Meeting of the Parliament

Meeting date: Wednesday, January 17, 2024

Official Report 1070KB pdf

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National Health Service Waiting Times

The next item of business is a debate on motion S6M-11874, in the name of Jackie Baillie, on ending long waits in the national health service.

16:01  

Scotland saw in the new year with accident and emergency departments in utter disarray as thousands of people—the sick and the injured—experienced long and dangerous waits. Only yesterday, we learned that, in the first week of 2024, only 59.4 per cent of patients were seen within four hours. Indeed, in Glasgow’s Queen Elizabeth university hospital, the figure was 31.1 per cent, with more than 1,200 people waiting longer.

It may be a new year, but nothing has changed. The crisis in the NHS and social care continues, and the response of the Scottish National Party is that there is nothing to see here. It is business as usual from the SNP, and the NHS and its hard-working staff remain at breaking point. Almost one in six Scots are stuck on a waiting list. That is 860,000 people, and 80,000 are waiting for over a year.

We all remember Humza Yousaf’s pledge in July 2022 to eliminate completely the longest waits in planned care. Let us have a look at how that is going. Two-year waits for out-patients were to be ended by August 2022. That failed. Eighteen-month waits for out-patients were to be eliminated by December 2022. That failed. One-year waits for out-patients were to be eliminated by March 2023. That failed.

In-patient activity is not much better. Two-year waits for in-patients were to be eliminated by September 2022. Guess what—that failed. Eighteen-month waits for in-patients were to be eliminated by September 2023. That failed, too. One-year waits for in-patients are to be ended by September 2024. On the basis of current delivery, I suspect that that will be a fail, too.

I know that SNP members do not like hearing it, but the facts are plain for everybody to see. The SNP promised to end long waits and it failed utterly. I repeat that almost one in six Scots are waiting for tests and treatment, which has real consequences. I have a constituent who works in theatre at the Golden Jubilee hospital. She has been on the waiting list for three years, but NHS Greater Glasgow and Clyde will not let her have her operation at the Jubilee. She is assisting people from other health board areas who have been waiting for as long as a year, but that is still two years less than her. She is no further forward, and her knee is now bone on bone. Should she take sick leave from the NHS, or will the cabinet secretary ensure that she has her operation? Successive SNP health secretaries—Nicola Sturgeon, Humza Yousaf and Michael Matheson—have simply failed to tackle the workforce pressures, and we have 6,700 medical vacancies in our NHS.

The current health secretary is distracted by personal scandals and has failed miserably to deliver for the NHS. Let us take, for example, the flagship national treatment centres—the cornerstone of the SNP’s NHS recovery plan. Many of those new centres were supposed to clear the waiting list backlog by 2026, but they have been delayed. Some might not proceed at all. Officials advised Humza Yousaf against citing figures on the additional capacity that national treatment centres would deliver because

“projections included in the NHS recovery plan have dropped significantly”.

The promise of 1,500 additional staff by 2026 is unlikely to be met, and some boards are experiencing recruitment challenges in relation to staffing. A cabinet secretary briefing from 8 March 2023 revealed that there was no revenue funding source for the national treatment centres that are not yet in construction and that the remaining programme is “not affordable” on the basis of the current capital spending review. National treatment centres have been delayed in NHS Grampian and NHS Tayside, and NHS Lanarkshire and NHS Ayrshire and Arran do not even have the full business case that is required to get the process started. In addition, what about the Edinburgh eye pavilion?

The SNP will not tell us what will be ditched until March—or possibly May—because it does not want scrutiny of the capital programme alongside the budget. The truth is that those centres will not be delivered on time, and some might not be delivered at all. The SNP’s recovery plan is simply not worth the paper that it is written on. All that we have are yet more broken promises from a party that has run out of ideas.

The Scottish Government is always keen to blame the pandemic. Of course, the pandemic happened, but the truth is that the NHS was in crisis long before Covid-19.

Finally, I will address the SNP’s latest promise on extra investment. We heard from the cabinet secretary that the Government is going to reduce waiting lists by 100,000 in two years’ time. First, what happens to the other 700,000 people who are waiting? Many patients and NHS staff will also rightly ask why they should have any faith left in this Government, after all its previous broken promises.

Secondly, let me tell members how it is being paid for. The SNP assumes that there will be a Labour Government in Westminster that delivers extra NHS funding to Scotland. Yes, that is right—even the SNP Government knows that we need a UK Labour Government for its plans to come to fruition.

The people of Scotland have been left high and dry by an SNP Government that is mired in scandal after scandal and that is more interested in playing fantasy politics than in dealing with the crisis in our NHS. Enough is enough—the SNP Government must prioritise tackling the NHS crisis before more lives are lost.

I move,

That the Parliament is alarmed that almost one in six people in Scotland are languishing on NHS waiting lists for tests or treatment; notes that the Scottish Government has failed to meet its own target, set out in July 2022 by the current First Minister, to eliminate the longest waits in planned care, with a staggering 80,000 people currently waiting over a year to be seen; recognises that the Scottish National Party’s flagship network of National Treatment Centres has been beset by delays; is concerned that the NHS is facing a workforce crisis, with 6,800 NHS vacancies that are unfilled, while agency costs have rocketed in recent years, and calls on the Scottish Ministers to set out a clear plan and timetable for when all long waits for planned care will be eradicated, and provide an update on the timescales and final costs for all the promised National Treatment Centres.

16:08  

As a Government, we remain focused on ensuring that our health service continues to recover from the long-term effects of the pandemic. Scotland is not unique in facing those challenges, as services across the UK continue to be challenged. Too many people are waiting too long for treatment, and I am committed to delivering sustained improvements and reducing waiting times, year on year, across our NHS.

That is why, in our draft budget, we have provided funding of more than £19.5 billion for health and social care, which gives our NHS a real-terms uplift that is in stark contrast to the UK Government’s autumn statement, which shows a real-terms cut to NHS England.

Even in the face of unprecedented pressures, we continue to see progress following the introduction of our long waits targets. Since the targets were announced, we have seen a substantive reduction in new out-patient waits of more than two years, with 85 per cent of specialties having fewer than 10 waits.

Will the cabinet secretary take an intervention?

