Chamber and committees

Thank you. Sai, can you tell us how the ecosystem that Lesley Jackson has set out and the loss of some of those overlaps feel to students who are trying to access projects or early-career research?

That was great. Thank you. Roy, are there similar collaborative things that have become more difficult for your sector with the loss of that interconnectivity and collaboration?

Sarah, what do we need from the current schemes in order to make things better overall for youth work? Is it about making it easier to apply for things or overcoming some of the anecdotal barriers that I am sure you have been hearing about from various organisations, to ensure that we can have vibrant collaboration across youth work organisations, too?

Thank you.

Are there things on staff mobility that are missing from SEEP? Given that the Scottish Government is in this learning phase, are there things that you would you like the Scottish Government to add in to SEEP to make those things easier?

Absolutely. Does anyone else want to add anything about what they want to see for their own sector, particularly in relation to SEEP?

In recent weeks, the Constitution, Europe, External Affairs and Culture Committee has highlighted how it is all too easy for some production companies to bring crews to Scotland to film projects and then just return to London. Will the cabinet secretary outline how the funding to Screen Scotland will help to strengthen and diversify the range of screen professionals and careers in Scotland?

Many colleagues on all sides of the chamber have made robust contributions to the debate, and the discussion has made it clear that, while there is widespread recognition of the dedication and resilience of those in our health and social care workforce, there is also deep concern about the challenges that they continue to face.

Many Labour members have mentioned a lack of workforce planning, and that is a fair challenge to Government. However, we need multiple workforce plans that address variety and gaps not only across specialties and across some hospitals in the same health boards but across the country. We need a GP workforce plan in the Highlands that is different from what we need in the central belt. If some hospitals are struggling in particular specialties, we need to investigate why. We cannot pretend that we have solved all the issues of poor culture in different bits of the NHS, and we cannot take our eye off that.

One of the most important things that we can do to help NHS workers is give them the tools to be able to work more efficiently and to deliver care in the most accessible place. For example, wait times for treatment in secondary care are far too long, and some people could be helped to stay well for longer before invasive treatment is needed if they were managed properly in the community. However, that would involve more money going to primary care, both to increase the overall GP head count and to enable the diversification of the multidisciplinary team. Utilising technology has to be part of the offer in primary care. It is also well beyond the time when we should be seeing electronic prescribing being used across the NHS. Having GPs signing prescriptions for hours is not a good use of their time, and I assume—I am sure that Dr Gulhane will correct me if I am wrong—that GPs do not enjoy the task either.

We could also take some of the burden off GPs by using the pharmacy first service to its fullest extent. I was grateful—as I am sure that other members were—earlier in the month to have time to speak to the Royal Pharmaceutical Society about how it would like pharmacy first to progress. Having all new pharmacists who graduate being prescribers is fantastic, but there is currently too much risk for pharmacists to be able to fully realise the ambitions of pharmacy first. I had first-hand experience of that a few weeks ago. Because of horrendous travel sickness and being unable to take normal travel sickness tablets, I needed anti-nausea medicine. However, because the pharmacist could not see my notes, and in particular my maternity notes, they did not feel that they could recommend anything, let alone prescribe it. That meant that I had to take up a 15-minute appointment with my GP.

I would be grateful if the cabinet secretary or others looked into whether they are willing to ensure that pharmacists have enough information to be able to prescribe with confidence and provide that further avenue for quick and effective treatment.

I thank the cabinet secretary for that, and I look forward to meeting him to discuss that point.

I also welcome the development of an app for the NHS. We could save so much time in out-patient clinics by ensuring that an app can add in remote monitoring of patients. I had the pleasure of meeting Kidney Research UK, which has lauded the use of the NHS app in other parts of the UK in enabling remote monitoring of those with kidney conditions, so that people are asked to come to hospital only if there is something of concern. That works by allowing patients to put kidney values into the app, which the consultant then reviews and takes action on if necessary.

The freedom for those patients in managing their own conditions is immense—there are fewer trips to the hospital, which means less time out of work, school or daily life. For consultants, it means that there is less of a need for constant out-patient review appointments for people who are otherwise managing a condition well, which frees up urgent appointments for those with concerning symptoms or concerns. That is only one example of where an app would be revolutionary.

I will touch briefly on mental health for children and young people and on another way in which I hope that the Government may look into supporting good mental health. Earlier in this parliamentary session, I visited Larbert high school to chat about the work that school nurses were doing across Falkirk to support young people. Not only were they helping young people to navigate exam stress and relationship issues but they were offering support for those having a period of poor mental health when a CAMHS referral was not appropriate or had not yet been provided. The nurses were trusted by the young people and, for some, were the preferred first line of contact with health services. However, in many areas, the number of school nurses is declining, even though they can support health and wellbeing in schools and provide support and guidance to staff and pupils alike.

NHS staff have to be a priority. During the pandemic, we all made pledges and commitments to make the working lives of nurses and other clinical staff better. Some work has been done, but it has never been more critical to do so much more. Some of that involves ensuring that there are enough staff so that burn-out is not the reality, but it is also about ensuring that the conditions in hospitals support people’s needs.

Multiple colleagues have raised the issue of waiting times. No one should have to wait the length of time that we have heard about today. However, I cannot imagine being a staff member in a health board listening to this debate, because every clinician I know wants to see people as quickly as possible. It is the structure that is failing, not our hard-working clinicians, which is why I strongly believe that the reform of services is as important as workforce planning.

