Chamber and committees

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?

On a point of order, Presiding Officer. My app looks like it has crashed and I would have voted yes.

I have previously raised in the chamber the pressure that is being put on out-of-hours GP services. Is the cabinet secretary concerned that people who are faced with long waits at A and E or for ambulances might turn to out-of-hours general practice, putting further strain on a service that is already under extreme pressure? What impact does the cabinet secretary think that the increased demand for out-of-hours and emergency services will have on out-of-hours GPs? Will a similar package of support be put in place for out-of-hours practitioners and services?

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?

I, too, pay tribute to Scotland’s incredible GPs, who have worked in extremely pressured and fast-changing conditions during the pandemic. The contribution of all practice staff has been immeasurable, so they deserve our sincere thanks.

They do not deserve the suggestions that general practice has been closed during the pandemic and that GPs have not been offering face-to-face appointments. I am seriously concerned about the tone of the Conservative motion in that respect. GPs have continued to deliver a 24/7 service, including out of hours services, and have always offered face-to-face appointments when they have been clinically necessary.

As the Government amendment notes, GPs

“were asked to change the way that they worked”

due to Covid and they rose to that challenge. They rapidly adapted their ways of working while also stepping in to help with vaccine roll-out and staffing at Covid assessment centres.

There were GP workforce shortages prior to the pandemic and, as we know, demand for GP services has risen considerably in recent months. People are now coming forward with conditions that emerged during lockdown and GPs are caring for patients who are on long waiting lists for secondary care. Contrary to what some people might think, remote working does not reduce people’s workload. Practice staff are tired, overstretched and demoralised, so I am seriously concerned about the impact of the debate on their morale.

We cannot afford to undermine GP recruitment and retention, but the Conservative motion has the potential to do just that. Instead of demanding that GPs return to doing something that they have been doing throughout the pandemic, we should be talking about how we can recruit more GPs and other members of the primary care team, and how we can best support practice teams’ mental and physical wellbeing in order that they can continue to deliver excellent patient care in difficult circumstances.

In recent months, there have been a number of serious incidents at Polmont young offenders institution, including a riot and an inmate being scalded. How is the Scottish Government working with the Scottish Prison Service to ensure the safety and wellbeing of young people in Polmont?