Official Report 471KB pdf
Good morning. The first item of business is general question time. As it is the shortest question session of the week, concise questions and responses will be appreciated.
Autism Spectrum Disorder Assessments (NHS Tayside)
To ask the Scottish Government, in light of NHS Tayside having stopped accepting referrals for children without coexisting mental health disorders in March 2025, what further action it has taken to support children in accessing timely autism spectrum disorder assessments. (S6O-05664)
I am aware of NHS Tayside’s decision to pause new neurodevelopmental referrals where a child does not have a coexisting mental health condition, but that does not mean that support is unavailable. For example, local authorities have a statutory duty to identify and make provision for children and young people with additional support needs, regardless of a diagnosis. I also recognise that demand for neurodevelopmental support and assessment has increased significantly. We are working with health boards and local authorities to implement our neurodevelopmental specification, which sets clear expectations for boards and children’s services to work together to deliver timely needs-based support, in line with the getting it right for every child approach.
I know that Tom Arthur gets it. We have had conversations in the past year and I have brought constituency cases to him, but I am distraught that, a year on, we still have families that are stuck with no pathway. I appreciate that schools can do a lot and I appreciate that they can put plans in place to help neurodiverse young people, but some people just need an assessment. Will the next Government put forward an appropriate strategy that will guarantee that those who really need an assessment can get one?
I appreciate and value the meeting that Mark Ruskell and I had to discuss the matter, and his on-going interest and engagement. I recognise that we are contending with a significant increase in demand over recent years, which necessitates not just a whole-system, but a whole-society, response. Our current systems are designed for 1 to 2 per cent of the population, but potentially as much as 20 per cent of the population requires support. That requires a needs-based approach.
I fully understand that, in addressing need, assessment and diagnosis can be vitally important for identity and validation and, specifically for those with attention deficit hyperactivity disorder, for access to medication. I recognise the importance of that and I have been seeking to work constructively with parliamentary colleagues through the two summits that have been convened. I hope that that will build momentum so that whoever forms the next Administration after the election can build on that work and utilise the additional resources that have been provided in the budget that was recently passed.
The move to separate autism spectrum disorder assessments from mental health services is more than a simple clinical distinction. I understand the motivation for separate pathways that the minister has set out, but I have been working with a young boy who has been on the child and adolescent mental health services neurodevelopmental waiting list since January 2023. The details of his case are distressing, but there is no diagnosis in sight. Does the minister recognise that that wait is far too long? There are deep consequences for my constituent’s wellbeing that are overwhelming both him and his family.
I concur with Mr Marra and appreciate the points that he raises. I want to be absolutely clear that such lengths of waits are completely unacceptable. I made that point directly to the chief executive of NHS Tayside, as I have to every other health board that I have met. I recognise the point that Mr Marra makes and I welcome his recognition of the important distinction between mental health services and neurodevelopmental services. Where there is a co-occurrence or a comorbidity, CAMHS may be the appropriate setting.
I assure the member that I have had reassurance from NHS Tayside that it is working in this area and I have had similar assurances from every health board. The Scottish Government is working with all health boards, including through the national autism implementation team. I encourage members to engage directly with their health boards. I appreciate that the member does that, as I know that he actively engages with NHS Tayside.
Briefly, please.
There is an opportunity, particularly in the next session of the Parliament, to work constructively together to ensure that people are receiving the support that they require.
NHS Grampian (Deficit)
To ask the Scottish Government how it expects NHS Grampian to address a projected deficit of £76 million for 2026-27, in light of it having already made £62 million of savings in 2025-26 and requiring a further £40 million of budget reductions in 2026-27. (S6O-05665)
The Scottish Government recognises the financial pressures facing NHS Grampian and continues to work closely with the board to support financial recovery and long-term sustainability. Following the board’s escalation to stage 4 for finance on 12 May 2025, an assurance board was established to support the board’s executive team to develop and implement an improvement plan. NHS Grampian’s financial grip and control have significantly improved since, with the board on track to meet its financial targets. As such, the Scottish Government remains confident that NHS Grampian will achieve its financial targets in 2025-26 and 2026-27.
I thank the cabinet secretary for his answer and welcome him back to the chamber. I am pleased to see him back. [Applause.]
NHS Grampian is staring into the abyss, following years of underfunding. In Aberdeen, £14.5 million-worth of cuts mean that the Rosewell House rehabilitation centre will close and budgets at city care homes will be slashed by £3 million. In Aberdeenshire, £5.7 million of savings includes a £1 million cut from prescribing and another £1 million in service redesign. Now, NHS Grampian chiefs need to cut a further £177 million over the next five years.
Does the cabinet secretary agree that the £300 million shortfall that NHS Grampian experiences under the national resource allocation committee formula is outrageous, and that the next Government must review it urgently to ensure a fair share for the north-east?
