Chamber and committees

How best do we determine the level of funding that the NHS and social care need after Covid? I know that the British Medical Association has said that

“short-term boosts won’t be enough to deliver the full recovery”

that services need, and that what is really needed is

“a full review”

of health and social care spending in the context of a national conversation about our expectations. Would the panel support that approach?

My question should probably be directed at Fiona Collie. A lot of unpaid carers have been unable to take breaks, and the pandemic has also had a significant impact on their mental health. I was caring for my grandpa. The pandemic, and the risk that my outside activities posed for his health if I brought Covid into the house, cast a shadow. What should we do in the immediate term to make sure that unpaid carers’ mental health and risk of burn-out is decreased to the greatest possible extent, and are there other things that we should be doing to make sure that, as we recover from the pandemic, unpaid carers do not continue to suffer unnecessarily?

At the beginning of the pandemic, there was a lot of focus on the incredible work that is done by care workers, but it feels as though some of that focus has waned as attention has moved to the pressure that is being placed on the health service. Are we doing enough to continue to value and highlight the contribution of care workers during the pandemic?

I am concerned about the decision to follow the UK Government’s approach and end the requirement for double-vaccinated people who are travelling from non-red-list countries to Scotland to take a PCR test on departure. I appreciate the reasons for taking that decision, which the First Minister has set out. However, it will weaken our ability to prevent new variants from entering the country, which could still pose a serious risk to Scotland’s Covid recovery.

Last week, I asked the First Minister to provide MSPs with the scientific evidence underpinning any such decision. Will she now do so, and can she provide a timescale for the announcement of the additional safeguards that she set out in her statement?

I, too, thank our ambulance crews and all those working in emergency care and the wider NHS for continuing to work extremely hard in very difficult conditions. The stories of extremely long waiting times for ambulances make for distressing reading and I cannot imagine the distress felt by the people who have faced those agonising waits. I am grateful for the measures that the cabinet secretary set out yesterday, and I hope that they begin to make an impact quickly.

Ambulance crews are working incredibly hard to reach people who need help as quickly as possible, but demand is simply outstripping supply. The pandemic means that staff have been working flat out for 18 months with no respite, and I am extremely concerned about the impact on their mental and physical health. There have been disturbing reports of crews being unable to access food, water or rest for whole shifts. How can we expect them to care for us when they have no time to care for themselves?

We need to protect Ambulance Service staff. As people become frustrated with long waits, staff will inevitably bear the brunt. I welcome the Scottish Government’s announcement of additional wellbeing support, but we also need strong messaging that abuse or intimidation of ambulance crews is not acceptable. There have been reports of call handlers receiving abuse due to long waits. I would therefore be grateful if the cabinet secretary could confirm whether the additional wellbeing support that is being put in place for ambulance crews will be extended to other staff.

Extra clinical capacity will no doubt relieve some of the pressure that is being placed on teams, and I am extremely grateful to the 100 second year students who will be working across the Ambulance Service while carrying out their studies. They should rightly be applauded. However, I have concerns about the impact that it will have on their studies and the potential risk of burnout. I therefore ask the cabinet secretary to confirm that no students will be academically disadvantaged and that they will receive wellbeing support.

The demand for ambulances will undoubtedly place pressure on other emergency and out-of-hours services, and I am concerned about the secondary impact of long waits on NHS 24 and out-of-hours general practice. We must ensure that they are properly supported to meet a potential surge in demand. Likewise, delayed discharge is placing pressure on hospital wards, A and E departments and the Ambulance Service as patients occupying hospital beds cannot be discharged without a care package.

We need to take a whole-system approach when looking at how we can relieve pressure. Dr Daniel Beckett, an acute care consultant, has spoken in the media today about the fact that, if we could meet patients’ social care needs, patients would be able to move out of hospitals, which would in turn reduce crowding in wards and emergency departments as well as reducing ambulance delays. A national care service is of course the Parliament’s long-term goal, but social care needs support now. I have previously spoken about the need for a social care recovery plan and I urge the Government to give serious consideration to that.

Although a whole-system approach is vital, we must also respond to acute pressure points in the system. NHS Forth Valley, in my region, is currently the worst-performing health board in terms of the four-hour A and E target. Nationally, 71.5 per cent of patients are being seen within four hours, whereas in Forth Valley it is just 53.4 per cent. That is a significant difference and I would be grateful to hear from the cabinet secretary whether he is considering targeted interventions for Forth Valley.

We must prioritise staff welfare. Our dedicated NHS workers continually go above and beyond, but that should never be taken for granted. Clapping on the doorsteps is not enough when paramedics cannot access food and water throughout a 12-hour shift.

On a point of order, Presiding Officer. Once again, noise in the chamber has prevented me from participating in some parts of today’s proceedings. I thank you for continuing to remind members of the barrier caused by excessive noise in the chamber.

However, I am particularly annoyed by what I believe to be ableist comments made either when I challenge others or after you intervene, Presiding Officer. When I challenged a member who shall—for now—remain nameless that I could not hear over their shouting, that was met with a shrug and a comment about others not taking interventions.

I remind all in the chamber that it is often their behaviour that is a barrier to others’ participation, not our impairments. I would be grateful, Presiding Officer, if you could advise on what more can be done.

We have talked about people‘s incomes, particularly during the pandemic. Furlough is due to come to an end, universal credit is being cut and incomes generally are declining for those who are least able to afford it during the pandemic. Would the panel agree that a universal basic income approach could help to tackle some of the economic inequalities that lead to poor health?

Do we need specific interventions in specific places or more system-wide interventions? For example, air pollution kills 2,500 Scots per year, according to Friends of the Earth Scotland. In my region, we have Scotland’s biggest polluter. In our papers, there is a focus on Glasgow, which is a unique example in Scotland, in that not only is it one of our major cities but it has a very large motorway running through its middle. There are particular issues in Glasgow with early deaths and so on. Does the panel think that we need specific, place-based interventions or wider system change on air pollution and other determinants of poor health?

Following on from Dr Robertson’s contributions, I am particularly interested in staff morale and wellbeing. Are clinical and other staff getting enough support? What can be done in the immediate short term to prevent a crisis of morale? What could be done in the long term to improve overall recruitment and retention in each of the groups that you represent?

The First Minister indicated that she is yet to make a final decision on whether PCR tests for fully vaccinated people entering the country from non-red list countries will still be required. If the decision is made to change testing requirements for international travel, will the First Minister commit to presenting members with strong epidemiological evidence to support such a change, given the danger posed by new variants, and will she confirm the timescale for the Scottish Government’s decision?