work and mingle, it is possible that there could be a slight increase in the spread of viral infections, so we expect the first few weeks of January to be extremely challenging.

There will continue to be challenges, but, as a result of the action that I have announced in relation to interim care beds and additional staffing for NHS 24, I hope that there will be some improvements in those pressures in the short term.

The health secretary is keen to tell us that the NHS is under unprecedented pressure this winter, and he cites Covid, flu and Strep A. Let me join him in thanking all NHS staff for everything that they are doing, but they would tell us that this crisis is not unprecedented; it was predicted by clinicians. In fact, fewer patients are being seen in A and E departments now than were being seen before the pandemic.

What is unprecedented is that the health secretary was warned about the crisis by clinicians for well over a year but failed to listen and to act on solutions. What is unprecedented is that the Government failed to end delayed discharge, which it promised to do in 2015. Eight years on, it is at record high levels.

Dr Iain Kennedy of the BMA is clear that the current crisis at the front door of A and E is because the back door, to social care, has not been fixed. What is unprecedented is that, because the Government has presided over inadequate workforce planning for the past 15 years, we now have 6,400 nursing vacancies and, in some areas, 14 per cent of consultant posts lie empty.

I therefore want to ask the health secretary about the 1,000 additional staff. How many of them are actually in post and where are they deployed? I also want to ask about the 300 extra beds. I am sure that they will help, but, when the latest data reveals a record high of more than 1,900 people stuck in hospitals, what impact will the measure have?

Will the cabinet secretary give a commitment to removing non-residential care charges and supporting home and family carers? That would directly contribute to helping to end delayed discharge.

Finally, why is the First Minister not here, giving the statement, as she did yesterday? Why has she instead sent along her spare?

I notice that Jackie Baillie is here, asking the questions, rather than Anas Sarwar, the leader of the Scottish Labour Party. I will not personally insult Jackie Baillie, because, at a time of national emergency, the people rightly expect their political leaders to rise above their petty political differences and work together in the national interest.

Let me respond—[Interruption.] Jackie Baillie and her colleagues can shout from a sedentary position, but it is important that I answer their questions. On delayed discharge, as I said to Sandesh Gulhane, I expect there to be improvement once we begin to move people from acute sites into the interim beds, which we expect to happen in the short term. Hopefully, as the levels of flu and Covid begin to abate and reduce, we will begin to see an improvement in our health service and in the performance indicators that Jackie Baillie referenced.

We have a very proud record—I am proud of it—on staffing in the NHS over the past 15 years. Staffing in the NHS is at record levels. However, Jackie Baillie is right to mention the high levels of vacancies, which we are keen to fill. That is why, last year, I announced additional funding to recruit nurses from overseas. Last year, we committed to 200 nurses—

How many have you recruited?

I hear Jackie Baillie shouting from a sedentary position—I was literally answering her question as she was talking.

We promised to recruit 200 nurses last winter, and we exceeded that. That funding is recurring. For this winter, we have said that, up to April, we will recruit an additional 750 nurses. I believe that there have been 126 firm offers and that 455 are in the pipeline—that is what boards expect to fulfil. That is all the way up to April. I will give a further update as we get towards the end of this financial year, and I will continue to push boards to go further in their recruitment, where possible.

On Jackie Baillie’s suggestion about non-residential charges, we have a promise—a programme for government commitment—to abolish non-residential charges. I will continue to work in my portfolio to do that at the earliest possible opportunity.

My question to the cabinet secretary relates to the number of people who are suffering from flu and Covid, not just in our hospitals but in our communities. What action can the Government take to increase the take-up of the Covid booster and flu vaccines?

Gillian Martin is absolutely right to focus on vaccination. We know that Covid vaccination, in particular, is a complete game changer and that the flu vaccine can be effective as well. In Scotland, we have decided to co-administer the Covid and flu vaccines. The uptake has been positive, but I encourage all those who are eligible and who have not come forward to do so. The statistics and data that we have show that uptake levels among health and social care workers are not as high as I would like them to be. I ask front-line health and social care workers who have not had the Covid or flu vaccine please to come forward, because that will help to protect them and, I hope, those to whom they give such exceptional care.

