United Kingdom Government Immigration Proposals (Impact on Public Services)
To ask the Scottish Government what assessment it has made of any implications for Scotland’s public services of the UK Government’s proposed reforms to the immigration system. (S6T-02522)
Scotland’s public services, communities and economy all benefit from inward migration. The Scottish Government does not support the majority of the proposals in the UK Government’s immigration white paper and calls on the UK Government to reverse those deeply damaging measures. The decision to end international care worker recruitment and planned changes to the graduate visa and skilled worker visa are short-sighted and will prove damaging to sectors that necessarily rely on international talent.
Scotland’s working-age population is growing only because of migration. Scotland requires a tailored approach to migration to meet our distinct demographic and economic needs.
Scottish Care has warned that Labour’s plan to scrap the care workers’ visa route would be
“profoundly damaging to Scotland’s social care sector and fails to recognise the country’s distinct demographic and workforce challenges”
and that it would be
“putting vital services at risk and directly harming those who rely on them.”
Does the minister share those concerns, and can she confirm whether the Scottish Government was consulted? Or is Scotland’s demographic reality once again an afterthought for Westminster?
I fully agree with the comments that were made by Scottish Care. The plan to end the international recruitment of care workers will be devastating for the care sector in Scotland.
I can confirm that the Scottish Government issued a comprehensive evidence-based proposal document to the Home Office during its development of the immigration white paper, but there has been no substantive engagement on any of the Scottish Government’s policy proposals, and the white paper completely fails to account for Scotland’s distinct demographic needs.
The ban on the international recruitment of care workers must not be implemented. Scotland is a welcoming nation, and one of the key principles that underpins our approach to migration is that we encourage and enable long-term settlement in Scotland, welcoming people from across the world to Scotland to work, raise families and make a positive contribution to society.
Labour’s plan to pull up the drawbridge mimics that of Nigel Farage’s Reform rather than challenging it, and it puts Scotland’s public services at risk. Inward migration is vital for our economy and society. Will the minister assure us that our Scottish Government will reject Labour’s pandering to Farage’s politics? Does she agree that the UK Government’s stance betrays the open and welcoming nation that Scotland aspires to be?
It is concerning that we have not heard anything from Scottish Labour on the plans, which are, frankly, designed by a Prime Minister simply to pander to Nigel Farage instead of considering any of Scotland’s demographic needs.
Scotland is a welcoming nation. One of the key principles that underpin our approach to migration is that we encourage people to come here, live here, raise their families here, contribute to the economy by working and make a positive contribution not only to our society but to our culture. Scotland will continue to actively welcome inward migration and recognise the benefits that it brings to our communities, public sector and economy.
Through our online platform, Scotland’s migration service, we will continue to attract talent to Scotland and address the barriers that are faced by migrants and employers when navigating the UK’s increasingly unsuitable immigration system.
I call Tess White to ask question 2.
After that rah-rah by the Scottish Government minister. To ask the Scottish Government—
Ms White, I have called you to ask question 2 of topical questions, and I would you ask you to restrict yourself to that, thank you.
NHS Grampian
To ask the Scottish Government what its response is to the announcement that NHS Grampian has been escalated to stage 4 of NHS Scotland’s national performance framework for finance, leadership and governance. (S6T-02523)
First, it is important to acknowledge that staff in NHS Grampian continue to work tirelessly to deliver the high-quality healthcare that we expect. I have been able to see that at first hand in the visits that I have made in Grampian of late.
Escalation to stage 4 will bring enhanced support and scrutiny from the Scottish Government. That will include a whole-system diagnostic to be carried out by an external consultancy, which is expected to conclude in June and will help to inform a tailored package of support. That intervention will provide a robust basis for the wider transformational work that is required over the longer term in NHS Grampian to ensure the sustainable delivery of high-quality healthcare services.
The Scottish National Party Government has repeatedly been warned about the perfect storm in NHS Grampian. Wherever we look, from waiting times to ambulance turnaround times, NHS Grampian is on its knees. That is little wonder, given that it has the lowest bed base in the whole of Scotland. A decade of chronic underfunding has put unsustainable pressure on national health service staff, and there are huge implications for patient safety. Just this week, front-line workers raised the alarm in The Press and Journal about patients dying and getting harmed because ambulances are still queuing for hours outside Aberdeen royal infirmary. Does the cabinet secretary finally accept that his Government has short-changed NHS Grampian for years?
No, I do not. In 2025-26, health boards will receive increased investment in their baseline funding totalling £16.2 billion, with NHS Grampian receiving more than £1.34 billion. NHS Grampian is receiving a 3 per cent baseline uplift of £39.2 million, which represents a 0.6 per cent real-terms increase compared with 2024-25.
The NHS Scotland resource allocation committee—NRAC—formula is an objective measure of the need for healthcare services across Scotland, and the Scottish Government’s approach has been to move boards towards NRAC parity. NHS Grampian’s £800,000 share of the £55 million additional parity maintains the board within 0.6 per cent of NRAC parity.
It is quite something for Ms White to raise the matter of funding of our public services when her party wants to take £1 billion out of public investment in Scotland.
This is not about taking pops. The deepening crisis in NHS Grampian is not just about board meetings and balance sheets; it is about people. A mother in her mid-70s, herself a nurse by profession, had a bad fall. Her husband spoke to NHS 24 and called 999, and an ambulance was eventually dispatched. He was advised that the wait would be four to eight hours. As she was drifting in and out of consciousness, her family took the difficult decision to lift her and drive to Aberdeen royal infirmary. Tragically, after they arrived, they were told that she would soon pass. Her family are shocked and are massively traumatised by what happened. Above all, they are haunted by how it happened.
