The next item of business is a debate on motion S6M-17869, in the name of Jackie Baillie, on addressing Scotland’s medical and nursing workforce crisis. I invite members who wish to speak in the debate to press their request-to-speak buttons.
14:53
Our national health service is on its knees. There are thousands of vacancies for doctors and nurses, and yet we are turning them away as posts lie unfilled or, even worse, are cut.
When 860,000 Scots are on a waiting list for tests or treatment, delayed discharge remains stubbornly high, the number of general practitioners is reducing instead of increasing, and there are shortages in almost every area of the NHS—from nurses to allied health professionals—the fact that we are training people to end up unemployed is, frankly, a disgrace.
Will the member take an intervention?
No—I think that you should listen.
It costs £300,000 to train a single doctor to the point at which they can land a specialty training place, and we are also training nurses at a cost of £60,000. We are throwing that down the drain—what a waste, not just of taxpayers’ money, but of those people’s futures.
Today, the British Medical Association Scotland published a survey of its resident doctors that shows that a staggering 70 per cent of them have concerns about their employment—all that while the vacancy rate for consultants is at 14.4 per cent. To put that into context, that is 1,000 vacant consultant posts, which is enough to fill two large hospitals.
These are the voices of resident doctors who have trained for years, but, in today’s Scotland, are not able to get jobs:
“It feels like a complete dead end … completely soul crushing after seven years of dedication”.
“I do not know if I will be able to pay my rent come August and, if I am unable to secure enough work, I will have to move back in with my parents”.
“It is literally giving me sleepless nights.”
Some are considering moving to England or, indeed, abroad. Others are forced to choose between their family life and a job on the other side of the country, and others still are considering a new career. That is the reality of being a resident doctor in the Scottish National Party’s Scotland. For the individuals concerned, it must be a crushing blow to realise that the stable career that they chose is anything but.
However, the SNP’s failure to come up with a proper workforce plan is also a betrayal of all of us. As Susan, a resident doctor in Hamilton, asked,
“Why are we spending money increasing university places for medical students, when there are not enough jobs, or training posts, to continue their career in Scotland?”
The Scots who cannot get an appointment should rightly be outraged at the idea that they cannot see a doctor when, somewhere nearby, an unemployed qualified doctor is sitting on their hands. Douglas, a resident doctor, said:
“I would love to be an anaesthetist, I would love to help bring down waiting lists but I can’t.”
The SNP Government will say all the right things about how important NHS staff are—and they are—but its actions betray it. I have today been sent information that shows that the SNP has cut the number of specialty training places for resident doctors in core surgical training, general surgery, neurosurgery, ear, nose and throat, urology, obstetrics and paediatrics.
It is not just doctors whose places are being cut. Last year, the Royal College of Nursing Scotland warned that newly qualified nurses could not find jobs, despite more than 2,600 whole-time-equivalent nursing and midwifery vacancies being unfilled. Hundreds of nurses graduated without jobs to go to. One mother, whose daughter is about to graduate this year as a paediatric nurse, contacted me to say that she and her fellow graduates could not find jobs in Scotland, despite working on short-staffed wards during their training. Her daughter is now preparing to move to Leicester.
All that must be mind boggling to the patients who are queuing at accident and emergency or just waiting for a test, diagnosis or treatment. It is no wonder that more and more people with means are going private because they can no longer cope with waiting in pain.
The SNP Government says that it wants to fix our NHS, but do you know something? After 18 years, if it had any idea of how to do so, we would have seen it by now. We all know that our NHS is nothing without its staff, but, instead of using them as a human shield, as this Government does, the SNP must get its head out of the sand and take action, because every month that the SNP drags its feet is another month when unemployed resident doctors do not know where to find the money for rent. It is another month for Australian headhunters to recruit them and another month that patients have to continue to wait for treatment.
That is why the Scottish Government has to act now—not next year, but right now. It needs to provide jobs for those resident doctors this August or risk losing them from the NHS completely. The Scottish Government needs to expedite its future medical workforce project and report back to Parliament by 1 September. It must also undertake a wider review of workforce planning, with independent modelling and projections, to report back by 1 December, because there is an urgent need for a proper workforce plan. Those would be important first steps towards that and, frankly, we cannot afford to wait any longer.
I will finish with another quote from a doctor who was surveyed by BMA Scotland. They said:
“My colleagues and patients love me, the feedback I get is great, but the system simply doesn’t care. I am betrayed by the career and country I loved, and the worst part is: I know I’m not alone.”
This is Parliament’s chance to speak up for the young, talented, hard-working people who have spent years training to work in our NHS as doctors, nurses and allied health professionals. They cannot get a job, and that is the fault of this Government and nobody else. This is the time for ministers to commit to changing the system, so that qualified doctors and nurses can do the jobs for which they trained.
I move,
That the Parliament recognises the scale of the crisis in Scotland’s NHS, with almost one in six people in Scotland on NHS waiting lists for tests or treatment, and private hospital admissions in Scotland reaching record levels in 2024, all while patients struggle to access a GP appointment; is concerned, therefore, regarding reports that resident doctors are unable to secure speciality training places in Scotland’s NHS, while newly qualified nurses cannot get jobs despite over 2,600 unfilled whole-time equivalent nursing and midwifery vacancies; regrets that inadequate NHS workforce planning by the Scottish National Party administration is forcing highly skilled clinicians to seek employment elsewhere, and calls on the Scottish Government to expedite its reported Future Medical Workforce project, and to report back to the Parliament by 1 September 2025, and undertake a wider review of workforce planning, with independent modelling and projections, and to report back by 1 December 2025, so that there is the required level of workforce to staff Scotland’s NHS.
I call the cabinet secretary, Neil Gray, to speak to and move amendment S6M-17869.2.
15:00
In this chamber, I have always been candid about the challenges that our NHS faces, and today will be no different.
Once again, I put on record my deep appreciation for all the hard-working staff without whom our NHS simply could not function. In the case of our agenda for change staff, I was delighted to be able to recognise their efforts through the recent agreement of a two-year pay deal, which will feed through into pay slips later this month.
We continue to invest heavily in our workforce, and the latest NHS Scotland workforce statistics, which were published last week, demonstrate 13 consecutive years of growth. There were other causes for optimism in those statistics, most notably the 62 per cent reduction in nurse agency staffing that was achieved over 2024-25.