I will if the member allows me to make progress first.

The number of waits of more than 78 weeks reduced by 30.1 per cent as of September last year, and 34 per cent of specialties had fewer than 10 patients waiting for more than 52 weeks. Waits of more than two years for in-patient or day-case treatment have also reduced by 26 per cent since the target was introduced. Thanks to the hard-working staff in our NHS boards, we have seen a further increase in activity, with the latest statistics showing activity for in-patient and day cases at the highest level since the start of the pandemic.

Is it not the case that you promised to end those waits, not simply reduce them, and that, by your own measure, you have failed?

Please always speak through the chair.

As I have set out, the reality is that we are making substantial progress, but, clearly, more needs to be done and we are determined to do that.

I know that challenges remain and that there are still unacceptable waits in some specialties. That is why we are committed to enhancing both regional and national working to develop national solutions to create a sustainable service and reduce the backlogs, focusing on those specialties where there are significant pressures. That work is supported by our national treatment centre programme. We opened two NTCs last year—one in Fife and the other in NHS Highland—with two further centres opening in the coming months, in Forth Valley and at the Golden Jubilee university national hospital.

Central to all of that is our £1 billion NHS recovery plan. Our second annual progress update, published on 6 December, demonstrates the improvements made as a result of our significant investment, which is delivering targeted reform and dedicated innovation.

Will the cabinet secretary give way?

I need to make progress, given the limited time, I am afraid.

For example, since 2021, we have invested £8.6 million in programmes through the Centre for Sustainable Delivery to support transformation and the roll-out of new techniques, innovations and safe, fast and efficient pathways for Scotland’s patients.

It is crucial that we secure best value wherever we are delivering services in NHS Scotland, to allow us to maximise the impact of our investment and the delivery of quality services to patients. Of course, none of that would be possible without the dedicated staff in NHS Scotland. NHS staffing levels are historically high under this Government, with more than 24 per cent more staff in post, and we remain committed to implementing our national workforce strategy.

Due to our constructive engagement with trade unions, Scotland is the only part of the UK that is not experiencing strike action in our NHS. I was somewhat surprised that Labour is bringing forward this debate in the same week that junior doctors are striking in Labour-run Wales, which has resulted in the cancellation of 6,500 out-patient appointments and 400 planned operations and will undoubtedly impact on its waiting times. Of course, that is dwarfed by the situation in NHS England, where a total of 1.3 million acute in-patient and out-patient appointments have been cancelled due to strike action since December 2022.

As a Government, we will continue to make progress, and I am determined to see continued improvements over the coming year. I am committed to making sure that we take forward the changes in order to deliver our recovery and to reform the way in which we provide services within NHS Scotland, so that we have a sustainable healthcare system that continues to deliver high-quality services to the patients of Scotland.

I move amendment S6M-11874.2, to leave out from “is alarmed” to end and insert:

“recognises that health services across the UK are dealing with the long-term effects of the COVID-19 pandemic on waiting times; further recognises that too many people are waiting too long for treatment, and welcomes the reductions in the longest waits, including a 69% reduction in patients waiting over two years for a new outpatient appointment from the end of June 2022 and a 26% reduction in patients waiting longer than two years for inpatient or day case treatment over the same period; highlights the launch of the Waiting Well Hub, to give people the information and tools that they need to look at their own health and wellbeing during the waiting period, think about what matters to them and what health improvements they could make in the meantime; welcomes that constructive engagement with trade unions has meant that Scotland is the only part of the UK not experiencing strike action and the associated unprecedented level of disruption for patients and families; further welcomes the Scottish Government’s draft Budget, which gives the NHS a real-terms uplift, in stark contrast to the UK Government Autumn Statement figures, which show a real-terms cut to NHS England; notes that, due to the deteriorating medium-term fiscal outlook, a revised Infrastructure Investment Plan Pipeline is expected to be published alongside the Medium-term Financial Strategy in May 2024; appreciates that the workforce is at the heart of all that the NHS does, and thanks all of Scotland’s highly skilled and committed NHS staff for their hard work and dedication, and believes that the NHS must be kept true to its founding principles of being publicly owned, publicly operated, and free at the point of need, and further believes that the only way to protect the NHS from the creeping privatisation imposed by UK administrations is through independence.”

16:13  

I draw members’ attention to my entry in the register of members’ interests as a practising NHS general practitioner.

There we have it: everything is fine here—there is no problem. The cabinet secretary says that our health service is rosy. In December 2023, only 66 per cent of patients at A and E were seen within four hours. Between July and September 2023, only 72 per cent of cancer patients began treatment within the statutory 62 days of an urgent referral. Another month, another set of dismal data. Another quarter, more failure.

We are sounding like a broken record, but the SNP just does not seem to care. It takes no responsibility, safe in the knowledge that the Scottish Greens have its back for the price of two ministerial limos.

Maybe we should stop talking about statistics and percentages and instead highlight what really matters: people’s lives. According to the Royal College of Emergency Medicine, an extra 1,400 avoidable deaths were linked to long A and E wait times in 2023. Those are 1,400 people, not numbers on a spreadsheet.

I want to be crystal clear that nobody is criticising our front-line staff—they go far beyond the call of duty. However, this incompetent SNP Government has left healthcare on its knees. Humza Yousaf, Michael Matheson and one health minister after another have offered no solutions. Scotland needs and deserves a fresh approach to deliver a modern, efficient and local NHS that is accessible to all, but instead the SNP has dithered and watched Scotland’s GP workforce shrink.

Scotland has had enough of the SNP playbook in which the First Minister or the cabinet secretary comes to the chamber, makes an announcement, fails to deliver on it, and then defends their record by tripping out spin and promising that lessons will be learned.

Let us take access to child and adolescent mental health services. Humza Yousaf promised to clear CAMHS waiting lists by March 2023, yet by September 2023 more than 5,000 children were still waiting to start treatment. One child has been waiting 37 weeks in Glasgow; some people have waited a year in Lothian. That matters, because poor mental health robs our kids of their childhood.

In the Borders, people are having to wait 39 weeks for their first appointment for CAMHS treatment. The Government should apologise for the appalling lack of support to young people.

I could not agree more. Our kids are suffering and our SNP Government is not looking after them.