I put on the record our thanks to the UK Government for the Covid vaccination programme.

Over the Christmas break, I was inundated with correspondence about the crisis in our Scottish NHS. The latest statistics seem to reflect a situation that is now spiralling out of control. Last week, just two in five patients were seen within four hours at the Royal infirmary of Edinburgh, despite weekly attendance being lower than it was in the same week in 2019, before the pandemic.

Let me put the current situation in the words of Dr David Caesar, a senior emergency medicine consultant at the Royal infirmary. Dr Caesar said that

“Dignity feels like a distant luxury”

and that the fatigue among clinicians is “bone deep”, with staff dejected and in total despair. In his answer, perhaps the cabinet secretary could speak to Dr Caesar, not to me. What is the one practical thing that the cabinet secretary will do today that will help Dr Caesar and his colleagues tomorrow?

I thank Sue Webber for the question. I know Dr Dave Caesar—he used to be one of my deputy chief medical officers in the Government, and I am grateful for the work that he has done. I read his piece, which I think was in The Times. I read the public comments that he made.

Before I answer Sue Webber’s question directly, I confirm that she is right and that attendances were lower. However, what that masks, as any clinician on the front line will tell you, is the fact that people are presenting with higher acuity: they are presenting sicker, and therefore their length of stay is longer. That is the challenge that we are currently facing, as well as the exit block—the lack of capacity within already very busy hospital sites.

What can we do to help the likes of Dr Dave Caesar and every other health and social care worker who is doing an exceptional job? We can reduce that workload pressure, which is why there is the additional funding for the 300 interim beds that we have identified and will look to utilise as quickly as possible. We hope that that will begin to reduce that workload pressure. We can continue to make sure that Dr David Caesar and NHS staff are properly rewarded. That is why we put forward a record pay rise for agenda for change staff. We will do what we can to retain our doctors and other staff, making sure that they are appropriately rewarded and remunerated.

I welcome the fact that the Scottish Government’s resilience room has been reconvened, given the level of pressure that our NHS and care services are facing. I am pleased that I played a wee part in suggesting that.

The First Minister’s briefing yesterday, just like the briefings during Covid, was incredibly useful and helpful. Will the Scottish Government continue to keep Parliament and the public regularly updated on the work that is being undertaken to help to address the pressures on our health and care services?

Yes, I am happy to. I am happy to do media briefings. The First Minister and I will reflect on whether to do another media briefing, and, of course, I am happy at any point to come to the chamber to answer questions on this issue and keep Parliament updated.

It is important that we have the ability to speak directly to the public. That public health messaging is incredibly important. The member may have seen that, throughout the festive period, I was reiterating some of that health messaging, as was the First Minister and the likes of the national clinical director, Jason Leitch. All of us have a role to play in communicating with not just our constituents but the public more widely.

In relation to the additional beds that have been announced, unpaid carers have raised concerns about the potential for loved ones to be “parked”—their word—in care homes, perhaps against their wishes, as they wait for care assessments. There are serious concerns for people’s wellbeing. How will the cabinet secretary increase capacity to ensure that people are appropriately assessed and not abandoned in a setting that may be inappropriate and unwelcomed, particularly with reports this week that social workers in Scotland missed more than 30,000 work days due to mental ill health? Does he accept that it all comes back to retaining and recruiting more social care staff by valuing them and ensuring that they are offered more than this Government’s insulting rise of 40p?

I thank Paul O’Kane for the important questions that he asked. I may disagree with some of the characterisation of the situation—I will come to that in a second—but they are incredibly important questions.

Those are difficult conversations to have, but, of course, our clinicians, who have those conversations day in and day out, do so compassionately, but also collaboratively with families. However, I was being up front in my statement that an interim placement may not be a family’s first or second choice.

Equally, when someone is clinically safe to be discharged, remaining in a hospital that might be at 95 per cent, 99 per cent or above 100 per cent capacity cannot be good for the individual who is involved, let alone for the hospital. Clinicians always try to work with families to ensure that the most suitable care placement is available for them. It might be the case for some of those placements that people are placed, the assessment takes place in the interim care placement and they are either moved on to a permanent care home place or get the package of care that they require for home. When someone is clinically safe to be discharged, being in hospital is not the best choice for them. We know that prolonged stays in hospital for people who are clinically safe for discharge is not good for those patients.