Through our on-going work to implement the recommendations of the nursing and midwifery task force, we will take further action that is designed both to attract and retain our nursing workforce, listening to the feedback that we have gleaned directly through conversations with staff on the ground.
I note Jackie Baillie’s concern around newly qualified nurses who are unable to secure posts. I am aware that a limited number of newly qualified children’s nurses and midwives had challenges in identifying suitable posts in their local area last year. My understanding is that vacancies are often available across nursing disciplines, and geography can impact fill rates. Indeed, the latest statistics indicate that there are historically high levels of nursing and midwifery staff, and that more than 1,000 band 5 nursing and midwifery vacancies across Scotland are open to newly qualified practitioners.
How many newly qualified paediatric nurses have found vacancies that enable them to take up a job?
I am aware that a limited number, on a geographical basis, have found that a struggle, but, as I have just said, a wide range of vacancies are available for newly qualified nurses to go into.
I am also aware of similar reports of resident doctors having difficulty in securing specialty training places; that has been part of our discussions with the workforce and with the First Minister and wider partners.
As I am sure that Jackie Baillie is aware, specialty training places are recruited for on a United Kingdom-wide basis and then allocated according to where the greatest service needs lie. Entry to specialty training is through a competitive application process that is run on a four-nations basis.
Contrary to Jackie Baillie’s assertion, we have funded the creation of hundreds of additional specialty training posts across all specialities, including 47 that were added in 2025. We are ensuring that we train the number of consultants that we need for the future, which is why we have funded the creation of hundreds of additional posts across specialties.
I recognise the calls for greater workforce planning to account for what patients and the public want from their health service and, importantly, to ensure that medical careers remain attractive. That is why the Scottish Government is taking forward the work that Jackie Baillie mentioned in her motion—to think 15 and 20 years into the future and gain an understanding of the needs of the future medical workforce.
Will the cabinet secretary give way?
Would I be able to get the time back, Presiding Officer?
There is very limited time.
I give way briefly.
I appreciate the cabinet secretary giving way, because I have a genuine question. When my daughter qualified as a midwife, there were 10 times as many applications as there were places. Now, midwifery places at universities are going through the clearing house. Does that cause the Government any concern?
I recognise that there are areas in our health service that are particularly attractive, such as paramedicine, midwifery and paediatric nursing. We want to ensure that the number of people who come through training is married to the number of positions that are available on a wider geographical basis, and that we have staff in the areas where we need them in order to respond to patients’ needs across the country.
The work that is under way to consider the future needs of the medical workforce will consider questions such as what the role of a doctor will be, what will look different for them in the way that they deliver care and, importantly, what steps we need to take now in order to deliver against that. The project has been welcomed by doctors at all stages of their careers, as well as by NHS employers, the royal colleges and the British Medical Association. Listening and dialogue will be key, and all doctors will have an opportunity to contribute their views.
In order to do that work well, the process cannot be rushed. That is why the report on that conversation will be published by the end of this year, alongside our assessment of the demand for medical services and the possible future supply of the medical workforce. Consultation on any future policy changes will also need to be informed by the outcomes of NHS England’s review of postgraduate training, which will have an impact, as there are benefits to all four nations if some of our systems and processes are developed in lockstep. That consultation will take place in 2026.
Even with continued effort and investment to grow and support our NHS Scotland workforce, the system can function effectively only if it operates as part of an integrated health and social care system. Therefore, I must take this opportunity to highlight my significant and grave concern about the recently published UK Government white paper on immigration and the Labour Government’s intention to close the social care visa to new applications from abroad. The implications of that will be catastrophic for our social care sector and will undoubtedly have an impact on the entire system.
Cabinet secretary, I have been generous with your time, but you need to conclude.
A vast amount of work is under way, both from a workforce perspective and from a reform and renewal perspective. The population health framework and the health and social care service renewal framework, which will be published soon, will build on those initial steps, setting the trajectory for the years ahead and demonstrating our ambition for the NHS in Scotland. I look forward to collaborating with the workforce as we seek to implement those new ways of working for the benefit of our patients and staff across the country.
I move motion S6M-17869.2, to leave out from “recognises” to end and insert:
“acknowledges the challenges facing the NHS and the critical contribution of its workforce; thanks the dedicated NHS staff for their hard work and professionalism in times of enormous pressure; notes with concern that too many people are waiting too long for treatment and welcomes, therefore, additional funding to reduce patient waits and deliver 150,000 extra appointments and procedures in 2025; acknowledges the challenges in primary care and community health settings, where too many people face difficulties making a GP appointment; recognises the calls for greater workforce planning to account for the changing landscape of delivering healthcare, building on historically high levels of staffing; notes the Scottish Government’s commitment to develop future workforce planning in response to the forthcoming population health and service renewal frameworks; believes that it is important that this work is informed by doctors working in the NHS through the Future Medical Workforce project, which will report on the planned dialogue, alongside an analysis of workforce demand and supply, by the end of 2025, while continuing with implementation of the Nursing and Midwifery Taskforce over the course of the year, and regrets deeply the UK Labour administration’s reckless decision to close the health and care worker visa to adult social care, which will lead to acute workforce challenges and the closure of services, and have a devastating impact on both those receiving care and staff providing care.”
15:07
I declare an interest as a practising NHS general practitioner and a former chair of the BMA GP trainees committee.
In my experience in my GP surgery, I see not statistics, but real-life stories that tell me that our workforce is stretched to breaking point. Behind every delayed scan or missed appointment is a patient who has been left in pain or desperately worried, and a clinician who has been left exhausted. Let us call that what it is: a workforce crisis that has been created in Bute house and presided over by a revolving door of Scottish National Party health secretaries who have failed to plan, failed to lead and failed Scotland’s patients.
As a consequence of those failures, junior doctors are finishing years of training only to find that there are no jobs. GPs who are being trained here are forced to leave Scotland to work; the SNP is training doctors for Australia. Newly qualified nurses and paramedics are joining the ranks of the unemployed, all at a time when patients are struggling to get appointments. That is happening right now outside the chamber in the real world.
The Royal College of Radiologists has laid bare the scale of the crisis. Scotland faces a 25 per cent shortfall in radiologists and a 19 per cent shortfall in clinical oncologists, which is the highest figure in the UK. By 2029, those shortfalls are projected to grow to 35 per cent and 31 per cent respectively. What does that mean for everyone out there and for our patients? It means that there will be longer wait times for cancer diagnosis, delayed treatments and worsening outcomes. In some parts of Scotland, the gaps are even more severe, which will deepen regional inequality. That is truly scary. The Scottish Government needs to get a grip and stop trotting out the kind of platitudes that are in the SNP’s amendment.