Let us look at the NHS estate. The SNP’s manifesto pledged to invest £10 billion over a decade to renew our NHS estate, yet today we hear that all NHS projects have been halted for at least two years. That applies even to the national treatment centres, so it is affecting the SNP’s solution to waiting lists.

I will close with another SNP failure: Scotland has the highest number of drug-related deaths in Europe. I will leave the matter of hunting down those who profit from the criminal trade in this misery to Police Scotland—drug dealers are criminals and gangsters—but we can bring the SNP to book for cutting the funding to drug and alcohol recovery services by £19 million. People addicted to drugs and alcohol deserve and desperately need our help. They should have a right to recovery.

It is only our front-line NHS workers who are preventing Scotland’s health service from keeling over. The SNP has been in charge of health since 2007. The party has failed to pass on £18 billion in health consequentials in that time and we are seeing the results of that. The SNP is responsible—no ifs, no buts.

I move amendment S6M-11874.1, to insert at end:

“; regrets that over one million people have had to wait more than four hours at A&E in this parliamentary session alone; stresses the need to bring down long waits for mental health services, and condemns the decision of the Scottish Ministers to introduce a real-terms cut to the budget for alcohol and drug services while drug deaths in Scotland remain disturbingly high.”

16:18  

I am very grateful to Jackie Baillie for bringing the motion to Parliament. Before I begin my remarks, I congratulate her on her investiture as a dame at the palace of Holyroodhouse this afternoon—her getting an honour for politics got up all the right people’s noses, I think.

Here we are again. The facts that are laid out in the motion for debate make grim reading. However, they are no surprise to any of us in the chamber, and we often see related matters in our casework postbags. Almost one in six people in Scotland are currently on NHS waiting lists for either tests or treatment, and 80,000 people are currently waiting over a year—365 days—to be seen. People are dying because they are waiting too long for emergency care. Just yesterday, A and E waiting times figures were released, and they are equal to the record-breaking figures of last year.

Things just are not getting any better. Whether people are being forced to wait hours for an ambulance or to be seen in A and E, or are being left abandoned on trolleys or languishing on wards, they are being let down. These problems are manifesting not just on the front line but across our health service in its entirety.

Let us take diabetes as an example. Currently, only 18 per cent of people who are living with diabetes in Scotland receive the essential regular health checks that they need. That is down from 40 per cent pre-pandemic, which was still well behind where it should have been.

I have lost count of the number of times that we have had debates like this in the chamber, and we keep having them—usually just in Opposition time. I fear that we have become inured to that. We have got used to our health service languishing and struggling in the way that it has, and we have become dangerously comfortable with crisis. Every time that we raise it in this place, ministers refer to the pandemic. Every time that they do so, they insult the intelligence of all of us here and the people who are watching us, and they seriously test the patience of the hard-working staff on whom we rely. The issues in our NHS were there long before anyone had heard of Covid-19, and people are tired of those excuses. They are tired of the ministerial lack of interest and mismanagement that have defined the SNP-Green Administration’s approach to health.

I want it to be crystal clear that none of that is the fault of our hard-working staff. They have worked their fingers to the bone. They have worked miracles and spun gold out of straw. They work long hours under the most stressful circumstances imaginable and deserve our utmost thanks, but they are being let down as well. There are currently almost 6,800 NHS workforce vacancies unfilled. That puts enormous, untold strain on the staff who are there. The chair of BMA Scotland has said that doctors and other healthcare workers are exhausted and facing burnout under those increasing workloads.

SNP-Green Government decisions have compounded the pressures on nursing staff, and that problem stretches all the way back to Nicola Sturgeon cutting nursing and midwifery training places and claiming at the time that it was the sensible thing to do.

The health secretary has shown zero sign of the innovative thinking that is necessary to resolve the issue. When Humza Yousaf was in his previous position, he repeatedly ignored my party’s call for a plan to address staff burnout and to set up a health and social care staff assembly. The Government has shown a pig-headed contempt for a strategy that would guarantee annual leave, ensure safe staffing levels and champion the expertise of those who know our health service best.

It is little wonder, then, that we are now finding it harder than ever to attract and retain new staff. On this Government’s watch, costs for temporary staff have risen to more than £0.5 billion in recent years. Instead of making the meaningful investment that our health service needs, the Government is relying on short-term fixes to plug the gaps.

To put it plainly, the Government is failing. It is failing Scotland’s NHS—both the hard-working staff who run it and the patients who depend on it. Staff and patients alike need long-term solutions. They need new hope.

The health secretary needs to do three things—I will close with these. He needs to urgently redraft his failing recovery plan, give hard-working staff the fair pay and conditions that they deserve, and fix the issues in social care so that people can be treated in the community, rather than being left to languish on hospital wards when they are well enough to go home but too frail to do so without a viable care package.

We move to the open debate.

16:22  

This issue is perhaps the one that I hear most about from constituents across South Scotland, and that is why it is essential that it is given fair hearing here today. Whether people live in rural or urban areas, are young or old, have a long-term condition or are seeking new advice, worries about NHS waiting times are a constant. It is described to me as not just waiting but languishing on NHS waiting lists. That is not my description but that of patients and constituents in all our communities. I expect that every one of us here has or knows someone who is waiting and experiencing that.

Put simply, our constituents want to know what can be done to stop our NHS being put under such constant pressure. Although they are sympathetic to the fact that waiting times are a reality of any health service, some of the extended waits that people are having to put up with are simply unheard of. There are 7,000 Scots waiting for more than two years. I was not going to bring this up, but in the cabinet secretary’s contribution he kept referring to other nations. In Scotland there are 7,000 people waiting for more than two years, and in England there are 227. It is not helpful to continue to go over those figures. People want to know what is happening.

In Scotland, it is at the point where it has become commonly accepted that there are certain operations and treatments that people might have to wait years for. In some cases, that wait can shorten lives and cause unmanageable stress.

Is that really what we came to this place to do? As lawmakers and elected representatives of our communities, we have to understand that the people who are telling us this are not just statistics moving from one column to another; they are real people with complex lives who are in constant limbo because they simply do not know when they will receive the treatment that they require.

