Good morning. The first item of business is general question time.
National Health Service (Mental Health Services Spend)
To ask the Scottish Government what progress it has made on ensuring that 10 per cent of front-line national health service spending is on mental health services. (S6O-04784)
We continue to work with national health service boards and integration joint boards towards delivery of the commitment that at least 10 per cent of front-line health spending will be dedicated to mental health by the end of this parliamentary session. The latest available cost book data confirmed that NHS expenditure on mental health has increased by £179.6 million to £1.486 billion in 2023-24. That is 9.03 per cent of total net expenditure, up from 8.53 per cent in 2022-23.
Although we remain committed to the delivery of the target, as we all know, there are continued and unprecedented challenges to public finances. Despite those pressures, since 2006, mental health spending across the NHS has doubled in cash terms, from £651 million in 2006-07 to more than £1.49 billion in 2023-24.
The Scottish Government pledged that boards should spend 1 per cent of their budget on child and adolescent mental health services. However, I understand that only one board has achieved that, while NHS Highland is spending only 0.37 per cent of its budget on CAMHS.
Young people are spending years of their childhood on waiting lists, while others are being rejected from the service altogether. When will all boards fulfil that pledge, and when will the lengthy CAMHS waiting times be dealt with?
I would want to acknowledge the significant progress that has been made on CAMHS waiting times this year, which members will be aware of.
I am aware of the specific points in relation to NHS Highland and have been discussing the matter actively. My officials have been engaged on the matter. I confirm to Rhoda Grant that I will meet NHS Highland in the near future, as well as all the other territorial health boards, because I want to work constructively and in partnership to ensure that all our health boards meet those spending targets.
Will the minister outline how the Scottish budget—which Ms Grant and her colleagues did not even engage with, let alone vote for—provides record funding for mental health services across Scotland, and how that will benefit thousands across Scotland to access crucial services?
As I set out in my initial response, since 2006, mental health spending by NHS Scotland has more than doubled in cash terms. The most recent figures show that spend was £1.486 billion in 2023-24.
Mental health is an absolute priority for this Government. Even in the context of the past few difficult financial years, we have continued to invest wisely. That is evidenced by statistics that show that we have the best national performance ever recorded for CAMHS waiting times, and that we have record numbers of staff providing more varied mental health support and services to a larger number of people than ever before.
Working towards delivery, when there is only one year to go before the end of this Government’s term in office, is simply not good enough. Fife is well down the league table in relation to spending on mental health and on CAMHS. The effect on other services, including the police, is dramatic, as is the effect on the economy, with lots of people unable to work, because this Government cannot give them the support that they need. When will there be a renewed focus on making sure that mental health is the priority that it deserves to be?
I recognise the seriousness of the issues that Mr Rennie raises, and I want to assure him that, although I have been in post fewer than 24 hours, I have already been actively engaging with my officials to take those matters forward.
We have seen an increase in spending on front-line mental health services—that much I have already referred to in my original answers. However, I recognise and appreciate that there is variation between boards, which will, ultimately, be part of any complex system that we are dealing with.
As I set out in my original answer to Rhoda Grant, I am committed to meeting all boards over the course of the summer, because I want to ensure that, collectively across Scotland, we are all working to meet those spending targets by the end of the parliamentary session.
There is much interest in this question time session, so I would be grateful for concise questions and responses.
NHS Highland (General Practitioner Vaccination Services)
To ask the Scottish Government when general practitioner vaccination services will be fully restored to GPs in NHS Highland, in light of reported concerns that the proposed hybrid model is less safe and more expensive. (S6O-04785)
In general, the model of health boards being responsible for delivering vaccinations is working well across Scotland, but I recognise the need for flexibility in some areas, such as those that I have discussed at various junctures with Mr Ewing, in order to account for specific circumstances that might negatively affect vaccine uptake.
That is why I have agreed to Highland health and social care partnership putting in place a mixed model. Oversight of how that will be developed and deployed to deliver local and accessible vaccination services in a safe and cost-effective way will ultimately remain the responsibility of Highland HSCP, with input and support from local GPs, practice managers, Public Health Scotland and the Scottish Government.
Over the past three or four years, I have raised with the cabinet secretary and his two predecessors that a GP-run service would save millions of pounds a year—a fact that the cabinet secretary appears to ignore. More important, it would be safer because, as the cabinet secretary well knows, we have already lost the life of one infant, because of the negligence of a centralised national health service system. Given the concerns and the fact that the vaccination service will not, even now, be returned to GPs for this winter, will the cabinet secretary intervene and demand that NHS Highland return the service to GPs before any more damage is caused to patients in my constituency in the Highlands?
In our interactions, I have listened to Mr Ewing’s testimony and that of the GPs that he represents and, as a result, I have taken action. I am concerned by Mr Ewing’s narration in the conclusion of his question about the pace at which the matter is moving. I would be more than happy to check in again with the Highland health and social care partnership to ensure that it is working at the necessary pace, and to stress that the effectiveness and safety of the system are paramount.