We have had enough of the cabinet secretary’s excuses. He needs to know just how bad the situation is on the ground, so that families are not asking the same difficult questions. My ask, cabinet secretary, is for you not just to do visits that are pre-arranged. Will you please do a shift with an ambulance crew in Grampian—a shift that interfaces with accident and emergency—-and see it for yourself?
Always speak through the chair, please.
First, I have shadowed front-line shifts—although not in NHS Grampian, I accept—in order to see what the situation is like for those who serve our public services on the front line in health and social care.
Secondly, on the constituency representation that Ms White makes, she paints an unacceptable picture for that family and for those who are served by NHS Grampian, referring to some of the pressures that have been felt.
I declare an interest in that I have a family member living in Grampian and served by NHS Grampian. We all have a personal vested interest in ensuring that our public services work well, which is why we have escalated NHS Grampian to level 4, and it is why we continue to provide that additional support and scrutiny.
Will the cabinet secretary advise what support is provided to the board of NHS Grampian at level 4 of the escalation framework? Will he advise when the board will set out a recovery plan to deliver an improved position with that support?
Escalation to stage 4 of the framework brings enhanced scrutiny and support from the Government, and we will work with the board to ensure sustained improvement. Action taken and any support provided at level 4 is tailored to the circumstances and will take account of the context in each case.
NHS Grampian will receive a tailored package of support as a result of the escalation to stage 4, starting with the diagnostic report being delivered by the external consultancy. We expect the report to be delivered in June and to set out key areas of focus for the board to improve sustainability. A more detailed, tailored support package will be designed on the basis of the recommendations in the report, and NHS Grampian’s financial recovery plan will be provided to the Scottish Government on 7 June, with the external diagnostic being delivered later in June. That will allow the diagnostic report to verify or improve on NHS Grampian’s financial forecasts.
In a briefing on 7 March, the leadership of NHS Grampian informed MSPs that the health board was projecting a £68 million deficit in 2025-26. That was to be submitted to the cabinet secretary on 17 March, so he has known about the extent of the deficit for two months. What has triggered the escalation of NHS Grampian to stage 4? Do those figures remain the same? What has changed?
Michael Marra rightly points to the financial position, which is one of the primary considerations, because we want to ensure that the board has a grip on that as quickly as possible. That is why we are sending in the external consultants, and it is why there is additional Scottish Government support—to get a handle on the financial position in NHS Grampian and to get an assurance that any savings that are required to be made will not impact on front-line services and will contribute to an improvement in service delivery in NHS Grampian.
I fully support the escalation to level 4. I called for that during a members’ business debate just two weeks ago.
Two months ago, I asked the cabinet secretary whether he had confidence in the board. I ask him today whether he has confidence in the chair of NHS Grampian.
Yes, I do.
Pregnant women, people waiting for surgery, cancer patients and other people across my constituency rely on NHS Grampian. What reassurances can the cabinet secretary give that the stage 4 measures will not negatively impact patients from Shetland who have to access NHS Grampian services?
I readily recognise the situation that Beatrice Wishart reflects of her constituents having interaction with NHS Grampian, which is also the case for her colleague Liam McArthur and his constituents. My officials and the consultancy will be working to get NHS Grampian to a more sustainable financial position, with improved service delivery, to ensure that residents of the NHS Grampian area, as well as Beatrice Wishart’s constituents and Liam McArthur’s constituents, see an improvement in service and financial sustainability.
I welcome the escalation to level 4 of the framework and the support that the cabinet secretary will give to NHS Grampian. Will those who are going in to help NHS Grampian take a look at the excessive bureaucracy that exists in the organisation—in my opinion—to ensure that it is eradicated, so that folk can do their level best for patients?
I thank Kevin Stewart for his question and recognise the considerable contribution that he has made in regard to the issue over recent months. I am clear that my officials and those who are supporting NHS Grampian should be looking at all possible options to improve the financial position and service delivery.
I reiterate the point that I made at the outset of my first answer, which is that the staff at NHS Grampian are doing an incredible job in challenging circumstances to deliver for people across Grampian and, indeed, Orkney and Shetland. I recognise that, and I want to enable them to go even further.
In April, NHS Grampian warned that the health board has too few acute hospital beds and too few staff to cope with demand in some key service areas and that it does not have enough funding or physical space to make any significant improvement. What assurances can the SNP Government give that moving to level 4 will see patients in Grampian getting the treatment that they need?
Jackie Baillie’s question recognises what is at the heart of the escalation, which is the improvement of services and financial sustainability in NHS Grampian with a view to improving patient services. That is why we have escalated the board to level 4. The decisions and options that come through from the support package and from increased scrutiny are all about ensuring that the patient experience improves and that we see services being delivered in a more sustainable way, so that we satisfy Jackie Baillie’s concerns.
A letter from Alan Gray, the Scottish Government director of health and social care finance, confirmed that brokerage would not be available for 2025-26 and that NHS boards would be expected to work towards a break-even trajectory in their three-year financial plans. If breaking even is not possible and no deficit is permitted, how much flexibility is there with brokerage repayments, and will the Government consider a different funding formula for NHS boards that are struggling?
I remind the cabinet secretary to answer only in relation to the substantive question.
NHS Grampian has been provided with brokerage in two consecutive years, and everyone has been able to see the public scrutiny of that. I am clear that I want all boards to move as quickly as possible to a break-even position, and more boards are now in that position than was the case in the past.
NHS Grampian is in particular difficulty, which is why we are putting in support and scrutiny to turn that board around. As I set out, we want that financial sustainability to happen in a way that is not detrimental to front-line services, which is why we need to provide additional support through escalation to level 4.