Although I appreciate the strength of feeling behind the Labour motion, I worry that providing a 10-year workforce strategy before the summer recess might not balance the need for a workforce plan with the need for reform and consideration of the nuances of regional disparity. However, the sentiments relating to the urgent need for workforce planning and work to support staff are absolutely not lost on me.

As I did yesterday, I encourage Labour members to speak to their colleagues at Westminster. Labour members could remove one of the biggest pressures on public services by fully funding the increase in national insurance contributions. I also hope that they will break with Wes Streeting’s increased cosiness with the private sector. I would like our reliance on the private sector to be reduced in Scotland, particularly—

I will start by apologising to the chamber. My Surface has had a moment with Zoom over the past five minutes, so I currently have my phone propped up while I try to make this speech. I hope to get the issue fixed ahead of my closing speech.

I thank Labour for bringing this important debate to the chamber. I hope that, together, we can recognise the importance of our health and social care workforce. Despite the workforce’s dedication, it continues often to face significant challenges that require not only urgent attention but concrete action. I hope that we can use this opportunity to highlight the key issues raised by those working on the front lines and to discuss the steps needed to ensure a sustainable and effective workforce for the future.

I will start by talking about mental health. I thank Scottish Action for Mental health for the support and briefing provided ahead of this afternoon’s debate. We know that access to timely mental health support remains a serious concern in Scotland. The on-going lack of meeting the 18-week waiting time for NHS psychological therapies and child and adolescent mental health services points to a system that is struggling to meet demand. Although there has been a 69 per cent increase in the NHS psychological services workforce over the past decade, and a 128 per cent increase in the CAMHS workforce since 2006, demand continues to outstrip capacity. That is particularly evident in the lack of community-based mental health provision and the vacancies in some health boards, including in NHS Forth Valley in my region, which has a significant number of unfulfilled psychiatrist roles.

The Scottish Government’s mental health and wellbeing workforce action plan sets out some priorities that are generally welcome, including a commitment to evidence-based workforce planning. However, SAMH points out that there are clear gaps that need to be addressed. The plan does not provide essential benchmarking or mapping, nor does it set out targets or an assessment of workforce needs. It also fails to fully recognise the third sector’s vital role in delivering mental health treatment and support. SAMH poses the question to the Scottish Government whether it will conduct a needs assessment of the mental health workforce, including the third sector, to establish clear targets. In addition, we need to see the Government guaranteeing sustainable funding for third sector mental health providers, which are doing huge amounts of work.

In the 2021 programme for government, a commitment was made that, by 2026, every GP practice would have access to a mental health and wellbeing service, which would be backed by funding for 1,000 additional dedicated staff. That was to be supported with an annual investment of £40 million by 2024-25. However, it is disappointing that the commitment has been paused due to financial pressures. I hope that, with additional money coming from Westminster, we will see it restarted.

As at March 2023, 17 per cent of GP practices in Scotland reported having no access to mental health workers. The need for investment in primary care is clear, and we must ensure that people can access the mental health support that they require at the first point of contact.

The Royal College of General Practitioners has shared important information on GPs. The single most impactful outcome for primary care would be an increase in the number of general practitioners—and that needs to be measured by whole-time equivalent rather than by headcount.

Data shared by the royal college, which originated from the GP workforce survey, reveal that the number of WTE GPs has decreased, with a reduction of 0.7 per cent between 2023 and 2024. Since 2015, the WTE GP workforce has declined by 4.2 per cent, while the number of WTE medical and dental consultants has increased by 21.2 per cent. The divergence is particularly concerning as GPs carry out 90 per cent of NHS patient consultations on any given day.

It must be recognised that some progress has been made, and the royal college welcomes the Scottish Government’s general practitioner recruitment and retention action plan. However, the royal college stresses that the plan must be adequately resourced and effectively implemented, as must other plans.

Workforce and workload data for Scotland’s GP workforce remains poor.

The number of GP practices in Scotland has already decreased, reflecting a concerning trend towards fewer practices overall. Evidence consistently shows that countries with strong primary care systems have better health outcomes and lower rates of unnecessary hospitalisations. The RCGP has also welcomed the First Minister’s recent speech on renewing the NHS, and his commitment to increasing the proportion of new NHS funding that is allocated to primary and community care. However, we need that to be progressed at pace.

The BMA highlights its on-going frustration with Scotland’s workforce plans, which in its opinion have lacked the necessary detail and long-term solutions. It continues to call for a comprehensive plan that sets out the required number of doctors in both primary and secondary care, along with clear strategies to improve recruitment and retention at every stage.

Alcohol Focus Scotland is calling for urgent action, as many feel undervalued and at risk of burnout. The alcohol and drug workforce survey highlighted high workloads, large case loads and heavy performance-reporting burdens. Among respondents from statutory services, 63 per cent reported feeling under pressure most or all of the time. Additionally, Audit Scotland has noted slow progress in implementing the Scottish Government’s drugs and alcohol workforce action plan, particularly in workforce mapping and developing a competency framework.

Scotland’s health and social care workforce is the very backbone of our country’s wellbeing yet, across mental health, primary care, general practice, social care and addiction services, we see challenges, staff shortages, unsustainable workloads and a lack of long-term workforce planning. Reform and workforce planning need to happen at the same time, and we need to ensure that we have the workforce to sustain and improve services and produce the workforce plans that we need to realise ambitions on reform. Both have to be done at the same time; otherwise services will continue to struggle to meet demand.

I welcome the First Minister’s renewed focus on supporting and strengthening the NHS. His commitment to increasing the share of new NHS funding that is directed to primary and community care is a step in the right direction. However, now is the time for the Scottish Government to deliver the solutions, investment and commitments that our workforce and the people whom they care for deserve.