Paul O’Kane and I rehearsed the social care staff question at committee this morning. Our 2023-24 budget has an uplift to £10.90 per hour. That is the third pay rise in the time that I have been Cabinet Secretary for Health and Social Care—from 2020-21—and it represents an increase of more than £2,000 a year for someone who is on a full-time wage. I say to Paul O’Kane—I will correct this if I am wrong—that £10.90, or the real living wage, is the same wage that is being offered by Labour in Wales, where it is in charge of the health service.

A recent report by the Nuffield Trust has warned that Britain’s departure from the European Union has worsened recruitment shortages, made accessing essential medicines more difficult and further exacerbated health inequalities. Does the cabinet secretary share my concerns that the economic hit of a hard Tory Brexit is fuelling the severe challenges that the NHS in Scotland is facing?

There is just no doubt about it. If you talk to any social care provider, they will tell you the damage that Brexit has caused. Social care has been hit by a number of difficult challenges over the years; a hard Tory Brexit is certainly one of them, and the pandemic is another. The most recent concern of social care providers, whether they are care home providers or care at home providers, is the high cost of inflation, which is a direct result of the UK Government’s mismanagement of the economy. That has led to care home energy costs being exceptionally high, and high fuel costs are a problem for care at home providers as well.

I am in constant dialogue with the care sector in Scotland, and I have regular conversations with other health ministers across the four nations. I will continue to implore the UK Government to do what it can in relation to migration, because there is more that can be done in relation to overseas recruitment to help our social care and NHS staff, and to see what more it can do in relation to mitigation of high energy and inflation costs.

There is much interest in this item of business, so I would be grateful for concise questions and responses.

It is now more than a year since I first asked the cabinet secretary to instruct an urgent Government inquiry into avoidable deaths caused by the crisis in emergency care. We now understand the quantum of that, with the Royal College of Emergency Medicine telling us over the Christmas period that, as a result of the crisis in emergency care, as many as 40 people a week might be dying who did not need to die. I ask the cabinet secretary again whether he will now instruct an urgent Government inquiry into avoidable deaths.

I am not disputing—I do not think that any of us would—the Royal College of Emergency Medicine’s underlying premise that, if patients are waiting excessively long periods for care, they will come to harm. However, each death would have to be individually examined to understand the true scale of that. Although I will not instruct a public inquiry into every single death that might have happened as a result of long waits, I will take time to consider what Alex Cole-Hamilton has said, so that we can understand the true picture of those who have come to harm due to excessively long waits.

Can the cabinet secretary confirm that all financial resources are allocated in the current year, which means that, in order to put any more resources into part of the NHS or the NHS as a whole, there would have to be a balancing cut elsewhere?

Yes. I do not know whether I made this clear in my statement, but the £8 million that we are putting towards the 300 interim care beds is coming from the health and social care portfolio. Every penny is allocated—it is not additional finance coming from central finance—so we have to find the money from the health and social care budget, which, as John Mason and other members know, is extremely challenging, given the current financial circumstances.

Delayed discharge predates the pandemic, severe workforce pressures predate the pandemic and long A and E waits predate the pandemic. The minister has been being warned about those problems for years and he has chosen to ignore those warnings. Now that the First Minister is doing his job, should he not do the decent thing and resign?

Again, I will not rise to pathetic and petty personal attacks. [Interruption.]

Thank you.

I ask Craig Hoy: is that it? When our country is facing a national emergency and the NHS is facing one of the biggest challenges that it has ever faced during its 74-year existence, is the best that Craig Hoy can come up with a quip that he practised in the mirror before coming down to the chamber? The Government is focused, and I am focused, on taking action, whether that be through the recruitment of additional staff, the recruitment of additional ambulance staff, or through putting in £600 million to help the NHS to cope with the winter pressures. As I say, I will allow Craig Hoy to do his flimsy and pathetic party politicking while the Government’s relentless focus will be on supporting the NHS, the people who receive care, and the wonderful workforce that give that exceptional care.