The problem extends beyond cancer care. In cardiology, more than 6,000 patients have been waiting more than a year for an echocardiogram. That is a vital test for heart disease, but not according to the SNP. Shockingly, the Scottish Government does not consider that to be one of its key diagnostic tests. It is omitted from workforce planning, routine reporting and serious political attention. After 18 years in Government, the SNP still has not got its head around the basics.
The waiting list for that test is more than double the combined total for the eight key tests that the Government tracks. Clearly, patients with suspected heart disease are having to wait for that test. There is a lack of trained cardiac physiologists. The only degree programme in Scotland for that specialty is ending and no replacement is in place for 2025. That profession, which is crucial to saving lives, is being allowed to wither from neglect. That is the SNP in a nutshell.
I turn to GPs. What I witness there is not isolated strain but the visible symptom of a deeper workforce crisis that the SNP has long ignored. Poor planning, a lack of vision and political complacency have left our NHS hollowed out even as demand continues to soar. There is what has been announced and then there is reality. The SNP promised 800 more GPs by 2027 but, lo and behold, GP numbers instead fell from 4,514 in 2022 to 4,438 last year. The BMA and the Royal College of General Practitioners have warned that general practice is in danger of collapse. However, under the slick management of the SNP, we find ourselves in the absurd position in which doctors are underemployed yet demand is soaring.
It is time for change and leadership rather than slogans and excuses. Our NHS staff and patients deserve better.
I move amendment S6M-17869.1, to insert after “vacancies,”:
“acknowledges that Scotland is experiencing a paradox of underemployed GPs who remain unable to find sufficient work despite widespread demand, as well as unemployed paramedics graduating from universities and paediatric nurses unable to secure roles; highlights that the Scottish National Party administration promised to increase GP numbers by 800 by 2027, but that this target is unlikely to be met as GP numbers are declining and junior doctors are struggling to find jobs; acknowledges that the Royal College of Nursing has claimed that current nursing staffing levels are inadequate, noting that, while the number of nurses employed by NHS Scotland has increased, levels of staff absence and agency use remain unsustainably high; references the report, The Nursing Workforce in Scotland 2025, which shows demand outstripping supply, and calls for better data to enable sustainable workforce planning; recognises that the Royal College of General Practitioners has criticised the Scottish Government’s plan to provide 100,000 extra GP appointments, as Scotland’s NHS currently does not have the workforce capacity to deliver this plan;”.
15:11
Everyone in Scotland, including everyone in the chamber, recognises the challenges that our NHS is facing. Of course, we are fortunate to still have a fully public NHS in Scotland. Scotland has taken a very different approach to NHS reform compared with England, especially since devolution. While NHS England underwent market-oriented reforms, starting with Tony Blair in the 1990s and then with the Conservative Health and Social Care Act 2012, Scotland focused on integration and collaboration, and not on competition.
Maintaining a fully public NHS while Scotland’s purse strings are held by a Government in London that prefers a market and profit-driven model is the subject of one of the many frustrations that I have with the devolution settlement. There is a limit to what Scotland can do, given where we sit in this unequal union.
Will the member acknowledge that hundreds of her constituents are going private because they cannot get appointments on the NHS in Scotland?
I do not disagree that there is a crisis in NHS Scotland. I will come to that, but the member will also acknowledge that many of the problems that we face in Scotland are made at Westminster. For example, the persecution of asylum seekers, who are not allowed to work, takes valuable people out of our workforce, and there is the persecution of immigrants and the hostility to people who come here. I will come to those points.
Scotland has a crisis in our medical and nursing workforces, as the member says. Everyone is aware of that. We are all aware of the absurd rigmarole that we go through when we try to get a GP appointment and we have to call over and over at 8 am or 2 pm to get through. We have all done that. It is quite a challenge to anyone who has a job or daytime responsibilities. Increasing the number and availability of GPs and expanding and enhancing general practice facilities and premises must be an urgent priority, and there are some things that we need our Governments to do to fix that.
We need the UK Government to let up on its hostility to foreigners and immigration. Some 40 per cent of GP trainees across the UK are international medical graduates—IMGs. The Labour Government at Westminster should offer them all indefinite leave to remain upon successful completion of GP speciality training. The Royal College of General Practitioners Scotland agrees with me on that.
The Scottish Government could help by creating a national umbrella body that was capable of sponsoring IMG visas to remove the bureaucracy and costs from GP practices. Of course, the UK Home Office could remove that at the stroke of a pen, but here we are.
The UK Government should also rethink its unworkable fiscal rules, commit to taxation of the most wealthy and of polluting industries and reverse the increase in employer national insurance contributions, which were its only options after making self-harming promises on taxation during its election campaign.
There is a great deal of anxiety among GPs about the risk of underemployment due to constrained practice finances. The recent increase in employer national insurance contributions has led many GP practices to freeze or scale back their recruitment plans. The Scottish Government must work to deliver the future medical workforce project urgently and to complete the implementation of the nursing and midwifery task force as soon as possible.
The Scottish Government must increase the general practice workforce and, just as important, increase capital investment in general practice premises to expand and enhance facilities and infrastructure. A 2022 survey by the Royal College of General Practitioners found that 62 per cent of respondents considered that their premises were not fit for purpose, with issues such as a lack of consulting rooms.
We see that in East Calder, where my Lothian region colleagues Sarah Boyack and Foysol Choudhury have led the campaign to expand the local health centre. The East Calder health centre was originally built for 4,000 patients but now serves up to 16,000, as the towns and villages in the area have expanded rapidly, which has led to challenges for medical staff and for patients who are trying to access those services. The lack of investment in infrastructure has left patients and staff in limbo.
GP surgeries are only one aspect of the health service, but they play a crucial role at the front line and in preventative care. If we help them, we help to unburden our emergency rooms and our hospitals.
15:16
I am pleased to speak in the debate, although I am tired of saying that there is an NHS workforce crisis, as we do so repeatedly. It is a crisis, and that fact is self-evident to those who work in our NHS and those who rely on it. The crisis is plain to see in waiting times and hospital pressures and in the workforce that our system depends on.
