Chamber and committees

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.

The member in charge of the bill has identified some routes that could be used to deal with some of the competence issues, which include orders under the Scotland Act 1998. If the bill passes stage 1, will the Scottish Government commit to discussing those matters with the United Kingdom Government?

Cabinet secretary, could you expand on the Scottish Government’s concerns on legislative competence? For clarity, do you regard the bill as being outwith the legislative competence of the Scottish Parliament, or is the Scottish Government concerned that it might not be possible to implement aspects of the bill within the current restrictions on legislative competence?

That is useful.

How do you believe Scotland’s legislation could best ensure that there is clarity, and minimise complications for individuals and families who are navigating the different legal frameworks on assisted dying across the UK, to ensure that they do not fall foul of any rules, which Steve Johnson has just talked about? Laura, how can we make it easy for families to navigate, so that they do not end up under investigation by either the police or the COPFS?

Thanks, convener, and good morning, witnesses.

Do you foresee a risk of confusion between the various eligibility criteria for assisted dying in different parts of the UK? Is there an associated risk that that would make law enforcement more complex? If so, what do you believe should be done to address that? Unbelievably, I will go to Steve Johnson first. [Laughter.]

Would anyone else like to come in on that, before we move on?

This has been a lively and diverse debate. I will start by reflecting on a few of the contributions to it.

Kevin Stewart is absolutely correct that we have spent far too much money on tackling crisis in social care. We must ensure that social care reform continues and that, despite what has happened with the national care service, it is not simply put in the “too hard to do” category. I also agree that we must ensure that the lived experience testimony and the work in that regard are not lost, so I was grateful to the Minister for Social Care, Mental Wellbeing and Sport for outlining how some of that will be retained.

Yes, absolutely. If we have learned nothing else through the whole process, we know that we need to centre the voice of lived experience. If it is possible to get someone with lived experience as the chair of the expert panel, it is essential that we do so and that they are supported to ensure that they can be in the role for a long time.

For that reason, I do not agree with Sandesh Gulhane that the money has been completely wasted. He conveniently forgot to mention the massive impact that years of Tory austerity, Brexit and the Tories’ disastrous fiscal policies have had on public services up and down the country.

I welcome the measures that the cabinet secretary outlined for the hospital at home and rapid access for frailty systems and for ensuring that people can see a GP more easily. We see many measures that will make staff’s lives, or jobs easier as well—I am demonstrating the pitfalls of writing notes and scribbling things down as I go.

The roll-out of a health service app is long overdue. Many of the digital advancements that we have spoken about could revolutionise how the public interact with the NHS and how care can be delivered. Although many of the things that the First Minister announced yesterday are welcome, we need fundamental reform across the NHS to improve care and the experience of staff, which is hugely important.

Karen Adam mentioned library closures in her constituency. My Green colleague Mark Ruskell has been working with local people on a campaign on library closures in Perth and Kinross. Karen Adam is entirely correct that libraries are not just about books and that, although literacy is hugely important, their wider social and health benefits for communities, including, in my region, baby and toddler groups, knitting groups and anti-loneliness initiatives, are hugely important. I encourage others to speak in the members’ business debate on libraries next week. However, the issue highlights the fragility of services and the urgent need for real conversation about how we make those services sustainable for the long term. Although I do not have any library closures in my region, sport and community venues are being impacted. Some will be transferred to local groups, and, although we should empower communities wherever we can, in some places we are passing on to local groups the burden of a backlog in building maintenance.

Sue Webber mentioned potholes, which are a serious issue. The way that council roads departments are funded is pretty wild, in my opinion. They have to keep back some funding in case of a poor winter, but, if the winter is mild and that funding is not all used, we see a load of potholes getting fixed at this time of year—before the end of the financial year. Climate change and the quality of the surfacing that we are using are major issues; multiyear funding for local authorities would absolutely help with some of the issues. That was a very random piece of knowledge about road surfaces, I note.

Not to allow the Lib Dems alone to have their way on their budget wins, I want to cover the Green impact on this year’s budget. We have secured the roll-out of free school meals for up to an additional 15,000 pupils. Across the chamber, we all know and agree that children cannot learn properly when they are hungry. That roll-out of free school meals is an important step towards the Scottish Greens’ goal of universal free school meals. We have also secured a year-long regional trial for bus fares to be capped at £2, because we know that the cost of public transport is too high. That builds on our work in previous budgets to give everyone under the age of 22 free bus travel.

As the climate is being put higher and higher up the agenda by many, we have worked to deliver record funding for major restoration and our environment. Those green projects are creating well-paid jobs in communities across the country, but in rural areas in particular. We have increased tax on the purchase of second or holiday homes; we are moving forward with proposals for a cruise ship levy, the consultation on which will be launched in February; and progress is on-going to give councils more direct power through our consultation on devolving parking fines to local authorities.

Well-funded public services are the bedrock of our society, as Stuart McMillan said. Our amendment also mentions the Government’s trial of the four-day working week that was piloted by South of Scotland Enterprise and which demonstrated promising outcomes in terms of productivity, employee wellbeing and job satisfaction. We reiterate our calls to the Government to build on that trial, to support a better work-life balance and to position Scotland as a leader in progressive and innovative workforce policies.