In the past few weeks, my inbox—like that of any other member—has been full of messages from constituents concerned about long waiting times at A and E, primarily at Monklands hospital in my area, with some reporting waits of up to 10 hours. I have also been contacted by many local NHS staff who have been working around the clock, and I offer them my heartfelt thanks.

I welcome today’s statement from the cabinet secretary. In light of the circumstances and the pressures faced by Monklands A and E, how can the additional support that he has outlined help NHS Lanarkshire avoid those pressures?

I thank Fulton MacGregor for his very important question. He is right to say that NHS Lanarkshire is one of the health boards that is facing that pressure most acutely, and as he might imagine, I have been to many sites in Lanarkshire and have spoken to the new chief executive, who has been in place since December, about those pressures. I am personally interacting quite closely with NHS Lanarkshire.

During my most recent visit to NHS Lanarkshire, I visited the A and E department at Wishaw, and it was clear to me that delayed discharge was causing some significant issues. I talked to one patient who had been waiting for far too long for treatment at A and E precisely because there was no bed available. A portion of the 300 interim beds will be in North and South Lanarkshire.

I commend Lanarkshire for its very good collaborative pan-Lanarkshire way of working. When I speak to the chief officers and chief executives of North and South Lanarkshire Councils, and the health boards, it is clear that good collaborative work is being done on the ground, and I encourage Lanarkshire to continue with that.

We should make no mistake: this is a humanitarian emergency. It is costing lives and damaging the wellbeing of NHS and social care workers. NHS Lanarkshire has just been mentioned. That is the crisis within the crisis. The code black nightmare that began in 2021 continues today in 2023, so constituents in Lanarkshire want to know when that will end.

I have two short questions for now, one of which is again about Lanarkshire. We need more doctors for out of hours and across primary care. Can the cabinet secretary update me on that?

As well as the immediate action that we need to take, we need long-term solutions, so will he agree, with the BMA and others, to facilitate a national conversation on the future and survival of the NHS?

Working out of hours is one of the key areas that the new chief executive of NHS Lanarkshire and I spoke about when we last met. The member might have seen from NHS Lanarkshire that GP practices in Lanarkshire will be open on additional days during the weekends. I welcome that.

There are standing directions to every single health board to work with their GP practices to see what more can be done around extending opening hours. I am grateful to the GPs and staff within their multidisciplinary teams who are working those additional hours, whether it be in the evenings or at weekends, to help practices to cope with some of the demand that they are facing.

Regarding Monica Lennon’s second question, I gave an indication during media interviews at the weekend that I am open to the idea of a national conversation with the public about the health service. I think that Monica Lennon and most—if not all—members of this Parliament would agree that that conversation must be grounded in the founding principles of the NHS. The idea of a national conversation is a good one: let us ensure that we do it in such a way and at such a time that it does not add pressure and work to a system that is already facing significant pressure. I am happy to keep Monica Lennon updated about those conversations.

What actions are being taken to ensure that health boards retain the ability to respond to local circumstances to alleviate some of the unique pressures that they currently face?

I hope that I gave an indication of that in my statement. There have been calls for the Government to declare a national major incident, but I think that it is right for health boards to retain decision-making at local level so that they can determine how best to flex their services in order to cope with the demand that they are facing. I will continue giving that flexibility to local health boards. At a national level I, the NHS chief executive, Caroline Lamb, and the chief operating officer, John Burns, will always remain close to our NHS boards to offer advice and support, where that is appropriate.

The cabinet secretary will be aware of my keen interest in staff welfare. A lack of time away from wards is cited as the biggest barrier to staff accessing breaks. If they are to be able to have those breaks, we need more staff, and Brexit has undoubtedly affected staffing. I welcome everything that the cabinet secretary has said so far about recruitment. Further to his answer to Rona Mackay‘s question, what conversations has the cabinet secretary had with the Home Office and UK Government ministers about fast-track visas for those coming to work in the Scottish NHS? If those conversations have not yet taken place, will he ask for a meeting as a matter of urgency?