Although I am grateful for Mr Kerr’s kind comments at the outset, I cannot agree with his conclusion. The NRAC formula provides target shares for regional national health service boards. The Government’s approach has been to move boards towards NRAC parity gradually over a number of years, backed by significant additional investment. Since 2012-13, more than £4 billion of additional funding has been committed to boards that are below their NRAC parity levels, including additional funding for NHS Grampian. NHS Grampian’s £800,000 share of the £55 million additional parity funding maintains the board within 0.6 of the NRAC parity target.
However, under new management and the board’s assurance process through the Scottish Government, we are seeing significant progress, and a better grip and control over the finances at NHS Grampian. As I have said repeatedly to Mr Kerr and other colleagues, that cannot be to the detriment of the services that patients receive. I am confident that we can achieve that.
Neonatal Intensive Care Units
To ask the Scottish Government what discussions it has had with national health service boards regarding the 2017 best start plan to downgrade the number of level 3 neonatal intensive care units from eight to three. (S6O-05666)
There have been extensive discussions with NHS boards about plans to improve care for the smallest and sickest babies by implementing the new model of neonatal intensive care. Following the announcement of the new model in July 2023, I asked regional chief executives to lead on the development of regional implementation plans. Implementation groups were established in each region, including clinicians, partnership and service users. The regional chief executives also established a task and finish group to take forward work to inform implementation, including maternity workforce modelling, financial modelling, cot capacity planning, and management and communication.
For the sickest and most pre-term babies, the Government seeks to centralise care to Glasgow, Edinburgh and Aberdeen. Meeting minutes that have been uncovered tell us that NHS Grampian does not have the cots or the staff. There are serious worries about ambulance cover, which is already a massive issue in the north of Scotland. One of the First Minister’s staff even said that they thought that downgrading Ninewells could have a deeply inhumane impact on mums travelling long distances. At its last meeting, the Citizen Participation and Public Petitions Committee advised ministers to stop downgrading Ninewells until outstanding transport capacity and finance questions have been answered. What is the Government’s response to that?
I need to be clear that the decision has been made, through expert advice, to ensure that the smallest and sickest babies get the best support and healthcare that can be achieved.
With regard to the points that Douglas Lumsden raised, as I indicated in my first answer, the Scottish Government contracted healthcare planning support from RSM UK to undertake the detailed modelling and capacity planning work to inform local implementation plans.
Implementation of the new model of neonatal intensive care was tested in practice in four boards—in NHS Fife and NHS Lothian in the east and in NHS Ayrshire and Arran and NHS Greater Glasgow and Clyde in the west. The Scottish Government has provided more than £7.5 million since 2018-19 in support of implementation in the east and west, and we have provided planning funding to the north region. Discussions are currently under way with NHS Grampian in relation to additional funding requirements.
There has, rightly, been local concern about the plans, but can the minister again reassure my constituents that, of the 55 or so neonatal babies that are cared for each month at Wishaw, one or two babies are likely to be affected by the change in the planning, which will ensure that the babies are co-located with specialist anaesthesia and neonatal surgery? That is why those decisions have been supported by the charity Bliss.
I thank Clare Adamson for her follow-up question. I absolutely agree that the decision is based on strong clinical evidence about the outcomes for the smallest and sickest babies when they are cared for in a unit with a high throughput of cases and where support services, such as surgery, are co-located. The model is supported by a range of stakeholders and clinicians, including Bliss, which recognises that it will improve the safety of services for the sickest and most pre-term babies.
National Health Service
To ask the Scottish Government how it would assess its handling of the NHS. (S6O-05667)
It is clear that our NHS is turning a corner under this Government and recovering following the pandemic. Long waits are down for eight months in a row, and thousands more operations are being delivered, with the Golden Jubilee hospital being named on Monday as the United Kingdom’s largest centre for hip and knee replacements.
General practitioner numbers are up, a historic deal, worth more than half a billion pounds, has been reached with GPs, and 30 new walk-in GP centres are to be delivered. There has been an increase in the number of doctors, nurses, midwives and consultants, and our MyCare.scot service will begin to be rolled out from April. There has been a record level of investment in our health service.
From personal experience as an unexpected secret shopper this week, I can say that our staff deliver world-class care to the people we seek to serve.
I declare an interest as a practising NHS GP.
It is great to see the cabinet secretary back in the chamber, but he is wrong, because, during this parliamentary session, we have seen three different health secretaries, record waiting lists, record drug deaths, problems with delayed discharge and a failure to modernise our NHS. After almost 19 years in government, this is a mess of the Scottish National Party’s own making.
I came into politics because I wanted to stand up for patients, stand up for ourselves as doctors, nurses and key workers, and strengthen our greatest asset—our NHS. Under the SNP Government, our NHS has been recklessly mismanaged, leading to countless scandals that have caused unimaginable suffering among patients and fear among staff, and patients have sat on two-year waiting lists.