As we have heard, under the SNP Government, 80,000 people and their loved ones are living with anxiety and, in many cases, pain for more than a year while waiting for planned care, because the Government is not getting it right. Those people view commitments that the Government has made as a personal promise, and time and again, they are seeing that those commitments amount to just words. That is not acceptable, and I implore those who have the power to change the trajectory not to say, “Look over there—it’s someone else’s fault,” or, “We’re not as bad as someone else.” That does not do justice to our constituents.

The Government should look at the NHS’s long-term investment and infrastructure needs in Scotland, be honest about delays on national treatment centres and reset the programme clearly. The cabinet secretary mentioned only a couple of the national treatment centres and did not speak about some of the other projected centres. We need to ensure that our workforce is secure and that we move away from the damaging and expensive reliance on agency workforce. That has been a thing under the SNP Government, and it needs to address the issue. Our job is to hold the Government to account, and I ask it to address that.

I have sympathy for any Government that has to put up with the constant undercutting of public services that is led by the Conservative Government in Westminster, but our job in this place is to deal with what we can do, and the Scottish Government can do things. Therefore, on behalf of my constituents, I say: let us be clear about what can be done. The Government has been in power for 17 years and should deliver its promises on staffing and national treatment centres. The staffing crisis is making commitments such as the one on the national treatment centres impossible to deliver.

We must do what we can. I make a genuine request to the cabinet secretary to feed back appropriately on the issue, so that we can feed that back to our communities and our constituents. Cabinet secretary, let us push forward into the new year with a serious plan and not even more empty promises.

16:27  

I refer members to my entry in the register of members’ interests, which shows that I hold a bank nurse contract with NHS Greater Glasgow and Clyde.

As someone who proudly continues to work in our NHS, I am under no illusions about the challenges that it currently faces. In the years ahead, those challenges will become more pronounced as a result of demographic changes and the expected increase in disease burden. It is therefore abundantly clear that significant investment in our NHS and, indeed, reform of the delivery of care are of paramount importance.

In the face of Tory austerity, the Tories’ shameful autumn statement and their mishandling of the economy, which has caused inflation to run rampant, the SNP Scottish Government is taking the necessary decisions to ensure that there is continued investment in health and social care services. In the draft budget, the Deputy First Minister announced an increase of more than £550 million to front-line NHS boards, which is a 4.3 per cent uplift that takes the total investment to more than £13.2 billion. Scottish Government funding of the NHS has ensured record high staffing levels. The funding will drive forward work to increase health service capacity, including through a network of national treatment centres, and it will reduce backlogs, delivering year-on-year reductions in waiting lists.

On that point, yes, of course too many people have waited too long for treatment. However, I welcome the fact that we have seen a significant reduction in the longest waits since the targets were announced, last July. That includes a 69 per cent reduction in patients waiting over two years for a new out-patient appointment from the end of June 2022. There has also been a 26 per cent reduction in patients waiting longer than two years for in-patient or day-case treatment since the targets were announced. That is welcome progress, but we know that there is still more to be done.

Scottish Labour never wants to talk about the significant and on-going impact that Covid has on our health service, notably in the area of planned care, as well as other external factors. It should listen to the Welsh Government’s Minister for Health and Social Services, who said only in the past week:

“The pressures on the NHS are unrelenting in every part of the UK.”

Over the past 13 years, the NHS, like other public services, has had to contend with austerity, the impact of a botched Brexit, the pandemic, record levels of inflation and rising demand. It is not difficult to work out why it is so challenged across the whole UK.

It is also worth noting that, while we are sitting in the chamber, junior doctors are striking in Wales, where Labour is in power. The NHS is nothing without its dedicated workforce, and I am proud that, due to the value that the SNP Government places on our health staff, Scotland remains the only country in the UK to have been successful in averting NHS strikes. In doing so, we have avoided the knock-on effect that that would have had on capacity, through postponed operations and on out-patient appointments.

That was looking at Wales, where Labour is in power. Even at Westminster, where it is in opposition, it is clear that Labour does not have the plans or ambition to tackle the challenges that health services across the UK face. Labour’s shadow health secretary has said that a UK Labour Government would

“hold the door wide open”

to private sector involvement in the NHS. He has also stated that he does not think that it is good enough that the NHS uses every winter crisis and every challenge that it faces as an excuse to ask for more money. That is hardly supportive of the hard-working staff for whom we hear faint praise from Opposition members.

Labour’s only plan for our NHS seems to be opening it up to the private sector’s involvement, starving it of much-needed investment, supporting a Brexit that impacts on the recruitment of health and social care staff, and undervaluing NHS staff, which leads to strikes. The Scottish Government remains committed to driving down waiting times, particularly for the people who wait the longest for treatment. We are resolute in doing what we can to support our workforce through ensuring record levels of staff, promoting their wellbeing and protecting and providing proper pay increases. We are absolutely committed to keeping our NHS publicly owned, with no private sector involvement, and free at the point of need.

16:31  

Once again, it was the pandemic that did it. That is the sole reason that we have heard from the Cabinet Secretary for Health and Social Care for the crisis that is engulfing our health and social care services. It is a damning admission that, two years on, Humza Yousaf’s plan is failing, but it also defies the reality that the seeds for the crisis were sown well before 2020.

Pre-pandemic, the Scottish Government received warning after warning, and alarm after alarm was sounded, about the risk to patients of the systematic underfunding, the absence of proper workforce planning and the lack of any clear plan for our health and social care services. As far back as 2017, the British Medical Association warned that the national health service was at breaking point, but there was a failure to listen to those warnings and to act. That incompetence has consequences for patients and staff.

A day rarely goes by when constituents do not share heartbreaking stories that show just how broken services are. A year ago, in the chamber, I told the story of Pat, who was receiving palliative care after a cancer diagnosis. Pat’s wish was to spend what time she had left at home. Her care needs were, of course, increasing, but that wish was not too much to ask. An assessment was made and a care package agreed, but there were no carers to deliver it. Marie Curie did what it could, as did the family, but the growing burden on Pat’s husband became too much. He was admitted to hospital and, tragically, that is where he remains. There were still no carers to take over, so Pat was also admitted to hospital, even though she was not receiving any medical treatment and could and should have been cared for at home. Sadly, Pat died in hospital.