I have previously raised that subject with the UK Government. In fairness, that subject has been raised not only by me but by the Welsh health secretary, too. I know that she is very supportive of continuing those discussions to try to get the UK Government to see sense about the current prohibitive and restrictive immigration rules. I genuinely do not understand those. I know that many NHS trusts in England face the same challenges that we do, in social care as well as in the NHS. Gillian Mackay makes a good suggestion. I will ask for the issue of immigration, and immigration rules in particular, to be back on the agenda at the next four nations meeting.

Given the additional pressure that Covid and seasonal flu are responsible for in both the primary and acute care sectors, can the cabinet secretary confirm whether medical opinion indicates that it would be a valuable step to extend eligibility for the vaccination booster programme—which is currently for adults aged 50 years and over—to include adults who are under 50?

Kaukab Stewart asks a good question. Eligibility for the Covid vaccination booster programme or for any future vaccination programme is always informed by advice from the Joint Committee on Vaccination and Immunisation. We have not previously departed in any significant way from JCVI advice. We will continue our discussions with the JCVI, but it is important to take its informed and expert advice and then to come to a decision based on circumstances at the time.

One in 10 patients who arrived at hospitals by ambulance in the final week of December waited for more than three hours to be offloaded into A and E departments. I have a constituent who called 999 and waited for 12 and half hours for an ambulance crew to arrive. What steps is the cabinet secretary taking to ensure that ambulances can be back on the road as soon as possible? What steps is he taking to ensure that call handlers have the training that they need and are able to prioritise calls as they come in?

Sharon Dowey asks an important question. She is right to say that ambulance turnaround times at far too many acute sites have been far too long. I think that she has a particular interest in the Ayr and Crosshouse hospitals. At those two sites in particular, turnaround times have been far too long.

We are working closely with Ayrshire and Arran NHS Board to try to improve the situation, as she would expect us to do. However, she is well aware that the entire system is connected. That is why I said in my statement that we are taking a whole-system approach.

If we can create some capacity by safely discharging 300 people in the system who it is clinically safe to discharge and get them out of busy acute sites, that will help with the flow in our hospitals and allow ambulances to convey patients to the acute sites much more quickly and get back out on to the road. That shortens the response times.

I agree that the type of response times that Ms Dowey referred to are not the standard of care that we expect. The measures that I announced today will directly help with those turnaround times. We are also working with the sites and health boards, such as NHS Ayrshire and Arran, where turnaround times are far too high to see whether other conveyancing areas can be created. We accept that there is limited capacity in acute sites, but we are examining whether any additional space can be found to convey patients and allow ambulances to turn around quickly and get back out on to the road.

I was contacted by a constituent regarding a recent call to NHS 24 that went unanswered and was cut off after a two-hour wait. I am sure that the cabinet secretary agrees that that should not happen. In such circumstances, patients are likely to attend A and E, which might not always be required and puts additional pressures on the service.

As a result of recent increased demand on NHS 24, what provisions are being put in place for future surge capacity to adequately handle calls to ensure that people can make use of the service instead of accessing other parts of the NHS, including hospitals?

I thank Bob Doris for an important question. I went to meet and speak to staff at NHS 24 on Christmas eve, so I was there at one of the moments when pressure was at its highest. In fact, if memory serves me right, I went at 10 o’clock in the morning and 900 people were already waiting for their calls to be answered.

I hope that Bob Doris understands and appreciates—I think that he does—the exceptional pressure over the festive period. I referred to the almost 100,000 calls that NHS 24 received over the two four-day weekends in the holiday period. That is a demonstration of the high level of demand.

NHS 24 expected high levels of demand and increased its staff between October and December but, even with those additional staff in place, there were still challenges for some people in getting through. That is why I referred to the 200 additional staff at NHS 24. That recruitment will help with call-answering times.

I also say to Bob Doris and anybody who is listening that the NHS 24 app is available. It is a minimal viable product. It has self-help guides on it and information about, for example, the local general practice and local pharmacy. We will keep building on that app so that it becomes a full digital offer in the weeks, months and years to come. I also point people towards NHS Inform.

Constituents in Lothian region have struggled to get through to a call handler on NHS 24, which is causing distress and anxiety to those who are ill and do not know where to turn. As a result, they might be more likely to attend A and E unnecessarily to get medical attention, thereby increasing pressure on NHS services that are already at breaking point this winter.