Let us be absolutely clear at the outset that the crisis is caused by years of complacency by the SNP Government, which has now been in power for almost two decades. One in six Scots is on a waiting list. People are forced to go private for healthcare, not as a choice but in desperation, and patients are waiting weeks just to get an appointment to see their GP. I am sure that I am not alone among members in this, but not a week goes by when I do not get a constituent visiting me or getting in touch to tell me the impact that the situation is having on them or someone they love.
I turn to the workforce. We have more than 2,500 unfilled nursing and midwifery vacancies, but newly qualified nurses are still struggling to find work. How can that be? How can it be that, in this chamber, we passed legislation to ensure that our nurses should never go to a shift that is not safely staffed, yet none of them reports confidence in the safety of the shifts that they are asked to staff? We have resident doctors who are unable to get on to specialty training programmes despite investing years of study and service in our NHS. That is not just a tragic waste of talent; it is an insult to those who are waiting for placements, but also to the staff and patients who desperately need their expertise on the front lines.
What is the point in increasing training places without ensuring that jobs exist at the other end? There is no proper bridge between training and practice, and the few bridges that exist are now bottlenecked, leaving exhausted senior clinicians to oversee more trainees with yet fewer resources. I have spoken with experienced locum doctors in my constituency who have told me that they cannot find work in Edinburgh—our capital city—where demand for healthcare, including primary care, has never been higher. That is how broken the system is. Patients are crying out for care, yet qualified clinicians are left on the sidelines because GP practice budgets are so stretched that they cannot reach for the luxury of sickness cover.
That is not just mismanagement; it is a direct result of a Government that has failed to take responsibility for national workforce planning. The Government has pushed responsibility on to local boards without the long-term modelling tools that are needed to deliver. It is clear that the Government’s future medical workforce project is not working. There are issues with the Government’s 2018 contract that expected GPs to work on a multidisciplinary model, and the demand for GP appointments has gone up significantly since then.
Will Alex Cole-Hamilton take an intervention?
I am afraid that I must make progress.
The NHS does not need more pilot schemes. It needs action and genuine change. It needs conversations—difficult conversations—and it needs innovation and reform.
One aspect of the Government’s amendment that I agree with is the point that the UK’s decision to close the health and care worker visa route to adult social care is short sighted and deeply damaging and risks worsening an already acute staffing crisis in our NHS and social care workforce. However, let us be clear that the recruitment and retention crisis that we have in Scotland’s care sector has been years in the making and is entirely of the SNP’s design. It is driven by low pay, poor workforce planning and a Scottish Government that consistently fails to value those who are on the front lines.
Here in Scotland, we can achieve change only if the Government chooses to act. It must match our ambition and give care workers the pay and recognition that they deserve. At Westminster, we are calling for an end to crippling Home Office visa fees that threaten to push services to the brink. Our message is simple: whether care workers grew up here or came here, they deserve fair pay, job security and respect. The Government needs to stop dragging its heels and act before the crisis deepens.
We move to the open debate.
15:20
I am pleased to speak on an issue that concerns the very backbone of our NHS: its workforce. I begin by echoing other members’ points about the value of our NHS workforce. It is the beating heart of the NHS and, without it, services and care would collapse, which is why it is so important that we discuss the matter openly and honestly in the Parliament. I thank all those who work tirelessly in Scotland’s NHS. Scottish Labour recognises the contribution and value of workers and understands the pressure and strain that they face daily.
When I speak to constituents, one of the many things that I hear is how difficult it is to see a local GP, and I hear about how long NHS waiting lists are. Ambulances are stacked up outside accident and emergency, patients are waiting hours for treatment and those who are ready to be discharged are forced to remain in hospital while waiting for appropriate care packages. Everything has stagnated, but let us be clear that people understand that it is not the staff’s fault. In fact, people speak very highly of the staff; the issue is the system, and the responsibility lies with the Government.
At the centre of the Government’s stagnation is our workforce, which is struggling to keep up with demand in a fundamentally broken system. After 18 years in power, the SNP has presided over a workforce crisis in which staff shortages not only risk patient safety but put additional pressure on the existing workforce, which impacts their mental and physical health.
Our healthcare system is crying out for additional staff, but newly trained doctors and nurses, who are highly motivated and ready to serve, are meeting with disappointment when they are being told, after years of training, that there are no jobs, although that is not true. The system is crying out for highly professional, trained staff. If we want safe staffing, the NHS must fill more posts, and the Government knows it. How can it be right that newly qualified nurses are being forced to find jobs outside Scotland, despite completing their training at Scottish universities and hospitals, where they see the pressures day in, day out? There are currently more than 2,600 unfilled whole-time-equivalent nursing and midwifery vacancies. We hear from nurses daily that going through and completing the recruitment process in the NHS is agonising.
Since 2013, the number of registered nurses who are employed in care homes has decreased by 28 per cent. That issue is important because those nurses greatly contribute to keeping hospital admissions down, so we must take the statistics seriously. Delivering and supporting a sustainable nursing workforce across Scotland is crucial to improving overall patient care and experience, yet our nurses report feeling undervalued and overlooked. When it comes to issues such as corridor care, poor planning has left staff feeling ashamed, demoralised and distraught.
Our NHS workforce deserves better, and things cannot continue as they are. The Government is aware that urgent work is needed to attract and retain a sustainable workforce, yet there is no obvious plan. There is a disconnect between what the Government promises to do and what it actually delivers. Delivery is essential.
Will the member give way?
The member is concluding her speech.
I am closing—I apologise.
I hope that members will support Labour’s motion, which recognises the on-going workforce crisis and calls on the Government to undertake a wider review of NHS workforce planning, which must be reported on by the end of the year. Our NHS workers and patients deserve better. The status quo of this Government is no longer an option, and Scottish Labour is ready to deliver the whole-scale change that our NHS needs and deserves.
15:24
First, I do not accept that the NHS in Scotland is in crisis. It avoided being in crisis even at the height of the Covid pandemic, which was due, in the main, to its extraordinary staff. Yes, it is in challenging circumstances, but to say that it is in crisis is scaremongering—not that Labour is known for that. If the NHS were in crisis, one would have thought that Labour would have assigned all its debating time to that subject, instead of holding this very short debate.
I will try my best to make the following points in the paltry four minutes that I have for my speech. In relation to pressures, Covid continues to have an impact. Research by the University of Strathclyde states:
“The challenges faced by NHS Scotland are not unique and reflect broader global trends within healthcare systems.”