Since then, things have got worse. I could share more tragic cases from my inbox. Constituents are being placed in care homes from hospital to fiddle the delayed discharge figures. Often, they are there for months and are miles from their families, waiting to go home, where they should be. Operations are routinely cancelled because beds are unnecessarily full due to delayed discharge.

Jackie Baillie listed many of the Government’s broken promises on health. Here is another one. Nine years ago, the SNP pledged to eradicate delayed discharge within a year. Today, delayed discharge has spiralled out of control and has drained £1.2 billion from our NHS over the past decade. In Dumfries and Galloway alone, between 2015 and 2023, the bill for it was a staggering £40 million, which is money that we could have used to pay carers a proper wage.

No service or constituent in my region has been left untouched by the crisis that is engulfing health and social care. Care homes have closed, community hospitals have closed, GP surgeries have closed and dentists have closed. Indeed, more than 20,000 patients in Dumfries and Galloway alone have been de-registered from the NHS recently. People cannot register with an NHS dentist in that region; there is no waiting list because there is nobody to register with in order to join a waiting list.

We have heard increasing concerns that the NHS is unsustainable in its current form, but the reality is that it is this Scottish Government’s negligence that is unsustainable. Its failure to take responsibility and to act decisively is a real threat to the future of our national health service. We need the Government to stop ignoring the warnings and to finally make good on its promise to eradicate delayed discharge. We need a long-term plan to tackle the low level of sheltered housing and the loss of care homes locally, and we need the Government to pay our care workers properly.

At a time when the national minimum wage will rise to £11.45 per hour from April, the Government’s pledge to pay carers just 56p more will make little difference to filling vacancies. However, listening to the calls from unions and from Labour to pay care workers a fair wage, with a clear timescale for moving towards £15 per hour and proper career progression, would help with the recruitment crisis. That would free up hospital beds and, ultimately, reduce the long waits for treatment. That is the least that patients and our dedicated, hard-working staff deserve.

16:36  

We all admire the dedication and hard work of NHS staff. Whatever help we need, they go to incredible lengths to keep us healthy, and we owe them our thanks for the work that they do. However, despite the amazing efforts of NHS staff, Scotland’s health service is in crisis.

Staff have been let down by the lack of support from the SNP Government. Systemic problems in our NHS have driven excellent nurses and doctors to breaking point. No matter how hard they work, they cannot give every patient the care that they deserve any more. That is the grim reality of Scotland’s NHS under the SNP’s leadership.

There is a crisis at practically every level of the NHS. Years of sub-par plans from the SNP, including Humza Yousaf’s flimsy NHS recovery plan, have seen the situation in our NHS spiral out of control. The SNP will blame the pandemic, but the reality is that most of these problems were already apparent before Covid; the pandemic only made them worse.

The situation in the NHS right now is that waiting times in A and E have hit record worst-ever levels. The treatment time target for A and E is four hours. However, since this session of Parliament began, that target has been missed more than 1 million times. That does not just inconvenience people, it costs lives. Last year, the Royal College of Emergency Medicine said that one extra death occurs for every 72 patients who wait more than eight hours in A and E. Based on those figures, more than 1,400 people lost their lives because of A and E waiting times just to the end of September last year.

The problems at A and E have sent the ambulance service into crisis, too. Ambulances are regularly forced to queue for hours outside hospitals before they can admit a patient and get back out on the road. The consequence is people waiting absurdly long times for ambulances—even up to 15 hours.

And the issues do not end there. People are often leaving treatment until it becomes an emergency and they need to attend A and E or get an ambulance because they have not been able to get a GP appointment. They cannot get an appointment quickly because there are simply not enough GPs. The SNP’s poor workforce planning has left GPs struggling to meet demand. The British Medical Association says that we need another 1,000 GPs to plug gaps. The SNP promised to increase GP numbers, but it is going in the wrong direction.

That is not the only broken promise from the SNP on Scotland’s NHS. Perhaps most damaging has been its failure to end delayed discharge, which the Deputy First Minister said it would do nine years ago. The consequences of failing to meet that promise have been huge. Almost 2,000 beds are occupied every day due to delayed discharge.

Neither is the SNP’s failure to recruit more GPs the only serious workforce issue in Scotland’s NHS. Spending on agency staff has quadrupled in two years, there are more than 5,000 nursing vacancies in NHS Scotland, and staff turnover is at its highest rate in a decade.

Will the member give way?

I do not have time. I have a lot to say and I am in my final minute.

The consequences of those systemic problems are that our excellent NHS staff cannot deliver the care that they want to deliver, and patients are left waiting days, weeks, months and sometimes even years for the treatment that they need. One thing is certain: the crisis in our NHS cannot go on like this. Our vision is for a modern, efficient and local Scottish health service that is accessible to all.

16:40  

It is a pleasure to speak in this very short debate on Scotland’s health service. It is important to recognise at the outset the challenges that we face and the successes that have been delivered in the on-going work that the cabinet secretary has outlined, including the fact that Scotland is the only part of the UK that has avoided strikes in our NHS. The service faces challenges, not least the ageing population, inflation in the health sector and the impact of Brexit on workforce availability, but also many others.

It is important to use the short time that we have available, not to, as the Opposition does, throw random talking points into the debate but to make clear proposals for specific improvements in addition to the work that is already being done. In the short time that I have available, I want to focus on a few of those.

First, I want to talk about the adoption of technology, including process improvement, and the leverage of the great work of Scotland’s fabulous life science sector. For example, only 1.5 per cent of operations across Scotland’s NHS are being delivered by robotics, which can deliver higher quality and increased efficiency. I ask the cabinet secretary to look more thoroughly at that, as well as at, for example, the use of artificial intelligence in radiography, sensor technology in falls monitoring and prevention and increased digitisation, not to mention Scotland’s great expertise in booking systems, digital dentistry and many other areas. I pay tribute to the great work that has been done by the accelerated national innovation adoption pathway—ANIA—but so much more can be done in that space.

Secondly, there is the roll-out of that technology and best practice across the health service and health boards across the country, and the once-for-Scotland approach. I know that work is being done there, but I ask the Government to evaluate the potential savings and improvements that could be made so that best practice in each health board is adopted across all health boards.