Will the cabinet secretary advise what support will be given to constituents who are desperately trying to get help from NHS 24 before the recruitment of new starts is completed by March? More than 100 trained staff are being let go from the Covid national contact centre. Could those workers be reassigned to assist?

I thank Foysol Choudhury for his question and suggestion. As we have begun to reduce the numbers working in the national contact centre, we have looked to deploy as many as we can back into the health service and some into social care.

The recruitment of the 200 additional staff at NHS 24 that I mentioned began in October to help with the festive period. We will continue to recruit. That will help Mr Choudhury’s constituents who are struggling to get through to NHS 24. I have seen the latest data, which show a reduction in the amount of time that people are waiting for their calls to be answered. I hope that that is a positive sign of things to come.

As well as NHS 24, we have the app that I have mentioned; NHS Inform, which has a symptom checker that has been checked millions of times over the past few months; the pharmacy first service; and GPs. There are many avenues that someone can go to before going to A and E, and I would encourage everybody to make sure that they get the right care in the right place at the right time.

Bob Doris and Foysol Choudhury have raised the really important issue of the time that it takes people to get through to someone on NHS 24. I have had examples of people waiting two hours or more to get an answer on the phone, which leads to additional problems.

Of course, people still have other problems in trying to access GP services, for exactly the same reasons. Despite making call after call, day after day, to get an appointment, they are unable to do so, which builds up problems for the future. What specific action will the Government take to increase the availability of GP appointments, in order to avoid unwarranted and unnecessary presentations at A and E?

That is a really important question. Murdo Fraser raises an important issue. It is worth saying—I think that Murdo Fraser would agree with this—that our GPs and GP staff are doing an incredible job in really difficult circumstances, and the workload pressure that is on them is unprecedented.

At the same time, I recognise the situation that Murdo Fraser articulates. Many members across the chamber, from all the political parties that are represented, have written to me over the past weeks and months to tell me that they have constituents who have struggled to get GP appointments. That is why I announced several measures, the first of which is funding for telephony services. Where GP practices can improve their telephony services to help with access issues, we have provided some funding.

I have also written to every GP practice to say that my expectation is that every GP practice should offer pre-bookable appointments, because we still have the situation in far too many GP practices whereby people have to phone up at 8 in the morning. They might not get through—they might be 25th in the queue and then hang up. As a result, people end up at A and E, as Murdo Fraser said. Pre-bookable appointments could help with that.

The last thing that I will say on the issue is that I have instructed a GP access group to be set up, which will have on it not just GPs, but a patient representative, to unblock any of the GP access issues that currently exist. I am in regular dialogue with the British Medical Association—I suspect that Murdo Fraser will know Dr Andrew Buist fairly well—about what more we can do to work together collaboratively to improve access to GP practices.

I will end my answer to the question where I started, by saying that I understand just how hard our GPs and GP practice staff are working under unprecedented pressure.

The next question is from Paul McLennan.

On a point of order, Presiding Officer.

Can the cabinet secretary provide an update on the measures—

Sorry, Mr McLennan. I am taking a point of order from Stephen Kerr.

Presiding Officer, I am mindful of the fact that you allocated 40 minutes for questions. We are now at 39 minutes, and I am sure that a number of colleagues still want to ask questions, including Conservative members. Would you be minded, on the precedent of last year’s statement on services at Dr Gray’s hospital, under rule 8.14.3 of standing orders, to extend business until all colleagues who have issues to raise with the cabinet secretary have had the opportunity to do so?

Although I am not minded to accept such a motion, I am determined that members who have pressed their request-to-speak buttons will have their questions taken.

Can the cabinet secretary provide an update on the progress that has been made on the measures that were previously put in place to recruit additional staff from outwith Scotland?

Before I answer that question, I say that I am happy to stay in the chamber for as long as necessary to answer these important questions.

On recruitment from outwith Scotland, I have referenced in some of my answers the efforts on international recruitment. We made efforts to recruit nurses from overseas last winter and provided recurring funding to help this winter. We exceeded our target of 200 nurses and have provided further funding. As the member probably knows, in October I announced around £8 million to support the recruitment of up to 750 nurses, midwives and allied health professionals. As I referenced in my answer to Jackie Baillie, around 126 firm offers have been accepted, and we expect there to be many more in the pipeline as we move towards April.