With that evidence in mind, how does the Scottish Government think that Scots would assess its performance on health and social care in this parliamentary session? Members of the public who are stuck on waiting lists would give it a score of zero.
The polls suggest that this party is the most trusted in this Parliament to be the custodian of our most cherished public asset, which is our national health service. Perhaps that is because of the progress that we are making.
Sandesh Gulhane and I share a desire for the continued recovery of our health service. I repeat that long waits in our health service are now down for eight months in a row. The numbers of operations and procedures are up and are reaching record levels. That is because of the record investment that we are making, which Sandesh Gulhane voted against, and because of the incredible commitment of our hard-working NHS staff who continue to deliver for the people of Scotland.
Pupil Support Assistants (Additional Support for Learning)
To ask the Scottish Government what assessment it has made of whether the current levels of pupil support assistant staffing in schools to support pupils with additional support for learning are adequate, including steps required where shortages exist. (S6O-05668)
All children and young people should get the support that they need to reach their full potential. The latest figures show that there are 17,046 full-time-equivalent pupil support assistants in Scotland. That is the second-highest level on record and an increase of nearly 1,800 since 2020. That is a direct result of our continued investment of £15 million to our local authorities every year, which supports more pupil support assistants.
Importantly, all teachers are responsible for supporting pupils with additional support needs, not just teachers whose role is specifically related to additional support for learning.
The number of pupils who are identified as having additional support needs has risen by about 97 per cent since 2013, with about 43 per cent of pupils now recorded as having an ASN. However, support provision has not kept pace. Although the £29 million funding increase from 2025 is welcome, Audit Scotland reports that only 12 per cent of education spending is allocated to ASL and only a minority of schools have dedicated facilities. Given the gap between demand and provision, what specific action will the Government take to increase pupil support assistant staffing and ensure that funding delivers tangible improvements for pupils in every classroom?
Mr Balfour raises a hugely important point. He is absolutely correct to say that additional support needs in our schools have grown in recent years. That has been driven, in part, by greater identification, but it has also been driven by increasing complexity in the support needs that are emerging in our schools.
The Government is taking a range of actions. Mr Balfour will be aware of the statement that I gave to the Parliament in January, when I provided members with an update on the work that the Government has been leading through the additional support for learning action plan, which was informed by the Morgan review.
More broadly, Mr Balfour’s former party contributed to a cross-party review of ASL, which was published last week and was led by Janie McManus, the former chief inspector of education. The report includes six recommendations that set out the next steps for strengthening our system delivery: having a clear national approach to planning and staged intervention; workforce alignment to match today’s level of need; stronger early intervention capacity; improved national visibility of need and progress; a more coherent delivery model; and a more coherent curriculum.
We are taking a range of actions through the ASL action plan. Last week, I was delighted to attend the launch of Janie McManus’s review, which was commissioned on a cross-party basis. We will take further steps in that regard to protect the funding that I identified through the budget.
Operation Branchform
To ask the Scottish Government for what reason the Lord Advocate briefed the First Minister that suspects arrested on alleged embezzlement charges as part of operation branchform were not being charged, before the individuals themselves had been notified. (S6O-05669)
I provided the First Minister with relevant information on that investigation when procedural milestones were reached and when information may have become public. Communication on 20 March 2025 was synchronised around an appearance in court and the notification to two suspects by police that they were not being reported to the procurator fiscal.
In the event, communications from my office to the First Minister, from Police Scotland to the suspects and from the Crown Office and Procurator Fiscal Service to the media were all made within a few minutes of one another. I am satisfied that established processes were followed and that actions were handled properly.
I am confused by that answer from the Lord Advocate, because she claims that the communication was synchronised, but we know definitively that she briefed John Swinney before the suspects were told that no charges would be continued.
Does the Lord Advocate understand the concern about the political leadership of the Scottish Government being informed before suspects? Does she have any concerns that her actions in briefing the First Minister on two separate occasions could jeopardise the ability of the Crown or the defence to call John Swinney as a witness in that case of alleged embezzlement?
I remind members that there are active criminal proceedings in the case and that the sub judice rule applies.
I am here as Lord Advocate. I discharge my duties in that office independently of any other person and independently of any political interference.
As I have explained previously, the Lord Advocate of the day may provide the First Minister of the day or, indeed, the Prime Minister or other minister with information on casework or investigations. That is done irrespective of the political party of the recipient of the information. It is done in the proper administration of the system, and I have provided the Parliament with examples of that happening.
The Lord Advocate does not brief political parties; the Lord Advocate advises constitutional office-holders of information that they require to be aware of. I am satisfied that established processes were followed and that actions have been handled properly.
That concludes general question time.