I have always joined with Fergus Ewing in calling for vaccinations to be returned to GPs in the Highlands, but NHS Highland seems to believe that the only place to deliver services is Raigmore hospital. That is why it has also pulled enhanced GP services across the Highlands. If NHS Highland cannot manage its finances, and as it appears that it will be £50 million in debt by the end of the year, is the answer to the problem that it should be put into special measures?
We continue to work with all boards, including NHS Highland, on their financial positions, and we keep those positions under review. I know that Mr Mountain has an interest, as does Mr Ewing, in the position on vaccination services in the Highlands. I am happy to continue to interact with the member to ensure that the effective, safe delivery of vaccinations is achieved in the Highlands, and I will ensure that I keep in touch with Mr Ewing and Mr Mountain to that end.
Scottish Attainment Challenge Funding (Dundee City Council)
To ask the Scottish Government what assessment it has made of any impact of the reported reduction in Scottish attainment challenge funding for Dundee City Council. (S6O-04786)
Since the inception of the Scottish attainment challenge in 2015, Dundee schools have received a total of £86.7 million. In refreshing the Scottish attainment challenge in 2022 to introduce strategic equity funding, the Scottish Government prioritised ensuring that funding was distributed equitably to all 32 local authorities, recognising that poverty exists in every local authority in Scotland. In taking that decision, an equality impact assessment was undertaken and published. The change in distribution, which was developed in close consultation with local government and agreed to by the Convention of Scottish Local Authorities, has taken place over four years, enabling challenge authorities to transition to their equitable share of SEF over time.
Several constituents have contacted me, as their jobs as health and wellbeing workers in Dundee schools are being cut. Despite years of service, they are set to lose their jobs at the end of this school term.
In 2021, when the Scottish National Party did not refresh but cut Dundee’s attainment challenge funding, I warned that the decision would inflict callous cuts on the poorest children in the poorest areas in Scotland. What does the cabinet secretary have to say to my constituents who have provided such vital support to some of the most vulnerable young people in Scotland for a decade now? Will she speak to her colleagues in Dundee City Council and stop these senseless and damaging cuts?
I recall that, in May 2022, Mr Marra made comments in that regard. In a meeting of the Education and Skills Committee, he said:
“We all recognise that what we might call hidden poverty exists in every community”.—[Official Report, Education and Skills Committee, 4 May 2022; c 9.]
At another meeting of the committee, he appeared to welcome the shift in funding and said:
“It is good that money is now available to local authorities … Fife is up £2 million.”—[Official Report, Education and Skills Committee, 18 May 2022; c 19.]
Across the piece, we know that, throughout the duration of the Scottish attainment challenge up to 2024-25, Dundee was allocated more than £43 million in challenge authority and strategic equity funding.
I go back to my original point that the request for us to move our approach in relation to that funding came directly from local government, and I note that Mr Marra appeared to welcome that at the time. I am more than happy to have my officials engage with officials in Dundee City Council on the substantive point that I think that the member was making.
Question 4 has not been lodged.
Racism and Racist Bullying (Schools)
To ask the Scottish Government how it is working to ensure that schools are tackling racism and racist bullying. (S6O-04788)
I am clear that there is no place for racism in our schools. Incidents of discrimination or prejudice must be addressed whenever they arise, and it is important that we are vigilant in challenging any racist behaviour in Scotland’s schools.
In November, we published updated anti-bullying guidance, “Respect for All: the National Approach to Anti-Bullying for Scotland’s Children and Young People”, which included guidance on responding to prejudice-based bullying. In the coming weeks, the Scottish Government will publish new guidance for schools on responding to racist incidents, including guidance on recording and monitoring. That has been developed in partnership with the racism and racist incidents workstream of the anti-racism in education programme.
I recently heard the story of Ekta Marwaha, who was forced to remove her daughter, Anisa, from school after months of racist bullying. The incident was reported and an apology was received from the bully, but records were not held, no follow-up work was done and the bullying continued.
There are many anti-racist toolkits, but can the cabinet secretary tell me how the Scottish Government is ensuring that they are put into practice? Will she meet me and Ekta to hear directly about the impact of racism on children?
I am happy to give Mr Choudhury an undertaking to meet him and his constituent. We know that, in the post-pandemic period, there are challenges in Scotland’s schools in relation to the recording of racism and other incidents. That speaks to wider work that we are undertaking on recording and monitoring, which we will publish details on before the end of this term.
The bullying and equalities module on the schools management information system—SEEMiS—has a specific recording category for incidents where race was a factor. SEEMiS also enables us to record where racism intersects with other forms of prejudice.
As I said, I am more than happy to engage with Mr Choudhury on that point, and I hope that he will take some heart from the updated guidance that we will publish before the end of this term.