We are also continuing to encourage GPs from across the rest of the UK, in particular, to see Scotland as a destination for them. Scotland—particularly in the case of our remote, rural and island communities—is a very attractive place to work. We have a proactive campaign under way to see if we can attract GPs from the rest of the UK to work here.

At quarter past 3, I received a text from my GP surgery, saying that it will be providing only emergency appointments. That is similar to the texts that I have been receiving since 13 June when I have tried to access my GP surgery. We are in a real crisis.

I have said many times in this place that the Scottish Government is taking an unsustainable trajectory in healthcare in Scotland and is managing the decline of our health service. Covid has just accelerated that decline.

Is it not about time that the long-term sustainability of the Scottish national health service was mapped out and we looked at the preventative health agenda and tackled Scotland’s poor health record? We are still the unhealthiest nation in Europe. Should we not be looking to prevent the need to seek healthcare in the first place or, at the very least, treating patients at an earlier stage, before they become acute and require more intensive care? Surely that is a significant way to reduce the pressure on our health service.

I agree with everything that Brian Whittle said in relation to the importance of the preventative agenda. I spoke at length about that at this morning’s meeting of the Health, Social Care and Sport Committee. Our 2023-24 budget continues that focus and our approach of putting investment and funding towards the preventative agenda.

Mr Whittle is right that there can be a temptation—which we will, of course, avoid—when dealing with an unprecedented emergency situation, to lose focus on the preventative agenda. We will not do that. We will continue to focus on smoking cessation, our work on alcohol and drugs treatment, and our work in relation to obesity and healthy and active lifestyles. I know that the latter is very important to Mr Whittle, and I give him a firm commitment that we will continue our focus on the preventative agenda, while also dealing with the unprecedented pressures that we face.

The cabinet secretary will be aware that allied health professionals have unique skills that help with discharge from hospital. They are essential in making that happen and returning people home safely, which undoubtedly helps with pressures on acute beds. AHP services are currently under pressure, with vacancies across the country. What discussions has the Government had to ensure that the increase in bed capacity also gives patients access to that essential group of staff?

I could not agree more with Carol Mochan about the importance of AHPs. A multidisciplinary approach needs to be taken to provide people with holistic healthcare. That is why we have recruited more than 3,220 members of those multidisciplinary teams, many of whom are working in general practice up and down the country. We are investing in AHPs in our hospitals, for example in our frailty teams, to help to reduce the length of time before people—particularly elderly people who have had a fall—come into hospital. We will continue to work with all the relevant bodies in relation to AHPs, and I place on record my thanks for the incredible work that they do, and the holistic care that they provide up and down the country.

Why did Scottish health boards have to wait for days for this slothful Scottish National Party Government to send a letter to allow them to move staff around to deal with the crisis when, on Friday, Humza Yousaf knew that Borders general hospital was cancelling routine operations for my constituents? I would like to know from the health secretary: why the delay?

Rachael Hamilton’s question betrays her ignorance of the health service and how the health service works. There has never been a blockage on local health boards being able to take local decisions. In fact, she has just given the example of how a local health board took a decision to meet local demand. That was happening up and down the country long before I was health secretary—it has happened for many years.

It is a founding principle of our national health service that local health boards have the ability to locally flex the care that they provide. What I did in my letter was simply ensure that there was further guidance, particularly in emergency-type situations, should health boards require it. As Rachael Hamilton referenced in her question, that is already being done. I am very grateful to local health boards for taking really difficult decisions in a time of great emergency.

The villages and communities of Port William and Whithorn in Wigtownshire have been without adequate GP coverage for many months. With the closest A and E department being an hour’s drive away and there currently being four-hour waits on the NHS 24 helpline, there is massive pressure on the community pharmacy, which is going above and beyond to look after the health concerns of local people. The pharmacist in Whithorn is looking at an average of 83 pharmacy first visits per week, of which 28 come under the pharmacy first plus service. That is over and above the normal day job. Over the past few weeks, the position has been dramatically worse. That number of visits is far more than an average pharmacy would see in the course of a month.