Thirdly, it was good to have a conversation on shifting resources in yesterday’s evidence session with the Cabinet Secretary for NHS Recovery, Health and Social Care at the Health, Social Care and Sport Committee. We know that prevention is significantly cheaper than cure, working on the Christie principles, and it would be great to see more happening in that space.

We know that there has to be a shift from management layers towards the front line and from high-cost to lower-cost interventions. I ask the Government to take forward some detailed work to help us to understand how we can better measure the resources that are applied in each of those areas and get under the skin of the health budget, so that we know what the potential savings would be and what improvements could be made by moving towards a more front-line service that focuses on prevention rather than on a downstream cure.

The next area is structures. A big-bang solution would be time consuming and expensive, but I do not doubt that there are many opportunities for the duplication of services by health boards in back-office management, administration and bureaucracy to be removed and for health boards to work closer together. We are looking for opportunities for consolidation where it makes sense to take out costs from the back office and reapply them to front-line services.

I also ask that the single-authority model be given more serious attention in certain areas of the country. I know that that is favoured particularly by smaller local authorities, and that it allows for a much more efficient service delivery model. We are looking to join the dots where possible and make delivery easier. There was an example of that in my constituency of Glasgow recently, concerning funding for community link workers. Different parts of the system were unable to agree to continue to fund that cost-effective intervention until the cabinet secretary stepped in to make it happen.

Finally, it is important to recognise the Government’s absolute commitment to the fundamental principles of the health service. This publicly provided service is free at the point of use, and we must resist all efforts towards its privatisation, as has unfortunately happened in other parts of the UK.

16:44  

I congratulate Dame Jackie Baillie on the honours that she received today. I am disappointed that she did not wear the hat to the chamber.

When Opposition parties debate those great pillars of devolved government, health and education, as we have done so well today, I think that they generally do so for good reason. The points that are made in such debates are often backed up with statistics and facts and informed by stakeholder evidence. I say gently to Mr McKee that they are not talking points; they are about facts, and they are worth debating in the chamber.

The Government’s response to such debates is predictable. There is little sign of contrition or acceptance of any of the criticism that is directed towards it; there is denial of the scale or extent of the problems that we face; and there is a huge amount of whataboutery, of the kind that we heard from the cabinet secretary. Today’s debate is a fine example of that.

Labour rightly pointed out that 80,000 people have waited for more than a year for planned care. It rightly raised the years of missed targets and the growing workforce problems that are faced. In our amendment, we highlighted the worrying cuts to drug and alcohol services and raised the plight of the 1 million people who have waited for more than four hours at A and E since 2020-21.

The Lib Dems raised issues around NHS staff, who are at the core of such debates, and the Greens did not even bother to turn up this afternoon. That says so much.

Immediately, in its opening line, the Government’s feeble amendment—it is a feeble amendment—seeks to remove the phrase “is alarmed” from the motion, because it is clearly not as alarmed as we or, indeed, our constituents are. The Government goes as far as to congratulate itself on the fact that fewer patients are waiting more than two years for an appointment to be seen. Its amendment seeks to remove all references to the drug and alcohol deaths, to A and E waiting times, to mental health waiting times and, frankly, to anything else that seems to embarrass it. In fact, the only defence in the Government’s amendment is that all devolved policy makers seem to be doing a terrible job at managing health. In other words, it is all relative. That is mediocrity at its very worst.

All too often, the bad news is buried away rather than being publicly available. For example, in doing research for the debate, audiology waiting times could not be found. From a response to a freedom of information request, we learned that that data is not published,

“following agreement with the Scottish Government”.

What a surprise.

Yesterday, speech therapy figures were released not by the Government but by the Royal College of Speech and Language Therapists. It, too, had to FOI the data. From that data, we discovered that 6,500 children in Scotland are currently on a waiting list for their first appointment. That is shocking. I have raised the issue because, in my area, the waiting list was closed because it was more than two years long. That is despicable.

What about mental health waiting times? One patient in Ayrshire and Arran waited 91 weeks for their first CAMHS appointment. Can members imagine that? We know that only because we FOI-ed it. We know such things only because we submit FOIs and ask written questions. We never hear such information from the Government, and we certainly never hear it in its debates.

I am afraid that the Government’s amendment is sheer brass neck. It has been parroted repeatedly today that the NHS in Scotland is free at the point of need. Well, here is a reality check. Someone who wants to see a dentist this week in Greenock will get an appointment only if they offer to pay for one. That is the reality of the NHS in Scotland. The same goes for people who want a hearing aid or who are desperate for a knee or hip replacement. They will have to borrow the money, cash in their savings and go abroad or go private. That is the reality of the health service today, in 2024.

With the Government’s amendment, the only people that it is fooling are themselves. Fixing the problem requires admitting that there is a problem. It is not creeping privatisation that we need to worry about—it is creeping ineptitude in Government, and there is plenty of that going around.

16:48  

With regard to this afternoon’s debate on the NHS in Scotland, it is worth observing that the substantive motion before us from the Labour Party offers not a single new idea or initiative on what Labour in Scotland would do differently to improve Scotland’s NHS, nor does it identify a single additional penny for Scotland’s NHS.

I acknowledge the Scottish Government’s amendment’s recognition of the fact that health services across the UK are dealing with the long-term impact of the Covid-19 pandemic on waiting times, and its recognition of the fact that too many people are waiting too long for treatment. Of course—despite some improvements—that includes people right here in Scotland. I readily acknowledge that we all wish to see those improvements gather pace.

The Labour motion refers to long-term waits in the NHS. In 2023, Stephanie Howarth, the chief statistician to the Welsh Government, sought to analyse long-term waits across all UK nations. Ms Howarth indicated that, in March 2023, the number of people in Wales waiting for more than one year for treatment pathways was 133,000. The figure in Scotland was 74,000. The number of people in Wales waiting two years was 28,000. In Scotland, it was 8,000. I acknowledge that Ms Howarth says:

“Although we know these figures aren’t entirely equivalent to each other and should not be directly compared”—

that is not what I am doing—

“the methodological differences cannot account for the scale of some of the differences in the numbers waiting longer than one and two years.”