Doctors and Dentists (Pay Recommendations)
To ask the Scottish Government what its response is to the recently published report from the Review Body on Doctors’ and Dentists’ Remuneration, which provides pay recommendations for doctors and dentists for the financial year 2025-26. (S6O-04789)
First, the trade unions for agenda for change staff, including those that represent nurses and midwives, unanimously accepted a two-year pay deal of 4.25 per cent and 3.75 per cent. The independent review body on doctors’ and dentists’ pay has recommended a United Kingdom-wide 4 per cent pay uplift for national health service medical and dental staff, and I intend to accept that recommendation. Resident doctors are excluded from that recommendation, and I will hold direct talks with them in the coming weeks. The pay recommendation will mean, for instance, increases of between £4,286 and £5,695 in consultants’ salaries, and it will mean that, at the top of their scale, a consultant will earn basic pay of more than £148,000.
I am proud that Scotland is the only part of the UK where general practitioners and dentists have seen real-terms growth in their wages in recent years. I hope that that will drive recruitment in the sectors as we continue to improve access to healthcare across Scotland. However, the UK Labour Government’s reckless increase to employer national insurance is hitting GP and dental practices hard. What discussions has the Scottish Government had with the UK Government regarding such damaging Westminster policies? Will he outline how the Scottish Government will work with stakeholders to retain and recruit health professionals in Scotland?
The Cabinet Secretary for Finance and Local Government has repeatedly raised with UK Treasury ministers the increase in employer national insurance contributions and has pressed for the additional cost to public services in Scotland to be fully funded. That increase is having a profound impact across Scottish public services, which are paying for a UK Government tax rise. Our GPs, social care services and voluntary sector partners are all paying for UK Government decisions, so it is incredibly disappointing that, in the recent spending review, the chancellor has yet again failed to fund that additional cost. We will have to consider the implications of that as we continue to deliver services for the people of Scotland.
National Resilience Strategy (Discussions with United Kingdom Government)
To ask the Scottish Government, in light of the strategic defence review’s emphasis on a “whole society” approach to national security, what discussions it has had with the UK Government regarding work to contribute to a comprehensive national resilience strategy. (S6O-04790)
I am pleased to confirm that there has been ministerial and official engagement before and since the launch of the UK strategic defence review. Defence policy is reserved, but the security and safety of people in Scotland are the top priority for this Government, and that is why we have taken an active and constructive role in the strategic defence review process, from its initial stages last year—when the First Minister wrote, on 30 September 2024, to Lord Robertson, who led the review, with the Scottish Government’s response to the SDR’s propositions—through to the ministerial discussions taking place in the days before and since the SDR was published on 3 June.
It is clear that the strategic defence review is far more comprehensive and wider ranging than probably any defence review that we have had in the past 25 years, and its clear recommendations have implications in devolved areas.
In recent days, we have heard arguments and points about industrial strategy, but civil contingency is a clear concern, and there are recommendations on co-ordination between civil and military authorities, such as local authorities, health services and the police, as well as devolved Governments. I would be grateful if the cabinet secretary outlined what discussions the Scottish Government has had with military authorities and the UK Government to set up the structures that are required to undertake that civil contingency work.
I assure Daniel Johnson that efforts are under way to optimise relations, which will maximise resilience. That requires developing existing and emerging relationships between the UK Government, devolved Administrations and a range of agencies and departments.
I would like to give Daniel Johnson the confidence that that work is being progressed and that there is a shared interest in doing so. I will be happy to update him on that progress.
Private Hospital Admissions
To ask the Scottish Government what its position is on the reasons for there being more private hospital admissions in 2024 than in any previous year on record, according to recent Private Healthcare Information Network data. (S6O-04791)
Although a patient has the right, at any time, to exercise choice and seek private treatment, we recognise that excessively long waits for national health service treatment are not acceptable. That is why we are determined to reduce patient waits in the year ahead. Our investment of £106 million of additional funding will help us to deliver more than 150,000 extra appointments and procedures in 2025-26. This includes £25 million for orthopaedics and more than £12 million for ophthalmology. That funding is just part of our record investment of £21.7 billion in health and social care this year, which will expand capacity and reduce waiting times.
Scots are forking out thousands of pounds—some are having to use personal savings or borrow from family members—to pay for cataract procedures, for hip and knee replacements and even for rounds of chemotherapy. I hear what the cabinet secretary says, but it is a lot of words that cover up the incompetence of the Scottish National Party Government. When will he accept that, after 18 years of the SNP in charge, Scots face the reality of a two-tier health service in Scotland?
I have set out—and have always been candid about—the challenges that our healthcare systems face. Those challenges are not unique to Scotland, but it is unacceptable for anybody to have to wait too long for their healthcare to be provided.
However, private healthcare is used much less in Scotland than in other parts of the UK. In England, for instance, the combination of the rate of admissions that are paid for by insurance and the uptake rate of private healthcare accounts for 1,445 admissions per 100,000, compared with 902 per 100,000 in Scotland.
Jackie Baillie looks to distance herself from those facts, which relate to her Labour Government’s performance, but they are facts. That reality demonstrates that there are shared challenges across the UK in responding to the situation that arose during Covid. We have a plan to deliver for the people of Scotland and we intend to deliver against it.
That concludes general question time.