In relation to demographics and the ageing population, it was estimated that a million Scottish residents were aged 65 years or older in 2020, but that number will rise to an estimated 1.4 million by 2040, which will represent 25 per cent of our population. I am one of those people. As we age, we require to use our medical services, including GP surgeries, pharmacies and hospitals, more and more. At 80, I can testify to that. An ageing population also means that there is a depleted available workforce.
In relation to policy interventions, the Scottish child payment, which has cost £1 billion since 2021, supports more than 326,000 families and mitigates Labour’s two-child benefit cap. Poverty equals disadvantage equals ill health. There are many Scotland-only preventative measures that will, in time, reduce pressures on our healthcare system. That is why the U-turn on the winter fuel payment by UK Labour—which was shamed into the change by pensioners and the Scottish Government—is welcome, before another Scottish winter hits home and hearth. It is a pity that we cannot shame Labour into ditching the two-child benefit cap. [Interruption.] I have four minutes—of course I will not give way.
In relation to staffing, there are fewer people in the working population, but UK visa restrictions, Brexit and Labour’s policy to increase employer national insurance contributions, which will cost NHS Scotland an additional £191 million in one financial year, all have an impact on staffing pressures across the entire health landscape. That includes general practices and pharmacies, which I know are not recruiting because of the added NI burden—it is a tax on jobs.
In relation to pay and conditions, NHS nurses, midwives, paramedics and other healthcare staff across Scotland have voted to accept an 8 per cent pay deal over two years. The figure in the Scottish deal is significantly higher than the 3 per cent that was recommended by pay review bodies in England and Wales, where pay negotiations are continuing and strike action is a real threat.
The hospital at home service has a role in reducing the time that people spend in hospital and leads to better recovery. All such interventions, preventative measures and modern ways of treating people are reducing—and will, in time, further reduce—pressures across our healthcare landscape. We need a wider review, given the value and cost of interventions to reduce health pressures.
The Labour Party has to be honest about the impact of the labour gaps that have been exacerbated by Brexit, which Sir Keir Starmer is now embracing, even though he used to oppose it. The visa restrictions and the dreadful burden on employers through the increase in their national insurance contributions are all UK Labour policies to which I have referred in this very short debate, which, as I anticipated, is only about chasing tabloid headlines—it has nothing to do with reality.
15:28
In securing the debate, Scottish Labour is confronting the crisis that is gripping the NHS in Scotland. That crisis is not simply measured in statistics; it is felt in the lives of patients, nurses, doctors and families across our nation.
We heard that clearly on the doorsteps and streets of Hamilton, Larkhall and Stonehouse during the recent by-election. I congratulate Davy Russell, Scottish Labour’s winning candidate, and I know that he is already working hard to represent his constituents. Frankly, they, like people across Scotland, are sick of the excuses. I know that there are very few SNP MPs left in the House of Commons, but that is the place to hold the UK Government to account. This is the Scottish Parliament. Responsibility for the NHS is devolved.
Unlike the Greens, we will not let the SNP off the hook any longer, because, as you heard from the emotion in Jackie Baillie’s voice, this is personal to every one of us. We care about the staff and our constituents, and we will not put up with complacency.
Will the Labour Government be changing its policies on allowing asylum seekers to work and on hostility to immigrants in order to support the NHS in Scotland?
Please speak through the chair.
Lorna Slater made some relevant and important points at the start of her speech, but she failed to address the purpose of the motion, which is to take the opportunity in the chamber to hold the Scottish Government to account for its broken promises, because I—
Will the member give way?
Hold on a second. I heard the cabinet secretary say that he hears the calls for workforce planning. I have been here for nine years, and for even longer than that—for the whole of the 18 years of this Government—we have been calling for better workforce planning. Why can the Government not do its job?
In our amendment, we set out the timescale for delivering that planning. I really resent the suggestion—Monica Lennon is better than this—that, somehow, SNP ministers do not care or do not have the same care for our health service, which brought my four children into this world and has saved and improved the lives of my family members as well as those of everybody else across the chamber. We need a bit more cross-party consensus on our joint support for the health service, as opposed to what Monica Lennon just suggested.
I can give Monica Lennon some of that time back.
I am not going to take those patronising comments and the emotional blackmail from the cabinet secretary, because no one doubts what is in his heart and his compassion, but this is about competence. Why has there been no proper workforce planning? That is what people were asking during the by-election campaign, and that is what they are asking as we face the polls next year.
I admit that I have some skin in the game because, today, my daughter successfully completed her first year as a medical student, and my son-in-law is a resident doctor. We are not making these things up. People are coming into the healthcare profession because they care, but the opportunities are not there—that is the reality. [Interruption.] The cabinet secretary can chunter away all he likes, but we need solutions.
One of the things that we heard clearly on doorsteps during the by-election campaign is that people are not going to stand for the Government downgrading the neonatal unit at University hospital Wishaw. That is why Davy Russell was elected. The staff have been ignored; the families have been ignored. The cabinet secretary can shake his head—I will take an intervention, if he wishes to make one. That is the absolute denial of an award-winning service for the most vulnerable, the sickest and the smallest babies in the country. Babies in Lanarkshire should not be sent away to Aberdeen for critical care at the most vulnerable time in their lives. That is the reality. That is not a UK Government problem. It is the responsibility of the Scottish Government, and we are not going to apologise for bringing these arguments to the chamber.
I encourage front benchers not to carry on a discourse while a member is on their feet.
15:32
How many times have we sat in this chamber and listened to successive health secretaries assure us that Scotland’s NHS is safe in their hands? Now we hear the First Minister making similar promises, claiming that, under his leadership, things will be different and that the NHS will be a priority in the coming months. Really?
Let us not forget that this out of touch SNP Administration has been in charge for nearly two decades, yet our health service continues to lurch from one crisis to the next. That alone speaks volumes about the Government’s abject failure to address the workforce crisis—the cause of our problems. Yes, the pandemic added pressure, but the truth is that Scotland’s workforce planning was in disarray long before Covid. Despite repeated promises to bolster front-line support and staffing, the stark reality is that that simply is not happening. I know it, members know it and the public certainly know it. If members were to knock on any door in my constituency of Galloway and West Dumfries, they will hear the same concerns: a lack of GP appointments, a shortage of NHS dentists and long waits for hospital treatment. These are not isolated issues; they are systemic failures across Scotland.