On this occasion, that suggests more impactful progress in Scotland than has been made elsewhere. That will not always be the case, so I ask the Scottish Government how we share such best practice across the UK and how we receive it from elsewhere.

I commend health and social care workers not only in Scotland but across the UK. We need to set the challenges that are faced by Scotland in a pan-UK context, even where that is uncomfortable for Labour, as it includes NHS performance in Wales. Given that the UK Government’s spending plans—which the UK Labour Party has not said that it would deviate from—would see only an additional £10 million increase to Scotland’s budget, thank heavens that our Scottish Government will increase the spend on our NHS by more than £0.5 billion.

I acknowledge that vacancy levels and recruitment remain significant challenges. Again, such challenges are faced right across the UK, which is understandable, given that the impact of Brexit has undermined workforce planning right across the UK. Indeed, Nuffield Trust research indicated that there are 4,000 fewer European doctors working in the NHS because of Brexit. The Nursing and Midwifery Council estimated that, in 2022, there were up to 58,000 fewer European nurses working across the UK compared with pre-Brexit trends.

That is a reality, but the Labour motion, which mentions recruitment challenges, makes no reference to Brexit. It does not have credibility. Of course it makes no reference to Brexit, because that does not suit its agenda. After all, Labour is a pro-Brexit party, which is something that Labour does not like to draw attention to here in Scotland.

I suspect that what will help Scotland’s NHS with its recruitment challenges is the fact that NHS workers in Scotland are the best paid and best supported in the UK. I am aware of the various recruitment initiatives that the Scottish Government is taking to tackle staff vacancies—there are very real challenges. However, I ask whether that includes attracting—unfortunately within the confines of Brexit Britain—many of those EU healthcare professionals who have chosen not to work in Britain as a direct consequence of Brexit.

I absolutely acknowledge the significant and enduring challenges that are faced by Scotland’s NHS—indeed, by healthcare systems right across the UK. Unfortunately, Labour set the terms of reference of today’s debate, and it has pursued cynical political opportunism rather than constructive dialogue. I look forward to the next debate, and I hope that the Labour Party will do much better in that.

We move to winding-up speeches.

16:53  

The complacency of the SNP Government as the NHS spirals is staggering. As we have heard in the debate, from waiting times to workforce planning the NHS is in crisis. National treatment centres were touted by Humza Yousaf as the cure-all for capacity problems, but now the SNP has hit the brakes on NHS capital projects. You just could not make it up.

Almost 830,000 patients are on NHS waiting lists—a figure that is barely believable. A patient in Tayside waited almost four and a half years for orthopaedic surgery. Another in Grampian waited three years and 179 days for cataract surgery. The impact on patient treatment and staff morale is profound, and there is no end in sight.

The beleaguered health secretary has been distracted and has been more preoccupied with saving his own job than he has with plugging the gaps in NHS vacancies. Jackie Baillie highlighted promises that have been made by the SNP-Green Government, such as its promise to eliminate completely the longest waits in planned care. She gave it a “Fail, fail, fail, fail,” and she said that Michael Matheson has been distracted by personal scandals.

Michael Matheson apologised for the unacceptable waits. He gave us more spin about £1 billion for NHS recovery and the national strategy. He talked about transformation, but those are just words—they are not worth the paper that they are written on. It is statistical spin yet again, but people see the reality on the ground. He deflects, whether to Wales, Westminster or the pandemic. Why do we not believe what the cabinet secretary says any more?

Sandesh Gulhane said that the First Minister and cabinet secretary come to the chamber, make an announcement then fail to deliver, and then defend their record by tripping out spin and promising that lessons will be learned. Just look at CAMHS. As Sandesh Gulhane said, Humza Yousaf promised to clear CAMHS waiting times by March 2023. That matters, because poor mental health robs children of their childhood. Jamie Greene talked about the shocking and despicable lack of action on CAMHS waiting times. He described waits in his constituency of 91 weeks for a first appointment. He also asked where the Greens are. I notice that two Greens miraculously just turned up near the end of the debate, but did not listen to any of it.

Jamie Greene also talked about “creeping ineptitude in Government”, and Bob Doris said that

“not a single new idea”

is coming forward from anyone else. You’ve had 17 years, Bob Doris.

Always speak through the chair, please.

The SNP says that the NHS has record staffing levels, but the SNP does not like to hear the truth. The reality is that the NHS has massive vacancies and high staff turnover. Annie Wells described the failure to recruit more GPs and said that spending on agency staff has quadrupled in two years. She also said that there are more than 5,000 nursing vacancies in NHS Scotland and that staff turnover is at its highest rate in a decade.

Will the member give way?

The member must conclude.

Scotland deserves a fresh approach to deliver a modern, efficient and local NHS, but the stark reality is that, although winter for the NHS is especially difficult, it is now “Condition: critical” for the health service all year round. Seventeen years of SNP mismanagement means that the system is at breaking point. The buck stops at Bute house, and there is no one else to blame.

16:57  

I thank those who are at the heart of our NHS for their commitment, hard work and dedication. Without them, we would not be able to talk about building on recovery and delivering on our promises.

We remain committed to driving down waiting times. We have, in the draft budget, increased investment in front-line NHS boards by more than £500 million, and we will continue to target resources at reducing waiting times, particularly for those who are waiting longest for treatment, through maximising productivity and providing additional resources.

The centre for sustainable delivery is working closely with boards to accelerate implementation of high-impact changes, including active clinical referral treatment and patient-initiated review, thereby freeing up additional capacity in the NHS system and providing sustainable solutions for the future.

With regard to delayed discharges, the winter plan for the NHS and social care for this year was published jointly by the Scottish Government and the Convention of Scottish Local Authorities, and it sets out a whole-system approach to responding to the surge in demand for health and social care services that is experienced in the winter. It includes significant new funding measures to support the health and social care system this winter, including £50 million to recruit 317 additional staff to the Scottish Ambulance Service and additional funding for hospital at home.

With regard to the Scottish Ambulance Service, I accept that there have been delays but, despite the challenges, the service continues to maintain fast responses to the most critically unwell patients and to divert cases away from accident and emergency departments by safely triaging patients in their community, whenever possible.