This is undeniably a crisis that is putting people’s lives at risk. Will the cabinet secretary consider intervening and, as a matter of urgency, deploying GPs to those two rural communities, which are undeniably experiencing the greatest pressure, the greatest need and the greatest risk?

I have regular conversations with our health boards, including NHS Dumfries and Galloway, NHS Borders and NHS Grampian, where we tend to see pretty significant pressures in relation to general practice and community pharmacies. I will continue having such conversations. On the back of Finlay Carson’s question, I will also ask the chief medical officer and the chief pharmaceutical officer to see what more can be done, particularly on general practice cover in the areas that he has referenced.

I am interested in patients’ rights with regard to the proposed interim beds in care homes. Can patients refuse to go to such beds if they want to go home but there is no care package to enable them to do so? Will they be parked for weeks in such beds, or is the cabinet secretary confident that he can move people on quickly? Can he guarantee that they will not be required to pay care home fees if they are self-funders?

Those are important questions. The choice guidelines are still in place—we have not suspended them—and clinicians are mindful of them. As I mentioned in a previous answer, they have conversations on such issues day in, day out. We will not be forcing people out. As I said in my comments, which I hope that Willie Rennie will take in the spirit in which they were intended, an interim place might not be someone’s first or even second choice. However, when it would be clinically safe for a patient to be clinically discharged, it would not be best for them to be in a hospital that is overoccupied and facing the pressures that currently exist if they can be in an interim place in a better environment. To answer Willie Rennie’s question directly, the choice guidelines are still in place and have not been suspended.

I do not like the suggestion that anyone would be “parked”; that will not happen. I think that Willie Rennie will agree that whether a patient is in an interim or a permanent care home place, people who work in social care provide exceptional support, so such a patient’s care needs will be attended to in the best way possible.

We are looking for that to be a short-term, interim measure, which should last for weeks and not months. We do not want people to be on interim placements for months and months; at most, we want them to be there for weeks. Whether they are in Fife or any other part of the country, I have every confidence that chief officers, who are excellent at their jobs, will do a phenomenal job in getting people the permanent care packages that they require.

On Mr Rennie’s final question, there will be no cost to individuals in relation to interim care placements.

The cabinet secretary will be well aware of why I might be concerned about the situation in Forth Valley royal hospital, in the context of the measures that have been taken to reinforce the management and work practices at NHS Forth Valley.

With that in mind, and not having had sight of or a chance to read the cabinet secretary’s statement in advance, I have listened carefully to find out whether it mentioned that something would happen, right here and now, that would meet the need that has been identified by the chair of BMA Scotland, who said:

“The NHS is haemorrhaging crucial staff—staff who we urgently need now more than ever before—and the government must step up to stop it. They can talk as much as they want about recruitment of staff, of investment in the system or of plans for improvement, but every single one will fall flat on its face unless there is a laser like focus on keeping the staff we have.”

Will the cabinet secretary please underline the one thing that will happen now that will reinforce the retention of those very valuable NHS workers?

I can give Mr Kerr more than one thing that will be done in just a second.

I am more than happy to have conversations with interested members about Forth Valley royal hospital. Mr Kerr will know that the improvement plan is in place and that I have committed to coming back to the Parliament with an update on how the plan is being enacted—I will do that.

One of the actions that we are taking that doctors have asked for is the reintroduction of a recycling of employer contributions—REC—scheme. We have given that ability to health boards and that scheme went live in many health boards up and down the country from the end of last year. That will help with retention and was a direct ask from the BMA. The other ask relates to pension issues. There has been some movement from the UK Government, but the BMA says that it is not enough, so we will continue to lobby the UK Government on that.

We will also pay our workforce. It is really important that we pay the members of our workforce adequately and fairly. We will continue to engage with them. The Scottish Government has put a record pay deal on offer for our agenda for change staff. We will continue to work with and listen to our medical workforce, especially junior doctors, who, understandably, are feeling particularly aggrieved, given the pressure that they are under and the pay differentials that exist between them and senior medical staff. We will continue to engage on pay. Of course, that will help with retention, too.

That concludes the ministerial statement on NHS winter pressures.