Now we face a paradox that lays bare the dysfunction that is at the heart of this Government’s workforce strategy: we have underemployed GPs who, despite widespread vacancies, are unable to find sufficient work, and we have newly qualified paramedics and paediatric nurses who are struggling to secure roles, even as vacancies remain unfilled. The SNP promised to increase GP numbers by 800 by 2027, but that target is slipping further out of reach as GP numbers decline and junior doctors struggle to find jobs.
The Royal College of Nursing has made it clear that current staffing levels are inadequate. Yes, the number of nurses employed by the NHS in Scotland has increased, but so have staff absences and reliance on costly agency workers. That is not sustainable; it is a sticking plaster on a gaping wound. “The?Nursing Workforce in Scotland 2025” ?report shows that demand is outstripping supply. We urgently need better data and more robust planning to ensure a sustainable workforce for the future. Without it, we are simply guessing—and guessing wrong.
Meanwhile, the Scottish Government’s plan to deliver 100,000 extra GP appointments has been criticised by the Royal College of General Practitioners, because the workforce simply is not there to deliver it. It is a headline-grabbing promise with no substance behind it.
In my constituency, the consequences are painfully clear. Mothers in Wigtownshire still have to face a journey of more than one and a half hours along the treacherous A75 to give birth in Dumfries, despite the presence of a fully equipped maternity unit at the Galloway community hospital in Stranraer. That is because NHS Dumfries and Galloway lacks the resources to staff the community hospital. That is not just inconvenient—it is dangerous.
The same goes for care beds. The local integration joint board promised 31 flexible beds, rather than reopening four cottage hospitals—something that the community overwhelmingly supported. However, the number has been paused at just 22 beds; in fact, the board has not even reached that as it tries to manage a £14 million overspend. The Government continues to ignore the unique needs of rural areas such mine, which has one of the largest ageing populations in the UK.
Let us not forget the human cost. One of my constituents has been told that he must wait 52 weeks for a cataract appointment, which is far beyond the 12-week target. It was suggested that he should take private treatment at a cost of £3,000, but he cannot afford to. Now his job is at risk. That is not just a statistic—it is someone’s livelihood and someone’s future.
Despite the tireless efforts of health and care staff, they are stretched to breaking point. It is a tragic irony. Waiting lists in Dumfries and Galloway are at record highs, with just 31 per cent of patients being seen within 12 weeks, a staggering 763 waiting longer than one year and 10 waiting more than two years.
Scotland’s NHS is not just under pressure; it is on life support. We need immediate, decisive action to address the workforce crisis. We need a Government that listens to the professionals, that plans for the future and that delivers on its promises. The people of Scotland deserve better, and it is time that the Government delivered.
We now move to the final speaker in the open debate.
15:37
The group leader of the Labour Party told the Parliament two weeks ago that
“There are now 860,925 people on an NHS waiting list”.—[Official Report, 29 May 2025; c 12.]
Jackie Baillie repeated that in her opening speech. However, Public Health Scotland—which, as I assume the Opposition parties understand, does not work for the SNP and is utterly politically impartial—has said that
“figures for the number of ongoing waits of patients waiting ... should not be added together to determine the proportion of the total population waiting”.
Mr Sarwar and his allies in the other parties were caught out on that last year, when the Full Fact organisation said of his misuse of statistics:
“Politicians and the media must take care to use the best evidence available and describe it accurately, so people are not misled about the state of public services.”
I could not agree more. If they cannot even get the basic facts of their attack lines right, why would anyone trust a word that they have to say about our health service?
It is misleading—[Interruption.]
Ms Harper, I ask you to resume your seat. Can members please spare me the back and forth—and not just those on the front benches, as they have encouraged back-bench members to join in.
I can give you the time back, Ms Harper.
Thank you, Presiding Officer.
If they cannae even get their attack lines right, why would we trust their word on our health services? No one in our national Parliament has denied the scale of the challenges facing our national health service. I know about those challenges, given my background as an NHS nurse and a former employee of NHS Dumfries and Galloway, with friends and connections who tell me what is going on on the ground. I thank everyone who commits their time and effort to the amazing professional care that they provide to patients every day.
I believe that the Scottish Government has taken step after step, not just in our post-Covid world, with all the additional challenges that have been added to our health systems, but in the years before that, to get our NHS working at full efficiency. Scotland offers the highest nursing, midwifery and paramedic bursaries anywhere on these isles: a non-means-tested £10,000 a year here, whereas England offers just half that. Our NHS provides the highest pay out of all four UK systems—a state of affairs that was reflected in the vote to accept the agenda for change pay deal earlier this year.
Scotland has also led the way in the training of physician associates and anaesthesia associates in our NHS, which has increased assessment and treatment capacity. We have worked with medical schools to ensure that the training and education are in place to continue that programme in the future.
As an MSP for South Scotland, I am acutely aware of the particular challenges that our health service faces in rural areas. That is why the uniquely Scottish ScotGEM—Scottish graduate entry medicine—programme is particularly welcome. It brings graduate training up to postgraduate medical degree level to NHS Dumfries and Galloway, to help to provide care in our part of Scotland.
I always find it interesting that I am the only person to big up ScotGEM and its success, and that the Opposition doesnae want to tell the good-news stories. The cabinet secretary and I have talked about that.
Again, the SNP is putting resources and money where it is needed, with bursaries funded for those who come to work in our rural communities. That is a Government that is acting when action is needed. What is more, we are committed to a public health service that remains free and in which medical need is the most important thing. It is for Labour members to explain why their health secretary down south has taken more than £370,000 in donations from profit-making private health businesses over the past decade. We are clear that our NHS will remain publicly owned and publicly accountable.
I do not doubt that Labour members are genuine about wanting a better national health service—I doubt that there are many people in the country who do not want that—but their words are not matched by deeds. Their attempt to weaponise the multiplicity of challenges that our NHS faces for electoral ends is an attempt to pull the wool over Scotland’s eyes.
We move to closing speeches. I am disappointed to note that Mr Cole-Hamilton is not in his seat; I expect an explanation and an apology.
15:41
In relation to workforce planning, I feel that we are stuck in a time loop. It seems as if, for all the time that I have been in the Parliament, and as Monica Lennon pointed out, we have been asking for some kind of credible workforce plan—and by credible, I mean one that actually addresses the need.