I still believe that the biggest challenges that we face in public services are sustainability, demand and the looming issue of national insurance contributions. We need a change there, and I hope that some Labour colleagues recognise the issues and will make representations to their colleagues at Westminster.

We recognise the importance of the public service reform programme in driving future financial sustainability. Transforming how our services are designed and delivered is key to ensuring that they remain effective, efficient and responsive to the needs of Scotland’s people, with the capacity to react and flex to any challenges that may arise.

I welcome the commitment to investing in our public services, particularly in my portfolio of health and social care. Far from being a burden on the economy, growth in public spending as a proportion of the economy has had a persistent positive link with gross domestic product for more than a century. The mechanisms that link public spending and economic growth include investment in and maintenance of infrastructure, supporting an educated and healthy workforce and redistributing income. There can be no sustainable economic growth without prioritising and properly resourcing our public services. That is why the increased investment across public services is very welcome.

However, the investment must be strategically deployed to address key challenges, including workforce capacity, service accessibility and a focus on preventative care. I recognise that there are pressures, but striking a balance between those financial constraints and the consequences of reducing spending on critical services remains an immense challenge. Scotland’s public finances face significant pressure, which must be met with bold action to ensure the sustainability and long-term stability of our public services. I would also like to point to the role that the Scottish Greens have played in securing progressive income tax reforms in past budgets, ensuring that lower earners in Scotland pay less tax than those elsewhere in the UK. That progressive approach underscores our commitment to fairness and equity in public finance and a commitment to bring about transformative change.

I agree with one of Michael Marra’s points. I do not do that particularly often, but he is correct that reform in the NHS urgently needs to be worked on. If I have time, I will come back to that.

Many members have referred to the UK Government’s decision to increase employer national insurance contributions. The impact of that move cannot be overstated, especially in Scotland, where public services depend on the hard work of more than 600,000 people, who make up 22 per cent of our total workforce; that is higher than the UK average of 17 per cent. The UK Government’s increase in employer national insurance contributions poses a very serious threat to third sector organisations, care providers and charities across Scotland, many of which are already grappling with surging demand and escalating costs as well as declining funding and declining certainty in that funding. There are several estimates that the increases will cost Scottish third sector organisations an additional £75 million in 2025-26. Hospices, homeless shelters and care providers could be hit the hardest.

Several charities have highlighted and described the devastating impact that additional cost will have. The Health and Social Care Alliance Scotland has pointed out that 62 per cent of its members anticipate needing to cut services, with 58 per cent expecting to reduce staff. It has reiterated the calls to exempt third sector organisations from the national insurance contributions increase, and it has pointed out that several providers have noted that such relief could be game changing.

Hospices have also opposed the increase, and a joint letter from 14 Scottish hospices warned the Chancellor of the Exchequer that rising costs could force them to turn people away from their essential services. It is the same story for social care providers. The increase is projected to cost organisations such as Turning Point Scotland £1.1 million annually, pushing them further into deficit. Nearly 48 per cent of care providers that were surveyed reported that service closures are a real possibility without additional support.

I was grateful to attend the Scottish Care care home conference, along with Brian Whittle, Jackie Baillie and the cabinet secretary, where we heard about the impact on individual care homes. Some said that the additional cost of the national insurance contributions could be £300,000 per care home and some expressed doubt about whether they could weather the additional cost for more than a year.

What happens if we lose some care homes should be a real concern to us all. The impact that that could have on our local authorities and the individuals who support the care homes is staggering, and we need a resolution to that. That is without even talking about the impact on GPs, councils’ arm’s-length organisations and commissioned services within local authorities. The Labour Government’s decision to prioritise a national insurance contribution increase over other tax reform exacerbates those issues. Aligning UK income tax rates with Scotland’s progressive system could raise an additional £11 billion.

It is important to recognise the scale of the challenges that we face and to double down on efforts to safeguard Scotland’s health and social care systems, and public services more generally, for generations to come. The investments that we welcome today are a step in the right direction, but they must be met with concrete action. We need sustained, focused funding that prioritises prevention, supports overstretched services and ensures equitable access to care. That means shifting from a system that reacts to crises to one that proactively supports good health and wellbeing. I echo the cabinet secretary’s calls on the UK Government to do its part by fully refunding the additional costs of employer national insurance contributions for the public sector. That is about protecting vital third sector organisations, sustaining our hospices and ensuring the resilience of the entire health and care system.

I sincerely wish that the chancellor would show more willingness to listen to the concerns of third sector organisations in the same way that she seems to have listened to and acknowledged the demands of the non-dom community recently. At the same time, I reiterate my call on the Scottish Government to tackle the harms that we see across public services and to ensure that health and social care services are properly funded, that we have the plans to tackle the on-going issues that we are seeing and that we have Scottish public services that generations to come can be proud of.

I move amendment S6M-16237.4, to leave out from “notes the importance” to “sustainability” and insert:

“further calls on the UK Government to fully fund the increase in employer national insurance contributions in commissioned services and arm’s-length external organisations; notes the importance of the public service reform programme to drive future financial sustainability; further notes the success of the four-day week pilot trialled by South of Scotland Enterprise, and calls on the Scottish Government to expand the four-day working week within the public sector workforce”.