I absolutely recognise that too many people are waiting too long for treatment. The launch of our waiting well hub gives people more information on the tools that they need to look after their health and wellbeing, and it gives them help in thinking about what matters to them and what health improvements they could make while they wait.

Mental health was mentioned by a couple of members. It is important to note that one in two children—50 per cent of children—is seen within 10 weeks, and that 13 out of 14 of our regional health boards have effectively eliminated their long waits in CAMHS.

I also want to make it clear that, under the Scottish Government, Scotland’s NHS will always remain in the hands of the public and be free at the point of use. However, make no mistake: privatisation by Westminster Governments poses a threat to Scotland’s NHS. The Tories have always wanted to privatise the NHS, but now we have a Labour Party that is following suit. Unbelievably, Labour’s shadow health secretary, Wes Streeting, said that a Labour Government would

“hold the door wide open”

for the private sector in the NHS. That matters for Scotland’s NHS—[Interruption.]

Let us hear the minister.

By ramping up privatisation in England, the UK Government is starving our NHS of investment. If members need proof of that, they need look no further than the autumn statement, which shows a real-terms cut to NHS England funding for 2024-25 and does not provide even a single penny to go towards next year’s NHS budget to pay for this year’s pay deal.

Even with the ongoing pressures, we have seen continued progress being made here. During the past three years, there was an 11 per cent increase in the number of planned operations from the figure for the previous 12 months. That demonstrates the continued post-pandemic recovery of Scotland’s NHS.

I was very pleased to hear Ivan McKee specifically reference the fantastic research work on AI and ANIA that is going on in Scotland. Those innovations will provide us with other ways forward.

The progress that we have made comes from our commitment to ensuring that Scotland has a sustainable and appropriately skilled workforce. Work is well under way to ensure that we have sustainable workforce pipelines now and in the future. Nursing and midwifery staffing is at a record high: we have 8.4 qualified nurses and midwives per 1,000 of the population. Allied health professional numbers are at a record high, and are up by 34.1 per cent.

Our NHS is our most cherished public—

Minister, you must conclude. I call on Paul Sweeney to wind up.

17:01  

The reason why Labour brought the motion to the Parliament today is that the waiting times scandal is unprecedented and comes up daily in our casework. We have all heard that in the speeches today and we all have skin in the game, because even if our own families are not affected, we will know someone who is languishing on an NHS waiting list. Colin Smyth raised the tragic case of his constituent, but that is only one horrendous example; I could rehearse several, if I had more time.

As we know, prevention and getting in early is better—otherwise families spiral out of control and much greater harm is caused. That is what is compounding the problem that we face. One in six Scots—more than 860,000 of us, or what would be the biggest city in Scotland’s worth of people—are languishing on an NHS waiting list, as my friend the member for Dumbarton, who is newly invested as Dame Jackie Baillie, mentioned earlier.

The warm words from the Scottish Government cut little ice on this side of the chamber. In 2022, the First Minister said that the Government would seek to eliminate the longest waits in planned care, but around 80,000 people are still waiting more than a year to be seen. That has consequences. As Annie Wells, a member for Glasgow, said, it is estimated that there are 1,600 excess deaths in A and E alone. The problem is severe and it is having a serious effect on our population. That is why this is a matter for debate.

With 7,000 Scots waiting more than two years for treatment—as opposed to only 227 people in England—it is disingenuous in the extreme for members to claim that Covid is the common denominator behind these matters. Covid has certainly had an effect, but it does not account for the extent to which the NHS in Scotland is not performing well enough. It is completely unacceptable for the Government not to take responsibility for that; it should stand by that record.

I ask the member to please clarify some things relating to a couple of points that I raised in my speech. The Welsh health minister said that Covid has had an impact on NHS waiting times. Does the member disagree with that? Does Scottish Labour support Wes Streeting—[Interruption.]

Let us hear the member.

Does Scottish Labour support Wes Streeting in his calls to privatise the NHS?

We seem to be in violent agreement: I accept that Covid has had an effect, but it does not account for the extent to which the NHS is in disarray in Scotland. As for privatisation, Clare Haughey has grossly misrepresented the Labour Party’s position.

We should consider the reality of what our constituents are telling us. After all, we are here today not to moan about other parts of the UK but to represent our constituents in this Parliament and to hold this Government to account for its actions.

I am afraid that it is simply not acceptable for people on more than one waiting list to have to prioritise one over another, for people to wait multiple years for surgery or for young people to wait more than a year for a mental health assessment, as happens in countless cases.

Some members of the SNP made constructive points. I refer to the member for Glasgow Provan, who raised the issue of digital spines for patient journeys. There are huge interventions that we could make to improve productivity in our NHS, but capital budgets are being cut in efforts to improve efficiency. Constrained GPs tell us that they simply do not have the headspace to even look at service reforms.

Members have raised serious concerns about mental health. The Scottish Government has failed to ever meet its target on waiting times for CAMHS, and the psychological therapies target has never been routinely met. Dr Gulhane, a member for Glasgow, mentioned that, as did Mr Greene, a member for West Scotland. Those are critical points that have to be continually made to the Government. The Government says that it takes the issue of those waits seriously, but the mental health budget has been frozen and subsequently cut in-year for two years running.

The Government is failing to meet its target of 10 per cent of NHS spend being allocated to mental health. Only this week, the cabinet secretary admitted to the Health, Social Care and Sport Committee that it is unlikely that the target will be met by the end of this session of Parliament. That is simply not acceptable, because if the 10 per cent commitment had been fulfilled over the past three years, almost £550 million more would have been invested in mental health services. Instead, we have a recruitment crisis that is costing us £567 million on bank and agency staffing. The Government has the cheek to talk about privatisation when it is ploughing £0.5 billion into private recruitment agencies. It is a sham and unacceptable.

As colleagues have referenced, the waiting times for cancer diagnostic tests are costing lives. I am afraid that people who are waiting for a cancer diagnosis are not waiting well but are dying while they wait for treatment. That is what is happening in our midst, and it is unacceptable for it to happen on the Government’s watch.

That is why we have brought the motion to the chamber today, and it is why we commend it to members. I hope that all parties will support it for the sake of Scotland’s health and to ensure that we provide the best possible outcomes for our constituents.