Back in 2018, the then Cabinet Secretary for Health and Sport, Jeane Freeman, decided that the Scottish Government would train an extra 800 GPs over a 10-year period, to address a shortfall of 860 in the number of GPs—the mathematicians among us may already see the flaw in that plan. However, as Audit Scotland pointed out, by the time those 800 new GPs are trained, some of the existing workforce will have retired—who could have foreseen that?—leaving an estimated deficit of 664 GPs in 2027.
Of course, the situation has got progressively worse than that: the Scottish Government is very keen to count the number of GPs, as opposed to the full-time equivalent number, which paints a really different picture of primary care.
The same applies to our stretched nursing and midwifery departments. “Burnout” is a word that is used increasingly often, as more and more of our NHS staff are either retiring early or off sick with stress. The Scottish Government often puffs out its chest and tells us about the record investment in the NHS and the record numbers of nurses, doctors, midwives and consultants. However, when we challenge that with the reality of record waiting lists and vacancy numbers, and continually growing ill health, we suddenly hear the words “Westminster”, “Brexit” and “pandemic”—anything other than “SNP responsibility”.
Both positions cannot be true, and the truth is that the Scottish Government’s response is akin to trying to fill the proverbial bucket with holes in it. Staff retention should be tackled first: recognising the issues that our GPs and nursing staff face, and creating an environment that encourages them to stay and, crucially, encourages more people to take up those positions. That is an approach that I have pushed ever since I arrived in the Parliament.
Incidentally, something that the Scottish Government could do right now is reintroduce nursing and midwifery apprenticeships as an alternative route into the profession. More than 40 per cent of midwifery students are over the age of 30 and have probably had to give up another career to pursue that one. We should be making it easier for them to access it.
Will the member give way?
I will, briefly.
I refer Mr Whittle to the nursing and midwifery task force, which is looking to implement alternative routes into nursing and midwifery training.
I will give you that time back, Mr Whittle.
I appreciate that.
That brings me to the way to tackle the pressures that have been put on our healthcare system and, specifically, our GPs and nurses. There are two elements to dealing with the pressure on hospitals and GP surgeries: increasing the head count and, crucially, reducing need. However, all I have ever heard the Scottish Government talk about is increasing the head count and the fact that we have record numbers of staff per head of population.
There are reasons for that need. Scotland’s rurality is one of them, but the poor health of our nation is the huge elephant in the room. As a result of ill health, we have high levels of economically inactive people, and there has been an alarming rise in poor mental health. If we focus only on increasing the head count, we will forever need to increase the head count. Preventative health has been the poor relation in that equation.
The deployment of a technology-agnostic interoperable solution is absolutely essential if we are serious about bringing our NHS into the 21st century. Apparently, the Minister for Social Care, Mental Wellbeing and Sport and her team did not understand the term “technology-agnostic interoperable solution”, so they decided to google the meaning of it—it appears that that is how the Scottish Government now decides policy—and were confused by the answer. Therefore, I thought that I would google the term. Here is what I got:
“A technology-agnostic interoperable solution is one that can work with various technologies and systems, allowing for flexibility and integration without being tied to a specific vendor or platform. This approach promotes interoperability, scalability and future-proofing, enabling businesses to adapt to evolving needs without being constrained by a single technology or vendor.”
If I was cynical, I would suggest that the minister was trying to avoid scrutiny.
The SNP Government is not a serious Government. It has no idea how to deal with the issues that we are debating today, and while it remains in office, the health of our nation and the support that our NHS needs will continue to slide.
15:46
I thank colleagues across the chamber for participating in the debate. I am grateful to everyone for their contributions. The way in which the debate has been conducted has been disappointing at times, but I want to close in a more consensual manner. As the Presiding Officer knows, I like to bring people together.
In my opening remarks, I did not have time to reflect on the immediate work that we are doing to improve the performance of NHS Scotland through the operational improvement plan and the investment that we are making to reduce waiting times and accident and emergency waits, and to increase access to the NHS. Those improvements will undoubtedly benefit people who are in need of care and treatment, but—crucially, in the context of this debate—they will, ultimately, alleviate the pressure on and support the wellbeing of members of our NHS Scotland workforce, who are the key focus of today’s discussion.
The greatest gift that we can all give is to bring about those service improvements and reductions in waiting times, and—I say this candidly—to reduce the potential for moral injury that is presented by the inability of our staff to respond to situations in the way that they would wish, to which colleagues have referred. We owe it to them to drive improvements and set the system up for future success, and I guarantee to colleagues that that is my top priority.
In my opening remarks, I also touched on our plans to bring forward our population health and service renewal frameworks in the very near future. The speeches that I have heard today have reinforced the importance of making the changes that will be enacted as a result of those frameworks.
When I talk about renewal, I am not talking only about changes in systems or plans for the benefit of patients, I am clear that the changes must also deliver for staff.
What can the cabinet secretary do for junior doctors this August? They face not having jobs this August.
Funding is in place for local boards to make employment decisions. That is for them to do, and we will continue to work with the BMA on those matters. Indeed, I will meet the BMA resident doctors committee very soon to discuss some of those issues.
In relation to the points that Sandesh Gulhane made, I can tell members that I met the Royal College of General Practitioners, and I will meet the BMA general practice committee tomorrow morning. I met the consultants committee and representatives of the speciality doctors committee today. The discussions are on-going.
Several colleagues picked up on the fact that Scotland faces serious and growing health challenges. More people are expected to be affected by disease in years to come, and too many lives are still being cut short by poverty and inequality. Addressing those challenges is not solely the task of people who work in acute and community health settings. Instead, we need to shift our focus from treating illness to preventing it. By taking that approach, we can reduce the burden on our healthcare system and the staff who operate it.
Alongside the population health framework, we will publish the service renewal framework, which is our long-term plan to reshape health and social care services. The framework is shaped by five key principles. The first of those, prevention, involves focusing on early intervention and reducing the burden of disease. The second principle, people, involves designing care around individuals, not systems. The third principle, community, involves shifting more care closer to home. The fourth principle, population, involves planning services based on real population needs rather than organisational boundaries. The fifth principle, digital, involves using technology to improve access, co-ordination and outcomes.
Will the cabinet secretary give way?
If I still have time, Presiding Officer?
Brian Whittle, briefly.
I am grateful to the cabinet secretary for giving way. I know that he wants to deploy technology in the way that it can be, but the reality is that it is not happening. I had a look at the app that is being deployed in South Lanarkshire, and all that can be accessed is dermatology. We are miles behind. What is preventing the Scottish Government from adopting technology in the first place?
That is the first iteration—the first pilot part—of the NHS digital front door, which is operating not only in South Lanarkshire but in the entirety of NHS Lanarkshire. We will build a product that goes beyond what Mr Whittle suggested, for the reasons that he has outlined, which I agree with.
I believe that the framework can and will support staff to work more flexibly and collaboratively across teams by enabling better access to the right digital tools that make their lives easier and the healthcare that they deliver better. More of the care that they deliver will be in the community, with hospitals’ capacity targeted towards those with the most complex needs. The service renewal framework will provide a blueprint for delivery and mark a step change in the way that we deliver healthcare.
Those frameworks represent a comprehensive package of reform, but they will be successful only if they have the support of Parliament. I therefore want to use today’s debate as an opportunity to restate my absolute commitment to working with colleagues across the chamber in the coming period to deliver the change that I believe we all want to see.
Through collaboration and consensus, I believe that we can set the system on the path for success. My door is always open to ideas about how we can deliver that change in a way that is as inclusive and as effective as possible, benefiting the entire Scottish population, including staff who deliver services across our health and social care system.
I will conclude by referring to the point in the motion about colleagues’ concerns about the future medical workforce project that is due to report at the end of the year. Once the project has reported, I will invite colleagues to participate in a cross-party panel to discuss its findings and to consider the onward reforms that are required, building consensus and showing our collective commitment to our NHS doctors in delivering real change and renewal.
15:52
It is a pleasure to close for Labour in today’s debate.
Having listened to the debate, I am not sure what the Government’s goal is. It seems that its instinct is to be defensive rather than to recognise an open scandal in our national health service. When discussing the issues with clinicians and doctors, junior doctors in particular, across Scotland, it is raised as a recurring and persistent matter. It does not seem that the tone of the debate—certainly from the Government benches—has been remotely concerned with that reality and the lived experience of our constituents or our medical professionals.
I wonder whether Paul Sweeney reflected on my conclusion and my closing remarks, which were far from defensive. They were an opening to further talks and discussions about how we can reflect on the issues and build consensus. That was not defensive—it was about opening up and seeking to reach out to find consensus and a way forward.
That is all well and good, but we need leadership from the health secretary in Scotland, not simply further commentary on the matter. I take the point, and I will give the health secretary the benefit of the doubt with regard to his willingness to build consensus. However, although he claimed in response to my colleague Ms Lennon that there is a workforce plan—which we have been calling for, for years—if we inspect the Government amendment, the reality is that it is about a
“commitment to develop future workforce planning in response to the forthcoming population health and service renewal frameworks ... which will report on the planned dialogue, alongside an analysis of workforce demand and supply, by the end of 2025”.
It does not feel as though there is a sense of urgency in Government, or a sense of grip.
That is why we lodged today’s motion for debate, which comprises fairly scandalous data from BMA Scotland. For example, seven in 10 resident doctors who responded to the survey were concerned about possible unemployment. When surveyed on the issue of applying successfully for specialty training, most people said that they had not been able to get their desired job and 27 per cent said that they applied for specialty training unsuccessfully. Of those applying for clinical development new fellow roles, 34 per cent were successful, and just 19 per cent of those who applied for a locally employed doctor position did so successfully. Of our junior doctors, 10 per cent said that they were planning to locum extensively, introducing even more waste into the national health service. Further, 11 per cent said that they were applying for medical jobs abroad.
An 11 per cent bleed rate overseas is not good enough. There needs to be a much greater effort to stem that flow. When it comes to the NHS, we do not have an immigration crisis, we have an emigration crisis—to Australia—which is endemic. Almost all of my university peer group who were medical students are in Australia or New Zealand right now. That is not just anecdotal; it is met by the data. People are disappointed that they do not have the opportunity to get their first-choice training post, and they are going overseas while they have the opportunity to do so before settling down.
The competition ratios have got worse in the past few years. The average is five people chasing one specialty training post. The disappointment rate is too much, and it has come about because the number of posts has flatlined while demand has increased. It feels as though the plug is out of the bath; simply turning the tap on to a faster flow will not solve the problem if there is no investment in those specialty training posts.
The irony is that, at the other end of the process, there is an increasing outflow of consultancy positions. We hear from the consultants that more and more of them are looking to leave the NHS or reduce their hours.
At both ends of the system, therefore, there is incoherence at the heart of the issue that we are facing. It applies not just to doctors but nurses, as was ably put by speakers in the debate. Not only do we have a huge vacancy issue in the NHS, we have a vicious cycle of dependency on agency nursing and the costs of that to the NHS.
Even within the inflow, there is pressure on nursing students. Brian Whittle made an excellent point about looking at directly paid training courses through an apprenticeship programme such as we might have in the police or the armed forces.
Last year, the agency nursing spend in Scotland was £94 million, which was down by 62 per cent. Would Paul Sweeney care to welcome that?
I certainly welcome any improvement, but huge amounts of waste are still involved, and we need to tackle that vigorously. That is a massive issue, which we need to address.
Also mentioned was the issue of places and nursing shortages in care homes, and the pressure that that places on primary and secondary care in the NHS.
Does Paul Sweeney agree that those pressures create moral injury, which affects our staff, who feel burnt out then just leave?
That was recognised across parties. It is a massive issue. However, the Government has not expressed the vigour that we would want in its addressing of that.
The sickness and absence rate across NHS Scotland has risen to 6.4 per cent, but we know that it is much higher in nursing, at more than 7 per cent across Scotland. To have that level of absenteeism across the NHS, due to that moral injury, burnout and sense of hopelessness—not to mention the mental health impacts that it has on staff—is atrocious.
We mentioned the inflow and pressure on training. Sixty-six per cent of nursing students have considered dropping out due to cost pressures. That is a massive waste of human potential and public resource.
We need to develop the workforce plan. The Government has had 18 years of incumbency in which to develop it. It is shocking that it is only now getting around to proposing getting together. The time has run out. We are less than a year away from the next election. The point of getting together to work it out has passed. The point of being held to account is now here. I hope that the people of Scotland, including the clinicians of Scotland—the people who work in our NHS every day—will hold the Government to account for its abject failure to meet the needs not just of that workforce but the whole population of this country.
That concludes the debate on addressing Scotland’s medical and nursing workforce crisis. There will be a brief pause before we move to the next item of business, to allow front benches to change.
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